Overview of the TREC 2013 Federated Web Search Track

NARCIS (Netherlands)

Demeester, Thomas; Trieschnigg, Rudolf Berend; Nguyen, Dong-Phuong; Hiemstra, Djoerd

2014-01-01

The TREC Federated Web Search track is intended to promote research related to federated search in a realistic web setting, and hereto provides a large data collection gathered from a series of online search engines. This overview paper discusses the results of the first edition of the track, FedWeb

Twenty-One at TREC-8: using Language Technology for Information Retrieval

NARCIS (Netherlands)

Kraaij, Wessel; Pohlmann, Renée; Hiemstra, Djoerd; Voorhees, E.M; Harman, D.K.

2000-01-01

This paper describes the official runs of the Twenty-One group for TREC-8. The Twenty-One group participated in the Ad-hoc, CLIR, Adaptive Filtering and SDR tracks. The main focus of our experiments is the development and evaluation of retrieval methods that are motivated by natural language

Improving Geoscience Education through the PolarTREC Teacher Research Experience Model (Invited)

Science.gov (United States)

Warburton, J.; Timm, K.; Larson, A. M.

2010-12-01

Teacher Research Experiences (TRE’s) are not new. For more than a decade, the National Science Foundation (NSF) as well as other federal agencies have been funding programs that place teachers with researchers in efforts to invigorate science education by bringing educators and researchers together through hands-on experiences. Many of the TRE’s are successful in providing a hands-on field experience for the teachers and researchers however many of the programs lack the resources to continue the collaborations and support the growing network of teachers that have had these field experiences. In 2007, NSF provided funding for PolarTREC—Teachers and Researchers Exploring and Collaborating, a program of the Arctic Research Consortium of the U.S. (ARCUS). PolarTREC is a TRE where K-12 teachers participate in polar field research, working closely with scientists as a pathway to improving science education. In just three years, it has become a successful TRE. What makes PolarTREC different than other the teacher research experience programs and how can others benefit from what we have learned? During this presentation, we will share data collected through the program evaluation and on how PolarTREC contributes to the discipline of Science, Technology, Engineering, and Mathematics (STEM) education and pedagogy through a model program conceived and organized according to current best practices, such as pre-research training, mentoring, support for classroom transfer, and long-term access to resources and support. Data shows that PolarTREC’s comprehensive program activities have many positive impacts on educators and their ability to teach science concepts and improve their teaching methods. Additionally, K-12 students polled in interest surveys showed significant changes in key areas including amount of time spent in school exploring research activities, importance of understanding science for future work, importance of understanding the polar regions as a person

Distributed Non-Parametric Representations for Vital Filtering: UW at TREC KBA 2014

Science.gov (United States)

2014-11-01

formation about the entity, every new document would drive an update to the entity profile, strongly suggesting vitalness. Figure 3 represents...of the Twenty-Second Text REtrieval Conference (TREC 2013), 2013. Caruana, Richard. Multitask Learning: A Knowledge-Based Source of Inductive Bias. In

University of Twente at TREC 2009: Indexing half a billion web pages

NARCIS (Netherlands)

Hauff, C.; Hiemstra, Djoerd; Voorhees, E.M; Buckland, L.P.

2010-01-01

This report presents results for the TREC 2009 adhoc task, the diversity task, and the relevance feedback task. We present ideas for unsupervised tuning of search system, an approach for spam removal, and the use of categories and query log information for diversifying search results.

Twenty-One at TREC-7: ad-hoc and cross-language track

NARCIS (Netherlands)

Hiemstra, Djoerd; Kraaij, Wessel; Voorhees, E.M; Harman, D.K.

1999-01-01

This paper describes the official runs of the Twenty-One group for TREC-7. The Twenty-One group participated in the ad-hoc and the cross-language track and made the following accomplishments: We developed a new weighting algorithm, which outperforms the popular Cornell version of BM25 on the ad-hoc

Overview of the TREC 2014 Federated Web Search Track

OpenAIRE

Demeester, Thomas; Trieschnigg, Rudolf Berend; Nguyen, Dong-Phuong; Zhou, Ke; Hiemstra, Djoerd

2014-01-01

The TREC Federated Web Search track facilitates research in topics related to federated web search, by providing a large realistic data collection sampled from a multitude of online search engines. The FedWeb 2013 challenges of Resource Selection and Results Merging challenges are again included in FedWeb 2014, and we additionally introduced the task of vertical selection. Other new aspects are the required link between the Resource Selection and Results Merging, and the importance of diversi...

Overview of the TREC 2013 federated web search track

OpenAIRE

Demeester, Thomas; Trieschnigg, D; Nguyen, D; Hiemstra, D

2013-01-01

The TREC Federated Web Search track is intended to promote research related to federated search in a realistic web setting, and hereto provides a large data collection gathered from a series of online search engines. This overview paper discusses the results of the first edition of the track, FedWeb 2013. The focus was on basic challenges in federated search: (1) resource selection, and (2) results merging. After an overview of the provided data collection and the relevance judgments for the ...

DETERMINATION OF REFERENCE VALUES FOR TREC AND KREC IN DRY BLOOD SPOTS OF NEWBORNS FROM DIFFERENT GESTATION AGES IN SVERDLOVSK REGION

Directory of Open Access Journals (Sweden)

S. S. Deryabina

2018-01-01

Full Text Available As a preparatory stage for implementation of genetic testing for severe combined immunodeficiency under a neonatal screening program, a study was performed in Sverdlovsk Region which concerned quantitative determination of T and B cell neogenesis markers (TREC and KREC, respectively in blood of conditionally healthy newborns. Archived samples of dry blood spots collected in test-forms for routine neonatal screening were used as biological material for the study of full-term 26 girls and 26 boys who did not exhibit serious illnesses during first year of their life. In addition, we investigated potential effects of foetal gestational age upon the number of TREC and KREC in preterm infants. Blood samples from 55 preterm infants (23 to 36 gestational weeks were also examined. It was shown that the levels of TREC and KREC increased sequentially with the increased gestation terms, but the quantitative changes of markers showed different dynamics. In this respect, the recommended terms of blood sample collection for SCID screening is entirely consistent with timing of blood sampling for routine newborn screening. An alternative result was obtained with a complete absence of TREC or KREC in blood sample of a newborn, irrespectively of prematurity degree (at valid copy numbers of a control gene which should serve as an indication for immediate consulting of the child by immunologist and in-depth immunological examination, because it may be a first prognostic sign of a fatal disease. In order to obtain correct cut-off levels for TREC/KREC, additional studies are needed on a larger sample of newborns (1.000 to 5.000, followed by validation of the obtained reference boundaries in studies involving patients with different forms of primary immunodeficiencies. 

Abnormal TREC-Based Newborn Screening Test in a Premature Neonate with Massive Perivillous Fibrin Deposition of the Placenta

Directory of Open Access Journals (Sweden)

Stefan Kostadinov

2016-01-01

Full Text Available Severe combined immunodeficiency (SCID, a primary immunodeficiency arising from variable defects in lymphocyte development and survival, is characterized by significant deficiency of thymus derived (T- lymphocytes and variable defects in the B-lymphocyte population. Newborn screening for SCID is based on detection of low numbers of T-cell receptor excision circles (TRECs by real time quantitative PCR (RT-qPCR. This screening allows for early identification of individuals with SCID and other disorders characterized by T-lymphopenia. Higher rates of abnormal screens are commonly seen in premature and critically ill neonates, often representing false positives. It is possible that many abnormal screens seen in these populations are result of conditions that are characterized by systemic inflammation or stress, possibly in the context of stress-induced thymic involution. We present a case of a male infant delivered at 27 weeks, 6 days of gestation, with severe intrauterine growth restriction who had an abnormal TREC screen and a massive perivillous fibrin deposition (MPFD of the placenta. This association has not been reported previously. We are raising the awareness to the fact that conditions, such as MPFD, that can create adverse intrauterine environment are capable of causing severe stress-induced thymic involution of the fetus which can present with abnormal TREC results on newborn screening.

Insights into the impact and use of research results in a residential long-term care facility: a case study

Directory of Open Access Journals (Sweden)

Cranley Lisa A

2012-09-01

Full Text Available Abstract Background Engaging end-users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC study influenced management and staff at one of 36 TREC facilities. We conducted the study at ‘Restwood’ (pseudonym nursing home because the Director of Care engaged actively in the study and TREC data showed that this site differed on some areas from other nursing homes in the province. The aims of the case study were two-fold: to gain a better understanding of how frontline staff engage with the research process, and to gain a better understanding of how to share more detailed research results with management. Methods We developed an Expanded Feedback Report for use during this study. In it, we presented survey results that compared Restwood to the best performing site on all variables and participating sites in the province. Data were collected regarding the Expanded Feedback Report through interviews with management. Data from staff were collected through interviews and observation. We used content analysis to derive themes to describe key aspects related to the study aims. Results We observed the importance of understanding organizational routines and the impact of key events in the facility’s environment. We gleaned additional information that validated findings from prior feedback mechanisms within TREC. Another predominant theme was the sense that the opportunity to engage in a research process was reaffirming for staff (particularly healthcare aides—what they did and said mattered, and TREC provided a means of having one’s voice heard. We gained valuable insight from the Director of Care about how to structure and format more detailed findings to assist with interpretation and use of results. Conclusions Four themes emerged regarding staff engagement with

Exploring the link between innate immune activation and thymic function by measuring sCD14 and TRECs in HIV patients living in Belgium.

Directory of Open Access Journals (Sweden)

Adrien De Voeght

Full Text Available Microbial translocation is now viewed as a central event in the pathogenesis of chronic inflammation during HIV infection. Thymic function failure is another crucial factor involved in HIV disease progression. The goal of this study was to explore the hypothesis of potential links between microbial translocation and thymic function in HIV-1 patients living in Belgium. The extent of microbial translocation was assessed through the measurement of soluble CD14 (sCD14. T-cell receptor excision circles (sjTRECs and dβTRECs were used as a measure of thymic function. Data were collected from 75 HIV-infected patients. Simple and complex linear regressions were done to analyze the link between these two processes. We found a statistically relevant negative correlation between thymopoiesis (sjTREC and sCD14 level (p = 0.004. These results suggest a link between thymic function failure, microbial translocation and innate immune activation.

CWI and TU Delft at TREC 2013: Contextual Suggestion, Federated Web Search, KBA, and Web Tracks

NARCIS (Netherlands)

A. Bellogín Kouki (Alejandro); G.G. Gebremeskel (Gebre); J. He (Jiyin); J.J.P. Lin (Jimmy); A. Said (Alan); T. Samar (Thaer); A.P. de Vries (Arjen); J.B.P. Vuurens (Jeroen)

2014-01-01

htmlabstractThis paper provides an overview of the work done at the Centrum Wiskunde & Informatica (CWI) and Delft University of Technology (TU Delft) for different tracks of TREC 2013. We participated in the Contextual Suggestion Track, the Federated Web Search Track, the Knowledge Base

A preliminary study measuring the number of T-cell receptor-rearrangement excision circles (TRECs) in peripheral blood T-cell populations of A-bomb survivors and control populations

International Nuclear Information System (INIS)

Kubo, Yoshiko; Yamaoka, Mika; Kusunoki, Yoichiro

2006-01-01

More than a half century after damage of the immune systems by the radiation from A-bomb, we can still observe significant decreases in the percentages of naieve CD4 and CD8 T cells among the survivors. To investigate whether the observed decreases in the naieve T-cell populations may have resulted from reduction in thymic T-cell production ability of survivors, we established a real-time polymerase chain reaction (PCR) method to examine the number of T-cell receptor-rearrangement excision circles (TRECs) in peripheral blood CD4 and CD8 T-cell populations. The real-time PCR quantitatively detected TREC sequences with a good reproducibility in human laboratory controls. In the 445 survivors so far been examined, multiple regression analysis indicated that the number of TRECs in the CD4 T-cell fraction was significantly higher in females than in males and decreased significantly with age in both males and females. This analysis also suggested a possible dose-dependent decrease in the number of TRECs in the CD4 T-cell fraction of the survivors who were less than 20 years of age at the time of bombing (p=0.09). A similar statistically significant trend for gender difference or age was observed in the CD8 T-cell fraction of the survivors. However, there was no effect of radiation exposure on the number of TRECs in the CD8-T cell fraction. The results indicate the possibility that A-bomb radiation exposure may have induced a long-term impairment in thymic CD4 T-cell production. Further investigations in a larger study population are necessary to test this hypothesis. (author)

[Building epilepsy care network in Japan].

Science.gov (United States)

Otsuki, Taisuke

2012-01-01

Number of epilepsy patient in Japan officially surveyed by our government in 2008 is 219,000, which is only 0.17% of the total population and less than one third of the prevalence rate reported in Western countries. Number of epilepsy surgery per year in Japan is also low and less than half of other countries such as US, UK and Korea. These numbers may suggest that epilepsy care in Japan is not sufficient to cover all hidden medical needs of people with epilepsy at present. To solve this issue, our research group funded by the government have started to build an epilepsy care network among primary care physicians, secondary care neurology specialists and tertiary care epilepsy centers by utilizing a web site: Epilepsy Care Network-Japan (http://www.ecn-japan.com/) from July 2012. We are also proposing an epilepsy care algorithm suitable for our complex medical community consisted with various neurology specialists such as pediatric and adult neurologists, neurosurgeons and psychiatrists. Building Epilepsy Care Network in Japan may facilitate better medical and social support for people with epilepsy in Japan.

TNO and RUN at the TREC 2012 Contextual Suggestion Track: Recommending Personalized Touristic Sights Using Google Places

Science.gov (United States)

2012-11-01

TNO and RUN at the TREC 2012 Contextual Suggestion Track: Recommending personalized touristic sights using Google Places Maya Sappelli∗1, Suzan...quite conservative . Figure 1: Accuracies on the ratings and contextual fits (0, 1 and 2) A more detailed look on the distribution of positive, neutral

Across the Arctic Teachers Experience Field Research

Science.gov (United States)

Warnick, W. K.; Warburton, J.; Wiggins, H. V.; Marshall, S. A.; Darby, D. A.

2005-12-01

From studying snow geese on the North Slope of Alaska to sediment coring aboard the U.S. Coast Guard Cutter Healy in the Arctic Ocean, K-12 teachers embark on scientific expeditions as part of a program that strives to make science in the Arctic a "virtual" reality. In the past two years, seventeen K-12 teachers have participated in Teachers and Researchers Exploring and Collaborating (TREC), a program that pairs teachers with researchers to improve science education through arctic field experiences. TREC builds on the scientific and cultural opportunities of the Arctic, linking research and education through topics that naturally engage students and the wider public. TREC includes expeditions as diverse as studying plants at Toolik Field Station, a research facility located 150 miles above the Arctic Circle; climate change studies in Norway's Svalbard archipelago; studying rivers in Siberia; or a trans-arctic expedition aboard the USCGC Healy collecting an integrated geophysical data set. Funded by the National Science Foundation Office of Polar Programs, TREC offers educators experiences in scientific inquiry while encouraging the public and students to become active participants in the scientific inquiry by engaging them virtually in arctic research. TREC uses online outreach elements to convey the research experience to a broad audience. While in remote field locations, teachers and researchers interact with students and the public through online seminars and live calls from the field, online journals with accompanying photos, and online bulletin boards. Since the program's inception in 2004, numerous visitors have posted questions or interacted with teachers, researchers, and students through the TREC website (http://www.arcus.org/trec). TREC teachers are required to transfer their experience of research and current science into their classroom through the development of relevant activities and resources. Teachers and researchers are encouraged to participate

T-cell receptor excision circles (TREC) in CD4+ and CD8+ T-cell subpopulations in atopic dermatitis and psoriasis show major differences in the emission of recent thymic emigrants

DEFF Research Database (Denmark)

Just, Helle L; Deleuran, Mette; Vestergaard, Christian

2008-01-01

. In contrast, both men and women with psoriasis had significantly reduced TREC levels, which were, on average, only 30% of that of healthy persons. In atopic dermatitis the levels of TREC declined with increasing levels of IgE, disease intensity and extent of eczema. Furthermore, patients with atopic......-cells, this indicates that atopic dermatitis patients can have compensatory emissions of thymic emigrants, whereas psoriatic patients do not, thus supporting different thymic function in these two diseases....

Bringing Antarctic Weddell seals to the classroom through PolarTREC

Science.gov (United States)

Eilers, A. A.

2017-12-01

PolarTREC (Teachers and Researchers Exploring and Collaborating) is an NSF funded professional development opportunity in which K-12 teachers and informal educators participated in hands-on field research experiences in the Polar Regions. The program goal is to invigorate polar science education and understanding by bringing together educators and polar researchers. This unique opportunity for educators has two main components: a 4-6 week field experience and a classroom/community connection piece. In preparation for these experiences, museum educator Alex Eilers and science team lead Dr. Jennifer Burns planned, developed and executed extensive outreach efforts for both students and the community to highlight the Weddell seal research project during the 2012, 2014 and 2016 seasons. The following outreach activities summarize the team's most successful attempts at engaging schoolchildren, teachers and the public, creating a broader impact of the Weddell seal scientific project. On-line Daily journal entries were uploaded to the PolarTREC website encouraging an active interaction between the science team and participants. A Polar Connect event offered participants a real-time, interactive internet presentation with the team. Schools A multitude of on-site presentations were made in classrooms, at teacher workshops and faculty meetings. Two 45 minute labs were developed for students visiting the museum, Animals of the Antarctic and Journey to the Poles, the latter is now included in our ongoing program repertoire. Two travelling kits, Extreme Cold Weather Gear and The Weddell Seal, were developed by museum staff and continue to circulate through schools. A multi-lesson educational module was developed by museum staff to bridge the gap between the scientific research conducted in the field and students in grades 3-8. It contains curriculum-based lessons, field data and strategic methods to assist students in analyzing the data. Community Community-wide interest

KISTI at TREC 2014 Clinical Decision Support Track: Concept-based Document Re-ranking to Biomedical Information Retrieval

Science.gov (United States)

2014-11-01

sematic type. Injury or Poisoning inpo T037 Anatomical Abnormality anab T190 Given a document D, a concept vector = {1, 2, … , ...integrating biomedical terminology . Nucleic acids research 32, Database issue (2004), 267–270. 5. Chapman, W.W., Hillert, D., Velupillai, S., et...Conference (TREC), (2011). 9. Koopman, B. and Zuccon, G. Understanding negation and family history to improve clinical information retrieval. Proceedings

Health Care Building Assessment through Post Occupancy Audit

Directory of Open Access Journals (Sweden)

Ahmad Ezanee Hashim

2016-01-01

Full Text Available Health care and hospital buildings are among the most complex construction in the built environment which comprises a broad range of utility, services, and functional units. The objectives of the study are to review the built environment performance level of the public teaching health care hospital in meeting user’s need. Three (3 public training health care hospitals in Selangor district in Malaysia are selected as a case study sample. Based on the finding the study revealed that the correlation coefficient between technical building performance and the importance of POE Guideline are positively correlated based on security, safety, and efficiency and health criteria.

TREC 2010 legal track: method and results of the ELK collaboration

Energy Technology Data Exchange (ETDEWEB)

Spearing, Shelly [Los Alamos National Laboratory; Roman, Jorge [Los Alamos National Laboratory; Mc Kay, Bain [KAYVIUM; Lindquist, Eric [EWA-IIT

2010-10-25

The ELK team ([E]WA-IIT, [L]os Alamos National laboratory (LANL), and [K]ayvium Corporation (ELK)) used the legal Track task 302 as an opportunity to compare and integrate advanced semantic-automation strategies. The team members believe that enabling parties to discover, consume, analyze, and make decisions in a noisy and information-overloaded environment requires new tools. Together, as well as independently, they are actively developing these tools and view the TREC exercise as an opportunity to test, compare, and complement tools and approaches. Our collaboration is new to TREC, brought together by a shared interest in document relevance, concept-in-context identification and annotation, and the recognition that words out-of-context do not a match make. The team's intent was to lay the foundation for automating the mining and analysis of large volumes of electronic information by litigants and their lawyers, not only in the context of document discovery, but also to support litigation strategy, motion practice, deposition, trial tactics, etc. The premise was that a Subject Matter Expert- (SME-) built model can be automatically mapped onto various search engines for document retrieval, organization, relevance scoring, analysis and decision support. In the end, we ran nearly a dozen models, mostly, but not exclusively, with Kayvium Corporation's knowledge automation technology. The Sal Database Search Engine we used had a bug in its proximity feature, requiring that we develop a workaround. While the work-around was successful, it left us with insufficient time to converge the models to achieve expected quality. However, with optimized proximity processing in place, we would be able to run the model many more times, and believe repeatable quality would be a matter of working through a few requests to get the approach right. We believe that with more time, the results we would achieve might point towards a new way of processing documents for litigation

Mining Tasks from the Web Anchor Text Graph: MSR Notebook Paper for the TREC 2015 Tasks Track

Science.gov (United States)

2015-11-20

Mining Tasks from the Web Anchor Text Graph: MSR Notebook Paper for the TREC 2015 Tasks Track Paul N. Bennett Microsoft Research Redmond, USA pauben...anchor text graph has proven useful in the general realm of query reformulation [2], we sought to quantify the value of extracting key phrases from...anchor text in the broader setting of the task understanding track. Given a query, our approach considers a simple method for identifying a relevant

El enojo en madres y padres de hijas adolescentes: propuesta de orientación desde la TREC y la inteligencia emocional / The anger in parents of teenage daughters: propose of guidance since the TREC and emotional intelligence

Directory of Open Access Journals (Sweden)

Murillo Aguilar, Osvaldo

2008-08-01

Full Text Available Resumen: Este artículo, basado en la tesis de grado denominada “Expresión del Enojo en Madres y Padres de Hijas Adolescentes: Propuesta de Orientación desde el Enfoque de la TREC”, realizada por Jessie Arroyo Zúñiga y Osvaldo Murillo Aguilar, para optar por el grado de licenciatura en Orientación en el año 2008, ofrece desde esta disciplina, una integración entre la teoría de la Inteligencia Emocional y el enfoque de la Terapia Racional Emotivo – Conductual (TREC, para comprender y abordar la expresión del enojo en estas madres y padres de hijas adolescentes. Por ello, como recomendación, se presenta una propuesta de Orientación que pretende fortalecer los vínculos de las madres y padres con sus hijas adolescentes, por medio de un proceso que propicie formas de expresión emocionalmente saludables del enojo, basado en la integración de la teoría de la inteligencia emocional y el enfoque de la TREC. Para la elaboración del presente trabajo se establecieron los siguientes objetivos: 1. Analizar las formas en las que expresan el enojo las madres y los padres de familia del Liceo María Auxiliadora.2. Elaborar estrategias de Orientación dirigidas a madres y padres de hijas adolescentes que promuevan una expresión saludable del enojo. La metodología se estableció bajo la perspectiva cualitativa, que permitió la comprensión de las experiencias de las madres y los padres, sus emociones, pensamientos y conductas. La principal técnica de recolección de información fueron los grupos focales, y se analizó a partir de la organización y codificación de datos, por medio de categorías de análisis.Abstract: This article, based on the thesis entitled "Expression of Anger in Mothers and Fathers of Daughters Teens: proposed of Guidance since the TREC" performed by Jessie Arroyo Zúñiga and Osvaldo Murillo Aguilar, to graduate in Guidance in the 2008; offers from this discipline, an integration between the theory of Emotional

DEVELOPMENT OF REAL-TIME MULTIPLEX PCR FOR THE QUANTITATIVE DETERMINATION OF TREC'S AND KREC'S IN WHOLE BLOOD AND IN DRIED BLOOD SPOTS

Directory of Open Access Journals (Sweden)

M. A. Gordukova

2015-01-01

Full Text Available Primary immunodeficiencies (PID such as severe combined immunodeficiency (SCID and X-linked agammaglobulinemia are characterized by the lack of functional Tand B-cells, respectively. Without early diagnosis and prompt treatment children with PID suffer from severe infectious diseases, leading to their death or disability. Our purpose was developing of simple, inexpensive, high throughput technique based on the quantitative determination of TREC and KREC molecules by real-time PCR, and its validation in a group of children with a verified diagnosis of SCID and X-linked agammaglobulinemia.In this study, we developed and validated multiplex real-time PCR for the TREC’s and KREC’s quantitative analysis. We have shown that linear range of Ct changes depending on the concentrations of targets with a correlation coefficient R2 not worse than 0.98 was observed at concentrations from 109 to 5 × 104 copies per ml. The lowest amount of targets reliably detected in a reaction volume was 10 TREC’s copies, 5 KREC ‘s copies and 5 copies of internal control (IL17RA. We determined the age-depended reference values of TRECs and KRECs in whole blood in 29 boys and 27 girls with normal immunological parameters. The normal cut-offs for TRECs and KRECs were defined in dry blood spots depending on the method of extraction.The proposed method showed 100% diagnostic sensitivity and specificity in the studied group. The method can be proposed as a screening tool for the diagnosis of SCID and X-linked agammaglobulinemia both in whole blood and in the dry blood spots. The further investigation is required with larger number of samples. 

[The architectural design of psychiatric care buildings].

Science.gov (United States)

Dunet, Lionel

2012-01-01

The architectural design of psychiatric care buildings. In addition to certain "classic" creations, the Dunet architectural office has designed several units for difficult patients as well as a specially adapted hospitalisation unit. These creations which are demanding in terms of the organisation of care require close consultation with the nursing teams. Testimony of an architect who is particularly engaged in the universe of psychiatry.

UPMC's blueprint for BuILDing a high-value health care system.

Science.gov (United States)

Keyser, Donna; Kogan, Jane; McGowan, Marion; Peele, Pamela; Holder, Diane; Shrank, William

2018-03-30

National-level demonstration projects and real-world studies continue to inform health care transformation efforts and catalyze implementation of value-based service delivery and payment models, though evidence generation and diffusion of learnings often occurs at a relatively slow pace. Rapid-cycle learning models, however, can help individual organizations to more quickly adapt health care innovations to meet the challenges and demands of a rapidly changing health care landscape. Integrated delivery and financing systems (IDFSs) offer a unique platform for rapid-cycle learning and innovation. Since both the provider and payer benefit from delivering care that enhances the patient experience, improves quality, and reduces cost, incentives are aligned to experiment with value-based models, enhance learning about what works and why, and contribute to solutions that can accelerate transformation. In this article, we describe how the UPMC Insurance Services Division, as part of a large IDFS, uses its Business, Innovation, Learning, and Dissemination (BuILD) model to prioritize, design, test, and refine health care innovations and accelerate learning. We provide examples of how the BuILD model offers an approach for quickly assessing the impact and value of health care transformation efforts. Lessons learned through the BuILD process will offer insights and guidance for a wide range of stakeholders whether an IDFS or independent payer-provider collaborators. Copyright © 2018 Elsevier Inc. All rights reserved.

Building better health care leadership for Canada: implementing evidence

National Research Council Canada - National Science Library

Denis, Jean-Louis; Sullivan, Terrence James

2011-01-01

... of the Government of Canada through the Canada Book Fund for our publishing activities. Library and Archives Canada Cataloguing in Publication Building better health care leadership for Canada: imple...

Critical Care Organizations: Business of Critical Care and Value/Performance Building.

Science.gov (United States)

Leung, Sharon; Gregg, Sara R; Coopersmith, Craig M; Layon, A Joseph; Oropello, John; Brown, Daniel R; Pastores, Stephen M; Kvetan, Vladimir

2018-01-01

New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care. Relevant medical literature was accessed through a literature search. Material published by federal health agencies and other specialty organizations was also reviewed. Collaboratively and iteratively, taskforce members corresponded by electronic mail and held monthly conference calls to finalize this report. The business and value/performance critical care organization building section comprised of leaders of critical care organizations with expertise in critical care administration, healthcare management, and clinical practice. Two phases of critical care organizations care integration are described: "horizontal," within the system and regionalization of care as an initial phase, and "vertical," with a post-ICU and postacute care continuum as a succeeding phase. The tools required for the clinical and financial transformation are provided, including the essential prerequisites of forming a critical care organization; the manner in which a critical care organization can help manage transformational domains is considered. Lastly, how to achieve organizational health system support for critical care organization implementation is discussed. A critical care organization that incorporates functional clinical horizontal and

Building evaluative culture in community services: Caring for evidence.

Science.gov (United States)

Mayne, John

2017-05-25

An organization with a strong evaluative culture engages in self-reflection, evidence-based learning and experimentation. It sees evidence as essential for managing well, but building such a culture is challenging. Community service organizations seek to provide effective services for their clients. To build an evaluative culture, they need to acquire basic monitoring and evaluation capabilities, be provided with opportunities for using these capabilities and be adequately motivated to care about evidence as a means to improve services to their clients. Leadership along with a phased in approach are key in bringing about these behaviour changes. Copyright © 2017. Published by Elsevier Ltd.

Building social capital in healthcare organizations: thinking ecologically for safer care.

Science.gov (United States)

Hofmeyer, Anne; Marck, Patricia B

2008-01-01

Research on patient safety and health human resources, 2 critical issues for 21st century healthcare, converges on similar findings. Specifically, it is apparent that along with the patients, families, and communities we serve, nurses and other healthcare professionals navigate a volatile health care system where persistent restructuring, market pressures, and workforce instability present ongoing threats to the delivery of safer care. Drawing from the fields of nursing, healthcare ethics, health systems management, and ecological restoration, we outline the role of social capital for organizational integrity, healthy workplace cultures, sustainable resource management, improved nurse retention, effective knowledge translation, and safer patient care. Nursing leaders can use ecological thinking to build the vital resource of social capital by taking concrete steps to commit the necessary human and material resources to: (1) forge relations to foster bonding, bridging and linking social capital; (2) build solidarity and trust; (3) foster collective action and cooperation; (4) strengthen communication and knowledge exchange; and (5) create capacity for social cohesion and inclusion.

Critical Care Organizations: Building and Integrating Academic Programs.

Science.gov (United States)

Moore, Jason E; Oropello, John M; Stoltzfus, Daniel; Masur, Henry; Coopersmith, Craig M; Nates, Joseph; Doig, Christopher; Christman, John; Hite, R Duncan; Angus, Derek C; Pastores, Stephen M; Kvetan, Vladimir

2018-04-01

Academic medical centers in North America are expanding their missions from the traditional triad of patient care, research, and education to include the broader issue of healthcare delivery improvement. In recent years, integrated Critical Care Organizations have developed within academic centers to better meet the challenges of this broadening mission. The goal of this article was to provide interested administrators and intensivists with the proper resources, lines of communication, and organizational approach to accomplish integration and Critical Care Organization formation effectively. The Academic Critical Care Organization Building section workgroup of the taskforce established regular monthly conference calls to reach consensus on the development of a toolkit utilizing methods proven to advance the development of their own academic Critical Care Organizations. Relevant medical literature was reviewed by literature search. Materials from federal agencies and other national organizations were accessed through the Internet. The Society of Critical Care Medicine convened a taskforce entitled "Academic Leaders in Critical Care Medicine" on February 22, 2016 at the 45th Critical Care Congress using the expertise of successful leaders of advanced governance Critical Care Organizations in North America to develop a toolkit for advancing Critical Care Organizations. Key elements of an academic Critical Care Organization are outlined. The vital missions of multidisciplinary patient care, safety, and quality are linked to the research, education, and professional development missions that enhance the value of such organizations. Core features, benefits, barriers, and recommendations for integration of academic programs within Critical Care Organizations are described. Selected readings and resources to successfully implement the recommendations are provided. Communication with medical school and hospital leadership is discussed. We present the rationale for critical

A theory-informed approach to mental health care capacity building for pharmacists.

Science.gov (United States)

Murphy, Andrea L; Gardner, David M; Kutcher, Stan P; Martin-Misener, Ruth

2014-01-01

Pharmacists are knowledgeable, accessible health care professionals who can provide services that improve outcomes in mental health care. Various challenges and opportunities can exist in pharmacy practice to hinder or support pharmacists' efforts. We used a theory-informed approach to development and implementation of a capacity-building program to enhance pharmacists' roles in mental health care. Theories and frameworks including the Consolidated Framework for Implementation Research, the Theoretical Domains Framework, and the Behaviour Change Wheel were used to inform the conceptualization, development, and implementation of a capacity-building program to enhance pharmacists' roles in mental health care. The More Than Meds program was developed and implemented through an iterative process. The main program components included: an education and training day; use of a train-the-trainer approach from partnerships with pharmacists and people with lived experience of mental illness; development of a community of practice through email communications, a website, and a newsletter; and use of educational outreach delivered by pharmacists. Theories and frameworks used throughout the program's development and implementation facilitated a means to conceptualize the component parts of the program as well as its overall presence as a whole from inception through evolution in implementation. Using theoretical foundations for the program enabled critical consideration and understanding of issues related to trialability and adaptability of the program. Theory was essential to the underlying development and implementation of a capacity-building program for enhancing services by pharmacists for people with lived experience of mental illness. Lessons learned from the development and implementation of this program are informing current research and evolution of the program.

Developing lifetime relationships with patients: strategies to improve patient care and build your practice.

Science.gov (United States)

Levin, Roger P

2008-01-01

The purpose of this article is to describe three strategies to build a thriving, patient-centered practice and promote oral health throughout a patient's lifetime. Compared to previous decades, more dental patients are "shopping around" for dental care and changing dental practices. This trend is due to factors such as acceptance of dental insurance, more comprehensive service offerings by other dentists, and effective marketing campaigns by other dental offices. Delivering customer service exceeding patient expectations ("WOW" service), advocating patient education, and developing customized home care regimens will help lead to long-term patient retention and promote optimal patient care. A dental team making relationship-building a priority conveys respect for their patients' time and well-being. Once trust has been established patients are more likely to be receptive to oral health education and become more compliant with home care regimens. Since a patient's oral health status will likely change over time, it's important to make education and customized treatment planning an integral part of each visit. By demonstrating a strong commitment to customer service, education, and home care, patients recognize the care providers in a dental practice are interested in their well-being rather than simply treating problems. If patients recognize a dental practice is focused on prevention and at-home oral health care, they are more likely to partner with that practice for a lifetime of excellent oral health care.

The relationship between building design and residents' quality of life in extra care housing schemes.

Science.gov (United States)

Orrell, Alison; McKee, Kevin; Torrington, Judith; Barnes, Sarah; Darton, Robin; Netten, Ann; Lewis, Alan

2013-05-01

Well-designed housing is recognised as being an important factor in promoting a good quality of life. Specialised housing models incorporating care services, such as extra care housing (ECH) schemes are seen as enabling older people to maintain a good quality of life despite increasing health problems that can accompany ageing. Despite the variation in ECH building design little is known about the impact of ECH building design on the quality of life of building users. The evaluation of older people's living environments (EVOLVE) study collected cross-sectional data on building design and quality of life in 23 ECH schemes in England, UK. Residents' quality of life was assessed using the schedule for the evaluation of individual quality of life-direct weighting (SEIQoL-DW) and on the four domains of control, autonomy, self-realisation and pleasure on the CASP-19. Building design was measured on 12 user-related domains by means of a new tool; the EVOLVE tool. Using multilevel linear regression, significant associations were found between several aspects of building design and quality of life. Furthermore, there was evidence that the relationship between building design and quality of life was partly mediated by the dependency of participants and scheme size (number of living units). Our findings suggest that good quality building design in ECH can support the quality of life of residents, but that designing features that support the needs of both relatively independent and frail users is problematic, with the needs of highly dependent users not currently supported as well as could be hoped by ECH schemes. Copyright © 2013 Elsevier Ltd. All rights reserved.

Customer centered health care: why managed care organizations must capitalize on new technology to build brands and customer loyalty.

Science.gov (United States)

Fell, D

1998-01-01

Now, more than ever, health care organizations are desperately trying to reach out to customers and establish stronger relationships that will generate increased loyalty and repeat business. As technology, like the Internet and related mediums, allow us to do a better job of managing information and communication, health care executives must invest the time and resources necessary to bring these new advances into the day-to-day operations of their businesses. Those that do will have a head start in building their brand and their customer loyalty.

Building nursing capacity for palliative care at a Jesuit Catholic University: A model program

Directory of Open Access Journals (Sweden)

Eileen R. O’Shea

2017-01-01

Full Text Available The average life span is increasing, due to vast advancements in social conditions, public health, and medical care. Globally, those living with chronic and serious medical conditions can benefit from palliative care services. Yet, the workforce is insufficient to support the demand. This case study describes efforts made by one Jesuit Catholic University to build nursing capacity and to promote access to high quality, compassionate palliative healthcare.

Building a Caring Economy and Society Beyond Capitalism, Socialism, and Other Old Isms

Directory of Open Access Journals (Sweden)

Riane Eisler

2013-05-01

Full Text Available Old economic approaches are not capable of meeting our economic, environmental, and social challenges. To effectively meet these challenges, we need a perspective that goes beyond the conventional capitalism vs. socialism debate. This paper places economic valua- tions in their social context from the perspective of two new social categories. It describes building blocks for a new paradigm for economics, focusing on new measurements, policies, and practices that support caring for people, starting in early childhood, as well as caring for our natural environment.

Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study.

Science.gov (United States)

Allen, Suzanne M; Ballweg, Ruth A; Cosgrove, Ellen M; Engle, Kellie A; Robinson, Lawrence R; Rosenblatt, Roger A; Skillman, Susan M; Wenrich, Marjorie D

2013-12-01

The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

Interprofessional team building in the palliative home care setting: Use of a conceptual framework to inform a pilot evaluation.

Science.gov (United States)

Shaw, James; Kearney, Colleen; Glenns, Brenda; McKay, Sandra

2016-01-01

Home-based palliative care is increasingly dependent on interprofessional teams to deliver collaborative care that more adequately meets the needs of clients and families. The purpose of this pilot evaluation was to qualitatively explore the views of an interprofessional group of home care providers (occupational therapists, nurses, personal support work supervisors, community care coordinators, and a team coordinator) regarding a pilot project encouraging teamwork in interprofessional palliative home care services. We used qualitative methods, informed by an interprofessional conceptual framework, to analyse participants' accounts and provide recommendations regarding strategies for interprofessional team building in palliative home health care. Findings suggest that encouraging practitioners to share past experiences and foster common goals for palliative care are important elements of team building in interprofessional palliative care. Also, establishing a team leader who emphasises sharing power among team members and addressing the need for mutual emotional support may help to maximise interprofessional teamwork in palliative home care. These findings may be used to develop and test more comprehensive efforts to promote stronger interprofessional teamwork in palliative home health care delivery.

Building Bridges to Integrate Care (BRIDGES): Incubating Health Service Innovation across the Continuum of Care for Patients with Multiple Chronic Conditions.

Science.gov (United States)

Bhattacharyya, Onil; Schull, Michael; Shojania, Kaveh; Stergiopoulos, Vicky; Naglie, Gary; Webster, Fiona; Brandao, Ricardo; Mohammed, Tamara; Christian, Jennifer; Hawker, Gillian; Wilson, Lynn; Levinson, Wendy

2016-01-01

Integrating care for people with complex needs is challenging. Indeed, evidence of solutions is mixed, and therefore, well-designed, shared evaluation approaches are needed to create cumulative learning. The Toronto-based Building Bridges to Integrate Care (BRIDGES) collaborative provided resources to refine and test nine new models linking primary, hospital and community care. It used mixed methods, a cross-project meta-evaluation and shared outcome measures. Given the range of skills required to develop effective interventions, a novel incubator was used to test and spread opportunities for system integration that included operational expertise and support for evaluation and process improvement.

Intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care: a descriptive qualitative study.

Science.gov (United States)

Ballangrud, Randi; Hall-Lord, Marie Louise; Persenius, Mona; Hedelin, Birgitta

2014-08-01

To describe intensive care nurses' perceptions of simulation-based team training for building patient safety in intensive care. Failures in team processes are found to be contributory factors to incidents in an intensive care environment. Simulation-based training is recommended as a method to make health-care personnel aware of the importance of team working and to improve their competencies. The study uses a qualitative descriptive design. Individual qualitative interviews were conducted with 18 intensive care nurses from May to December 2009, all of which had attended a simulation-based team training programme. The interviews were analysed by qualitative content analysis. One main category emerged to illuminate the intensive care nurse perception: "training increases awareness of clinical practice and acknowledges the importance of structured work in teams". Three generic categories were found: "realistic training contributes to safe care", "reflection and openness motivates learning" and "finding a common understanding of team performance". Simulation-based team training makes intensive care nurses more prepared to care for severely ill patients. Team training creates a common understanding of how to work in teams with regard to patient safety. Copyright © 2014 Elsevier Ltd. All rights reserved.

Building the Nonuniversity, Tertiary Care Center Hepatobiliary and Pancreatic Surgery Practice: Structural and Financial Considerations.

Science.gov (United States)

Baker, Erin H; Siddiqui, Imran; Vrochides, Dionisios; Iannitti, David A; Martinie, John B; Rorabaugh, Lauren; Jeyarajah, D Rohan; Swan, Ryan Z

2016-12-01

Early in their careers, many new surgeons lack the background and experience to understand essential components needed to build a surgical practice. Surgical resident education is often devoid of specific instruction on the business of medicine and practice management. In particular, hepatobiliary and pancreatic (HPB) surgeons require many key components to build a successful practice secondary to significant interdisciplinary coordination and a scope of complex surgery, which spans challenging benign and malignant disease processes. In the following, we describe the required clinical and financial components for developing a successful HPB surgery practice in the nonuniversity tertiary care center. We discuss significant financial considerations for understanding community need and hospital investment, contract establishment, billing, and coding. We summarize the structural elements and key personnel necessary for establishing an effectual HPB surgical team. This article provides useful, essential information for a new HPB surgeon looking to establish a surgical practice. It also provides insight for health-care administrators as to the value an HPB surgeon can bring to a hospital or health-care system.

Care of personnel on the building site of the Dukovany nuclear power plant

International Nuclear Information System (INIS)

Kurial, P.

1984-01-01

The accommodation is described of workers on the building site of the Dukovany nuclear power plant. The quality is appraised of accommodation, catering and refreshments. There is a health care unit on site and 15 beds are reserved at the Trebic hospital for emergency cases. Trade union and youth organizations look after sports and cultural activities. (E.S.)

Should we feed back research results in the midst of a study?

Directory of Open Access Journals (Sweden)

Estabrooks Carole A

2012-09-01

Full Text Available Abstract Background This report is an introduction to a series of three research papers that describe the evolution of the approaches taken by the Translating Research in Elder Care (TREC research team during its first four years to feed back the research findings to study participants. TREC is an observational multi-method health services research project underway in 36 nursing homes in the prairie provinces of Canada. TREC has actively involved decision makers from the sector in all stages from initial planning, through data collection to dissemination activities. However, it was not planned as a fully integrated knowledge translation project. These three papers describe our progress towards fully integrated knowledge translation—with respect to timely and requested feedback processes. The first paper reports on the process and outcomes of creating and evaluating the feedback of research findings to healthcare aides (unregulated health professionals. These aides provide over 80% of the direct care in our sample and actively requested the feedback as a condition of their continued cooperation in the data acquisition process. The second paper describes feedback from nursing home administrators on preliminary research findings (a facility annual report and evaluation of the reports’ utility. The third paper discusses an approach to providing a more in-depth form of feedback (expanded feedback report at one of the TREC nursing homes. Findings Survey and interview feedback from healthcare aides is presented in the first paper. Overall, healthcare aides’ opinions about presentation of the feedback report and the understand ability, usability, and usefulness of the content were positive. The second paper describes the use of telephone interviews with facility administrators and indicates that the majority of contextual areas (e.g., staff job satisfaction addressed in facility annual report to be useful, meaningful, and understandable. More than

Knowledge engineering as a support for building an actor profile ontology for integrating Home-Care systems.

Science.gov (United States)

Gibert, Karina; Valls, Aida; Riaño, David

2008-01-01

One of the tasks towards the definition of a knowledge model for home care is the definition of the different roles of the users involved in the system. The roles determine the actions and services that can or must be performed by each type of user. In this paper the experience of building an ontology to represent the home-care users and their associated information is presented, in a proposal for a standard model of a Home-Care support system to the European Community.

Building Quality Report Cards for Geriatric Care in The Netherlands: Using Concept Mapping to Identify the Appropriate "Building Blocks" from the Consumer's Perspective

Science.gov (United States)

Groenewoud, A. Stef; van Exel, N. Job A.; Berg, Marc; Huijsman, Robbert

2008-01-01

Purpose: This article reports on a study to identify "building blocks" for quality report cards for geriatric care. Its aim is to present (a) the results of the study and (b) the innovative step-by-step approach that was developed to arrive at these results. Design and Methods: We used Concept Mapping/Structured Conceptualization to…

PolarTREC—A Model Program for Taking Polar Literacy into the Future

Science.gov (United States)

Warburton, J.; Timm, K.; Larson, A. M.

2009-12-01

Polar TREC—Teachers and Researchers Exploring and Collaborating, is a three-year (2007-2009) NSF-funded International Polar Year (IPY) teacher professional development program that advances Science, Technology, Engineering, and Mathematics (STEM) education by improving teacher content knowledge and instructional practices through Teacher Research Experiences (TRE) in the Arctic and Antarctic. Leveraging profound changes and fascinating science taking place in the polar regions, PolarTREC broadly disseminates activities and products to students, educators, researchers, and the public, connecting them with the Arctic and Antarctica and sustaining the widespread interest in the polar regions and building on the enthusiasm that was generated through IPY. Central to the PolarTREC Teacher Research Experience Model, over 40 teachers have spent two to eight weeks participating in hands-on research in the polar regions and sharing their experiences with diverse audiences via live events, online multimedia journals, and interactive bulletin boards. The Connecting Arctic/Antarctic Researchers and Educators (CARE) Network unifies learning community members participants, alumni, and others, developing a sustainable association of education professionals networking to share and apply polar STEM content and pedagogical skills. Educator and student feedback from preliminary results of the program evaluation has shown that PolarTREC’s comprehensive program activities have many positive impacts on educators and their ability to teach science concepts and improve their teaching methods. Additionally, K-12 students polled in interest surveys showed significant changes in key areas including amount of time spent in school exploring research activities, importance of understanding science for future work, importance of understanding the polar regions as a person in today’s world, as well as increased self-reported knowledge and interest in numerous science content areas. Building

Building capacity and resilience in the dementia care workforce: a systematic review of interventions targeting worker and organizational outcomes.

Science.gov (United States)

Elliott, Kate-Ellen J; Scott, Jennifer L; Stirling, Christine; Martin, Angela J; Robinson, Andrew

2012-06-01

Dementia increasingly impacts every health and social care system in the world. Preparing the dementia care workforce is therefore paramount, particularly in light of existing problems of staff retention and turnover. Training interventions will need to increase worker and organizational capacity to deliver effective patient care. It is not clear which training interventions best enhance workers' capacity. A review of the evidence for dementia care training interventions to enhance worker capacity and facilitate organizational change is presented. A systematic literature review was conducted. All selected randomized intervention studies aimed to enhance some aspect of dementia care worker or workforce capacity such as knowledge of dementia, psychological well-being, work performance, and organizational factors such as retention or service delivery in dementia care. Seventy-four relevant studies were identified, but only six met inclusion criteria for the review. The six studies selected focused on worker and organizational outcomes in dementia care. All interventions were multi-component with dementia education or instructional training most commonly adopted. No interventions were found for the community setting. Variable effects were found for intervention outcomes and methodological concerns are raised. The rigor of scientific research in training interventions that aim to build capacity of dementia care workers is poor and a strong need exists for evaluation and delivery of such interventions in the community sphere. Wider domains of interest such as worker psychological health and well-being need to be examined further, to understand capacity-building in the dementia care workforce.

Building integrated care systems: a case study of Bidasoa Integrated Health Organisation

Directory of Open Access Journals (Sweden)

Nuria Toro Polanco

2015-06-01

Full Text Available Introduction: This paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011–2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions.Methods: This organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii overall impact of integration through several indicators based on the Triple Aim Framework.Results: The measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients’ perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure.Conclusion: There is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.

Building integrated care systems: a case study of Bidasoa Integrated Health Organisation

Directory of Open Access Journals (Sweden)

Nuria Toro Polanco

2015-06-01

Full Text Available Introduction: This paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011–2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions. Methods: This organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii overall impact of integration through several indicators based on the Triple Aim Framework. Results: The measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients’ perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure. Conclusion: There is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.

Small steps to health: building sustainable partnerships in pediatric obesity care.

Science.gov (United States)

Pomietto, Mo; Docter, Alicia Dixon; Van Borkulo, Nicole; Alfonsi, Lorrie; Krieger, James; Liu, Lenna L

2009-06-01

Given the prevalence of childhood obesity and the limited support for preventing and managing obesity in primary care settings, the Seattle Children's Hospital's Children's Obesity Action Team has partnered with Steps to Health King County to develop a pediatric obesity quality-improvement project. Primary care clinics joined year-long quality-improvement collaboratives to integrate obesity prevention and management into the clinic setting by using the chronic-disease model. Sustainability was enhanced through integration at multiple levels by emphasizing small, consistent behavior changes and self-regulation of eating/feeding practices with children, teenagers, and families; building local community partnerships; and encouraging broader advocacy and policy change. Cultural competency and attention to disparities were integrated into quality-improvement efforts. . Participating clinics were able to increase BMI measurement and weight classification; integrate management of overweight/obese children and family and self-management support; and grow community collaborations. Over the course of 4 years, this project grew from a local effort involving 3 clinics to a statewide program recently adopted by the Washington State Department of Health. This model can be used by other states/regions to develop pediatric obesity quality-improvement programs to support the assessment, prevention, and management of childhood obesity. Furthermore, these health care efforts can be integrated into broader community-wide childhood-obesity action plans.

Can we Save the rectum by watchful waiting or TransAnal microsurgery following (chemo) Radiotherapy versus Total mesorectal excision for early REctal Cancer (STAR-TREC study)?

DEFF Research Database (Denmark)

Rombouts, Anouk J M; Al-Najami, Issam; Abbott, Natalie L

2017-01-01

INTRODUCTION: Total mesorectal excision (TME) is the highly effective standard treatment for rectal cancer but is associated with significant morbidity and may be overtreatment for low-risk cancers. This study is designed to determine the feasibility of international recruitment in a study...... comparing organ-saving approaches versus standard TME surgery. METHODS AND ANALYSIS: STAR-TREC trial is a multicentre international randomised, three-arm parallel, phase II feasibility study in patients with biopsy-proven adenocarcinoma of the rectum. The trial is coordinated from Birmingham, UK...... endpoint of this phase II study is to demonstrate sufficient international recruitment in order to sustain a phase III study incorporating pelvic failure as the primary endpoint. Success in phase II is defined as randomisation of at least four cases per month internationally in year 1, rising to at least...

Using action research to build mentor capacity to improve orientation and quality of nursing students' aged care placements: what to do when the phone rings.

Science.gov (United States)

Lea, Emma J; Andrews, Sharon; Stronach, Megan; Marlow, Annette; Robinson, Andrew L

2017-07-01

To describe whether an action research approach can be used to build capacity of residential aged care facility staff to support undergraduate nursing students' clinical placements in residential aged care facilities, using development of an orientation programme as an exemplar. Aged care facilities are unpopular sites for nursing students' clinical placements. A contributing factor is the limited capacity of staff to provide students with a positive placement experience. Strategies to build mentor capability to shape student placements and support learning and teaching are critical if nursing students are to have positive placements that attract them to aged care after graduation, an imperative given the increasing care needs of the ageing population worldwide. Action research approach employing mixed-methods data collection (primarily qualitative with a quantitative component). Aged care facility staff (n = 32) formed a mentor group at each of two Tasmanian facilities and met regularly to support undergraduate nursing students (n = 40) during placements. Group members planned, enacted, reviewed and reflected on orientation procedures to welcome students, familiarise them with the facility and prepare them for their placement. Data comprised transcripts from these and parallel student meetings, and orientation data from student questionnaires from two successive placement periods (2011/2012). Problems were identified in the orientation processes for the initial student placements. Mentors implemented a revised orientation programme. Evaluation demonstrated improved programme outcomes for students regarding knowledge of facility operations, their responsibilities and emergency procedures. Action research provides an effective approach to engage aged care facility staff to build their capacity to support clinical placements. Building capacity in the aged care workforce is vital to provide appropriate care for residents with increasing care needs. © 2016 John

Building Children's Sense of Community in a Day Care Centre through Small Groups in Play

Science.gov (United States)

Koivula, Merja; Hännikäinen, Maritta

2017-01-01

This study examines the process through which children build a sense of community in small groups in a day care centre. The study asks the following: how does children's sense of community develop, and what are its key features? Data were collected by applying ethnographic methods in a group of three- to five-year-old children over eleven months.…

Solar energy in buildings solved by building information modeling

Science.gov (United States)

Chudikova, B.; Faltejsek, M.

2018-03-01

Building lead us to use renewable energy sources for all types of buildings. The use of solar energy is the alternatives that can be applied in a good ratio of space, price, and resultant benefits. Building Information Modelling is a modern and effective way of dealing with buildings with regard to all aspects of the life cycle. The basis is careful planning and simulation in the pre-investment phase, where it is possible to determine the effective result and influence the lifetime of the building and the cost of its operation. By simulating, analysing and insert a building model into its future environment where climate conditions and surrounding buildings play a role, it is possible to predict the usability of the solar energy and establish an ideal model. Solar systems also very affect the internal layout of buildings. Pre-investment phase analysis, with a view to future aspects, will ensure that the resulting building will be both low-energy and environmentally friendly.

Building the eye care team

Directory of Open Access Journals (Sweden)

Thulasiraj Ravilla

2014-07-01

Full Text Available Eye care services are people intensive. They require the right people (competence, in the right numbers (capacity, in the right mix (team with the right resources and processes (enabling conditions to ensure effective and sustainable delivery of patient care.

Significance of Building Maintenance Management on Life-Span of Buildings

Directory of Open Access Journals (Sweden)

Md Azree Othuman Mydin

2017-06-01

Full Text Available The attentions and skills of maintenance are required for the construction of buildings in this twenty-first century. Because much architectural education is still focused on the one-of-a-kind assignment, encouraging the notion of personal fulfillment through leaving a mark for off-springs and obtaining a design award by means of concept drawings. Due to the reason that many building designers (architects, engineers, technicians are not encompassed in the subsequent maintenance of the building, they just regard it as other specialists’ responsibilities. In all likelihood, the building user-to-be has no formal role: the building contractors just fulfill their accountabilities to complete the building in compliance with the contract documents, not to care occupier’s needs and wants. This paper will focus on the important of building maintenance management on the life-span of buildings.

Neonatal screening for severe combined immunodeficiency in Brazil

Directory of Open Access Journals (Sweden)

Marilia Pyles Patto Kanegae

2016-07-01

Full Text Available Objective: To apply, in Brazil, the T-cell receptor excision circles (TRECs quantification technique using real-time polymerase chain reaction in newborn screening for severe combined immunodeficiency and assess the feasibility of implementing it on a large scale in Brazil. Methods: 8715 newborn blood samples were collected on filter paper and, after DNA elution, TRECs were quantified by real-time polymerase chain reaction. The cutoff value to determine whether a sample was abnormal was determined by ROC curve analysis, using SSPS. Results: The concentration of TRECs in 8,682 samples ranged from 2 to 2,181 TRECs/μL of blood, with mean and median of 324 and 259 TRECs/μL, respectively. Forty-nine (0.56% samples were below the cutoff (30 TRECs/μL and were reanalyzed. Four (0.05% samples had abnormal results (between 16 and 29 TRECs/μL. Samples from patients previously identified as having severe combined immunodeficiency or DiGeorge syndrome were used to validate the assay and all of them showed TRECs below the cutoff. Preterm infants had lower levels of TRECs than full-term neonates. The ROC curve showed a cutoff of 26 TRECs/μL, with 100% sensitivity for detecting severe combined immunodeficiency. Using this value, retest and referral rates were 0.43% (37 samples and 0.03% (3 samples, respectively. Conclusion: The technique is reliable and can be applied on a large scale after the training of technical teams throughout Brazil. Resumo: Objetivo: aplicar no Brasil a técnica de quantificação de T-cell Receptor Excision Circles (TRECs por polymerase chain reaction em tempo real para triagem neonatal de imunodeficiência combinada grave (SCID e avaliar se é possível realizá-la em larga escala em nosso país. Métodos: foram coletadas 8.715 amostras de sangue de recém-nascidos em papel filtro e, após eluição do DNA, os TRECs foram quantificados por polymerase chain reaction em tempo real. O valor de corte para determinar se uma

Barriers to retrieving patient information from electronic health record data: failure analysis from the TREC Medical Records Track.

Science.gov (United States)

Edinger, Tracy; Cohen, Aaron M; Bedrick, Steven; Ambert, Kyle; Hersh, William

2012-01-01

Secondary use of electronic health record (EHR) data relies on the ability to retrieve accurate and complete information about desired patient populations. The Text Retrieval Conference (TREC) 2011 Medical Records Track was a challenge evaluation allowing comparison of systems and algorithms to retrieve patients eligible for clinical studies from a corpus of de-identified medical records, grouped by patient visit. Participants retrieved cohorts of patients relevant to 35 different clinical topics, and visits were judged for relevance to each topic. This study identified the most common barriers to identifying specific clinic populations in the test collection. Using the runs from track participants and judged visits, we analyzed the five non-relevant visits most often retrieved and the five relevant visits most often overlooked. Categories were developed iteratively to group the reasons for incorrect retrieval for each of the 35 topics. Reasons fell into nine categories for non-relevant visits and five categories for relevant visits. Non-relevant visits were most often retrieved because they contained a non-relevant reference to the topic terms. Relevant visits were most often infrequently retrieved because they used a synonym for a topic term. This failure analysis provides insight into areas for future improvement in EHR-based retrieval with techniques such as more widespread and complete use of standardized terminology in retrieval and data entry systems.

Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya.

Science.gov (United States)

Binanay, Cynthia A; Akwanalo, Constantine O; Aruasa, Wilson; Barasa, Felix A; Corey, G Ralph; Crowe, Susie; Esamai, Fabian; Einterz, Robert; Foster, Michael C; Gardner, Adrian; Kibosia, John; Kimaiyo, Sylvester; Koech, Myra; Korir, Belinda; Lawrence, John E; Lukas, Stephanie; Manji, Imran; Maritim, Peris; Ogaro, Francis; Park, Peter; Pastakia, Sonak D; Sugut, Wilson; Vedanthan, Rajesh; Yanoh, Reuben; Velazquez, Eric J; Bloomfield, Gerald S

2015-12-08

Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource-limited setting. Our experiences may guide the development of similar collaborations in other settings. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Building-level analyses to prospectively detect influenza outbreaks in long-term care facilities: New York City, 2013-2014.

Science.gov (United States)

Levin-Rector, Alison; Nivin, Beth; Yeung, Alice; Fine, Annie D; Greene, Sharon K

2015-08-01

Timely outbreak detection is necessary to successfully control influenza in long-term care facilities (LTCFs) and other institutions. To supplement nosocomial outbreak reports, calls from infection control staff, and active laboratory surveillance, the New York City (NYC) Department of Health and Mental Hygiene implemented an automated building-level analysis to proactively identify LTCFs with laboratory-confirmed influenza activity. Geocoded addresses of LTCFs in NYC were compared with geocoded residential addresses for all case-patients with laboratory-confirmed influenza reported through passive surveillance. An automated daily analysis used the geocoded building identification number, approximate text matching, and key-word searches to identify influenza in residents of LTCFs for review and follow-up by surveillance coordinators. Our aim was to determine whether the building analysis improved prospective outbreak detection during the 2013-2014 influenza season. Of 119 outbreaks identified in LTCFs, 109 (92%) were ever detected by the building analysis, and 55 (46%) were first detected by the building analysis. Of the 5,953 LTCF staff and residents who received antiviral prophylaxis during the 2013-2014 season, 929 (16%) were at LTCFs where outbreaks were initially detected by the building analysis. A novel building-level analysis improved influenza outbreak identification in LTCFs in NYC, prompting timely infection control measures. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Physicians' perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models.

Science.gov (United States)

Lee, Linda; Heckman, George; McKelvie, Robert; Jong, Philip; D'Elia, Teresa; Hillier, Loretta M

2015-03-01

To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors. Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods. Ontario. Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists. Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists(n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16).Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings. Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators. The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes,promote efficient use of health care resources, and reduce healthcare costs.

A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce?

Science.gov (United States)

Gordon, Christopher J; Aggar, Christina; Williams, Anna M; Walker, Lynne; Willcock, Simon M; Bloomfield, Jacqueline

2014-01-01

This debate discusses the potential merits of a New Graduate Nurse Transition to Primary Health Care Program as an untested but potential nursing workforce development and sustainability strategy. Increasingly in Australia, health policy is focusing on the role of general practice and multidisciplinary teams in meeting the service needs of ageing populations in the community. Primary health care nurses who work in general practice are integral members of the multidisciplinary team - but this workforce is ageing and predicted to face increasing shortages in the future. At the same time, Australia is currently experiencing a surplus of and a corresponding lack of employment opportunities for new graduate nurses. This situation is likely to compound workforce shortages in the future. A national nursing workforce plan that addresses supply and demand issues of primary health care nurses is required. Innovative solutions are required to support and retain the current primary health care nursing workforce, whilst building a skilled and sustainable workforce for the future. This debate article discusses the primary health care nursing workforce dilemma currently facing policy makers in Australia and presents an argument for the potential value of a New Graduate Transition to Primary Health Care Program as a workforce development and sustainability strategy. An exploration of factors that may contribute or hinder transition program for new graduates in primary health care implementation is considered. A graduate transition program to primary health care may play an important role in addressing primary health care workforce shortages in the future. There are, however, a number of factors that need to be simultaneously addressed if a skilled and sustainable workforce for the future is to be realised. The development of a transition program to primary health care should be based on a number of core principles and be subjected to both a summative and cost

Physicians’ perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models

Science.gov (United States)

Lee, Linda; Heckman, George; McKelvie, Robert; Jong, Philip; D’Elia, Teresa; Hillier, Loretta M.

2015-01-01

Abstract Objective To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors. Design Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods. Setting Ontario. Participants Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists. Methods Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists (n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16). Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings. Main findings Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators. Conclusion The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes, promote efficient use of health care resources, and reduce health care costs. PMID:25932482

An exploratory qualitative analysis of student midwives views of teaching methods that could build their confidence to deliver perinatal bereavement care.

Science.gov (United States)

Martin, Caroline J Hollins; Robb, Yvonne; Forrest, Eleanor

2016-04-01

Equipping student midwives with confidence to deliver bereavement care to childbearing women is a challenge for midwifery lecturers. To explore qualitative data provided by student midwives who evaluated the workbook Bereavement care for childbearing women and their families (Hollins Martin & Forrest, 2013) to explore their views of potential teaching strategies that could build their confidence to deliver real bereavement care. An exploratory qualitative thematic analysis was used to provide, analyse and report themes identified within data collected in a prior study. Participants were student midwives (n=179) in their second/third year of a midwifery degree program at 1 of 3 universities in the UK were included in the study. Data to evaluate effectiveness of the bereavement workbook as a teaching method was collected using a survey instrument. It was the comments written under questions by participants that were analysed in the present study. Three themes emerged: (1) increasing classroom interaction, (2) the importance of reflecting on emotions, and (3) need for experience. Although this study has addressed delivery of education that relates to midwives, the findings are cross transferable to other healthcare educators, practitioners, and students. Several solutions are proposed that could potentially build student confidence to deliver bereavement care: lecturers should (1) encourage group discussion in the classroom to help build student confidence to emotionally cope during real bereavement events; (2) ensure students gain exposure by encouraging qualified midwives to include them in real bereavement events early on in their training, and (3) develop packages of perinatal bereavement scenarios for simulation and rehearsal in the clinical skills laboratory. Post-implementation, it is recommended that these teaching strategies be evaluated. Copyright © 2016 Elsevier Ltd. All rights reserved.

Nursing home administrators’ perspectives on a study feedback report: a cross sectional survey

Directory of Open Access Journals (Sweden)

Boström Anne-Marie

2012-09-01

Full Text Available Abstract Background This project is part of the Translating Research in Elder Care (TREC program of research, a multi-level and longitudinal research program being conducted in 36 nursing homes in three Canadian Prairie Provinces. The overall goal of TREC is to improve the quality of care for older persons living in nursing homes and the quality of work life for care providers. The purpose of this paper is to report on development and evaluation of facility annual reports (FARs from facility administrators’ perspectives on the usefulness, meaningfulness, and understandability of selected data from the TREC survey. Methods A cross sectional survey design was used in this study. The feedback reports were developed in collaboration with participating facility administrators. FARs presented results in four contextual areas: workplace culture, feedback processes, job satisfaction, and staff burnout. Six weeks after FARs were mailed to each administrator, we conducted structured telephone interviews with administrators to elicit their evaluation of the FARs. Administrators were also asked if they had taken any actions as a result of the FAR. Descriptive and inferential statistics, as well as content analysis for open-ended questions, were used to summarize findings. Results Thirty-one facility administrators (representing thirty-two facilities participated in the interviews. Six administrators had taken action and 18 were planning on taking action as a result of FARs. The majority found the four contextual areas addressed in FAR to be useful, meaningful, and understandable. They liked the comparisons made between data from years one and two and between their facility and other TREC study sites in their province. Twenty-two indicated that they would like to receive information on additional areas such as aggressive behaviours of residents and information sharing. Twenty-four administrators indicated that FARs contained enough information, while eight

Stent for Life Initiative: leading example in building STEMI systems of care in emerging countries.

Science.gov (United States)

Kaifoszova, Zuzana; Kala, Petr; Alexander, Thomas; Zhang, Yan; Huo, Yong; Snyders, Adriaan; Delport, Rhena; Alcocer-Gamba, Marco Antonio; Gavidia, Leslie Marisol Lugo

2014-08-01

This paper describes the opportunities and challenges in building ST-elevation acute myocardial infarction (STEMI) systems of care in Stent for Life affiliated and collaborating so-called emerging countries, namely India, China, South Africa and Mexico, where CAD mortality is increasing and becoming a significant healthcare problem. The Stent for Life model supports the implementation of ESC STEMI Guidelines in Europe and endeavours to impact on morbidity and mortality by improving services and developing regional STEMI systems of care, whereby STEMI patients' timely access to a primary percutaneous coronary intervention (PPCI) is assured. In India, the STEMI India model incorporates a dual approach of combining PPCI with a pharmacoinvasive strategy of reperfusion. The architecture of the system is based on a hub and spoke model with each unit called a STEMI cluster. The project is driven by a private non-profit organisation. In China, the STEMI PCI programme is led by the Chinese College of Cardiovascular Physicians and supported by the national government. Although primary PCI is performed nationwide, a thrombolytic treatment strategy is still the first option in many rural areas because of logistic considerations. Establishing local STEMI transfer networks and then implementing a pharmacoinvasive strategy of reperfusion are being considered and promoted currently. In South Africa, the pharmacoinvasive approach currently dominates as STEMI treatment option in many areas. A pilot study shows that low symptom awareness leads to long patient delays. The education of all role players, from patients to healthcare professionals and including institutions and governmental structures, is needed to achieve prompt diagnosis and treatment. In Mexico, improving the treatment of STEMI requires considering myocardial infarction to be an emergency that must be treated by an entire system and not just by a particular service. Patients need to receive quick treatment from

From intelligent buildings to careful buildings : a concept to implement individual health and comfort demands

NARCIS (Netherlands)

Zeiler, W.; Wortel, W.; Houten, van M.A.; Hommelberg, M.P.F.; Kamphuis, I.G.; Jelsma, J.; Oliveira Fernandes, de E.; Gameiro da Silva, M.; Rosado Pinto, J.

2006-01-01

Buildings are built for users, so the user preferences and their behaviour should become leading in building services control strategy. The paper reviews 3 projects on intelligent process control. The insights of these projects were combined into a new technology; FACT, Forgiving Agent Comfort

Building patient safety in intensive care nursing : Patient safety culture, team performance and simulation-based training

OpenAIRE

Ballangrud, Randi

2013-01-01

Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven I...

Building consensus on key priorities for rural health care in South Africa using the Delphi technique.

Science.gov (United States)

Versteeg, Marije; du Toit, Lilo; Couper, Ian

2013-01-24

South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

Long-term care policy for older Americans: building a continuum of care.

Science.gov (United States)

Palley, Howard A

2003-01-01

This paper deals primarily with social policy considerations relevant to the development of long-term care policy for the frail elderly in the United States. However, it also includes some commentary on meeting the acute care needs of the frail elderly. It defines chronic care treatment as a mix of "short-term" and "long-term" modes of care. Furthermore, it explores the need for treatment of such long-term illnesses to recognize the importance of alternative modes of caring which include strategies, both medical and nonmedical, delivered within and outside of hospitals and nursing homes. The paper includes an analysis of public and private sector priorities based in data published by the U.S. Health Care Financing Administration. It also includes some discussion of the PACE program in the United States and some other efforts to stimulate more in-home and community-based alternatives to nursing home care. Furthermore, it includes a discussion of the policy goal of "appropriateness" in developing long-term care (as well as general health priorities) and provides a critical discussion of problems with utilizing "cost/benefit analysis." The study concludes that too exclusive a focus on nursing home care for the elderly in the United States is unfortunate-both in terms of the desires of the elderly, their families and friends and in terms of focusing on "appropriateness" as a legitimate policy goal in the development of long-term care policy for the elderly in the United States.

Pioneering the Transdisciplinary Team Science Approach: Lessons Learned from National Cancer Institute Grantees.

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Vogel, Amanda L; Stipelman, Brooke A; Hall, Kara L; Nebeling, Linda; Stokols, Daniel; Spruijt-Metz, Donna

2014-01-01

The National Cancer Institute has been a leader in supporting transdisciplinary (TD) team science. From 2005-2010, the NCI supported Transdisciplinary Research on Energetic and Cancer I (TREC I), a center initiative fostering the TD integration of social, behavioral, and biological sciences to examine the relationships among obesity, nutrition, physical activity and cancer. In the final year of TREC I, we conducted qualitative in-depth-interviews with 31 participating investigators and trainees to learn more about their experiences with TD team science, including challenges, facilitating factors, strategies for success, and impacts. Five main challenges emerged: (1) limited published guidance for how to engage in TD team science, when TREC I was implemented; (2) conceptual and scientific challenges inherent to efforts to achieve TD integration; (3) discipline-based differences in values, terminology, methods, and work styles; (4) project management challenges involved in TD team science; and (5) traditional incentive and reward systems that do not recognize or reward TD team science. Four main facilitating factors and strategies for success emerged: (1) beneficial attitudes and beliefs about TD research and team science; (2) effective team processes; (3) brokering and bridge-building activities by individuals holding particular roles in a research center; and (4) funding initiative characteristics that support TD team science. Broad impacts of participating in TD team science in the context of TREC I included: (1) new positive attitudes about TD research and team science; (2) new boundary-crossing collaborations; (3) scientific advances related to research approaches, findings, and dissemination; (4) institutional culture change and resource creation in support of TD team science; and (5) career advancement. Funding agencies, academic institutions, and scholarly journals can help to foster TD team science through funding opportunities, institutional policies on

The grounded theory of "trust building".

Science.gov (United States)

Ramezani, Monir; Ahmadi, Fazlollah; Mohammadi, Eesa; Kazemnejad, Anoshirvan

2017-01-01

Despite the growing importance of spiritual care, the delivery of spiritual care is still an area of disagreement among healthcare providers. To develop a grounded theory about spiritual care delivery based on Iranian nurses' perceptions and experiences. A grounded theory approach: A qualitative study using the grounded theory approach. Participants and research context: Data were collected through holding 27 interviews with 25 participants (17 staff nurses, 3 physicians, 3 patients, 1 family member, and 1 nurse assistant). The study setting was the Imam Khomeini Hospital Complex. Sampling was started purposively and continued theoretically. Data analysis was performed by the method proposed by Strauss and Corbin. Ethical consideration: The study was approved by the Ethics Committee of Tarbiat Modares University and the agreement of the administrators of the study setting was got before starting the study. The core category of the study was "Trust building" which reflected the nature of spiritual care delivery by nurses. Trust building was the result of eight main categories or strategies including creating a positive mentality at hospital admission, understanding patients in care circumstances, having a caring presence, adhering to care ethics, developing meaningful relationships, promoting positive thinking and energy, establishing effective communication with patients, and attempting to create a safe therapeutic environment. Poor interprofessional coordination negatively affected this process while living toward developing greater cognizance of divinity and adhering to the principles of professional ethics facilitated it. The outcome of the process was to gain a sense of partial psychological security. The "Trust building" theory can be used as a guide for describing and expanding nurses' roles in spiritual care delivery, developing care documentation systems and clinical guidelines, and planning educational programs for nursing students and staff nurses.

Building the capacity of family day care educators to promote children's social and emotional wellbeing: an exploratory cluster randomised controlled trial

Directory of Open Access Journals (Sweden)

Sims Margaret

2011-11-01

Full Text Available Abstract Background Childhood mental health problems are highly prevalent, experienced by one in five children living in socioeconomically disadvantaged families. Although childcare settings, including family day care are ideal to promote children's social and emotional wellbeing at a population level in a sustainable way, family day care educators receive limited training in promoting children's mental health. This study is an exploratory wait-list control cluster randomised controlled trial to test the appropriateness, acceptability, cost, and effectiveness of "Thrive," an intervention program to build the capacity of family day care educators to promote children's social and emotional wellbeing. Thrive aims to increase educators' knowledge, confidence and skills in promoting children's social and emotional wellbeing. Methods/Design This study involves one family day care organisation based in a low socioeconomic area of Melbourne. All family day care educators (term used for registered carers who provide care for children for financial reimbursement in the carers own home are eligible to participate in the study. The clusters for randomisation will be the fieldworkers (n = 5 who each supervise 10-15 educators. The intervention group (field workers and educators will participate in a variety of intervention activities over 12 months, including workshops; activity exchanges with other educators; and focused discussion about children's social and emotional wellbeing during field worker visits. The control group will continue with their normal work practice. The intervention will be delivered to the intervention group and then to the control group after a time delay of 15 months post intervention commencement. A baseline survey will be conducted with all consenting educators and field workers (n = ~70 assessing outcomes at the cluster and individual level. The survey will also be administered at one month, six months and 12 months post

Building consensus on key priorities for rural health care in South Africa using the Delphi technique

Directory of Open Access Journals (Sweden)

Marije Versteeg

2013-01-01

Full Text Available Background: South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. Methods: The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Results: Response rates ranged from 83% in the first round (n=44 to 64% in the final round (n=34. The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH, governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Conclusion: Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

A systematic review of essential obstetric and newborn care capacity building in rural sub-Saharan Africa.

Science.gov (United States)

Ni Bhuinneain, G M; McCarthy, F P

2015-01-01

Progress in maternal survival in sub-Saharan Africa has been poor since the Millennium Declaration. This systematic review aims to investigate the presence and rigour of evidence for effective capacity building for Essential Obstetric and Newborn Care (EONC) to reduce maternal mortality in rural, sub-Saharan Africa, where maternal mortality ratios are highest globally. MEDLINE (1990-January 2014), EMBASE (1990-January 2014), and the Cochrane Library were included in our search. Key developing world issues of The Lancet and the British Journal of Obstetrics and Gynaecology, African Ministry of Health websites, and the WHO reproductive health library were searched by hand. Studies investigating essential obstetric and newborn care packages in basic and comprehensive care facilities, at community and institutional level, in rural sub-Saharan Africa were included. Studies were included if they reported on healthcare worker performance, access to care, community behavioural change, and emergency obstetric and newborn care. Data were extracted and all relevant studies independently appraised using structured abstraction and appraisal tools. There is moderate evidence to support the training of healthcare workers of differing cadres in the provision of emergency obstetric and newborn services to reduce institutional maternal mortality and case-fatality rates in rural sub-Saharan Africa. Community schemes that sensitise and enable access to maternal health services result in a modest rise in facility birth and skilled birth attendance in this rural setting. Essential Obstetric and Newborn Care has merit as an intervention package to reduce maternal mortality in rural sub-Saharan Africa. © 2014 Royal College of Obstetricians and Gynaecologists.

Building to Make a Difference: Advanced Practice Nurses' Experience of Power.

Science.gov (United States)

Schoales, Catherine A; Bourbonnais, Frances Fothergill; Rashotte, Judy

2018-02-01

Power is necessary for nurses to affect change in patient care and to move the nursing profession forward. Despite the evolving body of nursing research on power, there have been no studies that have investigated the nature of advanced practice nurses' (APNs') power. The purpose of this study was to explore the APNs' lived experience of power. Interpretive phenomenology guided the method and analysis. Eight APNs employed in a single Canadian tertiary care teaching health-care organization engaged in in-depth interviews. The overarching theme, building to make a difference, reflected the APNs' perception of power in their practice, which involved a passion to facilitate change in practice to improve patient care. Building to make a difference involved three themes: building on, building with, and building for. The APNs experienced more power-a process they described as power creep-when they used soft power that was shared with others to affect positive change in health care. These findings contribute to our understanding of how power is perceived and manifested in the APN role, thus further enabling organizations to create working conditions to support the APNs' endeavors to empower others.

Building Social Web Applications

CERN Document Server

Bell, Gavin

2009-01-01

Building a web application that attracts and retains regular visitors is tricky enough, but creating a social application that encourages visitors to interact with one another requires careful planning. This book provides practical solutions to the tough questions you'll face when building an effective community site -- one that makes visitors feel like they've found a new home on the Web. If your company is ready to take part in the social web, this book will help you get started. Whether you're creating a new site from scratch or reworking an existing site, Building Social Web Applications

Building trust to work with children after a severe traumatic accident.

Science.gov (United States)

Hall, Julianne; Nayar, Shoba

2014-01-01

Trust is integral to nursing; yet little is known about how nurses establish trust when working with patients. This grounded theory study explored nurses' perspectives of how to build trust with a child and family in the context of paediatric acute health care. Seven paediatric acute care nurses were asked what they did when they cared for a child admitted to an acute care ward from emergency department or intensive care unit following a severe traumatic accident. Building trust emerged as the basic social process for an effective working relationship between a nurse and family to promote the rehabilitation of the child. This paper argues that building trust is critical to nurses developing a working relationship with both child and family to promote optimal health, and enables nurses to effectively step out and handover the care of the child to the family.

Drexel at TREC 2014 Federated Web Search Track

Science.gov (United States)

2014-11-01

of its input RS results. 1. INTRODUCTION Federated Web Search is the task of searching multiple search engines simultaneously and combining their...or distributed properly[5]. The goal of RS is then, for a given query, to select only the most promising search engines from all those available. Most...result pages of 149 search engines . 4000 queries are used in building the sample set. As a part of the Vertical Selection task, search engines are

Caring buildings: user based indoor climate control

NARCIS (Netherlands)

Zeiler, W.; Houten, van M.A.

2007-01-01

Global warming, caused largely by energy consumption, has become a major problem. In comfort control strategy there is an exciting development based on inclusive design: the user's preferences and their behaviour have become central in the building services control strategy. Synergy between end-user

Bringing Experience from the Field into the Classroom with the NOAA Teacher at Sea and PolarTREC Teacher Research Experience Programs

Science.gov (United States)

Eubanks, E. D.; Kohin, S.; Oberbauer, S.

2008-12-01

As a participant of the National Oceanic and Atmospheric Administration (NOAA), Teacher at Sea (2007) and the Arctic Research Consortium of the U.S., PolarTREC (2008) programs, I have had the opportunity to participate in hands-on research with leading scientific researchers from the tropics to the Arctic. These Teacher Researcher Experiences (TRE's) and the resulting relationships that have developed with the scientific community have been an asset to my professional development and have greatly enhanced my students' learning. The opportunity to participate in data collection and hands-on research with a NOAA researcher, Dr. Kohin, helped me bring shark, ocean, and ship science from my expedition onboard the NOAA Ship David Starr Jordan in the Channel Island region into my classroom. The new knowledge, experiences, and resources that I brought back allowed me to create lesson plans and host Shark Month--an activity that involved all 300 students in my school. My students were able to link real data regarding the location of sharks to practical application and still meet state standards. Likewise, the scientist from my PolarTREC expedition, Dr. Oberbauer, is assisting me in a long-term plan to incorporate his data into my classroom curricula. Already, my experiences from Barrow, Alaska, have been shared through webinars with my community and as a keynote speaker to over 600 Palm Beach County science teachers. We are also working together to develop a yearlong curriculum, in which my entire school of 300 students will discover interdisciplinary polar science. Participation in TRE's has been beneficial for my students and my community, but what is the return on the investment for the scientists who invited me to participate in their research? Both scientists have transferred their knowledge out of the laboratory and made a link between their research and a different generation--our future scientists. They become instrumental science leaders in a community of young

Four Essential Practices for Building Trust

Science.gov (United States)

Combs, Julie Peterson; Harris, Sandra; Edmonson, Stacey

2015-01-01

The presence of trust can enhance an organization's efforts to fulfill its mission, and the lack of trust can constrict those efforts. The authors offer four essential guidelines to help school leaders communicate in a way that builds trust. Build trust by understanding trust. Trusted leaders demonstrate care, character, and competence in their…

Developing Integrated Care: Towards a development model for integrated care

NARCIS (Netherlands)

M.M.N. Minkman (Mirella)

2012-01-01

textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated

Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment

Directory of Open Access Journals (Sweden)

Naoko Muramatsu

2017-04-01

Full Text Available Home care aides (HCAs, predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients’ homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs’ work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise (p = 0.027. Almost all (98% HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs’ job is feasible and can effectively promote HCAs’ health, especially among older HCAs.

Building Health Promotion into the Job of Home Care Aides: Transformation of the Workplace Health Environment.

Science.gov (United States)

Muramatsu, Naoko; Yin, Lijuan; Lin, Ting-Ti

2017-04-05

Home care aides (HCAs), predominantly women, constitute one of the fastest growing occupations in the United States. HCAs work in clients' homes that lack typical workplace resources and benefits. This mixed-methods study examined how HCAs' work environment was transformed by a pilot workplace health promotion program that targeted clients as well as workers. The intervention started with training HCAs to deliver a gentle physical activity program to their older clients in a Medicaid-funded home care program. Older HCAs aged 50+ reported increased time doing the types of physical activity that they delivered to their clients (stretching or strengthening exercise) ( p = 0.027). Almost all (98%) HCAs were satisfied with the program. These quantitative results were corroborated by qualitative data from open-ended survey questions and focus groups. HCAs described how they exercised with clients and how the psychosocial work environment changed with the program. Building physical activity into HCAs' job is feasible and can effectively promote HCAs' health, especially among older HCAs.

Atomic force microscopy-based antibody recognition imaging of proteins in the pathological deposits in Pseudoexfoliation Syndrome

Energy Technology Data Exchange (ETDEWEB)

Creasey, Rhiannon [School of Chemical and Physical Sciences, Flinders University of SA, GPO Box 2100, Adelaide, SA 5001 (Australia); Sharma, Shiwani [School of Medicine, Ophthalmology, Flinders University of SA, GPO Box 2100, Adelaide, SA 5001 (Australia); Gibson, Christopher T. [School of Chemical and Physical Sciences, Flinders University of SA, GPO Box 2100, Adelaide, SA 5001 (Australia); Craig, Jamie E. [School of Medicine, Ophthalmology, Flinders University of SA, GPO Box 2100, Adelaide, SA 5001 (Australia); Ebner, Andreas [Institute for Biophysics, Johannes Kepler Universitaet Linz, Altenbergerstr. 69, A-4040 Linz (Austria); Becker, Thomas [Nanochemistry Research Institute, Curtin University, GPO Box U1987, Perth, 6845 WA (Australia); Hinterdorfer, Peter [Institute for Biophysics, Johannes Kepler Universitaet Linz, Altenbergerstr. 69, A-4040 Linz (Austria); Voelcker, Nicolas H., E-mail: nico.voelcker@flinders.edu.au [School of Chemical and Physical Sciences, Flinders University of SA, GPO Box 2100, Adelaide, SA 5001 (Australia)

2011-07-15

The phenomenon of protein aggregation is of considerable interest to various disciplines, including the field of medicine. A range of disease pathologies are associated with this phenomenon. One of the ocular diseases hallmarked by protein aggregation is the Pseudoexfoliation (PEX) Syndrome. This condition is characterized by the deposition of insoluble proteinaceous material on the anterior human lens capsule. Genomic and proteomic analyses have revealed an association of specific genetic markers and various proteins, respectively, with PEX syndrome. However, the ultrastructure of the protein aggregates is poorly characterized. This study seeks to build capacity to determine the molecular nature of PEX aggregates on human lens capsules in their native state by AFM-based antibody recognition imaging. Lysyl oxidase-Like 1 (LOXL1), a protein identified as a component of PEX aggregates, is detected by an antibody-modified AFM probe. Topographical AFM images and antibody recognition images are obtained using three AFM-based techniques: TREC, phase and force-volume imaging. LOXL1 is found to be present on the lens capsule surface, and is localized around fibrous protein aggregates. Our evaluation shows that TREC imaging is best suited for human tissue imaging and holds significant potential for imaging of human disease tissues in their native state. -- Highlights: {yields} Atomic force microscopy techniques were applied to diseased human tissues. {yields} LOXL1 protein was detected on the small fibers of Pseudoexfoliation deposits. {yields} PicoTREC was the optimum technique for investigating protein aggregates.

Europe sees mixed results from public-private partnerships for building and managing health care facilities and services.

Science.gov (United States)

Barlow, James; Roehrich, Jens; Wright, Steve

2013-01-01

Prompted in part by constrained national budgets, European governments are increasingly partnering with the private sector to underwrite the costs of constructing and operating public hospitals and other health care facilities and delivering services. Through such public-private partnerships, governments hope to avoid up-front capital expenditure and to harness private-sector efficiencies, while private-sector partners aim for a return on investment. Our research indicates that to date, experience with these partnerships has been mixed. Early models of these partnerships-for example, in which a private firm builds a hospital and carries out building maintenance, which we term an "accommodation-only" model-arguably have not met expectations for achieving greater efficiencies at lower costs. Newer models described in this article offer greater opportunities for efficiency gains but are administratively harder to set up and manage. Given the shortages in public capital for new infrastructure, it seems likely that the attractiveness of these partnerships to European governments will grow.

Team Building e a enfermagem Team Building e enfermería Team Building and nursing

Directory of Open Access Journals (Sweden)

Filipa Homem

2012-07-01

: profundizar los conocimientos sobre Team Building, contextualizar el Team Building y reflexionar sobre su utilidad del Team Building en su contexto dentro de las prestaciones de atención de enfermería. De este modo, se realizaron búsquedas en la base de datos electrónica EBSCO, y se consultó la literatura relacionada con la psicología organizacional. Con esta investigación se concluyó que la estrategia de dinamización de equipo es útil aplicada a la enfermería, puede incluso mejorar la comunicación y las relaciones interpersonales, identificar fortalezas y debilidades de los equipos, proporcionar una mayor satisfacción en el trabajo y así, mejorar la calidad la atención sanitaria prestada.In this environment of growing dissatisfaction and unpredictability in nursing, it is increasingly important to motivate teams, giving them personal, relational, and communicative competencies and, above all, to build team working and thus improve productivity. Team Building emerges as an effective strategy to achieve positive results within organizations. Because it is a strategy not yet widely used in Portugal, we decided to look into the issue and reflect on its relevance and potential in nursing teams with the following objectives: to deepen knowledge about Team Building, to frame Team Building within the context of organizational theories, to describe different models of Team Building and to reflect on the usefulness of Team Building for the quality of nursing care. Articles were searched in EBSCO electronic databases, and organizational psychology literature was consulted. With this research, we conclude that Team Building applied to nursing can improve communication and interpersonal relationships, identify strengths and weaknesses of teams, provide greater job satisfaction and thus enhance the quality of health care provided.

Building the Caring School Community: The James Hamblin School Experience.

Science.gov (United States)

Sedo, Julie; Hindle, Douglas R.

2000-01-01

A rural Saskatchewan K-12 school developed a schoolwide sense of community and a solid relationship with the larger community by setting new directions, team building, and building bridges with parents and the community. Positive staff behaviors, school appearance, and cross-grade interactive projects were critical to the success of the plan. (TD)

Financing medical office buildings.

Science.gov (United States)

Blake, J W

1995-01-01

This article discusses financing medical office buildings. In particular, financing and ownership options from a not-for-profit health care system perspective are reviewed, including use of tax-exempt debt, taxable debt, limited partnerships, sale, and real estate investment trusts (REITs).

Troubling gifts of care: vulnerable persons and threatening exchanges in Chicago's home care industry.

Science.gov (United States)

Buch, Elana D

2014-12-01

By tracing the transformations of troubling exchanges in paid home care, this article examines how differently positioned individuals strive to build caring relations within potentially restrictive regimes of care. In paid home care in Chicago, older adults and their workers regularly participate in exchanges of money, time, and material goods. These gifts play a crucial role in building good care relationships that sustain participants' moral personhood. Amid widespread concern about vulnerable elders, home care agencies compete in a crowded marketplace by prohibiting these exchanges, even as they depend on them to strengthen relationships. Supervisors thus exercise discretion, sometimes reclassifying gift exchanges as punishable thefts. In this context, the commodification of care did not lead to the actual elimination of gift relations, but rather transformed gift relations into a suspicious and troublesome source of value. © 2014 by the American Anthropological Association.

Building IT capability in health-care organizations.

Science.gov (United States)

Khatri, Naresh

2006-05-01

While computer technology has revolutionized industries such as banking and airlines, it has done little for health care so far. Most of the health-care organizations continue the early-computer-era practice of buying the latest technology without knowing how it might effectively be employed in achieving business goals. By investing merely in information technology (IT) rather than in IT capabilities they acquire IT components--primarily hardware, software, and vendor-provided services--which they do not understand and, as a result, are not capable of fully utilizing for achieving organizational objectives. In the absence of internal IT capabilities, health-care organizations have relied heavily on the fragmented IT vendor market in which vendors do not offer an open architecture, and are unwilling to offer electronic interfaces that would make their 'closed' systems compatible with those of other vendors. They are hamstrung as a result because they have implemented so many different technologies and databases that information stays in silos. Health systems can meet this challenge by developing internal IT capabilities that would allow them to seamlessly integrate clinical and business IT systems and develop innovative uses of IT. This paper develops a comprehensive conception of IT capability grounded in the resource-based theory of the firm as a remedy to the woes of IT investments in health care.

Classification of Building Object Types

DEFF Research Database (Denmark)

Jørgensen, Kaj Asbjørn

2011-01-01

made. This is certainly the case in the Danish development. Based on the theories about these abstraction mechanisms, the basic principles for classification systems are presented and the observed misconceptions are analyses and explained. Furthermore, it is argued that the purpose of classification...... systems has changed and that new opportunities should be explored. Some proposals for new applications are presented and carefully aligned with IT opportunities. Especially, the use of building modelling will give new benefits and many of the traditional uses of classification systems will instead...... be managed by software applications and on the basis of building models. Classification systems with taxonomies of building object types have many application opportunities but can still be beneficial in data exchange between building construction partners. However, this will be performed by new methods...

Building the national health information infrastructure for personal health, health care services, public health, and research

Directory of Open Access Journals (Sweden)

Detmer Don E

2003-01-01

Full Text Available Abstract Background Improving health in our nation requires strengthening four major domains of the health care system: personal health management, health care delivery, public health, and health-related research. Many avoidable shortcomings in the health sector that result in poor quality are due to inaccessible data, information, and knowledge. A national health information infrastructure (NHII offers the connectivity and knowledge management essential to correct these shortcomings. Better health and a better health system are within our reach. Discussion A national health information infrastructure for the United States should address the needs of personal health management, health care delivery, public health, and research. It should also address relevant global dimensions (e.g., standards for sharing data and knowledge across national boundaries. The public and private sectors will need to collaborate to build a robust national health information infrastructure, essentially a 'paperless' health care system, for the United States. The federal government should assume leadership for assuring a national health information infrastructure as recommended by the National Committee on Vital and Health Statistics and the President's Information Technology Advisory Committee. Progress is needed in the areas of funding, incentives, standards, and continued refinement of a privacy (i.e., confidentiality and security framework to facilitate personal identification for health purposes. Particular attention should be paid to NHII leadership and change management challenges. Summary A national health information infrastructure is a necessary step for improved health in the U.S. It will require a concerted, collaborative effort by both public and private sectors. If you cannot measure it, you cannot improve it. Lord Kelvin

30 Ways to Build Your Center's Enrollment.

Science.gov (United States)

Child Care Information Exchange, 1991

1991-01-01

The Exchange Panel of 100 Members shares ideas for building enrollment in day care centers. Suggestions include stimulating communication with parents and promoting word-of-mouth referrals, offering visits and child care to prospective clients, sponsoring community activities, and serving as a source of child development expertise. (SH)

Detection of newly produced T and B lymphocytes by digital PCR in blood stored dry on nylon flocked swabs.

Science.gov (United States)

Tessitore, Marion Vaglio; Sottini, Alessandra; Roccaro, Aldo M; Ghidini, Claudia; Bernardi, Simona; Martellosio, Giovanni; Serana, Federico; Imberti, Luisa

2017-04-05

A normal number of T-cell receptor excision circles (TRECs) and K-deleting recombination excision circles (KRECs) is considered a biomarker for adequate new T- and B-cell production. In newborns, detection of TRECs and KRECs by real time PCR from dried blood spotted on filter paper is used for the screening of severe immunodeficiency. In adults, elderly and during diseases, where the number of TRECs is lower than in newborns and children, a large amount of DNA and a sensitive method of amplification are necessary to identify newly produced lymphocytes. DNA was prepared from blood of 203 healthy adults (range: 18-91 years old) absorbed for 10 s on flocked swabs and let to dry, or from peripheral blood mononuclear cells. DNA was subjected to digital PCR and to well established conventional real time PCR-based method using TREC- and KREC-specific primers and probes. The number of TRECs and KRECs was expressed per mL of blood. Statistical analysis was performed by nested ANOVA, Pearson coefficient of determination, and by linear regression tests. The novel method for the storage of dried blood on nylon flocked swabs and the use of digital PCR allow quantification of TRECs and KRECs with high degree of sensitivity, specificity, accuracy, and precision. TRECs and KRECs were amplified by digital PCR in all tested blood samples, including those obtained from elderly individuals (>70 years old) and that were negative by real time PCR. Furthermore, values of TRECs and KRECs obtained by digital PCR were in the range of those acquired by real time PCR. Our findings demonstrate that DNA isolation from dried blood on flocked swabs followed by digital PCR-based analysis represents a useful tool for studying new lymphocyte production in adults and elderly individuals. This suggests the potential use of the methodology when monitoring of clinical variables is limited by the number of molecules that can be amplified and detected, such as in patients with immunodeficiency or under

Towards Sustainable Health Care Organizations

Directory of Open Access Journals (Sweden)

Mauro ROMANELLI

2017-09-01

Full Text Available Health care organizations have to develop a sustainable path for creating public value by seeking legitimacy for building and maintaining public trust with patients as social and economic institutions creating value and sustaining both health and wealth for people and communities within society. Health care organizations having at disposal decreasing resources and meeting increasing demands of citizens are following an unsustainable path. Designing sustainable health care systems and organizations is emerging as a strategic goal for developing the wealth of people and communities over time. Building sustainable organizations relies on valuing human resources, designing efficient and effective processes, using technology for better managing the relationships within and outside organizations. Sustainable health care organizations tend to rediscover the importance of human resource management and policies for effectively improving communication with patients and building trust-based relationships. While processes of accreditation contribute to legitimizing effectiveness and quality of health care services and efficient processes, introducing and using new information and communication technologies (ICTs and informatics helps communication leading to restore trust-based relationships between health care institutions and patients for value creation within society.

Troubling Gifts of Care: Vulnerable Persons and Threatening Exchanges in Chicago’s Home Care Industry

Science.gov (United States)

Buch, Elana

2015-01-01

By tracing the transformations of troubling exchanges in paid home care, this article examines how differently positioned individuals strive to build caring relations within potentially restrictive regimes of care. In paid home care in Chicago, older adults and their workers regularly participate in exchanges of money, time, and material goods. These gifts play a crucial role in building good care relationships that sustain participants’ moral personhood. Amid widespread concern about vulnerable elders, home care agencies compete in a crowded marketplace by prohibiting these exchanges, even as they depend on them to strengthen relationships. Supervisors thus exercise discretion, sometimes reclassifying gift exchanges as punishable thefts. In this context, the commodification of care did not lead to the actual elimination of gift relations, but rather transformed gift relations into a suspicious and troublesome source of value. PMID:25331658

Using a strengths-based approach to build caring work environments.

Science.gov (United States)

Henry, Linda S; Henry, James D

2007-12-01

The current health care environment has a growing shortage of nurses and other health care professionals. Health care organizations face the twofold task of retaining employees and preventing "brain drain". A caring work environment can be instrumental in attracting and retaining productive and loyal employees, leading to increased employee and patient satisfaction and a positively impacted bottom line. A strengths-based approach powerfully and effectively promotes and nurtures a caring work environment in all health care specialties and organizations.

Resource-poor settings: infrastructure and capacity building: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

Science.gov (United States)

Geiling, James; Burkle, Frederick M; Amundson, Dennis; Dominguez-Cherit, Guillermo; Gomersall, Charles D; Lim, Matthew L; Luyckx, Valerie; Sarani, Babak; Uyeki, Timothy M; West, T Eoin; Christian, Michael D; Devereaux, Asha V; Dichter, Jeffrey R; Kissoon, Niranjan

2014-10-01

Planning for mass critical care (MCC) in resource-poor or constrained settings has been largely ignored, despite their large populations that are prone to suffer disproportionately from natural disasters. Addressing MCC in these settings has the potential to help vast numbers of people and also to inform planning for better-resourced areas. The Resource-Poor Settings panel developed five key question domains; defining the term resource poor and using the traditional phases of disaster (mitigation/preparedness/response/recovery), literature searches were conducted to identify evidence on which to answer the key questions in these areas. Given a lack of data upon which to develop evidence-based recommendations, expert-opinion suggestions were developed, and consensus was achieved using a modified Delphi process. The five key questions were then separated as follows: definition, infrastructure and capacity building, resources, response, and reconstitution/recovery of host nation critical care capabilities and research. Addressing these questions led the panel to offer 33 suggestions. Because of the large number of suggestions, the results have been separated into two sections: part 1, Infrastructure/Capacity in this article, and part 2, Response/Recovery/Research in the accompanying article. Lack of, or presence of, rudimentary ICU resources and limited capacity to enhance services further challenge resource-poor and constrained settings. Hence, capacity building entails preventative strategies and strengthening of primary health services. Assistance from other countries and organizations is needed to mount a surge response. Moreover, planning should include when to disengage and how the host nation can provide capacity beyond the mass casualty care event.

Organizational leadership for building effective health care teams.

Science.gov (United States)

Taplin, Stephen H; Foster, Mary K; Shortell, Stephen M

2013-01-01

The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they all need support from leadership to succeed. Teams have been invoked as a necessary tool to address the needs of patients with multiple chronic conditions and to address medical workforce shortages. Invoking teams, however, is much easier than making them function effectively, so we need to consider the implications of the growing emphasis on teams. Although the ACA will spur team development, organizational leadership must use what we know now to train, support, and incentivize team function. Meanwhile, we must also advance research regarding teams in health care to give those leaders more evidence to guide their work.

[Coordinating complex nursing care: building a guidance tool for cancer patients, to direct them towards the coordination nurse].

Science.gov (United States)

Froger, Raphael; Allenet, Benoit; Guillem, Pascale

2017-03-01

Introduction : following the 2009-2013 Cancer Plan, the experimental oncology nursing coordination (IDEC) showed a positive impact on the fluidity of care pathways. The 2014-2019 cancer plan guides their mission to complex cases. The objective of this study is to build a tool to facilitate the recruitment of patients likely to experience a complex path. Method : two phases have formed this research. The first one collected the elements of the dimensions that can predict the complexity of the care path, by focus group. The second consisted of reduction and selection of priority items and to estimate their importance by the Delphi method. Results : from the 12 selected items, two are recognized as a significant risk scoring, seven probably correlated with a complex pathway and three unrelated to the complexity of the pathways. Discussion : later this instrument would be validated by a test sample to evaluate its psychometric properties, metrological and feasibility.

Comfort Care Rounds: a staff capacity-building initiative in long-term care homes.

Science.gov (United States)

Wickson-Griffiths, Abigail; Kaasalainen, Sharon; Brazil, Kevin; McAiney, Carrie; Crawshaw, Diane; Turner, Mickey; Kelley, Mary Lou

2015-01-01

This article reports a pilot evaluation of Comfort Care Rounds (CCRs)--a strategy for addressing long-term care home staff's palliative and end-of-life care educational and support needs. Using a qualitative descriptive design, semistructured individual and focus group interviews were conducted to understand staff members' perspectives and feedback on the implementation and application of CCRs. Study participants identified that effective advertising, interest, and assigning staff to attend CCRs facilitated their participation. The key barriers to their attendance included difficulty in balancing heavy workloads and scheduling logistics. Interprofessional team member representation was sought but was not consistent. Study participants recognized the benefits of attending; however, they provided feedback on how the scheduling, content, and focus could be improved. Overall, study participants found CCRs to be beneficial to their palliative and end-of-life care knowledge, practice, and confidence. However, they identified barriers and recommendations, which warrant ongoing evaluation. Copyright 2015, SLACK Incorporated.

Morphological and physio-chemical characterization of five Canistel accessions at the subtropical horticulture research station in Miami Florida

Science.gov (United States)

Fruit of five canistel cultivars, 'Fairchild','E11', 'Keisau', 'TREC#3' and 'TREC 3680' were evaluated and characterized at the National Germplasm Repository, Subtropical horticulture Research Station (SHRS) Miami, Florida. Thirty fruits were harvested from clonal accessions during July and August, ...

Building successful coalitions for promoting advance care planning.

Science.gov (United States)

Marchand, Lucille; Fowler, Kathryn J; Kokanovic, Obrad

2006-01-01

Advance care planning (ACP) has had few successful initiatives. This qualitative study explores the challenges and successes of an advance care planning coalition in Wisconsin called Life Planning 2000 using key informant interviews (n = 24) and grounded theory. Major themes included: commitment (the need for leadership, recruitment of key members, and funding); cohesiveness (disparate groups collaborating toward a common purpose), and outcomes (shift in paradigm from signing documents to process of advanced care planning, new-found collaborative relationships, and educational tool development). Coalitions need to define short-, intermediate-, and long-term goals that result in measurable outcomes and an evaluation process. Resources must be commensurate with goals. Strong leadership, paid staff adequate funding, and the collaboration of diverse groups working toward common goals are the basic requirements of a successful coalition.

Building systems. Applications - technologies - demands; Vernetzte Gebaeudesysteme. Anwendungen - Technologien - Forderungen

Energy Technology Data Exchange (ETDEWEB)

Moehl, U. [JOHNSON CONTROLS JCI Regelungstechnik GmbH, Essen (Germany)

2003-09-01

The dream of the 'Smart Home' or 'Intelligent Building' seems to become reality. Building users can operate their building systems from anywhere inside and outside the building based upon proven technologies. Service providers have the opportunity to take partial or full responsibility for building systems, facility management and even care taking in an effective way. Besides all the success, there are still many hurdles that need to be managed during planning, installation and operation. This paper provides inside information on above-mentioned subject and possible areas of concern. (orig.)

Increased cell division but not thymic dysfunction rapidly affects the T-cell receptor excision circle content of the naive T cell population in HIV-1 infection

NARCIS (Netherlands)

Hazenberg, Mette D.; Borleffs, J.C.C.; Otto, S.A.; Cohen Stuart, J.W.T. (James Willem Theodoor); Verschuren, M.C.M. (Martie); Boucher, C.A.B.; Coutinho, R.A.; Lange, Joep M.A.; Rinke de Wit, T.F. (Tobias); Tsegaye, A. (Aster); Dongen, J.J.M. (Jaques) van; Hamann, D. (Dörte); Boer, R.J. de; Miedema, F.

2000-01-01

Recent thymic emigrants can be identified by T cell receptor excision circles (TRECs) formed during T-cell receptor rearrangement. Decreasing numbers of TRECs have been observed with aging and in human immunodeficiency virus (HIV)-1 infected individuals, suggesting for thymic impairment. Here,

The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care.

Science.gov (United States)

Asplund, Kjell; Hulter Åsberg, Kerstin; Appelros, Peter; Bjarne, Daniela; Eriksson, Marie; Johansson, Asa; Jonsson, Fredrik; Norrving, Bo; Stegmayr, Birgitta; Terént, Andreas; Wallin, Sari; Wester, Per-Olov

2011-04-01

Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described. Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented). Annually, approximately 25,000 patients are included. In 2009, approximately 320,000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care. It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines. © 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization.

FEM Updating of the Heritage Court Building Structure

DEFF Research Database (Denmark)

Ventura, C. E.; Brincker, Rune; Dascotte, E.

2001-01-01

. The starting model of the structure was developed from the information provided in the design documentation of the building. Different parameters of the model were then modified using an automated procedure to improve the correlation between measured and calculated modal parameters. Careful attention......This paper describes results of a model updating study conducted on a 15-storey reinforced concrete shear core building. The output-only modal identification results obtained from ambient vibration measurements of the building were used to update a finite element model of the structure...

Inverse associations between obesity indicators and thymic T-cell production levels in aging atomic-bomb survivors.

Directory of Open Access Journals (Sweden)

Kengo Yoshida

Full Text Available Reduction of the naive T-cell population represents a deteriorating state in the immune system that occurs with advancing age. In animal model studies, obesity compromises the T-cell immune system as a result of enhanced adipogenesis in primary lymphoid organs and systemic inflammation. In this study, to test the hypothesis that obesity may contribute to the aging of human T-cell immunity, a thousand atomic-bomb survivors were examined for obesity status and ability to produce naive T cells, i.e., T-cell receptor excision circle (TREC numbers in CD4 and CD8 T cells. The number of TRECs showed a strong positive correlation with naive T cell numbers, and lower TREC numbers were associated with higher age. We found that the TREC number was inversely associated with levels of obesity indicators (BMI, hemoglobin A1c and serum CRP levels. Development of type-2 diabetes and fatty liver was also associated with lower TREC numbers. This population study suggests that obesity with enhanced inflammation is involved in aging of the human T-cell immune system. Given the fact that obesity increases the risk of numerous age-related diseases, attenuated immune competence is a possible mechanistic link between obesity and disease development among the elderly.

Inverse associations between obesity indicators and thymic T-cell production levels in aging atomic-bomb survivors.

Science.gov (United States)

Yoshida, Kengo; Nakashima, Eiji; Kubo, Yoshiko; Yamaoka, Mika; Kajimura, Junko; Kyoizumi, Seishi; Hayashi, Tomonori; Ohishi, Waka; Kusunoki, Yoichiro

2014-01-01

Reduction of the naive T-cell population represents a deteriorating state in the immune system that occurs with advancing age. In animal model studies, obesity compromises the T-cell immune system as a result of enhanced adipogenesis in primary lymphoid organs and systemic inflammation. In this study, to test the hypothesis that obesity may contribute to the aging of human T-cell immunity, a thousand atomic-bomb survivors were examined for obesity status and ability to produce naive T cells, i.e., T-cell receptor excision circle (TREC) numbers in CD4 and CD8 T cells. The number of TRECs showed a strong positive correlation with naive T cell numbers, and lower TREC numbers were associated with higher age. We found that the TREC number was inversely associated with levels of obesity indicators (BMI, hemoglobin A1c) and serum CRP levels. Development of type-2 diabetes and fatty liver was also associated with lower TREC numbers. This population study suggests that obesity with enhanced inflammation is involved in aging of the human T-cell immune system. Given the fact that obesity increases the risk of numerous age-related diseases, attenuated immune competence is a possible mechanistic link between obesity and disease development among the elderly.

Cold-Water Immersion for Hyperthermic Humans Wearing American Football Uniforms.

Science.gov (United States)

Miller, Kevin C; Swartz, Erik E; Long, Blaine C

2015-08-01

Current treatment recommendations for American football players with exertional heatstroke are to remove clothing and equipment and immerse the body in cold water. It is unknown if wearing a full American football uniform during cold-water immersion (CWI) impairs rectal temperature (Trec) cooling or exacerbates hypothermic afterdrop. To determine the time to cool Trec from 39.5°C to 38.0°C while participants wore a full American football uniform or control uniform during CWI and to determine the uniform's effect on Trec recovery postimmersion. Crossover study. Laboratory. A total of 18 hydrated, physically active, unacclimated men (age = 22 ± 3 years, height = 178.8 ± 6.8 cm, mass = 82.3 ± 12.6 kg, body fat = 13% ± 4%, body surface area = 2.0 ± 0.2 m(2)). Participants wore the control uniform (undergarments, shorts, crew socks, tennis shoes) or full uniform (control plus T-shirt; tennis shoes; jersey; game pants; padding over knees, thighs, and tailbone; helmet; and shoulder pads). They exercised (temperature approximately 40°C, relative humidity approximately 35%) until Trec reached 39.5°C. They removed their T-shirts and shoes and were then immersed in water (approximately 10°C) while wearing each uniform configuration; time to cool Trec to 38.0°C (in minutes) was recorded. We measured Trec (°C) every 5 minutes for 30 minutes after immersion. Time to cool from 39.5°C to 38.0°C and Trec. The Trec cooled to 38.0°C in 6.19 ± 2.02 minutes in full uniform and 8.49 ± 4.78 minutes in control uniform (t17 = -2.1, P = .03; effect size = 0.48) corresponding to cooling rates of 0.28°C·min(-1) ± 0.12°C·min(-1) in full uniform and 0.23°C·min(-1) ± 0.11°C·min(-1) in control uniform (t17 = 1.6, P = .07, effect size = 0.44). The Trec postimmersion recovery did not differ between conditions over time (F1,17 = 0.6, P = .59). We speculate that higher skin temperatures before CWI, less shivering, and greater conductive cooling explained the faster cooling

How to build a Caredroid

NARCIS (Netherlands)

Hoorn, J.F.

2013-01-01

There is a world to be gained with the establishment of a new industrial sector for robotic assistance in the care domain. How to Build a Caredroid is a signpost to its opportunities. Caredroids are humanoid systems that assist patients and caregivers in their duties and needs, simulating emotions,

The genetic basis of parental care evolution in monogamous mice.

Science.gov (United States)

Bendesky, Andres; Kwon, Young-Mi; Lassance, Jean-Marc; Lewarch, Caitlin L; Yao, Shenqin; Peterson, Brant K; He, Meng Xiao; Dulac, Catherine; Hoekstra, Hopi E

2017-04-27

Parental care is essential for the survival of mammals, yet the mechanisms underlying its evolution remain largely unknown. Here we show that two sister species of mice, Peromyscus polionotus and Peromyscus maniculatus, have large and heritable differences in parental behaviour. Using quantitative genetics, we identify 12 genomic regions that affect parental care, 8 of which have sex-specific effects, suggesting that parental care can evolve independently in males and females. Furthermore, some regions affect parental care broadly, whereas others affect specific behaviours, such as nest building. Of the genes linked to differences in nest-building behaviour, vasopressin is differentially expressed in the hypothalamus of the two species, with increased levels associated with less nest building. Using pharmacology in Peromyscus and chemogenetics in Mus, we show that vasopressin inhibits nest building but not other parental behaviours. Together, our results indicate that variation in an ancient neuropeptide contributes to interspecific differences in parental care.

Building relationships: the key to successful health care philanthropy.

Science.gov (United States)

Grace, Kay Sprinkel

2002-01-01

Creating and maintaining a vigorous philanthropy program has seldom been more challenging to health care organizations. To our communities that are discontent with changed health care management and practices, we have now added economic insecurity and global unrest.

Gains from an integrated market for tradable renewable energy credits

International Nuclear Information System (INIS)

Mozumder, Pallab; Marathe, Achla

2004-01-01

Decoupling the environmental attributes of renewable energy (RE) generation from the physical unit of energy is an innovative mechanism for marketing green or renewable power. The introduction of 'Tradable Renewable Energy Credits' (TRECs) allows the green power attributes of energy to be sold or traded separately from the physical unit of energy. Since the green power certificate system removes potential locational and physical bottlenecks, both suppliers and consumers gain flexibility in the marketplace. The TREC is also an efficient tool to meet 'Renewable Portfolio Standard' (RPS) required by different states in the US. This paper discusses the RPS requirements for different states and examines the implications of an integrated TREC market. It offers a competitive setting to the consumers to pay for renewable energy and a cost effective tool to support renewable energy generation [Grace and Wiser, 2002]. This paper also highlights some practical difficulties that should be addressed in order to establish an efficient integrated TREC market

Multiple Learning Strategies Project. Building Maintenance & Engineering. Visually Impaired.

Science.gov (United States)

Smith, Dwight; And Others

This instructional package is designed for visually impaired students in the vocational area of building maintenance and engineering. The twenty-eight learning modules are organized into six units: floor care, general maintenance tasks; restrooms; carpet care; power and hand tools; and cabinet construction. Each module, printed in large block…

Tight or sick building syndrome

Energy Technology Data Exchange (ETDEWEB)

Thirumalaikolundusubramanian, P; Shanmuganadan, S [Madurai Kamaraj Univ. (India). Dept. of Geography; Uma, A [Madurai Medical Coll. (India). Dept. of Medicine and Microbiology

1991-01-01

Modern buildings are designed with the usual heating, air-conditioning and ventilation equipment. In most of these buildings, air is continuously recirculated and, as a result, workers suffer from tight or sick building syndrome. This syndrome is discussed with reference to symptoms of air contamination, ventilation system standards and research needs. The most common symptoms of tight building syndrome are eye, nose and throat irritation, headache, fatigue, sneezing, difficulty in wearing contact lenses, chest tightness, nausea, dizziness and dermatitis. Symptoms experienced by 50 doctors and 50 paramedical personnel working in an air-conditioned intensive care unit and operating theatres of the Government Rajaji Hospital, Madurai in India were studied by means of a questionnaire survey. In the present study, respiratory and ocular symptoms were observed more in those working in operating theatres and were believed to be due to excessive use of formaldehyde used for sterilization. Various suggestions were made to prevent sick building syndrome. Moreover, the physicians treating sick individuals should be aware of the symptoms caused by indoor air pollutants as sufferers invariably require a change of environment rather than drugs. (orig.).

Building leadership capacity in advanced nurse practitioners - the role of organisational management.

Science.gov (United States)

Elliott, Naomi

2017-01-01

To highlight the organisation-level management's role in building leadership capacity in advanced nurse practitioners and the need for appropriate supports to increase their becoming leaders. Little is published about the role of organisation-level management in building leadership capacity and in developing the next generation of nurse leaders. In times of economic constraint, organisations need to focus their efforts on targeted leadership initiatives. Advanced nurse practitioners are ideally positioned to act as leaders both within and beyond the health care organisation. From the available research evidence, several support structures and mechanisms are identified as enablers for advanced nurse practitioners to enact their leadership role. Health care organisations need to include building leadership capacity as a priority in their strategic plan and take action to build-up the level of advanced nurse practitioner leadership. Nurse executives have a vital role in influencing the organisation's strategic plan and making a business case for prioritising leadership capacity building within advanced nurse practitioners. A challenge for nurse executives faced with competing service and leadership development demands, involves strategic decision-making regarding whether the advanced nurse practitioner's role is limited to service delivery or its potential in leading health care reforms is realised. © 2016 John Wiley & Sons Ltd.

Primary energy implications of different design strategies for an apartment building

International Nuclear Information System (INIS)

Tettey, Uniben Yao Ayikoe; Dodoo, Ambrose; Gustavsson, Leif

2016-01-01

In this study, we explored the effects of different design strategies on final and primary energy use for production and operation of a newly constructed apartment building. We analysed alternatives of the building “As built” as well as to energy efficiency levels of the Swedish building code and passive house criteria. Our approach is based on achieving improved versions of the building alternatives from combination of design strategies giving the lowest space heating and cooling demand and primary energy use, respectively. We found that the combination of design strategies resulting in the improved building alternatives varies depending on the approach. The improved building alternatives gave up to 19–34% reduction in operation primary energy use compared to the initial alternatives. The share of production primary energy use of the improved building alternatives was 39–54% of the total primary energy use for production, space heating, space cooling and ventilation over 50-year lifespan, compared to 31–42% for the initial alternatives. This study emphasises the importance of incorporating appropriate design strategies to reduce primary energy use for building operation and suggests that combining such strategies with careful choice of building frame materials could result in significant primary energy savings in the built environment. - Highlights: • Primary energy implications of different design strategies were analysed. • The improved building alternatives had 19–34% lower operation primary energy use. • The improved building alternatives had higher production primary energy use. • Still, the improved building alternatives had lower overall primary energy use. • Design strategies should be combined with careful building frame material choice.

A Part-Of-Speech term weighting scheme for biomedical information retrieval.

Science.gov (United States)

Wang, Yanshan; Wu, Stephen; Li, Dingcheng; Mehrabi, Saeed; Liu, Hongfang

2016-10-01

In the era of digitalization, information retrieval (IR), which retrieves and ranks documents from large collections according to users' search queries, has been popularly applied in the biomedical domain. Building patient cohorts using electronic health records (EHRs) and searching literature for topics of interest are some IR use cases. Meanwhile, natural language processing (NLP), such as tokenization or Part-Of-Speech (POS) tagging, has been developed for processing clinical documents or biomedical literature. We hypothesize that NLP can be incorporated into IR to strengthen the conventional IR models. In this study, we propose two NLP-empowered IR models, POS-BoW and POS-MRF, which incorporate automatic POS-based term weighting schemes into bag-of-word (BoW) and Markov Random Field (MRF) IR models, respectively. In the proposed models, the POS-based term weights are iteratively calculated by utilizing a cyclic coordinate method where golden section line search algorithm is applied along each coordinate to optimize the objective function defined by mean average precision (MAP). In the empirical experiments, we used the data sets from the Medical Records track in Text REtrieval Conference (TREC) 2011 and 2012 and the Genomics track in TREC 2004. The evaluation on TREC 2011 and 2012 Medical Records tracks shows that, for the POS-BoW models, the mean improvement rates for IR evaluation metrics, MAP, bpref, and P@10, are 10.88%, 4.54%, and 3.82%, compared to the BoW models; and for the POS-MRF models, these rates are 13.59%, 8.20%, and 8.78%, compared to the MRF models. Additionally, we experimentally verify that the proposed weighting approach is superior to the simple heuristic and frequency based weighting approaches, and validate our POS category selection. Using the optimal weights calculated in this experiment, we tested the proposed models on the TREC 2004 Genomics track and obtained average of 8.63% and 10.04% improvement rates for POS-BoW and POS

Building codes: An often overlooked determinant of health.

Science.gov (United States)

Chauvin, James; Pauls, Jake; Strobl, Linda

2016-05-01

Although the vast majority of the world's population spends most of their time in buildings, building codes are not often thought of as 'determinants of health'. The standards that govern the design, construction, and use of buildings affect our health, security, safety, and well-being. This is true for dwellings, schools, and universities, shopping centers, places of recreation, places of worship, health-care facilities, and workplaces. We urge proactive engagement by the global public health community in developing these codes, and in the design and implementation of health protection and health promotion activities intended to reduce the risk of injury, disability, and death, particularly when due to poor building code adoption/adaption, application, and enforcement.

How a Beacon Community Program in New Orleans Helped Create a Better Health Care System by Building Relationships before Technology.

Science.gov (United States)

Khurshid, Anjum; Brown, Lisanne

2014-01-01

In the aftermath of Hurricane Katrina, much of New Orleans' healthcare infrastructure was destroyed. Initial federal funding after the storm expanded primary care services and helped set up medical homes for New Orleans' large uninsured and underinsured population. Following that, the Beacon Community in New Orleans, charged with improving health care through the use of technology, decided the best way to accomplish those goals was to build community partnerships and introduce technology improvements based on their input and on their terms. The purpose of this paper is to describe how those partnerships were wrought, including the innovative use of a conceptual framework, and how they are being sustained; how different technologies were and are being introduced; and what the results have been so far. Past successful community experiences, as well as a proven conceptual framework, were used to help establish community partnerships and governance structures, as well as to demonstrate their linkages. This paper represents a compilation of reports and information from key Beacon leaders, staff and providers and their firsthand experiences in setting up those structures, as well as their conclusions. The community partnerships proved extremely successful in not only devising successful ways to introduce new technology into healthcare settings, but in sustaining those changes by creating a governance structure that has enough fluidity to adapt to changing circumstances. Building and developing community partnerships takes time and effort; however, these relationships are necessary and essential to introducing and sustaining new technologies in a healthcare setting and should be a first step for any organization looking to accomplish such goals.

Optimal Decision Model for Sustainable Hospital Building Renovation—A Case Study of a Vacant School Building Converting into a Community Public Hospital

Science.gov (United States)

Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

2016-01-01

Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient. PMID:27347986

Optimal Decision Model for Sustainable Hospital Building Renovation-A Case Study of a Vacant School Building Converting into a Community Public Hospital.

Science.gov (United States)

Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

2016-06-24

Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient.

Revealing tact within postnatal care.

Science.gov (United States)

Smythe, Elizabeth; Payne, Deborah; Wilson, Sally; Paddy, Ann; Heard, Kate

2014-02-01

In this article, we explore the nature of good postnatal care through a hermeneutic unpacking of the notion of tact, drawing on the philosophical writings of Heidegger, Gadamer, and van Manen. The tactful encounters considered were from a hermeneutic research study within a small, rural birthing center in New Zealand. Insights drawn from the analysis were as follows: the openness of listening, watching and being attuned that builds a positive mode of engagement, recognizing that the distance the woman needs from her nurse/midwife is a call of tact, that tact is underpinned by a spirit of care, within tact there are moods and tact might require firmness, and that all of these factors come together to build trust. We conclude that the attunement of tact requires that the staff member has time to spend with a woman, enough energy to engage, and a spirit of care. Women know that tactful practice builds their confidence and affects their mothering experience. Tact cannot be assumed; it needs to be nurtured and sheltered.

A computational intelligence decision-support environment for architectural and building design : CIDEA

NARCIS (Netherlands)

Chatzikonstantinou, I.

2016-01-01

Environmentally friendly and comfortable buildings are a much sought after goal in today's architectural practice. In order to improve energy consumption of buildings without sacrificing indoor comfort, careful consideration of design decisions is needed. Simulation tools provide a solution to

Building our stories

DEFF Research Database (Denmark)

Tourism transforms people and places. New stakeholders are emerging, landscapes of power are shifting, and lines of responsibilities are being redrawn. Everyday stories of coping, success, empowerment, nurturing, relationship building and activism are important tools for reflection and learning...... for our first TEFI regional conference. Storytelling is a powerful way of exploring, linking and crafting values, articulating them is such a way as to instil action. This conference proceedings assembles 31research stories of sustainable, caring and ethical worldmaking in tourism....

Could the ethics of institutionalized health care be anything but Kantian? Collecting building blocks for a unifying metaethics.

Science.gov (United States)

Kaldis, Byron

2005-01-01

Is a Health Care Ethics possible? Against sceptical and relativist doubts Kantian deontology may advance a challenging alternative affirming the possibility of such an ethics on the condition that deontology be adopted as a total programme or complete vision. Kantian deontology is enlisted to move us from an ethics of two-person informal care to one of institutions. It justifies this affirmative answer by occupying a commanding meta-ethical stand. Such a total programme comprises, on the one hand, a dual-aspect strategy incorporating the macro- (institutional) and micro- (person-to-person) levels while, on the other, it integrates consistently within moral epistemology a meta-ethics with lower-ground moral theories. The article describes the issues to be dealt with and the problems which have to be solved on the way to a unifying theory of that kind (Sections I-III) and indicates elements of Kantian moral philosophy which may serve as building blocks (Section IV). Among these are not only Kant's ideas concerning the moral acting of persons and his ideas concerning civil society and state but also his ideas concerning morality, schematism and religion.

Objective and automated protocols for the evaluation of biomedical search engines using No Title Evaluation protocols.

Science.gov (United States)

Campagne, Fabien

2008-02-29

The evaluation of information retrieval techniques has traditionally relied on human judges to determine which documents are relevant to a query and which are not. This protocol is used in the Text Retrieval Evaluation Conference (TREC), organized annually for the past 15 years, to support the unbiased evaluation of novel information retrieval approaches. The TREC Genomics Track has recently been introduced to measure the performance of information retrieval for biomedical applications. We describe two protocols for evaluating biomedical information retrieval techniques without human relevance judgments. We call these protocols No Title Evaluation (NT Evaluation). The first protocol measures performance for focused searches, where only one relevant document exists for each query. The second protocol measures performance for queries expected to have potentially many relevant documents per query (high-recall searches). Both protocols take advantage of the clear separation of titles and abstracts found in Medline. We compare the performance obtained with these evaluation protocols to results obtained by reusing the relevance judgments produced in the 2004 and 2005 TREC Genomics Track and observe significant correlations between performance rankings generated by our approach and TREC. Spearman's correlation coefficients in the range of 0.79-0.92 are observed comparing bpref measured with NT Evaluation or with TREC evaluations. For comparison, coefficients in the range 0.86-0.94 can be observed when evaluating the same set of methods with data from two independent TREC Genomics Track evaluations. We discuss the advantages of NT Evaluation over the TRels and the data fusion evaluation protocols introduced recently. Our results suggest that the NT Evaluation protocols described here could be used to optimize some search engine parameters before human evaluation. Further research is needed to determine if NT Evaluation or variants of these protocols can fully substitute

Building-in-Briefcase: A Rapidly-Deployable Environmental Sensor Suite for the Smart Building.

Science.gov (United States)

Weekly, Kevin; Jin, Ming; Zou, Han; Hsu, Christopher; Soyza, Chris; Bayen, Alexandre; Spanos, Costas

2018-04-29

A building’s environment has profound influence on occupant comfort and health. Continuous monitoring of building occupancy and environment is essential to fault detection, intelligent control, and building commissioning. Though many solutions for environmental measuring based on wireless sensor networks exist, they are not easily accessible to households and building owners who may lack time or technical expertise needed to set up a system and get quick and detailed overview of environmental conditions. Building-in-Briefcase (BiB) is a portable sensor network platform that is trivially easy to deploy in any building environment. Once the sensors are distributed, the environmental data is collected and communicated to the BiB router via the Transmission Control Protocol/Internet Protocol (TCP/IP) and WiFi technology, which then forwards the data to the central database securely over the internet through a 3G radio. The user, with minimal effort, can access the aggregated data and visualize the trends in real time on the BiB web portal. Paramount to the adoption and continued operation of an indoor sensing platform is battery lifetime. This design has achieved a multi-year lifespan by careful selection of components, an efficient binary communications protocol and data compression. Our BiB sensor is capable of collecting a rich set of environmental parameters, and is expandable to measure others, such as CO 2 . This paper describes the power characteristics of BiB sensors and their occupancy estimation and activity recognition functionality. We have demonstrated large-scale deployment of BiB throughout Singapore. Our vision is that, by monitoring thousands of buildings through BiB, it would provide ample research opportunities and opportunities to identify ways to improve the building environment and energy efficiency.

Power Relative to Body Mass Best Predicts Change in Core Temperature During Exercise-Heat Stress.

Science.gov (United States)

Gibson, Oliver R; Willmott, Ashley G B; James, Carl A; Hayes, Mark; Maxwell, Neil S

2017-02-01

Gibson, OR, Willmott, AGB, James, CA, Hayes, M, and Maxwell, NS. Power relative to body mass best predicts change in core temperature during exercise-heat stress. J Strength Cond Res 31(2): 403-414, 2017-Controlling internal temperature is crucial when prescribing exercise-heat stress, particularly during interventions designed to induce thermoregulatory adaptations. This study aimed to determine the relationship between the rate of rectal temperature (Trec) increase, and various methods for prescribing exercise-heat stress, to identify the most efficient method of prescribing isothermic heat acclimation (HA) training. Thirty-five men cycled in hot conditions (40° C, 39% R.H.) for 29 ± 2 minutes. Subjects exercised at 60 ± 9% V[Combining Dot Above]O2peak, with methods for prescribing exercise retrospectively observed for each participant. Pearson product moment correlations were calculated for each prescriptive variable against the rate of change in Trec (° C·h), with stepwise multiple regressions performed on statistically significant variables (p ≤ 0.05). Linear regression identified the predicted intensity required to increase Trec by 1.0-2.0° C between 20- and 45-minute periods and the duration taken to increase Trec by 1.5° C in response to incremental intensities to guide prescription. Significant (p ≤ 0.05) relationships with the rate of change in Trec were observed for prescriptions based on relative power (W·kg; r = 0.764), power (%Powermax; r = 0.679), rating of perceived exertion (RPE) (r = 0.577), V[Combining Dot Above]O2 (%V[Combining Dot Above]O2peak; r = 0.562), heart rate (HR) (%HRmax; r = 0.534), and thermal sensation (r = 0.311). Stepwise multiple regressions observed relative power and RPE as variables to improve the model (r = 0.791), with no improvement after inclusion of any anthropometric variable. Prescription of exercise under heat stress using power (W·kg or %Powermax) has the strongest relationship with the rate of change in

First Year of Israeli Newborn Screening for Severe Combined Immunodeficiency—Clinical Achievements and Insights

Directory of Open Access Journals (Sweden)

Erez Rechavi

2017-11-01

Full Text Available Severe combined immunodeficiency (SCID, the most severe form of T cell immunodeficiency, is detectable through quantification of T cell receptor excision circles (TRECs in dried blood spots obtained at birth. Herein, we describe the results of the first year of the Israeli SCID newborn screening (NBS program. This important, life-saving screening test is available at no cost for every newborn in Israel. Eight SCID patients were diagnosed through the NBS program in its first year, revealing an incidence of 1:22,500 births in the Israeli population. Consanguine marriages and Muslim ethnic origin were found to be a risk factor in affected newborns, and a founder effect was detected for both IL7Rα and DCLRE1C deficiency SCID. Lymphocyte subset analysis and TREC quantification in the peripheral blood appear to be sufficient for confirmation of typical and leaky SCID and ruling out false positive (FP results. Detection of secondary targets (infants with non-SCID lymphopenia did not significantly affect the management or outcomes of these infants in our cohort. In the general, non-immunodeficient population, TREC rises along with gestational age and birth weight, and is significantly higher in females and the firstborn of twin pairs. Low TREC correlates with both gestational age and birth weight in extremely premature newborns. Additionally, the rate of TREC increase per week consistently accelerates with gestational age. Together, these findings mandate a lower cutoff or a more lenient screening algorithm for extremely premature infants, in order to reduce the high rate of FPs within this group. A significant surge in TREC values was observed between 28 and 30 weeks of gestation, where median TREC copy numbers rise by 50% over 2 weeks. These findings suggest a maturational step in T cell development around week 29 gestation, and imply moderate to late preterms should be screened with the same cutoff as term infants. The SCID NBS program is still

"Live from IPY"--Connecting Students, Teachers and the Public to Polar Research

Science.gov (United States)

Breen, K.; Warnick, W. K.; Warburton, J.; Fischer, K.; Wiggins, H.

2007-12-01

PolarTREC-Teachers and Researchers Exploring and Collaborating is a three-year (2007-2009) teacher professional development program of the Arctic Research Consortium of the U.S. (ARCUS) that pairs K-12 teachers with researchers to improve science education through authentic polar research experiences. Each year of PolarTREC, approximately 15 teachers spend two to six weeks in the Arctic or Antarctic, working closely with researchers investigating a wide range of topics such as sea-ice dynamics, terrestrial ecology, marine biology, atmospheric chemistry, and long-term climate change. PolarTREC is funded by the National Science Foundation. While in the field, teachers and researchers communicate extensively with their colleagues, communities, and hundreds of students of all ages across the globe, using a variety of communication technologies and tools to appeal to broad student and public engagement in polar science. Through the PolarTREC website (www.polartrec.com) teachers connect from the field through the use of online journals and forums, photo galleries, podcasts, and learning resources. "Live from IPY," a key activity of PolarTREC, is a free, interactive, distance-learning experience that virtually transports students and the public to unique and remote polar locations through a live Internet interface. Rather than relying solely on the asynchronous elements of online journals, forums, photo albums, and podcasts, "Live from IPY" allows real-time interaction by adding elements including live voice, video, chat, application sharing, polling, and whiteboards, but requires only telephone and/or Internet access for participants and presenters to connect. "Live from IPY" and the online outreach elements of PolarTREC convey the excitement of polar research experiences to a broad audience far beyond the classrooms of the PolarTREC teachers, allowing anyone to join a global network of scientists, teachers, students, and communities and actively participate in the

Digital Technologies Supporting Person-Centered Integrated Care - A Perspective.

Science.gov (United States)

Øvretveit, John

2017-09-25

Shared electronic health and social care records in some service systems are already showing some of the benefits of digital technology and digital data for integrating health and social care. These records are one example of the beginning "digitalisation" of services that gives a glimpse of the potential of digital technology and systems for building coordinated and individualized integrated care. Yet the promise has been greater than the benefits, and progress has been slow compared to other industries. This paper describes for non-technical readers how information technology was used to support integrated care schemes in six EU services, and suggests practical ways forward to use the new opportunities to build person-centered integrated care.

Caring Buildings: a concept to implement comfort and well-being

NARCIS (Netherlands)

Zeiler, W.; Houten, van M.A.; Kamphuis, I.G.; Hommelberg, M.P.F.

2006-01-01

Global warming, caused largely by energy consumption, has become a major problem. During the last decades the introduction of energy saving technologies have strongly reduced energy consumption of buildings. In comfort control strategy there is an exciting development: the user’s preferences and

Building Performance Simulation tools for planning of energy efficiency retrofits

DEFF Research Database (Denmark)

Mondrup, Thomas Fænø; Karlshøj, Jan; Vestergaard, Flemming

2014-01-01

Designing energy efficiency retrofits for existing buildings will bring environmental, economic, social, and health benefits. However, selecting specific retrofit strategies is complex and requires careful planning. In this study, we describe a methodology for adopting Building Performance...... to energy efficiency retrofits in social housing. To generate energy savings, we focus on optimizing the building envelope. We evaluate alternative building envelope actions using procedural solar radiation and daylight simulations. In addition, we identify the digital information flow and the information...... Simulation (BPS) tools as energy and environmentally conscious decision-making aids. The methodology has been developed to screen buildings for potential improvements and to support the development of retrofit strategies. We present a case study of a Danish renovation project, implementing BPS approaches...

Patronage or partnership: Local capacity building in humanitarian ...

International Development Research Centre (IDRC) Digital Library (Canada)

2011-02-09

Feb 9, 2011 ... "People are dying like flies," says an understandably emotional ... chapter looks at health care, and the Guatemala chapter deals with gender issues. ... So it's important to think through what we mean by capacity building when ...

A systematic review of team-building interventions in non-acute healthcare settings.

Science.gov (United States)

Miller, Christopher J; Kim, Bo; Silverman, Allie; Bauer, Mark S

2018-03-01

Healthcare is increasingly delivered in a team-based format emphasizing interdisciplinary coordination. While recent reviews have investigated team-building interventions primarily in acute healthcare settings (e.g. emergency or surgery departments), we aimed to systematically review the evidence base for team-building interventions in non-acute settings (e.g. primary care or rehabilitation clinics). We conducted a systematic review in PubMed and Embase to identify team-building interventions, and conducted follow-up literature searches to identify articles describing empirical studies of those interventions. This process identified 14 team-building interventions for non-acute healthcare settings, and 25 manuscripts describing empirical studies of these interventions. We evaluated outcomes in four domains: trainee evaluations, teamwork attitudes/knowledge, team functioning, and patient impact. Trainee evaluations for team-building interventions were generally positive, but only one study associated team-building with statistically significant improvement in teamwork attitudes/knowledge. Similarly mixed results emerged for team functioning and patient impact. The evidence base for healthcare team-building interventions in non-acute healthcare settings is much less developed than the parallel literature for short-term team function in acute care settings. Only one intervention we identified has been tested in multiple non-acute settings by distinct research teams. Positive findings regarding the utility of team-building interventions are tempered by a lack of control conditions, inconsistency in outcome measures, and high probability of bias. Considering these results alongside the well-recognized costs of poor healthcare teamwork suggests that additional research is sorely needed to develop the evidence base for team-building in non-acute settings.

Continuous Briefing and User Participation in Building Projects

DEFF Research Database (Denmark)

Jensen, Per Anker

2006-01-01

and the methods for user participation, identifies problem areas and point out possible improvements. The author has been actively involved in the project as deputy project director with re-sponsibility for the briefing process until spring 2005 and is now a researcher.......Briefing is not just about specifying needs as requirements but also about evaluating how well design pro-posals fulfill the needs and aspirations. Furthermore, briefing is not only about building design. Briefing starts at the pre-project stage to create a basis for the project decision...... into the building is required. A building project is often part of a change process of the organisation that is going to occupy the building, and this change process should be management carefully to reach a successful result. An important aspect of briefing is to manage the par-ticipation of the coming users...

Trends in energy use in commercial buildings -- Sixteen years of EIA's commercial buildings energy consumption survey

Energy Technology Data Exchange (ETDEWEB)

Davis, J.; Swenson, A.

1998-07-01

The Commercial Buildings Energy Consumption Survey (CBECS) collects basic statistical information on energy consumption and energy-related characteristics of commercial buildings in the US. The first CBECS was conducted in 1979 and the most recent was completed in 1995. Over that period, the number of commercial bindings and total amount of floorspace increased, total consumption remained flat, and total energy intensity declined. By 1995, there were 4.6 million commercial buildings and 58.8 billion square feet of floorspace. The buildings consumed a total of 5.3 quadrillion Btu (site energy), with a total intensity of 90.5 thousand Btu per square foot per year. Electricity consumption exceeded natural gas consumption (2.6 quadrillion and 1.9 quadrillion Btu, respectively). In 1995, the two major users of energy were space heating (1.7 quadrillion Btu) and lighting (1.2 quadrillion Btu). Over the period 1979 to 1995, natural gas intensity declined from 71.4 thousand to 51.0 thousand Btu per square foot per year. Electricity intensity did not show a similar decline (44.2 thousand Btu per square foot in 1979 and 45.7 thousand Btu per square foot in 1995). Two types of commercial buildings, office buildings and mercantile and service buildings, were the largest consumers of energy in 1995 (2.0 quadrillion Btu, 38% of total consumption). Three building types, health care, food service, and food sales, had significantly higher energy intensities. Buildings constructed since 1970 accounted for half of total consumption and a majority (59%) of total electricity consumption.

Development, implementation and evaluation of a clinical research engagement and leadership capacity building program in a large Australian health care service.

Science.gov (United States)

Misso, Marie L; Ilic, Dragan; Haines, Terry P; Hutchinson, Alison M; East, Christine E; Teede, Helena J

2016-01-14

Health professionals need to be integrated more effectively in clinical research to ensure that research addresses clinical needs and provides practical solutions at the coal face of care. In light of limited evidence on how best to achieve this, evaluation of strategies to introduce, adapt and sustain evidence-based practices across different populations and settings is required. This project aims to address this gap through the co-design, development, implementation, evaluation, refinement and ultimately scale-up of a clinical research engagement and leadership capacity building program in a clinical setting with little to no co-ordinated approach to clinical research engagement and education. The protocol is based on principles of research capacity building and on a six-step framework, which have previously led to successful implementation and long-term sustainability. A mixed methods study design will be used. Methods will include: (1) a review of the literature about strategies that engage health professionals in research through capacity building and/or education in research methods; (2) a review of existing local research education and support elements; (3) a needs assessment in the local clinical setting, including an online cross-sectional survey and semi-structured interviews; (4) co-design and development of an educational and support program; (5) implementation of the program in the clinical environment; and (6) pre- and post-implementation evaluation and ultimately program scale-up. The evaluation focuses on research activity and knowledge, attitudes and preferences about clinical research, evidence-based practice and leadership and post implementation, about their satisfaction with the program. The investigators will evaluate the feasibility and effect of the program according to capacity building measures and will revise where appropriate prior to scale-up. It is anticipated that this clinical research engagement and leadership capacity building

Patronage or Partnership: Local Capacity Building in Humanitarian ...

International Development Research Centre (IDRC) Digital Library (Canada)

Much has been written about the need to build local capacities in emergency and ... In reality, strengthening local capacity is easier said than done, and there are ... Fund—managed by the Department of Health and Social Care (DHSC)—are ...

Primary care and addiction treatment: lessons learned from building bridges across traditions.

Science.gov (United States)

Stanley, A H

1999-01-01

A primary care unit combined with residential addiction treatment allows patients with addictive disease and chronic medical or psychiatric problems to successfully complete the treatment. These are patients who would otherwise fail treatment or fail to be considered candidates for treatment. Health care providers should have a background in primary care and have the potential to respond professionally to clinical problems in behavioral medicine. Ongoing professional training and statistical quality management principles can maintain morale and productivity. Health education is an integral part of primary care. The costs of such concurrent care when viewed in the context of the high societal and economic costs of untreated addictive disease and untreated chronic medical problems are low. The principles used to develop this primary care unit can be used to develop health care units for other underserved populations. These principles include identification of specific health care priorities and continuity of rapport with the target population and with addiction treatment staff.

Digital Technologies Supporting Person-Centered Integrated Care – A Perspective

Directory of Open Access Journals (Sweden)

John Øvretveit

2017-09-01

Full Text Available Shared electronic health and social care records in some service systems are already showing some of the benefits of digital technology and digital data for integrating health and social care. These records are one example of the beginning “digitalisation” of services that gives a glimpse of the potential of digital technology and systems for building coordinated and individualized integrated care. Yet the promise has been greater than the benefits, and progress has been slow compared to other industries. This paper describes for non-technical readers how information technology was used to support integrated care schemes in six EU services, and suggests practical ways forward to use the new opportunities to build person-centered integrated care.

Digital Technologies Supporting Person-Centered Integrated Care – A Perspective

Science.gov (United States)

2017-01-01

Shared electronic health and social care records in some service systems are already showing some of the benefits of digital technology and digital data for integrating health and social care. These records are one example of the beginning “digitalisation” of services that gives a glimpse of the potential of digital technology and systems for building coordinated and individualized integrated care. Yet the promise has been greater than the benefits, and progress has been slow compared to other industries. This paper describes for non-technical readers how information technology was used to support integrated care schemes in six EU services, and suggests practical ways forward to use the new opportunities to build person-centered integrated care. PMID:29588629

Developing a Family-Centered Care Model for Critical Care After Pediatric Traumatic Brain Injury.

Science.gov (United States)

Moore, Megan; Robinson, Gabrielle; Mink, Richard; Hudson, Kimberly; Dotolo, Danae; Gooding, Tracy; Ramirez, Alma; Zatzick, Douglas; Giordano, Jessica; Crawley, Deborah; Vavilala, Monica S

2015-10-01

This study examined the family experience of critical care after pediatric traumatic brain injury in order to develop a model of specific factors associated with family-centered care. Qualitative methods with semi-structured interviews were used. Two level 1 trauma centers. Fifteen mothers of children who had an acute hospital stay after traumatic brain injury within the last 5 years were interviewed about their experience of critical care and discharge planning. Participants who were primarily English, Spanish, or Cantonese speaking were included. None. Content analysis was used to code the transcribed interviews and develop the family-centered care model. Three major themes emerged: 1) thorough, timely, compassionate communication, 2) capacity building for families, providers, and facilities, and 3) coordination of care transitions. Participants reported valuing detailed, frequent communication that set realistic expectations and prepared them for decision making and outcomes. Areas for capacity building included strategies to increase provider cultural humility, parent participation in care, and institutional flexibility. Coordinated care transitions, including continuity of information and maintenance of partnerships with families and care teams, were highlighted. Participants who were not primarily English speaking reported particular difficulty with communication, cultural understanding, and coordinated transitions. This study presents a family-centered traumatic brain injury care model based on family perspectives. In addition to communication and coordination strategies, the model offers methods to address cultural and structural barriers to meeting the needs of non-English-speaking families. Given the stress experienced by families of children with traumatic brain injury, careful consideration of the model themes identified here may assist in improving overall quality of care to families of hospitalized children with traumatic brain injury.

Body size mediates social and environmental effects on nest building behaviour in a fish with paternal care.

Science.gov (United States)

Lehtonen, Topi K; Lindström, Kai; Wong, Bob B M

2015-07-01

Body size, social setting, and the physical environment can all influence reproductive behaviours, but their interactions are not well understood. Here, we investigated how male body size, male-male competition, and water turbidity influence nest-building behaviour in the sand goby (Pomatoschistus minutus), a marine fish with exclusive paternal care. We found that environmental and social factors affected the nest characteristics of small and large males differently. In particular, association between male size and the level of nest elaboration (i.e. the amount of sand piled on top of the nest) was positive only under clear water conditions. Similarly, male size and nest entrance size were positively associated only in the absence of competition. Such interactions may, in turn, help to explain the persistence of variation in reproductive behaviours, which-due to their importance in offspring survival-are otherwise expected to be under strong balancing selection.

Scientific Participation at the Poles: K-12 Teachers in Polar Science for Careers and Classrooms

Science.gov (United States)

Crowley, S.; Warburton, J.

2012-12-01

PolarTREC (Teachers and Researchers Exploring and Collaborating) is a National Science Foundation (NSF) funded program in which K-12 teachers participate in hands-on field research experiences in the polar regions. PolarTREC highlights the importance of involving teachers in scientific research in regards to their careers as educators and their ability to engage students in the direct experience of science. To date, PolarTREC has placed over 90 teachers with research teams in the Arctic and Antarctic. Published results of our program evaluation quantify the effect of the field experience on the teachers' use of the real scientific process in the classroom, the improvement in science content taught in classrooms, and the use of non-fiction texts (real data and science papers) as primary learning tools for students. Teachers and students both report an increase of STEM literacy in the classroom content, confidence in science education, as well as a markedly broadened outlook of science as essential to their future. Research conducted with science teams affirms that they are achieving broader impacts when PolarTREC teachers are involved in their expeditions. Additionally, they reported that these teachers making vital contributions to the success of the scientific project.

Lessons Learned From Transitioning PEPFAR Track 1.0 Care and Treatment Programs: Case Studies in Financial Management Capacity Building in Zambia and Botswana.

Science.gov (United States)

Kuehn, Chuck; Tidwell, George; Vhugen, Jann; Sharma, Anjali

2015-01-01

In 2008, the United States government mandated transition of internationally managed HIV care and treatment programs to local country ownership. Three case studies illustrate the US Health Resources Services Administration's fiscal assessment and technical assistance (TA) processes to strengthen local organizations' capabilities to absorb and manage United States government funding. Review of initial, TA and follow-up reports reveal that the 1 Botswanan and 2 Zambian organizations closed 10 of 17 financial capacity gaps, with Health Resources Services Administration assisting on 2. Zambian organizations requested and absorbed targeted TA on the basis of the consultant's desk review, their finance staff revised fiscal policies and procedures, and accordingly trained other staff. In Botswana, delays in integrating recommendations necessitated on-site TA for knowledge building and role modeling. Organizational maturity may explain differences in responsiveness, ownership, and required TA approaches. Clarifying expectations of capacity building, funding agreement, and nonmonetary donor involvement can help new organizations determine and act on intervening actions.

Investing in nursing research in practice settings: a blueprint for building capacity.

Science.gov (United States)

Jeffs, Lianne; Smith, Orla; Beswick, Susan; Maoine, Maria; Ferris, Ella

2013-12-01

Engaging clinical nurses in practice-based research is a cornerstone of professional nursing practice and a critical element in the delivery of high-quality patient care. Practising staff nurses are well suited to identify the phenomena and issues that are clinically relevant and appropriate for research. In response to the need to invest in and build capacity in nursing research, hospitals have developed creative approaches to spark interest in nursing research and to equip clinical nurses with research competencies. This paper outlines a Canadian hospital's efforts to build research capacity as a key strategy to foster efficacious, safe and cost-effective patient care practices. Within a multi-pronged framework, several strategies are described that collectively resulted in enhanced research and knowledge translation productivity aimed at improving the delivery of safe and high-quality patient care.

Building Civic Bridges: Community-Centered Action Civics

Science.gov (United States)

LeCompte, Karon; Blevins, Brooke

2015-01-01

Project-based learning is an example of powerful social studies learning in which student engage in active inquiry. Action civics is a relatively new educational practice in which students "act as citizens" through a cycle of research, action, and reflection about problems they care about in their community. "Building Civic…

Atmospheric dispersion from releases in the vicinity of buildings

International Nuclear Information System (INIS)

Walsh, C.; Jones, J.A.

2002-01-01

The objective of this study is to advise FSA on the extent to which its current models for calculating air concentration and deposition for continuous releases close to sites with many buildings are adequate, whether there are circumstances for which the explicit modelling of building wake effects is required, and, if so, to recommend an appropriate model for this. The study considered the predictions of simple Gaussian models and the ADMS model. Results from the models are presented and compared, for a range of on-site building configurations and release locations. In addition, the extent to which details of the buildings on the site are required in ADMS is considered. The results indicate that buildings only affect the predicted concentration in a relatively small area around the site (less than 1 km from the site even for tall buildings). For dose calculations beyond 1 km, no allowance is required for modelling building effects. The results suggest that modelling the effects of buildings can be sensitive to a number of parameters and care should be used in interpreting results for locations within the region affected by buildings. However, because ADMS explicitly treats these factors, it is considered a better model for use than those based on a simple Gaussian approach. (author)

Tandem mass spectrometry, but not T-cell receptor excision circle analysis, identifies newborns with late-onset adenosine deaminase deficiency.

Science.gov (United States)

la Marca, Giancarlo; Canessa, Clementina; Giocaliere, Elisa; Romano, Francesca; Duse, Marzia; Malvagia, Sabrina; Lippi, Francesca; Funghini, Silvia; Bianchi, Leila; Della Bona, Maria Luisa; Valleriani, Claudia; Ombrone, Daniela; Moriondo, Maria; Villanelli, Fabio; Speckmann, Carsten; Adams, Stuart; Gaspar, Bobby H; Hershfield, Michael; Santisteban, Ines; Fairbanks, Lynette; Ragusa, Giovanni; Resti, Massimo; de Martino, Maurizio; Guerrini, Renzo; Azzari, Chiara

2013-06-01

Adenosine deaminase (ADA)-severe combined immunodeficiency (SCID) is caused by genetic variants that disrupt the function of ADA. In its early-onset form, it is rapidly fatal to infants. Delayed or late-onset ADA-SCID is characterized by insidious progressive immunodeficiency that leads to permanent organ damage or death. Quantification of T-cell receptor excision circles (TRECs) or tandem mass spectrometry (tandem-MS) analysis of dried blood spots (DBSs) collected at birth can identify newborns with early-onset ADA-SCID and are used in screening programs. However, it is not clear whether these analyses can identify newborns who will have delayed or late-onset ADA-SCID before symptoms appear. We performed a retrospective study to evaluate whether tandem-MS and quantitative TREC analyses of DBSs could identify newborns who had delayed-onset ADA-SCID later in life. We tested stored DBSs collected at birth from 3 patients with delayed-onset ADA-SCID using tandem-MS (PCT EP2010/070517) to evaluate levels of adenosine and 2'-deoxyadenosine and real-time PCR to quantify TREC levels. We also analyzed DBSs from 3 newborns with early-onset ADA-SCID and 2 healthy newborn carriers of ADA deficiency. The DBSs taken at birth from the 3 patients with delayed-onset ADA-SCID had adenosine levels of 10, 25, and 19 μmol/L (normal value, <1.5 μmol/L) and 2'-deoxyadenosine levels of 0.7, 2.7, and 2.4 μmol/L (normal value, <0.07 μmol/L); the mean levels of adenosine and 2'-deoxyadenosine were respectively 12.0- and 27.6-fold higher than normal values. DBSs taken at birth from all 3 patients with delayed-onset ADA deficiency had normal TREC levels, but TRECs were undetectable in blood samples taken from the same patients at the time of diagnosis. Tandem-MS but not TREC quantification identifies newborns with delayed- or late-onset ADA deficiency. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

The Living, Dynamic and Complex Environment Care in Intensive Care Unit.

Science.gov (United States)

Backes, Marli Terezinha Stein; Erdmann, Alacoque Lorenzini; Büscher, Andreas

2015-01-01

to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care. Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units. built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions); "Providing a suitable environment" and "having relatives with concern" (context); "Mediating facilities and difficulties" (intervenienting conditions); "Organizing the environment and managing the dynamics of the unit" (strategy) and "finding it difficult to accept and deal with death" (consequences). confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

Health Care Aides' Struggle to Build and Maintain Relationships with Families in Complex Continuing Care Settings

Science.gov (United States)

McGilton, Katherine S.; Guruge, Sepali; Librado, Ruby; Bloch, Lois; Boscart, Veronique

2008-01-01

Research on the relationships between health care aides (HCAs) and families of clients has been situated mainly in long-term care settings and includes scant findings about the perceptions of HCAs. Based on the findings of a larger qualitative study using a grounded theory approach, this paper addresses the topic of HCA-family relationships in…

Family-centred residential care : the new reality?

NARCIS (Netherlands)

Geurts, Esther M. W.; Boddy, Janet; Noom, Marc J.; Knorth, Erik J.

This paper considers therapeutic approaches to residential care with specific attention to the question of family involvement. It builds on a body of literature indicating the potential of residential care as a positive intervention for young people, and examines the contention that even when family

The role of the U.S. Department of Energy in indoor air quality and building ventilation policy development

Energy Technology Data Exchange (ETDEWEB)

Traynor, G.W. [Lawrence Berkeley Lab., Berkeley, CA (United States). Indoor Environment Program; Talbott, J.M. [U.S. Dept. of Energy, Washington, DC (United States). Office of Building Technologies; Moses, D.O. [U.S. Dept. of Energy, Washington, DC (United States). Office of Environmental Analysis

1993-12-31

Building ventilation consumes about 5.8 exajoules of energy each year in the U.S. The annual cost of this-energy, used for commercial building fans (1.6 exajoules/yr) and the heating and cooling of outside air (4.2 exajoules/yr), is about $US 33 billion per year. Energy conservation measures that reduce heating and cooling season ventilation rates 15 to 35 % in commercial and residential buildings can result in a national savings of about 0.6 to 15 exajoules (doll US 3-8 billion) per year assuming no reduction of commercial building fan energy use. The most significant adverse environmental impact of reduced ventilation and infiltration is the potential degradation of the building`s indoor air quality. Potential benefits to the U.S from the implementation of sound indoor air quality and building ventilation reduction policies include reduced building-sector energy consumption; reduced indoor, outdoor, and global pollution; reduced product costs; reduced worker absenteeism; reduced health care costs; reduced litigation; increased worker well-being and absenteeism; reduced health care costs; reduced litigation; increased productivity; and increased product quality and competitiveness. (author)

Building a patient-centered and interprofessional training program with patients, students and care professionals: study protocol of a participatory design and evaluation study.

Science.gov (United States)

Vijn, Thomas W; Wollersheim, Hub; Faber, Marjan J; Fluit, Cornelia R M G; Kremer, Jan A M

2018-05-30

A common approach to enhance patient-centered care is training care professionals. Additional training of patients has been shown to significantly improve patient-centeredness of care. In this participatory design and evaluation study, patient education and medical education will be combined by co-creating a patient-centered and interprofessional training program, wherein patients, students and care professionals learn together to improve patient-centeredness of care. In the design phase, scientific literature regarding interventions and effects of student-run patient education will be synthesized in a scoping review. In addition, focus group studies will be performed on the preferences of patients, students, care professionals and education professionals regarding the structure and content of the training program. Subsequently, an intervention plan of the training program will be constructed by combining these building blocks. In the evaluation phase, patients with a chronic disease, that is rheumatoid arthritis, diabetes and hypertension, and patients with an oncologic condition, that is colonic cancer and breast cancer, will learn together with medical students, nursing students and care professionals in training program cycles of three months. Process and effect evaluation will be performed using the plan-do-study-act (PDSA) method to evaluate and optimize the training program in care practice and medical education. A modified control design will be used in PDSA-cycles to ensure that students who act as control will also benefit from participating in the program. Our participatory design and evaluation study provides an innovative approach in designing and evaluating an intervention by involving participants in all stages of the design and evaluation process. The approach is expected to enhance the effectiveness of the training program by assessing and meeting participants' needs and preferences. Moreover, by using fast PDSA cycles and a modified control design

Is there a role of palliative care in the neonatal intensive care unit in India?

Directory of Open Access Journals (Sweden)

Manjiri P Dighe

2011-01-01

Full Text Available Recent advances in medical care have improved the survival of newborn babies born with various problems. Despite this death in the neonatal intensive care unit (NICU is an inevitable reality. For babies who are not going to "get better," the health care team still has a duty to alleviate the physical suffering of the baby and to support the family. Palliative care is a multidisciplinary approach to relieve the physical, psycho social, and spiritual suffering of patients and their families. Palliative care provision in the Indian NICU settings is almost nonexistent at present. In this paper we attempt to "build a case" for palliative care in the Indian NICU setting.

Interior thermal insulation systems for historical building envelopes

Science.gov (United States)

Jerman, Miloš; Solař, Miloš; Černý, Robert

2017-11-01

The design specifics of interior thermal insulation systems applied for historical building envelopes are described. The vapor-tight systems and systems based on capillary thermal insulation materials are taken into account as two basic options differing in building-physical considerations. The possibilities of hygrothermal analysis of renovated historical envelopes including laboratory methods, computer simulation techniques, and in-situ tests are discussed. It is concluded that the application of computational models for hygrothermal assessment of interior thermal insulation systems should always be performed with a particular care. On one hand, they present a very effective tool for both service life assessment and possible planning of subsequent reconstructions. On the other, the hygrothermal analysis of any historical building can involve quite a few potential uncertainties which may affect negatively the accuracy of obtained results.

A framework to evaluate research capacity building in health care

Directory of Open Access Journals (Sweden)

Cooke Jo

2005-10-01

Full Text Available Abstract Background Building research capacity in health services has been recognised internationally as important in order to produce a sound evidence base for decision-making in policy and practice. Activities to increase research capacity for, within, and by practice include initiatives to support individuals and teams, organisations and networks. Little has been discussed or concluded about how to measure the effectiveness of research capacity building (RCB Discussion This article attempts to develop the debate on measuring RCB. It highlights that traditional outcomes of publications in peer reviewed journals and successful grant applications may be important outcomes to measure, but they may not address all the relevant issues to highlight progress, especially amongst novice researchers. They do not capture factors that contribute to developing an environment to support capacity development, or on measuring the usefulness or the 'social impact' of research, or on professional outcomes. The paper suggests a framework for planning change and measuring progress, based on six principles of RCB, which have been generated through the analysis of the literature, policy documents, empirical studies, and the experience of one Research and Development Support Unit in the UK. These principles are that RCB should: develop skills and confidence, support linkages and partnerships, ensure the research is 'close to practice', develop appropriate dissemination, invest in infrastructure, and build elements of sustainability and continuity. It is suggested that each principle operates at individual, team, organisation and supra-organisational levels. Some criteria for measuring progress are also given. Summary This paper highlights the need to identify ways of measuring RCB. It points out the limitations of current measurements that exist in the literature, and proposes a framework for measuring progress, which may form the basis of comparison of RCB

ACOG Committee Opinion No. 660: Family Building Through Gestational Surrogacy.

Science.gov (United States)

2016-03-01

Gestational surrogacy is an increasingly common form of family building that can allow individuals or a couple to become parents despite circumstances in which carrying a pregnancy is biologically impossible or medically contraindicated. The practice of gestational surrogacy involves a woman known as a gestational carrier who agrees to bear a genetically unrelated child with the help of assisted reproductive technologies for an individual or couple who intend(s) to be the legal and rearing parent(s), referred to as the intended parent(s). Obstetrician-gynecologists may become involved in gestational surrogacy through caring for the gestational carrier or by caring for the intended parent(s). Although gestational surrogacy increases options for family building, this treatment also involves ethical, medical, psychosocial, and legal complexities that must be taken into account to minimize risks of adverse outcomes for the gestational carrier, intended parent(s), and resulting children. The purpose of this document is to provide an overview of gestational surrogacy and to describe the ethical responsibilities for obstetrician-gynecologists who take part in the care of women who participate in these arrangements.

Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension

Science.gov (United States)

Ono, Sarah S.; Crabtree, Benjamin F.; Hemler, Jennifer R.; Balasubramanian, Bijal A.; Edwards, Samuel T.; Green, Larry A.; Kaufman, Arthur; Solberg, Leif I.; Miller, William L.; Woodson, Tanisha Tate; Sweeney, Shannon M.; Cohen, Deborah J.

2018-01-01

Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension—technological and quality improvement support, practice capacity building, and linking with community resources—to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services. PMID:29401016

A summation of online recruiting practices for health care organizations.

Science.gov (United States)

Gautam, Kanak S

2005-01-01

Worker shortage is among the foremost challenges facing US health care today. Health care organizations are also confronted with rising costs of recruiting and compensating scarce workers in times of declining reimbursement. Many health care organizations are adopting online recruitment as a nontraditional, low-cost method for hiring staff. Online recruitment is the fastest growing method of recruitment today, and has advantages over traditional recruiting in terms of cost, reach, and time-saving. Several health care organizations have achieved great success in recruiting online. Yet awareness of online recruiting remains lower among health care managers than managers in other industries. Many health care organizations still search for job candidates within a 30-mile radius using traditional methods. This article describes the various aspects of online recruitment for health care organizations. It is meant to help health care managers currently recruiting online by answering frequently asked questions (eg, Should I be advertising on national job sites? Why is my Web site not attracting job seekers? Is my online ad effective?). It is also meant to educate health care managers not doing online recruiting so that they try recruiting online. The article discusses the salient aspects of online recruiting: (a) using commercial job boards; (b) building one's own career center; (c) building one's own job board; (d) collecting and storing resumes; (e) attracting job seekers to one's Web site; (f) creating online job ads; (g) screening and evaluating candidates online; and (h) building long-term relationships with candidates. Job seekers in health care are adopting the Internet faster than health care employers. To recruit successfully during the current labor shortage, it is imperative that employers adopt and expand online recruiting.

A Call to Include Severe Combined Immunodeficiency in Newborn Screening Program

Directory of Open Access Journals (Sweden)

Raz Somech

2014-01-01

Full Text Available Quantification of the T cell receptor excision circles (TRECs has recently emerged as a useful non-invasive clinical and research tool to investigate thymic activity. It allows the identification of T cell production by the thymus. Quantification of TREC copies has recently been implemented as the preferred test to screen neonates with severe combined immunodeficiency (SCID or significant lymphopenia. Neonatal genetic screening for SCID is highly important in countries with high rates of consanguinous marriages, such as Israel, and can be used for early diagnosis, enabling prompt therapeutic intervention that will save lives and improve the outcome of these patients. TREC measurement is also applicable in clinical settings where T cell immunity is involved, including any T cell immunodeficiencies, HIV infection, the aging process, autoimmune diseases, and immune reconstitution after bone marrow transplantation.

Multigenerational Challenges: Team-Building for Positive Clinical Workforce Outcomes

Science.gov (United States)

Moore, Jill M; Everly, Marcee; Bauer, Renee

2016-05-31

Patient acuity in hospital settings continues to increase, and there is greater emphasis on patient outcomes. The current nursing workforce is comprised of four distinct generational cohorts that include veterans, baby boomers, millennials, and generation Xers. Each group has unique characteristics that add complexity to the workforce and this can add challenges to providing optimal patient care. Team building is one strategy to increase mutual understanding, communication, and respect, and thus potentially improve patient outcomes. In this article, we first briefly define generational cohorts by characteristics, and discuss differing expectations for work/life balance and potential negative outcomes. Our discussion offers team building strategies for positive outcomes, a case scenario, and concludes with resources for team building and organizational opportunities.

Building managed primary care practice networks to deliver better clinical care: a qualitative semi-structured interview study.

Science.gov (United States)

Pawa, Jasmine; Robson, John; Hull, Sally

2017-11-01

Primary care practices are increasingly working in larger groups. In 2009, all 36 primary care practices in the London borough of Tower Hamlets were grouped geographically into eight managed practice networks to improve the quality of care they delivered. Quantitative evaluation has shown improved clinical outcomes. To provide insight into the process of network implementation, including the aims, facilitating factors, and barriers, from both the clinical and managerial perspectives. A qualitative study of network implementation in the London borough of Tower Hamlets, which serves a socially disadvantaged and ethnically diverse population. Nineteen semi-structured interviews were carried out with doctors, nurses, and managers, and were informed by existing literature on integrated care and GP networks. Interviews were recorded and transcribed, and thematic analysis used to analyse emerging themes. Interviewees agreed that networks improved clinical care and reduced variation in practice performance. Network implementation was facilitated by the balance struck between 'a given structure' and network autonomy to adopt local solutions. Improved use of data, including patient recall and peer performance indicators, were viewed as critical key factors. Targeted investment provided the necessary resources to achieve this. Barriers to implementing networks included differences in practice culture, a reluctance to share data, and increased workload. Commissioners and providers were positive about the implementation of GP networks as a way to improve the quality of clinical care in Tower Hamlets. The issues that arose may be of relevance to other areas implementing similar quality improvement programmes at scale. © British Journal of General Practice 2017.

The Living, Dynamic and Complex Environment Care in Intensive Care Unit

Directory of Open Access Journals (Sweden)

Marli Terezinha Stein Backes

2015-06-01

Full Text Available OBJECTIVE: to understand the meaning of the Adult Intensive Care Unit environment of care, experienced by professionals working in this unit, managers, patients, families and professional support services, as well as build a theoretical model about the Adult Intensive Care Unit environment of care.METHOD: Grounded Theory, both for the collection and for data analysis. Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from three different Adult Intensive Care Units.RESULTS: built up the so-called substantive theory "Sustaining life in the complex environment of care in the Intensive Care Unit". It was bounded by eight categories: "caring and continuously monitoring the patient" and "using appropriate and differentiated technology" (causal conditions; "Providing a suitable environment" and "having relatives with concern" (context; "Mediating facilities and difficulties" (intervenienting conditions; "Organizing the environment and managing the dynamics of the unit" (strategy and "finding it difficult to accept and deal with death" (consequences.CONCLUSION: confirmed the thesis that "the care environment in the Intensive Care Unit is a living environment, dynamic and complex that sustains the life of her hospitalized patients".

Structural response of steel high rise buildings to fire

DEFF Research Database (Denmark)

Gentili, Filippo; Giuliani, Luisa; Bontempi, Franco

2013-01-01

Due to the significant vertical elevation and complexity of the structural system, high rise buildings may suffer from the effects of fire more than other structures. For this reason, in addition to evacuation strategies and active fire protection, a careful consideration of structural response t...

Primary care research in Denmark

DEFF Research Database (Denmark)

Vedsted, Peter; Kallestrup, Per

2016-01-01

International Perspectives on Primary Care Research examines how the evidence base from primary care research can strengthen health care services and delivery, tackle the growing burden of disease, improve quality and safety, and increase a person-centred focus to health care. Demonstrating...... the inter-professional nature of the discipline, the book also features a section on cross-nation organisations and primary care networks supporting research. National perspectives are offered from researchers in 20 countries that form part of the World Organization of Family Doctors, providing case...... histories from research-rich to resource-poor nations that illustrate the range of research development and capacity building. This book argues the importance of primary care research, especially to policy makers, decision makers and funders in informing best practice, training primary health care providers...

Challenges towards Realization of Health Care Sector Goals of ...

African Journals Online (AJOL)

Background: Human resource for health (HRH) is an essential building block for effective and efficient health care system. In Tanzania this component is faced by many challenges which in synergy with others make the health care system inefficient. In vision 2025 the country recognizes the importance of the health care ...

A Call to Include Severe Combined Immunodeficiency in Newborn Screening Program

OpenAIRE

Raz Somech; Amos Etzioni

2014-01-01

Quantification of the T cell receptor excision circles (TRECs) has recently emerged as a useful non-invasive clinical and research tool to investigate thymic activity. It allows the identification of T cell production by the thymus. Quantification of TREC copies has recently been implemented as the preferred test to screen neonates with severe combined immunodeficiency (SCID) or significant lymphopenia. Neonatal genetic screening for SCID is highly important in countries with high rates of co...

Sentence Level Information Patterns for Novelty Detection

Science.gov (United States)

2006-07-01

had new discourse entities that were not found in the growing history list of discourse entities. Eichmann et al [38] considered the number of new...TREC2002: Question Answering and Novelty Tracks”, TREC 2002. [10] D. Eichmann and P. Srinivasan. “Novel Results and Some Answers, The University...D. Eichmann , P. Srinivasan, M. Light, H. Wang, X. Y. Qiu, R. J. Arens, and A. Sehgal, “Experiments in Novelty, Genes and Questions at the

Adsorption of Organic Compounds to Building Products

DEFF Research Database (Denmark)

Kjær, Ulla Dorte

The presence of VOCs (Volatile Organic Compounds) in the indoor air may be a contributory cause of complaints about irritation of mucous membranes in eyes, nose and throat, difficulty in breathing, frequent airway inflammation, skin irritation, fatigue, concentration difficulty, dizziness and hea...... (6 pages). Detailed summary in English (15 pages). Background (23 pages). Objective and hypotheses (2 pages). Methods and materials (20 pages). Results (26 pages). Discussion (12 pages). Conclusion (3 pages). References (14 pages). Appendices (95 pages)....... on sorption equilibrium and kinetics of temperature, relative humidity, VOC concentrations and air velocity past the surface of the building product. Four common building materials were carefully selected for the sorption/desorption experiments: Painted gypsum board, lacquered beechwood parquet, PVC flooring...

The Building Fabric Thermal Performance of Passivhaus Dwellings—Does It Do What It Says on the Tin?

Directory of Open Access Journals (Sweden)

David Johnston

2016-01-01

Full Text Available The Passivhaus (or Passive House Standard is one of the world’s most widely known voluntary energy performance standards. For a dwelling to achieve the Standard and be granted Certification, the building fabric requires careful design and detailing, high levels of thermal insulation, building airtightness, close site supervision and careful workmanship. However, achieving Passivhaus Certification is not a guarantee that the thermal performance of the building fabric as designed will actually be achieved in situ. This paper presents the results obtained from measuring the in situ whole building heat loss coefficient (HLC of a small number of Certified Passivhaus case study dwellings. They are located on different sites and constructed using different technologies in the UK. Despite the small and non-random nature of the dwelling sample, the results obtained from the in situ measurements revealed that the thermal performance of the building fabric, for all of the dwellings, performed very close to the design predictions. This suggests that in terms of the thermal performance of the building fabric, Passivhaus does exactly what it says on the tin.

Evaluating Training Programs for Primary Care Providers in Child/Adolescent Mental Health in Canada: A Systematic Review.

Science.gov (United States)

Gotovac, Sandra; Espinet, Stacey; Naqvi, Reza; Lingard, Lorelei; Steele, Margaret

2018-04-01

The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families.

Evaluating Training Programs for Primary Care Providers in Child/Adolescent Mental Health in Canada: A Systematic Review

Science.gov (United States)

Espinet, Stacey; Naqvi, Reza; Lingard, Lorelei; Steele, Margaret

2018-01-01

Introduction The need for child/adolescent mental health care in Canada is growing. Primary care can play a key role in filling this gap, yet most providers feel they do not have adequate training. This paper reviews the Canadian literature on capacity building programs in child and adolescent psychiatry for primary care providers, to examine how these programs are being implemented and evaluated to contribute to evidence-based initiatives. Methods A systematic literature review of peer-reviewed published articles of capacity building initiatives in child/adolescent mental health care for primary care practitioners that have been implemented in Canada. Results Sixteen articles were identified that met inclusion criteria. Analysis revealed that capacity building initiatives in Canada are varied but rigorous evaluation methodology is lacking. Primary care providers welcome efforts to increase mental health care capacity and were satisfied with the implementation of most programs. Discussion Objective conclusions regarding the effectiveness of these programs to increase mental health care capacity is challenging given the evaluation methodology of these studies. Conclusion Rigorous evaluation methods are needed to make evidence-based decisions on ways forward to be able to build child/adolescent mental health care capacity in primary care. Outcome measures need to move beyond self-report to more objective measures, and should expand the measurement of patient outcomes to ensure that these initiative are indeed leading to improved care for families. PMID:29662521

Building

OpenAIRE

Seavy, Ryan

2014-01-01

Building for concrete is temporary. The building of wood and steel stands against the concrete to give form and then gives way, leaving a trace of its existence behind. Concrete is not a building material. One does not build with concrete. One builds for concrete. MARCH

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

Science.gov (United States)

Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

2018-04-23

This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Mental health care reforms in Asia: the urgency of now: building a recovery-oriented, community mental health service in china.

Science.gov (United States)

Tse, Samson; Ran, Mao-Sheng; Huang, Yueqin; Zhu, Shimin

2013-07-01

For the first time in history, China has a mental health legal framework. People in China can now expect a better life and more accessible, better-quality health care services for their loved ones. Development of a community mental health service (CMHS) is at a crossroads. In this new column on mental health reforms in Asia, the authors review the current state of the CMHS in China and propose four strategic directions for future development: building on the strengths of the "686 Project," the 2004 initiative that launched China's mental health reform; improving professional skills of the mental health workforce, especially for a recovery approach; empowering families and caregivers to support individuals with severe mental illness; and using information and communications technology to promote self-help and reduce the stigma associated with psychiatric disorders.

Health care consumerism movement takes a step forward.

Science.gov (United States)

Thompson, Michael; Cutler, Charles M

2010-01-01

One of the contributing factors to both the increase in health care costs and the backlash to managed care was the lack of consumer awareness of the cost of health care service, the effect of health care costs on profits and wages, and the need to engage consumers more actively as consumers in health care decisions. This article reviews the birth of the health care consumerism movement and identifies gaps in health care consumerism today. The authors reveal some of the keys to building a sustainable health care consumerism framework, which involves enlisting consumers as well as other stakeholders.

BUILDING AN EFFECTIVE SALES FORCE

Directory of Open Access Journals (Sweden)

Ioana Olariu

2016-06-01

Full Text Available Building an effective sales force starts with selecting good salespeople, but good salespeople are very difficult to find. The reason for this is that most sales jobs are very demanding and require a great deal from the salesperson. There are many different types of sales jobs. Before it can hire salespeople, each company must do a careful job analysis to see what particular types of selling and other skills are necessary for each sales job. One task of the market planner is to establish clear objectives each year for the entire sales force, for each region, each sales office, and each salesperson. Sales jobs are different from in-house jobs in some significant ways. Nevertheless, each company must continually work on building and maintaining an effective sales force using the following steps: recruitment, selection, training, compensation and evaluation of each salesperson.

WikiBuild: A New Application to Support Patient and Health Care Professional Involvement in the Development of Patient Support Tools

Science.gov (United States)

2011-01-01

Active patient and public involvement as partners in their own health care and in the development of health services is key to achieving a health care system that is responsive to patients’ needs and values. It promotes better use of the health care system, and improves health outcomes, quality of life and patient satisfaction. By involving patients and health care professionals as partners in the creation and updating of patient health support tools, wikis—highly accessible, interactive vehicles of communication—have the potential to empower users to implement these support tools in daily life. Acknowledging the potential of wikis, and recognizing that they capitalize on the free and open access to information, scientists, opinion leaders and patient advocates have suggested that wikis could help decision-making constituencies improve the delivery of health care. They might also decrease its cost and improve access to knowledge within developing countries. However, little is known about the efficacy of wikis in helping to attain these goals. There is also a need to know more about the intention of patients and health care workers to use wikis, in what circumstances and what factors will influence their use of wikis. In this issue of the Journal of Medical Internet Research, Gupta et al describe how they developed and tested a new wiki-inspired application to improve asthma care. The researchers involved patients with asthma, primary care physicians, pulmonologists and certified asthma educators in the construction of an asthma action plan. Their paper—entitled “WikiBuild: a new online collaboration process for multistakeholder tool development and consensus building”—is the first description of a wiki-inspired technology built to involve patients and health care professionals in the development of a patient support tool. This innovative study has made important contributions toward how wikis could be generalized to involve multiple stakeholders in

Building Resilience for Palliative Care Clinicians: An Approach to Burnout Prevention Based on Individual Skills and Workplace Factors.

Science.gov (United States)

Back, Anthony L; Steinhauser, Karen E; Kamal, Arif H; Jackson, Vicki A

2016-08-01

For palliative care (PC) clinicians, the work of caring for patients with serious illness can put their own well-being at risk. What they often do not learn in training, because of the relative paucity of evidence-based programs, are practical ways to mitigate this risk. Because a new study indicates that burnout in PC clinicians is increasing, we sought to design an acceptable, scalable, and testable intervention tailored to the needs of PC clinicians. In this article, we describe our paradigm for approaching clinician resilience, our conceptual model, and curriculum for a workplace resilience intervention for hospital-based PC teams. Our paradigm for approaching resilience is based on upstream, early intervention. Our conceptual model posits that clinician well-being is influenced by personal resources and work demands. Our curriculum for increasing clinician resilience is based on training in eight resilience skills that are useful for common challenges faced by clinicians. To address workplace issues, our intervention also includes material for the team leader and a clinician perception survey of work demands and workplace engagement factors. The intervention will focus on individual skill building and will be evaluated with measures of resilience, coping, and affect. For PC clinicians, resilience skills are likely as important as communication skills and symptom management as foundations of expertise. Future work to strengthen clinician resilience will likely need to address system issues more directly. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The home care teaching and learning process in undergraduate health care degree courses.

Science.gov (United States)

Hermann, Ana Paula; Lacerda, Maria Ribeiro; Maftum, Mariluci Alves; Bernardino, Elizabeth; Mello, Ana Lúcia Schaefer Ferreira de

2017-07-01

Home care, one of the services provided by the health system, requires health practitioners who are capable of understanding its specificities. This study aimed to build a substantive theory that describes experiences of home care teaching and learning during undergraduate degree courses in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy. A qualitative analysis was performed using the grounded theory approach based on the results of 63 semistructured interviews conducted with final year students, professors who taught subjects related to home care, and recent graduates working with home care, all participants in the above courses. The data was analyzed in three stages - open coding, axial coding and selective coding - resulting in the phenomenon Experiences of home care teaching and learning during the undergraduate health care degree courses. Its causes were described in the category Articulating knowledge of home care, strategies in the category Experiencing the unique nature of home care, intervening conditions in the category Understanding the multidimensional characteristics of home care, consequences in the category Changing thinking about home care training, and context in the category Understanding home care in the health system. Home care contributes towards the decentralization of hospital care.

Building teams in primary care: what do nonlicensed allied health workers want?

Science.gov (United States)

Saba, George W; Taché, Stephanie; Ward, Lisa; Chen, Ellen H; Hammer, Hali

2011-01-01

Nonlicensed allied health workers are becoming increasingly important in collaborative team care, yet we know little about their experiences while filling these roles. To explore their perceptions of working as health coaches in a chronic-disease collaborative team, the teamlet model, we conducted a qualitative study to understand the nature and dynamics of this emerging role. During semistructured interviews, 11 health coaches reflected on their yearlong experience in the teamlet model at an urban underserved primary care clinic. Investigators conducted a thematic analysis of transcriptions of the interviews using a grounded theory process. Four themes emerged: 1) health-coach roles and responsibilities included acting as a patient liaison between visits, providing patient education and cultural brokering during medical visits, and helping patients navigate the health care system; 2) communication and relationships in the teamlet model of care were defined by a triad of the patient, health coach, and resident physician; 3) interest in the teamlet model was influenced by allied health workers' prior education and health care roles; and 4) factors influencing the effectiveness of the model were related to clinical and administrative time pressures and competing demands of other work responsibilities. Nonlicensed allied health workers participating in collaborative teams have an important role in liaising between patients and their primary care physicians, advocating for patients through cultural brokering, and helping patients navigate the health care system. To maximize their job satisfaction, their selection should involve strong consideration of motivation to participate in these expanded roles, and protected time must be provided for them to carry out their responsibilities and optimize their effectiveness.

Field building: lessons from the Robert Wood Johnson Foundation's anthology series.

Science.gov (United States)

Isaacs, Stephen L; Knickman, James R

2005-01-01

As editors of the Robert Wood Johnson Foundation's (RWJF's) anthology series, we have examined the entire range of the foundation's grant making since 1972. We found that the RWJF has enjoyed considerable success in building fields--from nurse practitioners to tobacco control to end-of-life care. The RWJF has done this by shaping fields as they were emerging, by adopting a wide-ranging "bear hug" approach, and by staying the course. The lessons from the RWJF's field-building efforts are relevant for both large and small foundations: Small funders can develop strategic plans aimed at building fields in their home state or locality.

Transition care for children with special health care needs.

Science.gov (United States)

Davis, Alaina M; Brown, Rebekah F; Taylor, Julie Lounds; Epstein, Richard A; McPheeters, Melissa L

2014-11-01

Approximately 750,000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice. Copyright © 2014 by the American Academy of Pediatrics.

Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.

Science.gov (United States)

Thoumi, Andrea; Udayakumar, Krishna; Drobnick, Elizabeth; Taylor, Andrea; McClellan, Mark

2015-09-01

The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases. Project HOPE—The People-to-People Health Foundation, Inc.

ACOG Committee Opinion No. 660 Summary: Family Building Through Gestational Surrogacy.

Science.gov (United States)

Ryan, Ginny L

2016-03-01

Gestational surrogacy is an increasingly common form of family building that can allow individuals or a couple to become parents despite circumstances in which carrying a pregnancy is biologically impossible or medically contraindicated. The practice of gestational surrogacy involves a woman known as a gestational carrier who agrees to bear a genetically unrelated child with the help of assisted reproductive technologies for an individual or couple who intend(s) to be the legal and rearing parent(s), referred to as the intended parent(s). Obstetrician-gynecologists may become involved in gestational surrogacy through caring for the gestational carrier or by caring for the intended parent(s). Although gestational surrogacy increases options for family building, this treatment also involves ethical, medical, psychosocial, and legal complexities that must be taken into account to minimize risks of adverse outcomes for the gestational carrier, intended parent(s), and resulting children. The purpose of this document is to provide an overview of gestational surrogacy and to describe the ethical responsibilities for obstetrician-gynecologists who take part in the care of women who participate in these arrangements.

Quantitative near-infrared spectroscopy on patients with peripheral vascular disease

Science.gov (United States)

Franceschini, Maria-Angela; Fantini, Sergio; Palumbo, Renato; Pasqualini, Leonella; Vaudo, Gaetano; Franceschini, Edoardo; Gratton, Enrico; Palumbo, Barbara; Innocente, Salvatore; Mannarino, Elmo

1998-01-01

We have used near-infrared spectroscopy to measure the hemoglobin saturation at rest and during exercise on patients affected by peripheral vascular disease (PVD). The instrument used in our study is a frequency-domain tissue oximeter which employs intensity modulated (110 MHz) laser diodes. We examined 9 subjects, 3 of which were controls and 6 were patients affected by stage II PVD. The optical probe was located on the calf muscle of the subjects. The measurement protocol consisted of: (1) baseline (approximately 5 min); (2) stationary bicycle exercise (approximately 5 min); (3) recovery (approximately 15 min). The change in hemoglobin saturation during exercise ((Delta) Y) and the recovery time after exercise (trec) were significantly greater in the PVD patients ((Delta) Y equals -21 +/- 3%, trec equals 5.9 +/- 3.8 min) than in the control subjects ((Delta) Y equals 2 +/- 3%, trec equals 0.6 +/- 0.1 min).

Comparison of an in-helmet temperature monitor system to rectal temperature during exercise.

Science.gov (United States)

Wickwire, P Jason; Buresh, Robert J; Tis, Laurie L; Collins, Mitchell A; Jacobs, Robert D; Bell, Marla M

2012-01-01

Body temperature monitoring is crucial in helping to decrease the amount and severity of heat illnesses; however, a practical method of monitoring temperature is lacking. In response to the lack of a practical method of monitoring the temperature of athletes, Hothead Technologies developed a device (HOT), which continuously monitors an athlete's fluctuations in body temperature. HOT measures forehead temperature inside helmets. The purpose of this study was to compare HOT against rectal temperature (Trec). Male volunteers (n = 29, age = 23.5 ± 4.5 years, weight = 83.8 ± 10.4 kg, height = 180.1 ± 5.8 cm, body fat = 12.3 ± 4.5%) exercised on a treadmill at an intensity of 60-75% heart rate reserve (HRR) (wet bulb globe temperature [WBGT] = 28.7° C) until Trec reached 38.7° C. The correlation between Trec and HOT was 0.801 (R = 0.64, standard error of the estimate (SEE) = 0.25, p = 0.00). One reason for this relatively high correlation is the microclimate that HOT is monitoring. HOT is not affected by the external climate greatly because of its location in the helmet. Therefore, factors such as evaporation do not alter HOT temperature to a great degree. HOT was compared with Trec in a controlled setting, and the exercise used in this study was moderate aerobic exercise, very unlike that used in football. In a controlled laboratory setting, the relationship between HOT and Trec showed favorable correlations. However, in applied settings, helmets are repeatedly removed and replaced forcing HOT to equilibrate to forehead temperature every time the helmet is replaced. Therefore, future studies are needed to mimic how HOT will be used in field situations.

Using DOE Commercial Reference Buildings for Simulation Studies: Preprint

Energy Technology Data Exchange (ETDEWEB)

Field, K.; Deru, M.; Studer, D.

2010-08-01

The U.S. Department of Energy developed 256 EnergyPlus models for use in studies that aim to characterize about 70% of the U.S. commercial building stock. Sixteen building types - including restaurants, health care, schools, offices, supermarkets, retail, lodging, and warehouses - are modeled across 16 cities to represent the diversity of U.S. climate zones. Weighting factors have been developed to combine the models in proportions similar to those of the McGraw-Hill Construction Projects Starts Database for 2003-2007. This paper reviews the development and contents of these models and their applications in simulation studies.

Seismic design of RC buildings theory and practice

CERN Document Server

Manohar, Sharad

2015-01-01

This book is intended to serve as a textbook for engineering courses on earthquake resistant design. The book covers important attributes for seismic design such as material properties, damping, ductility, stiffness and strength. The subject coverage commences with simple concepts and proceeds right up to nonlinear analysis and push-over method for checking building adequacy. The book also provides an insight into the design of base isolators highlighting their merits and demerits. Apart from the theoretical approach to design of multi-storey buildings, the book highlights the care required in practical design and construction of various building components. It covers modal analysis in depth including the important missing mass method of analysis and tension shift in shear walls and beams. These have important bearing on reinforcement detailing. Detailed design and construction features are covered for earthquake resistant design of reinforced concrete as well as confined and reinforced masonry structures. Th...

Equity in Health and Health Financing: Building and Strengthening ...

International Development Research Centre (IDRC) Digital Library (Canada)

Equity in Health and Health Financing: Building and Strengthening Developing Country Networks. Equity in health is a pressing global concern. Disparities in health status and access to health care within and across countries are both a cause and a consequence of social inequality. Access to health services continues to ...

VIP A B C. Vacuum Insulation Panels Applied in Building Constructions

Energy Technology Data Exchange (ETDEWEB)

Tenpierik, M.J.

2010-02-01

-scale application of VIPs in the building industry. However, integration of VIPs into buildings must be performed very meticulously for several reasons; first, due to its nature a VIP cannot be processed on site and needs careful planning in advance; second, it is very sensitive to mechanical damage thus requiring careful handling; third, thermal bridges along the panel's edges reduce its performance; fourth, the composite system is highly subjected to aging. This dissertation therefore looks into many of these aspects, presents several calculation tools and shows how VIPs can be applied in facade panels, EPS insulation boards and as under-floor insulation. With the wide-spread proliferation of VIPs in buildings a more sustainable and healthy environment can then be achieved.

Building Better Buildings: Sustainable Building Activities in California Higher Education Systems.

Science.gov (United States)

Sowell, Arnold; Eichel, Amanda; Alevantis, Leon; Lovegreen, Maureen

2003-01-01

This article outlines the activities and recommendations of California's sustainable building task force, discusses sustainable building activities in California's higher education systems, and highlights key issues that California is grappling with in its implementation of sustainable building practices. (EV)

Building capacity in VA to provide emergency gynecology services for women.

Science.gov (United States)

Cordasco, Kristina M; Huynh, Alexis K; Zephyrin, Laurie; Hamilton, Alison B; Lau-Herzberg, Amy E; Kessler, Chad S; Yano, Elizabeth M

2015-04-01

Visits to Veterans Administration (VA) emergency departments (EDs) are increasingly being made by women. A 2011 national inventory of VA emergency services for women revealed that many EDs have gaps in their resources and processes for gynecologic emergency care. To guide VA in addressing these gaps, we sought to understand factors acting as facilitators and/or barriers to improving VA ED capacity for, and quality of, emergency gynecology care. Semistructured interviews with VA emergency and women's health key informants. ED directors/providers (n=14), ED nurse managers (n=13), and Women Veteran Program Managers (n=13) in 13 VA facilities. Leadership, staff, space, demand, funding, policies, and community were noted as important factors influencing VA EDs building capacity and improving emergency gynecologic care for women Veterans. These factors are intertwined and cross multiple organizational levels so that each ED's capacity is a reflection not only of its own factors, but also those of its local medical center and non-VA community context as well as VA regional and national trends and policies. Policies and quality improvement initiatives aimed at building VA's emergency gynecologic services for women need to be multifactorial and aimed at multiple organizational levels. Policies need to be flexible to account for wide variations across EDs and their medical center and community contexts. Approaches that build and encourage local leadership engagement, such as evidence-based quality improvement methodology, are likely to be most effective.

Simultaneous topography and recognition imaging: physical aspects and optimal imaging conditions

International Nuclear Information System (INIS)

Preiner, Johannes; Ebner, Andreas; Zhu Rong; Hinterdorfer, Peter; Chtcheglova, Lilia

2009-01-01

Simultaneous topography and recognition imaging (TREC) allows for the investigation of receptor distributions on natural biological surfaces under physiological conditions. Based on atomic force microscopy (AFM) in combination with a cantilever tip carrying a ligand molecule, it enables us to sense topography and recognition of receptor molecules simultaneously with nanometre accuracy. In this study we introduce optimized handling conditions and investigate the physical properties of the cantilever-tip-sample ensemble, which is essential for the interpretation of the experimental data gained from this technique. In contrast to conventional AFM methods, TREC is based on a more sophisticated feedback loop, which enables us to discriminate topographical contributions from recognition events in the AFM cantilever motion. The features of this feedback loop were investigated through a detailed analysis of the topography and recognition data obtained on a model protein system. Single avidin molecules immobilized on a mica substrate were imaged with an AFM tip functionalized with a biotinylated IgG. A simple procedure for adjusting the optimal amplitude for TREC imaging is described by exploiting the sharp localization of the TREC signal within a small range of oscillation amplitudes. This procedure can also be used for proving the specificity of the detected receptor-ligand interactions. For understanding and eliminating topographical crosstalk in the recognition images we developed a simple theoretical model, which nicely explains its origin and its dependence on the excitation frequency.

A hybrid system using a regenerative electrochemical cycle to harvest waste heat from the proton exchange membrane fuel cell

International Nuclear Information System (INIS)

Long, Rui; Li, Baode; Liu, Zhichun; Liu, Wei

2015-01-01

A new hybrid system consisting of a PEMFC (proton exchange membrane fuel cell) subsystem and a TREC (thermally regenerative electrochemical cycle) subsystem is proposed to convert the waste heat produced by the PEMFC system into electricity. The performance of the hybrid system and its corresponding subsystems is analyzed. Results reveal that there exists optimal current densities of the PEMFC and TREC systems leading to the maximum power output of the hybrid system. With the maximum power output as the objective function, an optimization of the hybrid system based on genetic algorithm method is conducted under different operating temperatures of the PEMFC subsystem. The power output of the hybrid system is 6.85%–20.59% larger than that of the PEMFC subsystem. And the total electrical efficiency is improved by 2.74%–8.27%. The corresponding electrical efficiency of the TREC is 4.56%–13.81%. The hybrid system proposed in this paper could contribute to utilizing the fuel energy more efficiently and sufficiently. - Highlights: • A hybrid power system consisting of a PEMFC and a TREC subsystems is proposed. • Parameters' impacts on performance of the hybrid system have been analyzed. • The maximum power output of the hybrid system is investigated based on genetic algorithm. • Total power output of the hybrid system is 7.63%–18.84% larger than that of the PEMFC subsystem.

Physicians Care for Connecticut, Inc. Business philosophy.

Science.gov (United States)

Czarsty, C W; Coffey, J R

1997-03-01

Physicians Care will distinguish itself from competitors in the marketplace through the introduction of products with significant value. Physicians Care is dedicated to working closely with providers to identify the contributions made by each party to the building of product value and to appropriately reward providers for those efforts. The ultimate goal is the development of an insurance company in which physicians are truly invested and committed to best clinical practices and who exercise enhanced autonomy in managing their patient's care with clinical and administrative support from Physicians Care.

Floors: Care and Maintenance.

Science.gov (United States)

Post Office Dept., Washington, DC.

Guidelines, methods and policies regarding the care and maintenance of post office building floors are overviewed in this handbook. Procedures outlined are concerned with maintaining a required level of appearance without wasting manpower. Flooring types and characteristics and the particular cleaning requirements of each type are given along with…

The importance of health information technology in care coordination and transitional care.

Science.gov (United States)

Cipriano, Pamela F; Bowles, Kathryn; Dailey, Maureen; Dykes, Patricia; Lamb, Gerri; Naylor, Mary

2013-01-01

Care coordination and transitional care services are strategically important for achieving the priorities of better care, better health, and reduced costs embodied in the National Strategy for Quality Improvement in Health Care (National Quality Strategy [NQS]). Some of the most vulnerable times in a person’s care occur with changes in condition as well as movement within and between settings of care. The American Academy of Nursing (AAN) believes it is essential to facilitate the coordination of care and transitions by using health information technology (HIT) to collect, share, and analyze data that communicate patient-centered information among patients, families, and care providers across communities. HIT makes information accessible, actionable, timely, customizable, and portable. Rapid access to information also creates efficiencies in care by eliminating redundancies and illuminating health history and prior care. The adoption of electronic health records (EHRs) and information systems can enable care coordination to be more effective but only when a number of essential elements are addressed to reflect the team-based nature of care coordination as well as a focus on the individual’s needs and preferences. To that end, the AAN offers a set of recommendations to guide the development of the infrastructure, standards, content, and measures for electronically enabled care coordination and transitions in care as well as research needed to build the evidence base to assess outcomes of the associated interventions.

Being the Change: An Inner City School Builds Peace

Science.gov (United States)

Curry, Marnie W.

2014-01-01

This article describes an urban high school's response to gun violence, chronicling how the school's mission, full-service community orientation, and commitment to authentic cariño (caring) allowed students to respond to grief and tragedy and develop an ongoing peace building movement that seeks to transform students' lives and the communities…

Better team management--better team care?

Science.gov (United States)

Shelley, P; Powney, B

1994-01-01

Team building should not be a 'bolt-on' extra, it should be a well planned, integrated part of developing teams and assisting their leaders. When asked to facilitate team building by a group of NHS managers we developed a framework which enabled individual members of staff to become more effective in the way they communicated with each other, their teams and in turn within the organization. Facing the challenge posed by complex organizational changes, staff were able to use 3 training days to increase and develop their awareness of the principles of teamwork, better team management, and how a process of leadership and team building could help yield better patient care.

Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery.

Science.gov (United States)

Cosimi, Lisa A; Dam, Huong V; Nguyen, Thai Q; Ho, Huyen T; Do, Phuong T; Duc, Duat N; Nguyen, Huong T; Gardner, Bridget; Libman, Howard; Pollack, Todd; Hirschhorn, Lisa R

2015-07-17

The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care. We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans. After 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program. We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.

Collaborative HIV care in primary health care: nurses' views.

Science.gov (United States)

Ngunyulu, R N; Peu, M D; Mulaudzi, F M; Mataboge, M L S; Phiri, S S

2017-12-01

Collaborative HIV care between the nurses and traditional health practitioners is an important strategy to improve health care of people living with HIV. To explore and describe the views of nurses regarding collaborative HIV care in primary healthcare services in the City of Tshwane, South Africa. A qualitative, descriptive design was used to explore and describe the views of nurses who met the study's inclusion criteria. In-depth individual interviews were conducted to collect data from purposively selected nurses. Content analysis was used to analyse data. Two main categories were developed during the data analysis stage. The views of nurses and health system challenges regarding collaborative HIV care. The study findings revealed that there was inadequate collaborative HIV care between the nurses and the traditional health practitioners. It is evident that there is inadequate policy implementation, monitoring and evaluation regarding collaboration in HIV care. The study findings might influence policymakers to consider the importance of collaborative HIV care, and improve the quality of care by strengthening the referral system and follow-up of people living with HIV and AIDS, as a result the health outcomes as implied in the Sustainable Development Goals 2030 might be improved. Training and involvement of traditional health practitioners in the nursing and health policy should be considered to enhance and build a trustworthy working relationship between the nurses and the traditional health practitioners in HIV care. © 2017 International Council of Nurses.

Mothers' Emotional Care Work in Education and Its Moral Imperative

Science.gov (United States)

O'Brien, Maeve

2007-01-01

This paper seeks to build on feminist and egalitarian critiques of the traditional allocation of care work to mothers, particularly in relation to understandings of educational care work. It seeks to locate the emotional support work carried out by mothers in the educational field within their daily routines of care, and to make visible the…

Building a system-wide approach to community relationships with the findings of a scoping review in health and social care.

Science.gov (United States)

Grimshaw, Paul; McGowan, Linda; McNichol, Elaine

2016-10-10

Purpose For leadership and management of Western health systems, good quality relationships are a fundamental cornerstone of organising health and social care (H&SC) delivery, delivering benefits across organisations and communities. The purpose of this paper is to explore the extant management, H&SC literature, grounded in older people care, reveal behaviours, processes and practices that if readily identified across a context will support healthy relationships across the "whole system" of stakeholders. Design/methodology/approach An academic/practitioner group designed and guided a scoping literature review of the H&SC and broader management literature to identify and extract important behaviours, processes and practices underlying the support of high-quality relationships. A search strategy was agreed and key health and management databases were interrogated and 51 papers selected for inclusion. Working with the practitioners, the selected papers were coded and then organised into emergent themes. Findings The paper outlines the relational behaviours, processes and practice elements that should be present within an older peoples care community, to support a healthy relational environment. These elements are presented under the five emergent literature themes of integrity, compassion, respect, fairness and trust. These five topics are examined in detail. A way forward for building statements using the review material, that may be applied to reveal relational patterns within older people care, is also explored and outlined. Research limitations/implications All literature reviews are subject to practical decisions around time, budget, scope and depth restraints. Therefore potentially relevant papers may have been missed in the review process. The scoping review process adapted here does not seek to make any major considerations with regards to the weighting of evidence behind the primary research. Originality/value This paper contributes to a growing need for

Building performance simulation for sustainable buildings

NARCIS (Netherlands)

Hensen, J.L.M.

2010-01-01

This paper aims to provide a general view of the background and current state of building performance simulation, which has the potential to deliver, directly or indirectly, substantial benefits to building stakeholders and to the environment. However the building simulation community faces many

Towards an empirical ethics in care: relations with technologies in health care.

Science.gov (United States)

Pols, Jeannette

2015-02-01

This paper describes the approach of empirical ethics, a form of ethics that integrates non-positivist ethnographic empirical research and philosophy. Empirical ethics as it is discussed here builds on the 'empirical turn' in epistemology. It radicalizes the relational approach that care ethics introduced to think about care between people by drawing in relations between people and technologies as things people relate to. Empirical ethics studies care practices by analysing their intra-normativity, or the ways of living together the actors within these practices strive for or bring about as good practices. Different from care ethics, what care is and if it is good is not defined beforehand. A care practice may be contested by comparing it to alternative practices with different notions of good care. By contrasting practices as different ways of living together that are normatively oriented, suggestions for the best possible care may be argued for. Whether these suggestions will actually be put to practice is, however, again a relational question; new actors need to re-localize suggestions, to make them work in new practices and fit them in with local intra-normativities with their particular routines, material infrastructures, know-how and strivings.

Achieving a competitive advantage in managed care.

Science.gov (United States)

Stahl, D A

1998-02-01

When building a competitive advantage to thrive in the managed care arena, subacute care providers are urged to be revolutionary rather than reactionary, proactive rather than passive, optimistic rather than pessimistic and growth-oriented rather than cost-reduction oriented. Weaknesses must be addressed aggressively. To achieve a competitive edge, assess the facility's strengths, understand the marketplace and comprehend key payment methods.

Fundamental care guided by the Careful Nursing Philosophy and Professional Practice Model©.

Science.gov (United States)

Meehan, Therese Connell; Timmins, Fiona; Burke, Jacqueline

2018-02-05

To propose the Careful Nursing Philosophy and Professional Practice Model © as a conceptual and practice solution to current fundamental nursing care erosion and deficits. There is growing awareness of the crucial importance of fundamental care. Efforts are underway to heighten nurses' awareness of values that motivate fundamental care and thereby increase their attention to effective provision of fundamental care. However, there remains a need for nursing frameworks which motivate nurses to bring fundamental care values to life in their practice and strengthen their commitment to provide fundamental care. This descriptive position paper builds on the Careful Nursing Philosophy and Professional Practice Model © (Careful Nursing). Careful Nursing elaborates explicit nursing values and addresses both relational and pragmatic aspects of nursing practice, offering an ideal guide to provision of fundamental nursing care. A comparative alignment approach is used to review the capacity of Careful Nursing to address fundamentals of nursing care. Careful Nursing provides a value-based comprehensive and practical framework which can strengthen clinical nurses' ability to articulate and control their practice and, thereby, more effectively fulfil their responsibility to provide fundamental care and measure its effectiveness. This explicitly value-based nursing philosophy and professional practice model offers nurses a comprehensive, pragmatic and engaging framework designed to strengthen their control over their practice and ability to provide high-quality fundamental nursing care. © 2018 John Wiley & Sons Ltd.

WA42 Proving its worth - changing public policy for palliative care, end of life care and bereavement through advocacy and communications.

Science.gov (United States)

Edghill, Angela; Donohoe, Miriam

2015-04-01

The 2015 palliative care budget is €72 million (Euros) but up to €1.3 billion spent on end of life care annually - much of this larger figure unplanned and uncoordinated. Geographic and other inequities evident in palliative care provision. Build support for the development and implementation of a National Strategy on Palliative Care, End of Life and Bereavement. Multi-layered approach to raising awareness and building consensus: Targeting the correct audience who can make change happen Presenting robust evidence including costs justifying reform and investment Demonstrating that issues affect a significant number of people Sharing experience and knowledge Knowing their policy priorities Staying resilient - advancing and introducing new angles to argument Engaging directly as advocates within the political system at all political levels - developing relationships with politicians Identifying advocates in the public service to promote policy change Using a variety of new and existing projects and programmes Encouraging patients and families to be self-advocates - using a novel project for discussing and recording future care preferences Supporting healthcare professionals to become effective advocates for patients Creating alliances to lobby for policy development Using media opportunities to sell the message The recognition of the importance of a strategic approach to palliative and end of life care acknowledged in Parliamentary Committee Report affords an opportunity to develop further policy and practice. This a long - term exercise, dependent on supporting the implementation plan, building momentum and promoting a public dialogue on sensitive issues around dying, death and bereavement. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Building a capacity building manual

CSIR Research Space (South Africa)

Clinton, DD

2010-02-01

Full Text Available Organizations 2010 Building a capacity building manual Daniel D. Clinton, Jr., P.E., F.NSPE Chair, WFEO Capacity Building Committee Dr Andrew Cleland, FIPENZ, Chief Executive, IPENZ, NZ Eng David Botha, FSAICE, Executive Director, SAICE, SA Dawit... 2010 Tertiary level University curricula Coaches and mentors Facilities EXCeeD Remuneration of Academics Experiential training Outreach to Students Students chapters Young members forum World Federation of Engineering Organizations 2010 Post...

Quality of web-based family-building information for LGBTQ individuals.

Science.gov (United States)

Kreines, Fabiana M; Farr, Alex; Chervenak, Frank A; Grünebaum, Amos

2018-02-01

The number of patients who seek health information on the internet is increasing. Rates are particularly high among lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals, due to health care barriers. The aim of this study was to evaluate the quality and inclusivity of web-based information pertaining to LGBTQ family building. The first 100 US-based websites pertaining to LGBTQ family building were identified through a terminology-based internet search. After eliminating 45 websites, 55 websites were found to be eligible. The 2016 Website Information Reliability Evaluation Instrument (of the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services) was used to analyse the quality of information on each website. Websites were analysed for inclusivity of important topics surrounding LGBTQ family building. A total of 46 websites (83.6%) belonged or were related to reproductive services and served as advertisements for their respective owners; nine websites (16.4%) belonged to third parties. No website met more than four of the six major reliability criteria, and 42 websites (76.4%) met only one or two of the six major reliability criteria. When inclusivity was considered, 29 websites (52.7%) mentioned options for transgender individuals and nine websites (16.4%) mentioned adoption. There is a lack of reliable web-based information for LGBTQ family building and a need for improvement in quality and scope. Improvements could lead to a shift in reproductive health care towards better inclusion of and catering to LGBTQ individuals.

The weather-stains of care: interpreting the meaning of bad weather for front-line health care workers in rural long-term care.

Science.gov (United States)

Joseph, Gillian M; Skinner, Mark W; Yantzi, Nicole M

2013-08-01

This paper addresses the gap in health services and policy research about the implications of everyday weather for health care work. Building on previous research on the weather-related challenges of caregiving in homes and communities, it examines the experiences of 'seasonal bad weather' for health care workers in long-term care institutions. It features a hermeneutic phenomenology analysis of six transcripts from interviews with nurses and personal support workers from a qualitative study of institutional long-term care work in rural Canada. Focussing on van Manen's existential themes of lived experience (body, relations, space, time), the analysis reveals important contradictions between the lived experiences of health care workers coping with bad weather and long-term care policies and practices that mitigate weather-related risk and vulnerability. The findings contribute to the growing concern for rural health issues particularly the neglected experiences of rural health providers and, in doing so, offer insight into the recent call for greater attention to the geographies of health care work. Copyright © 2012 Elsevier Ltd. All rights reserved.

20 strategies for marketing your managed care plan.

Science.gov (United States)

Firshein, J

1996-01-01

In today's fiercely competitive managed care marketplace, healthcare executives must find a way to set their plans apart from the competition and build a sufficient customer base. At the same time, they must confront a growing anti-managed care backlash among a wary and confused public. Healthcare executive magazine talked with managed care experts to gather their views on key strategies to help executives meet both of these challenges. Here's what they suggest.

Associations of family-centered care with health care outcomes for children with special health care needs.

Science.gov (United States)

Kuo, Dennis Z; Bird, T Mac; Tilford, J Mick

2011-08-01

The objective of this study is to examine the association of family-centered care (FCC) with specific health care service outcomes for children with special health care needs (CSHCN). The study is a secondary analysis of the 2005-2006 National Survey of Children with Special Health Care Needs. Receipt of FCC was determined by five questions regarding how well health care providers addressed family concerns in the prior 12 months. We measured family burden by reports of delayed health care, unmet need, financial costs, and time devoted to care; health status, by stability of health care needs; and emergency department and outpatient service use. All statistical analyses used propensity score-based matching models to address selection bias. FCC was reported by 65.6% of respondents (N = 38,915). FCC was associated with less delayed health care (AOR: 0.56; 95% CI: 0.48, 0.66), fewer unmet service needs (AOR: 0.53; 95% CI: 0.47, 0.60), reduced odds of ≥1 h/week coordinating care (AOR: 0.83; 95% CI: 0.74, 0.93) and reductions in out of pocket costs (AOR: 0.88; 95% CI: 0.80, 0.96). FCC was associated with more stable health care needs (AOR: 1.11; 95% CI: 1.01, 1.21), reduced odds of emergency room visits (AOR: 0.90; 95% CI: 0.82, 0.99) and increased odds of doctor visits (AOR: 1.25; 95% CI: 1.14, 1.37). Our study demonstrates associations of positive health and family outcomes with FCC. Realizing the health care delivery benefits of FCC may require additional encounters to build key elements of trust and partnership.

Distribution of variable vs fixed costs of hospital care.

Science.gov (United States)

Roberts, R R; Frutos, P W; Ciavarella, G G; Gussow, L M; Mensah, E K; Kampe, L M; Straus, H E; Joseph, G; Rydman, R J

1999-02-17

Most strategies proposed to control the rising cost of health care are aimed at reducing medical resource consumption rates. These approaches may be limited in effectiveness because of the relatively low variable cost of medical care. Variable costs (for medication and supplies) are saved if a facility does not provide a service while fixed costs (for salaried labor, buildings, and equipment) are not saved over the short term when a health care facility reduces service. To determine the relative variable and fixed costs of inpatient and outpatient care for a large urban public teaching hospital. Cost analysis. A large urban public teaching hospital. All expenditures for the institution during 1993 and for each service were categorized as either variable or fixed. Fixed costs included capital expenditures, employee salaries and benefits, building maintenance, and utilities. Variable costs included health care worker supplies, patient care supplies, diagnostic and therapeutic supplies, and medications. In 1993, the hospital had nearly 114000 emergency department visits, 40000 hospital admissions, 240000 inpatient days, and more than 500000 outpatient clinic visits. The total budget for 1993 was $429.2 million, of which $360.3 million (84%) was fixed and $68.8 million (16%) was variable. Overall, 31.5% of total costs were for support expenses such as utilities, employee benefits, and housekeeping salaries, and 52.4% included direct costs of salary for service center personnel who provide services to individual patients. The majority of cost in providing hospital service is related to buildings, equipment, salaried labor, and overhead, which are fixed over the short term. The high fixed costs emphasize the importance of adjusting fixed costs to patient consumption to maintain efficiency.

Iranian women and care providers' perceptions of equitable prenatal care: A qualitative study.

Science.gov (United States)

Gheibizadeh, Mahin; Abedi, Heidar Ali; Mohammadi, Easa; Abedi, Parvin

2016-06-01

Equity as a basic human right builds the foundation of all areas of primary healthcare, especially prenatal care. However, it is unclear how pregnant women and their care providers perceive the equitable prenatal care. This study aimed to explore Iranian women's and care providers' perceptions of equitable prenatal care. In this study, a qualitative approach was used. Individual in-depth unstructured interviews were conducted with a purposeful sample of pregnant women and their care providers. Data were analyzed using inductive content analysis method. A total of 10 pregnant women and 10 prenatal care providers recruited from six urban health centers across Ahvaz, a south western city in Iran, were participated in the study. The study was approved by the Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences. The ethical principles of voluntary participation, confidentiality, and anonymity were considered. Analysis of participants' interviews resulted in seven themes: guideline-based care, time-saving care, nondiscriminatory care, privacy-respecting care, affordable comprehensive care, effective client-provider relationships, and caregivers' competency. The findings explain the broader and less discussed dimensions of equitable care that are valuable information for the realization of equity in care. Understanding and focusing on these dimensions will help health policy-makers in designing more equitable healthcare services for pregnant women. © The Author(s) 2015.

ISO 50001 for US Commercial Buildings - Current Status and Opportunities

Energy Technology Data Exchange (ETDEWEB)

Liu, Jingjing; Sheaffer, Paul

2017-12-01

''ISO 50001: 2011 Energy management systems – Requirements with guidance for use'' is a voluntary International Standard which provides organizations a proven framework to manage energy and continuously improve their energy performance. Implementing ISO 50001 in the commercial building sector has its unique opportunities and challenges in comparison with the industrial sector. The energy footprint of a portfolio of commercial buildings can be just as significant as a large industrial facility in comparison. There are many energy-saving opportunities in commercial buildings that can be addressed without capital investments, and the perceived risks for making energy improvements can be lower than in the industrial sector. In addition, the energy-consuming systems in commercial buildings are limited in types and have many similarities across buildings, which makes it much easier to standardize many ISO 50001 required processes, 5 procedures and documents to simplify implementation. There are also some sector-unique challenges, such as less familiar with ISO systems and the certification process. Another challenge arises from the complexity in some buildings’ ownership, tenancy, and O&M responsibilities. This whitepaper discusses these opportunities and issues in detail. The paper also recommends the characteristics of organizations in the commercial building sector that can benefit the most from adopting the ISO 50001 standard – namely the “suitable market”. Eight segments (education, food sales, retail, inpatient health care, hospitality, office buildings, laboratories and data centers) within the commercial building sector are highlighted.

Building a Sustainable Primary Care Workforce: Where Do We Go from Here?

Science.gov (United States)

Linzer, Mark; Poplau, Sara

2017-01-01

The article by Puffer et al in this month's JABFM confirms a high burnout rate (25%) among family physicians renewing their credentials, with a higher rate among young and female doctors. Recent reports confirm high burnout rates among general internists. Thus, mechanisms to monitor and improve worklife in primary care are urgently needed. We describe the Mini Z (for "zero burnout program") measure, designed for these purposes, and suggest interventions that might improve satisfaction and sustainability in primary care, including longer visits, clinician control of work schedules, scribe support for electronic medical record work, team-based care, and an explicit emphasis on work-home balance. © Copyright 2017 by the American Board of Family Medicine.

Management Model for efficient quality control in new buildings

Directory of Open Access Journals (Sweden)

C. E. Rodríguez-Jiménez

2017-09-01

Full Text Available The management of the quality control of each building process is usually set up in Spain from different levels of demand. This work tries to obtain a model of reference, to compare the quality control of the building process of a specific product (building, and to be able to evaluate its warranty level. In the quest of this purpose, we take credit of specialized sources and 153 real cases of Quality Control were carefully revised using a multi-judgment method. Applying different techniques to get a specific valuation (impartial of the input parameters through Delphi’s method (17 experts query, whose matrix treatment with the Fuzzy-QFD tool condenses numerical references through a weighted distribution of the selected functions and their corresponding conditioning factors. The model thus obtained (M153 is useful in order to have a quality control reference to meet the expectations of the quality.

Bellanca building, Yellowknife : building envelope retrofit project

Energy Technology Data Exchange (ETDEWEB)

Rajewski, G. [A.D. Williams Engineering Inc., Edmonton, AB (Canada)

2008-07-01

The Bellanca building is a ten-story, commercial office building, located in Yellowknife, Northwest Territories. The owner was concerned about annual fuel consumption, relative to other buildings of similar size. Tenants reported cold drafts and some ice build-up had been reported in the past, on the exterior of the cladding. In addition, some water penetration had occurred during rainfall. This presentation provided background information on the Bellanca building and discussed a building envelope retrofit project. A.D. Williams was hired in late 2006 in order to provide an opinion on the present condition of the building envelope. This presentation described the site investigation and presented an interior and exterior review of the building. It also presented a thermographic survey in order to map thermal anomalies and establish trends. Following acceptance of the report on findings, one of five options was selected for further development. This included removal of existing cladding, exterior gypsum wallboard, fiberglass insulation and application of BASF Walltite CT foam, sheathing, rigid insulation, drainage plane and new cladding. The preliminary design was then presented. This paper also described the tender and award of the contract; construction phase; and substantial completion of the project. tabs, figs.

Smart buildings: Energy efficient conditioning of building occupants

NARCIS (Netherlands)

Zeiler, W.; Houten, van M.A.; Boxem, G.; Vehler, R.; Verhoeven, M.; Fremouw, M.

2009-01-01

To further optimize energy performance of buildings, intelligent building control offers new possibilities. Intelligent Software Agents (ISA) can be implemented at different levels of building automation. Individual agents for individual climate control for each user of the building in combination

Concepts and definitions for "supportive care," "best supportive care," "palliative care," and "hospice care" in the published literature, dictionaries, and textbooks.

Science.gov (United States)

Hui, David; De La Cruz, Maxine; Mori, Masanori; Parsons, Henrique A; Kwon, Jung Hye; Torres-Vigil, Isabel; Kim, Sun Hyun; Dev, Rony; Hutchins, Ronald; Liem, Christiana; Kang, Duck-Hee; Bruera, Eduardo

2013-03-01

Commonly used terms such as "supportive care," "best supportive care," "palliative care," and "hospice care" were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms. We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched. Nine of 32 "SC/BSC," 25 of 182 "PC," and 12 of 42 "HC" articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. "SC" focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, "HC" focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both "PC" and "SC/BSC" were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for "SC/BSC," "PC," and "HC," respectively. "SC/BSC" was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings. We identified defining concepts for "SC/BSC," "PC," and "HC" and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions.

CTEPP DATA COLLECTION FORM 05: CHILD DAY CARE CENTER PRE-MONITORING QUESTIONNAIRE

Science.gov (United States)

This data collection form is used to identify the potential sources of pollutants at the day care center. The day care teacher is asked questions related to the age of their day care building; age and frequency of cleaning carpets or rugs; types of heating and air conditioning de...

Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities.

Science.gov (United States)

Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen

2015-01-01

Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. Copyright © 2015 Elsevier Inc. All rights reserved.

Building our global family--achieving treatment for all.

Science.gov (United States)

Skinner, M W

2010-07-01

Building our global family by reaching out to women, children and youth and those in sub-Saharan Africa to achieve Treatment for All. The World Federation of Hemophilia (WFH) has committed to recognizing and incorporating the critical and important challenges that are faced by women with bleeding disorders within our global family. The next crucial steps include the development of outreach and registry programmes which can be adapted globally to accelerate the identification of such women, and to educate and guide them to the appropriate clinical care setting. Equally important, awareness must be raised within the broader medical community where women would typically first present with clinical symptoms. Family practitioners, nurse-midwives, obstetricians, gynaecologists and community health clinics will increasingly be strategic and central to WFH outreach efforts, in addition to serving as new care partners essential to the multidisciplinary model of care. Adapting and implementing the WFH development model regionally within Africa is proving to be a successful approach both for the introduction as well as the development of sustainable national care programmes for patients with bleeding disorders. The targeted development of solid national programmes such as in South Africa, Senegal and Kenya has expanded the training capacity of the WFH, as well as providing key regional examples. Local medical professionals are now responsible for providing the training in many regional programmes. Children with bleeding disorders in low-income countries are at great risk of dying young. WFH data demonstrate that among such patients, as the economic capacity of a country decreases so does the ratio of adults to children. The organization of care, training of a multi-disciplinary healthcare team, and education of patients and their families lead to improved mortality independent of economic capacity or increased clotting factor concentrate availability. Additionally, through

Danish building typologies and building stock analyses

DEFF Research Database (Denmark)

Wittchen, Kim Bjarne; Kragh, Jesper

energy savings in residential buildings. The intension with this analysis was to investigate the possible energy reduction in Denmark if the same approach had been taken for the entire Danish building stock. The report concludes that the ZeroHome initiative clearly results in energy savings, but far from...... enough to meet the government’s plan to make Danish buildings free from use of fossil fuels by 2035. This will probably require around 50 % energy savings in the Danish building stock as a whole. However, the project has proven that dedicated engagement of locals can speed up market penetration...... for energy savings in the existing Building stock....

Engaging men in health care.

Science.gov (United States)

Malcher, Greg

2009-03-01

Engaging men in health care involves a multifaceted approach that has as its main principle the recognition that men consume health care differently to women. This article identifies barriers to engaging men in health care and offers potential and existing solutions to overcome these barriers in a range of health care settings. The concept of multiple masculinities recognises that not all men can be engaged via a particular technique or strategy. The perception that men are disinterested in their health is challenged and a range of approaches discussed, both in the community and in health care facilities. In the general practice setting opportunities exist for the engagement of men at the reception desk and waiting room, as well as during the consultation. Use of the workplace in engaging men is discussed. Future activities to build the capacity of health care providers to better engage men are identified and the role of policy and program development is addressed.

Building Imaging Institutes of Patient Care Outcomes: Imaging as a Nidus for Innovation in Clinical Care, Research, and Education.

Science.gov (United States)

Petrou, Myria; Cronin, Paul; Altaee, Duaa K; Kelly, Aine M; Foerster, Bradley R

2018-05-01

Traditionally, radiologists have been responsible for the protocol of imaging studies, imaging acquisition, supervision of imaging technologists, and interpretation and reporting of imaging findings. In this article, we outline how radiology needs to change and adapt to a role of providing value-based, integrated health-care delivery. We believe that the way to best serve our specialty and our patients is to undertake a fundamental paradigm shift in how we practice. We describe the need for imaging institutes centered on disease entities (eg, lung cancer, multiple sclerosis) to not only optimize clinical care and patient outcomes, but also spur the development of a new educational focus, which will increase opportunities for medical trainees and other health professionals. These institutes will also serve as unique environments for testing and implementing new technologies and for generating new ideas for research and health-care delivery. We propose that the imaging institutes focus on how imaging practices-including new innovations-improve patient care outcomes within a specific disease framework. These institutes will allow our specialty to lead patient care, provide the necessary infrastructure for state-of-the art-education of trainees, and stimulate innovative and clinically relevant research. Copyright © 2018 The Association of University Radiologists. All rights reserved.

Evaluation of a Research Mentorship Program in Community Care

Science.gov (United States)

Ploeg, Jenny; de Witt, Lorna; Hutchison, Brian; Hayward, Lynda; Grayson, Kim

2008-01-01

This article describes the results of a qualitative case study evaluating a research mentorship program in community care settings in Ontario, Canada. The purpose of the program was to build evaluation and research capacity among staff of community care agencies through a mentorship program. Data were collected through in-depth, semi-structured…

Refurbishment of industrial buildings

International Nuclear Information System (INIS)

Gustafsson, Stig-Inge

2006-01-01

When a building is subject for refurbishment, there is a golden opportunity to change its behavior as an energy system. This paper shows the importance of careful investigations of the processes, the climate shield and the heating systems already present in the building before measures are implemented in reality. A case study is presented dealing with a carpentry factory. The building is poorly insulated according to standards today, and initially it was assumed that a better thermal shield would be of vital importance in order to reach optimal conditions. Instead, it is shown that the main problem is the ordinary heating system. This uses steam from a wood chips boiler and the wood chips come from the manufacturing processes. These wood chips are, therefore, a very cheap fuel. The boiler had, during decades of use, slowly degraded into a poor state. Hence, aero-tempers using expensive electricity have been installed to remedy the situation. These use not only expensive kWh but also very expensive kW due to the electricity tariff. It is shown that electricity for heating purposes must be abandoned and further, that this could be achieved at a surprisingly small cost. By stopping a large waste of steam, it was possible to find resources, in the form of unspent money, for further mending the existing heating system. Not only economy but also environmental hazards in the form of CO 2 emissions urges us to abandon electricity and instead use heat from cheap biomass fired boilers. Such equipment saves environment at the same time it saves money

Development of a field measurement methodology for studying the thermal indoor environment in hybrid GEOTABS buildings

DEFF Research Database (Denmark)

Kazanci, Ongun Berk; Khovalyg, Dolaana; Olesen, Bjarne W.

2018-01-01

buildings. The three demonstration buildings were an office building in Luxembourg, an elderly care home in Belgium, and an elementary school in Czech Republic. All of these buildings are equipped with hybrid GEOTABS systems; however, they vary in size and function, which requires a unique measurement...... methodology for studying them. These buildings already have advanced Building Management Systems (BMS); however, a more detailed measurement plan was needed for the purposes of the project to document the current performance of these systems regarding thermal indoor environment and energy performance......, and to be able to document the improvements after the implementation of the MPC. This study provides the details of the developed field measurement methodology for each of these buildings to study the indoor environmental quality (IEQ) in details. The developed measurement methodology can be applied to other...

Use of the Culture Care Theory and ethnonursing method to discover how nursing faculty teach culture care.

Science.gov (United States)

Mixer, Sandra J

2008-04-01

As the world becomes increasingly multicultural, transcultural nursing education is critical to ensuring a culturally competent workforce. This paper presents a comprehensive review of literature and results of an ethnonursing pilot study using the Culture Care Theory (CCT) to discover how nursing faculty teach culture care. The literature revealed that despite 50 years of transcultural nursing knowledge development through theory, research and practice, there remains a lack of formal, integrated culture education in nursing. The importance of faculty providing generic and professional care to nursing students and using an organising framework to teach culture care was discovered. Additionally, care was essential for faculty health and well-being to enable faculty to teach culture care. This unique use of the theory and method demonstrates its usefulness in discovering and describing the complex nature of teaching culture care. Larger scale studies are predicted to further substantiate the CCT, building the discipline of nursing.

Digitalization as Driver for Standardized Specification and Design of Buildings: In Search of an Efficient Building Design Management Methodology

DEFF Research Database (Denmark)

Treldal, Niels

of this research is, therefore, to increase the understanding of the relation between information needs, standardisation and efficient design management. The research draws on findings from previous research on information management, design management and socio-technical science and focuses in particular......-value adding design iterations will occur too frequently if the variability is not carefully managed. Building a strong community within the design team is found to be critical to reduce variability as it allows project managers to entrust the team to find solutions and coordinate activities more efficiently...... standards were developed in the current research. An IDM package framework is proposed to make the current IDM methodology from buildingSMART more modular and easier to reuse and utilize on projects. A generic LOD framework is proposed to make the agreement on geometry information exchange more pragmatic...

Approaches to Sustainable Capacity Building for Cardiovascular Disease Care in Kenya.

Science.gov (United States)

Barasa, Felix A; Vedanthan, Rajesh; Pastakia, Sonak D; Crowe, Susie J; Aruasa, Wilson; Sugut, Wilson K; White, Russ; Ogola, Elijah S; Bloomfield, Gerald S; Velazquez, Eric J

2017-02-01

Cardiovascular diseases are approaching epidemic levels in Kenya and other low- and middle-income countries without accompanying effective preventive and therapeutic strategies. This is happening in the background of residual and emerging infections and other diseases of poverty, and increasing physical injuries from traffic accidents and noncommunicable diseases. Investments to create a skilled workforce and health care infrastructure are needed. Improving diagnostic capacity, access to high-quality medications, health care, appropriate legislation, and proper coordination are key components to ensuring the reversal of the epidemic and a healthy citizenry. Strong partnerships with the developed countries also crucial. Copyright © 2016 Elsevier Inc. All rights reserved.

Building patient-centeredness: hospital design as an interpretive act.

Science.gov (United States)

Bromley, Elizabeth

2012-09-01

Hospital designs reflect the sociocultural, economic, professional, and aesthetic priorities prevalent at a given time. As such, hospital buildings concretize assumptions about illness, care and healing, patienthood, and medical providers' roles. Trends in hospital design have been attributed to the increasing influence of consumerism on healthcare, the influx of business-oriented managers, and technological changes. This paper describes the impact of the concept of patient-centeredness on the design of a new hospital in the USA. Data come from 35 interviews with planners, administrators, and designers of the new hospital, as well as from public documents about the hospital design. Thematic content analysis was used to identify salient design principles and intents. For these designers, administrators, and planners, an interpretation of patient-centeredness served as a heuristic, guiding the most basic decisions about space, people, and processes in the hospital. I detail the particular interpretation of patient-centeredness used to build and manage the new hospital space and the roles and responsibilities of providers working within it. Three strategies were central to the implementation of patient-centeredness: an onstage/offstage layout; a concierge approach to patients; and the scripting of communication. I discuss that this interpretation of patient-centeredness may challenge medical professionals' roles, may construct medical care as a product that should sate the patient's desire, and may distance patients from the realities of medical care. By describing the ways in which hospital designs reflect and reinforce contemporary concepts of patienthood and caring, this paper raises questions about the implementation of patient-centeredness that deserve further empirical study by medical social scientists. Copyright © 2012 Elsevier Ltd. All rights reserved.

Multidisciplinary acute care research organization (MACRO): if you build it, they will come.

Science.gov (United States)

Early, Barbara J; Huang, David T; Callaway, Clifton W; Zenati, Mazen; Angus, Derek C; Gunn, Scott R; Yealy, Donald M; Unikel, Daniel; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

2013-07-01

Clinical research will increasingly play a core role in the evolution and growth of acute care surgery program development across the country. What constitutes an efficient and effective clinical research infrastructure in the current fiscal and academic environment remains obscure. We sought to characterize the effects of implementation of a multidisciplinary acute care research organization (MACRO) at a busy tertiary referral university setting. In 2008, to minimize redundancy and cost as well as to maximize existing resources promoting acute care research, MACRO was created, unifying clinical research infrastructure among the Departments of Critical Care Medicine, Emergency Medicine, and Surgery. During the periods 2008 to 2012, we performed a retrospective analysis and determined volume of clinical studies, patient enrollment for both observational and interventional trials, and staff growth since MACRO's origination and characterized changes over time. From 2008 to 2011, the volume of patients enrolled in clinical studies, which MACRO facilitates has significantly increased more than 300%. The percentage of interventional/observational trials has remained stable during the same period (50-60%). Staff has increased from 6 coordinators to 10, with an additional 15 research associates allowing 24/7 service. With this significant growth, MACRO has become financially self-sufficient, and additional outside departments now seek MACRO's services. Appropriate organization of acute care clinical research infrastructure minimizes redundancy and can promote sustainable, efficient growth in the current academic environment. Further studies are required to determine if similar models can be successful at other acute care surgery programs.

Improving organizational climate for excellence in patient care.

Science.gov (United States)

Arnold, Edwin

2013-01-01

Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

Building a better delivery system: a new engineering/health care partnership

National Research Council Canada - National Science Library

Reid, Proctor P; Compton, W. Dale; Grossman, Jerome H; Fanjiang, Gary

2005-01-01

.... health care sector from an underperforming conglomerate of independent entities (individual practitioners, small group practices, clinics, hospitals, pharmacies, community health centers et. al...

Long-range correlations in rectal temperature fluctuations of healthy infants during maturation.

Directory of Open Access Journals (Sweden)

Georgette Stern

Full Text Available BACKGROUND: Control of breathing, heart rate, and body temperature are interdependent in infants, where instabilities in thermoregulation can contribute to apneas or even life-threatening events. Identifying abnormalities in thermoregulation is particularly important in the first 6 months of life, where autonomic regulation undergoes critical development. Fluctuations in body temperature have been shown to be sensitive to maturational stage as well as system failure in critically ill patients. We thus aimed to investigate the existence of fractal-like long-range correlations, indicative of temperature control, in night time rectal temperature (T(rec patterns in maturing infants. METHODOLOGY/PRINCIPAL FINDINGS: We measured T(rec fluctuations in infants every 4 weeks from 4 to 20 weeks of age and before and after immunization. Long-range correlations in the temperature series were quantified by the correlation exponent, alpha using detrended fluctuation analysis. The effects of maturation, room temperature, and immunization on the strength of correlation were investigated. We found that T(rec fluctuations exhibit fractal long-range correlations with a mean (SD alpha of 1.51 (0.11, indicating that T(rec is regulated in a highly correlated and hence deterministic manner. A significant increase in alpha with age from 1.42 (0.07 at 4 weeks to 1.58 (0.04 at 20 weeks reflects a change in long-range correlation behavior with maturation towards a smoother and more deterministic temperature regulation, potentially due to the decrease in surface area to body weight ratio in the maturing infant. alpha was not associated with mean room temperature or influenced by immunization CONCLUSIONS: This study shows that the quantification of long-range correlations using alpha derived from detrended fluctuation analysis is an observer-independent tool which can distinguish developmental stages of night time T(rec pattern in young infants, reflective of maturation of

Building a team through a strategic planning process.

Science.gov (United States)

Albert, Debra; Priganc, Dave

2014-01-01

Strategic planning is a process often left to senior hospital leadership, with limited input from unit-level, bedside patient care providers. This frequent approach to strategic planning misses the opportunity to engage a wide range of employees, build a shared sense of commitment, produce a collaborative team environment, and to generate greater acceptance of the plan. The Patient Care Services division at the University of Chicago Medicine used a strategic planning process that incorporated 360-degree input from both within the Patient Care Services division and outside of the division. The result is a strategic vision and plan that, shaped by broad-based input from both internal and external constituencies, is strengthened by the team that emerged from the process. Through the process of identifying a common understanding of the group's future direction, a shared purpose was created that transcended traditional professional boundaries and shaped a cohesive team focused on effective and efficient patient care. Now, with a focused strategic plan and a team centered on a shared purpose, the team is beginning to effectively deliver on the plan.

Effect of facade components on energy efficiency in office buildings

International Nuclear Information System (INIS)

Ihara, Takeshi; Gustavsen, Arild; Jelle, Bjørn Petter

2015-01-01

Highlights: • Investigation of facade properties for energy efficiency of Tokyo office buildings. • Higher reflectance for opaque parts may slightly reduce energy demand. • Lower window U-value and solar heat gain coefficient are potential solutions. • Decreased heating due to insulation did not always compensate increased cooling. • Fundamental data for adjustment of facade properties of buildings are provided. - Abstract: Properties of facade materials should be considered to determine which of them strongly affect building energy performance, regardless of the building shapes, scales, ideal locations, and building types, and thus may be able to promote energy efficiency in buildings. In this study, the effects of four fundamental facade properties related to the energy efficiency of office buildings in Tokyo, Japan, were investigated with the purpose of reducing the heating and cooling energy demands. Some fundamental design factors such as volume and shape were also considered. It was found that the reduction in both the solar heat gain coefficient and window U-value and increase in the solar reflectance of the opaque parts are promising measures for reducing the energy demand. Conversely, the reduction in the U-value of the opaque parts decreased the heating energy demand, and this was accompanied by an increase in the cooling energy demand in some cases because the total energy demands were predominantly for cooling. The above-mentioned promising measures for reducing building energy demands are thus recommended for use, and an appropriate U-value should be applied to the opaque parts based on careful considerations. This study provides some fundamental ideas to adjust the facade properties of buildings.

Compliance with building energy regulations for new-build dwellings

International Nuclear Information System (INIS)

Pan, Wei; Garmston, Helen

2012-01-01

Despite increasingly stringent building energy regulations worldwide, non-compliance exists in practice. This paper examines the profile of compliance with building energy regulations for new-build dwellings. In total 404 new-build dwellings completed in the UK from 2006 to 2009 were investigated. Only a third of these dwellings were evidenced as being compliant with Building Regulations Part L (England and Wales). Such low compliance casts a serious concern over the achievability of the UK Government's target for all new-build homes to be ‘zero carbon’ from 2016. Clearly evidenced was a lack of knowledge of Part L and its compliance requirements among the supply and building control sides of new-build dwellings. The results also indicate that the compliance profile was influenced by factors including Standard Assessment Procedure (UK Government's methodology for energy efficiency) calculation submissions, learning and experience of builders and building controls with Part L, use of Part L1A checklist, the introduction of energy performance certificate (EPC), build method, dwelling type, and project size. Better compliance was associated with flats over houses and timber frame over masonry. The use of EPC and Part L1A checklist should be encouraged. Key to addressing the lack of compliance with building energy regulations is training. -- Highlights: ► There exists a lack of compliance, worldwide, with building energy regulations. ► The implementation of England and Wales building energy regulations is problematic. ► Training, learning and experience of builders and building control are critical. ► Energy performance certificate and Part L 2006 checklist helped achieve compliance. ► Flats achieved better compliance over houses; and timber frame over masonry.

Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors.

Science.gov (United States)

Valaitis, Ruta K; O'Mara, Linda; Wong, Sabrina T; MacDonald, Marjorie; Murray, Nancy; Martin-Misener, Ruth; Meagher-Stewart, Donna

2018-04-12

AimThe aim of this paper is to examine Canadian key informants' perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration. Primary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context. This interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.FindingsA total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor - effective communication - interacted with all of them. Results support and extend our understanding of what influences

Meaning of caring in pediatric intensive care unit from the perspective of parents: A qualitative study.

Science.gov (United States)

Mattsson, Janet Yvonne; Arman, Maria; Castren, Maaret; Forsner, Maria

2014-12-01

When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment. © The Author(s) 2013.

Problems of building social and production bases for the construction of the Temelin nuclear power plant

International Nuclear Information System (INIS)

Suchopar, J.

1984-01-01

A survey is given of capital costs of building parts and the concept is presented of the equipment of a building site. The social basis consists of accommodation units, cloakrooms, catering units, utility units, a health care centre and a shopping centre. The production base consists of a central concrete plant, cement plant, central armour unit, forming hall, storage area, buildings for pre-assembly, fleet of trucks and other machines, maintenance and repair shops. The network infrastructure and the mains connections are designed and the procedure of the build up of the site is described. The experience is summed up and recommendations made for future nuclear power plant projects. (E.S.)

Valuing Equality in Irish Social Care

Directory of Open Access Journals (Sweden)

Niall Hanlon

2009-01-01

Full Text Available In this article the author critiques Irish social care by presenting an equality perspective on practice. An equality perspective involves developing emancipatory practices, that is, ways of helping that provide egalitarian solutions and outcomes. Although emancipatory values are often contrasted with traditional social care values, the author seeks a pragmatic and integrated approach to emancipatory practices rather than a restatement of traditional dichotomies. Emancipatory practice begins with an appreciation of the nature and relevance of inequalities on the lives of diverse social care users. Building a commitment to equality within social care education and practice is an important step in altering many individual and institutional social care practices by focussing on equality processes and outcomes as central social care objectives. Using a well credited framework that outlines five dimensions of inequality (Baker, Lynch, Cantillon and Walsh, 2004, the author argues that social care educators and practitioners need to debate the issues raised and develop emancipatory practices.

Building an ethical organizational culture.

Science.gov (United States)

Nelson, William A; Taylor, Emily; Walsh, Thom

2014-01-01

The success of a health care institution-as defined by delivering high-quality, high-value care, positive patient outcomes, and financial solvency-is inextricably tied to the culture within that organization. The ability to achieve and sustain alignment between its mission, values, and everyday practices defines a positive organizational culture. An institution that has a diminished organizational culture, reflected in the failure to consistently align management and clinical decisions and practices with its mission and values, will struggle. The presence of misalignment or of ethics gaps affects the quality of care being delivered, the morale of the staff, and the organization's image in the community. Transforming an organizational culture will provide a foundation for success and a framework for daily ethics-grounded operations in any organization. However, building an ethics-grounded organization is a challenging process requiring strong organization leadership and planning. Using a case study, the authors provide a multiyear, continuous step-by-step strategy consisting of identifying ethics culture gaps, establishing an ethics taskforce, clarifying and prioritizing the problems, developing strategy for change, implementing the strategy, and evaluating outcomes. This process will assist organizations in aligning its actions with its mission and values, to find success on all fronts.

Strategies and Challenges for Energy Efficient Retrofitting: Study of the Empire State Building

Science.gov (United States)

De, B.; Mukherjee, M.

2013-11-01

Operational and maintenance cost of existing buildings is escalating making it tough for both the owner and the tenants. Retrofitting them with state of the art technologies help them to keep pace with amended recent code provisions and thus extending the older building stocks one more chance to live responsively. Retrofitted iconic buildings can thus retain their status in commerce driven real estate sector. It helps in reducing green house gas emission as well. World's iconic skyscraper, the Empire State Building (ESB), has undergone an exemplary retrofit process since 2008 to reduce its energy demands. To achieve the goal of operational cost and energy consumption reduction, stiff challenges had taken care in a systematic manner to realize benefit throughout the entire lifespan of the ESB. Least disturbances to the tenant and on-site component handling strategies required precise planning. The present paper explores strategies and process adopted for retrofitting the ESB, and derived insightful guidelines towards operational cost savings and energy efficiency of existing buildings through retrofitting.

Building 2000

International Nuclear Information System (INIS)

Den Ouden, C.; Steemers, T.C.

1992-01-01

This is the first volume of Building 2000, a pilot project of the Commission's R and D-programme 'Solar Energy Applications to Buildings' with the purpose of encouraging the adoption of solar architecture in large buildings. In this first rich illustrated volume the results of the design studies illustrating passive solar architecture in buildings in the European Community are presented in particular for the building categories as mentioned in the subtitle. In a second volume, a similar series of studies is presented for the building categories: office buildings, public buildings and hotels and holiday complexes. Several Design Support Workshops were organized during the Building 2000 programme during which Building 2000 design teams could directly exchange ideas with the various design advice experts represented at these workshops. In the second part of the Building 2000 final report a summary of a selection of many reports is presented (15 papers), as produced by Design Support experts. Most of the design support activities resulted in changes of the various designs, as have been reported by the design teams in the brochures presented in the first part of this book. It is to be expected that design aids and simulation tools for passive solar options, daylighting concepts, comfort criteria etc., will be utilized more frequently in the future. This will result in a better exchange of information between the actual design practitioners and the European R and D community. This technology transfer will result in buildings with a higher quality with respect to energy and environmental issues

Building 2000

Energy Technology Data Exchange (ETDEWEB)

Den Ouden, C [EGM Engineering BV, Dordrecht (Netherlands); Steemers, T C [Commission of the European Communities, Brussels (Belgium)

1992-01-01

This is the first volume of Building 2000, a pilot project of the Commission's R and D-programme 'Solar Energy Applications to Buildings' with the purpose of encouraging the adoption of solar architecture in large buildings. In this first rich illustrated volume the results of the design studies illustrating passive solar architecture in buildings in the European Community are presented in particular for the building categories as mentioned in the subtitle. In a second volume, a similar series of studies is presented for the building categories: office buildings, public buildings and hotels and holiday complexes. Several Design Support Workshops were organized during the Building 2000 programme during which Building 2000 design teams could directly exchange ideas with the various design advice experts represented at these workshops. In the second part of the Building 2000 final report a summary of a selection of many reports is presented (15 papers), as produced by Design Support experts. Most of the design support activities resulted in changes of the various designs, as have been reported by the design teams in the brochures presented in the first part of this book. It is to be expected that design aids and simulation tools for passive solar options, daylighting concepts, comfort criteria etc., will be utilized more frequently in the future. This will result in a better exchange of information between the actual design practitioners and the European R and D community. This technology transfer will result in buildings with a higher quality with respect to energy and environmental issues.

A pilot study on the effects of a team building process on the perception of work environment in an integrative hospital for neurological rehabilitation

OpenAIRE

Ostermann, Thomas; Bertram, Mathias; Büssing, Arndt

2010-01-01

Abstract Background Neurological rehabilitation is one of the most care-intensive challenges in the health care system requiring specialist therapeutic and nursing knowledge. In this descriptive pilot study, we investigated the effects of a team building process on perceived work environment, self-ascribed professional competence, life satisfaction, and client satisfaction in an anthroposophic specialized hospital for neurological rehabilitation. The team-building process consisted of didacti...

Factors associated with advance care planning discussions by area agency on aging care managers.

Science.gov (United States)

Hazelett, Susan; Baughman, Kristin R; Palmisano, Barbara R; Sanders, Margaret; Ludwick, Ruth E

2013-12-01

Initiating advance care planning (ACP) discussions in the home may prevent avoidable hospitalizations by elucidating goals of care. Area agencies on aging care managers (AAACMs) work in the home with high-risk consumers. To determine which AAACM characteristics contribute to an increased frequency of ACP discussions. Cross-sectional investigator-generated surveys administered to AAACMs at 3 AAAs in Ohio. Of 289 AAACMs, 182 (63%) responded. The more experience and comfort AAACMs felt with ACP discussions, the more likely they were to initiate ACP discussions. It may be necessary to build interactive educational experiences where, for example, AAACMs are asked to fill out their own advance directives and/or facilitate others in ACP discussions to improve experience and comfort with ACP discussions.

LIFE-CYCLE COST MODEL AND DESIGN OPTIMIZATION OF BASE ISOLATED BUILDING STRUCTURES

Directory of Open Access Journals (Sweden)

Chara C. Mitropoulou

2016-11-01

Full Text Available Design of economic structures adequately resistant to withstand during their service life, without catastrophic failures, all possible loading conditions and to absorb the induced seismic energy in a controlled fashion, has been the subject of intensive research so far. Modern buildings usually contain extremely sensitive and costly equipment that are vital in business, commerce, education and/or health care. The building contents frequently are more valuable than the buildings them-selves. Furthermore, hospitals, communication and emergency centres, police and fire stations must be operational when needed most: immediately after an earthquake. Conventional con-struction can cause very high floor accelerations in stiff buildings and large interstorey drifts in flexible structures. These two factors cause difficulties in insuring the safety of both building and its contents. For this reason base-isolated structures are considered as an efficient alternative design practice to the conventional fixed-base one. In this study a systematic assessment of op-timized fixed and base-isolated reinforced concrete buildings is presented in terms of their initial and total cost taking into account the life-cycle cost of the structures.

Reinforcement learning for optimal control of low exergy buildings

International Nuclear Information System (INIS)

Yang, Lei; Nagy, Zoltan; Goffin, Philippe; Schlueter, Arno

2015-01-01

Highlights: • Implementation of reinforcement learning control for LowEx Building systems. • Learning allows adaptation to local environment without prior knowledge. • Presentation of reinforcement learning control for real-life applications. • Discussion of the applicability for real-life situations. - Abstract: Over a third of the anthropogenic greenhouse gas (GHG) emissions stem from cooling and heating buildings, due to their fossil fuel based operation. Low exergy building systems are a promising approach to reduce energy consumption as well as GHG emissions. They consists of renewable energy technologies, such as PV, PV/T and heat pumps. Since careful tuning of parameters is required, a manual setup may result in sub-optimal operation. A model predictive control approach is unnecessarily complex due to the required model identification. Therefore, in this work we present a reinforcement learning control (RLC) approach. The studied building consists of a PV/T array for solar heat and electricity generation, as well as geothermal heat pumps. We present RLC for the PV/T array, and the full building model. Two methods, Tabular Q-learning and Batch Q-learning with Memory Replay, are implemented with real building settings and actual weather conditions in a Matlab/Simulink framework. The performance is evaluated against standard rule-based control (RBC). We investigated different neural network structures and find that some outperformed RBC already during the learning phase. Overall, every RLC strategy for PV/T outperformed RBC by over 10% after the third year. Likewise, for the full building, RLC outperforms RBC in terms of meeting the heating demand, maintaining the optimal operation temperature and compensating more effectively for ground heat. This allows to reduce engineering costs associated with the setup of these systems, as well as decrease the return-of-invest period, both of which are necessary to create a sustainable, zero-emission building

Multiple Learning Strategies Project. Building Maintenance & Engineering. Low Reader. [Vol. 2.

Science.gov (United States)

Steinberg, A.; And Others

This instructional package is one of two designed for low reader students (those reading at grade level 3-6) in the vocational area of building maintenance and engineering. The forty-four learning modules are organized into eleven units: chalkboards; carpet care; office cleaning; grounds; sanitation; boiler maintenance and operation; power and…

The sick-building syndrome; Das Sick-Building-Syndrom

Energy Technology Data Exchange (ETDEWEB)

Henne, A.; Neumann, H.F.; Winneke, G.

1992-12-31

The sick-building syndrome is characterized by the presence of general, non-specific symptoms (e.g., headache, tiredness, respiratory problems, eye trouble, vertigo, nausea, unspecific hypersensitivity) in association with a particular indoor ambience. It is clearly distinguishable from `building-related illness`, referring to a well-defined clinical syndrome due to staying in a building and for which a cause can, in general, be established. Disorders in the case of the sick-building syndrome are manifold and confirmed objectifiable results are hardly available so far. Yet there are some organ-related methods for the confirmation of findings concerning, for instance, the eyes, the skin and the area of the nose. The causes of the incidence of sick-building syndrome are more or less unclear. It is a multifactorial phenomenon involving physical, biological, chemical, individual-specific and psychological factors. Buildings where sick-building syndrome occurs typically exhibit certain properties. The European Community has already made proposals for the investigation of incriminated buildings. A systematic survey by questionnaire together with individual interviews plays an import part towards clarifying the syndrome. (orig./UWA) [Deutsch] Das Sick-Building-Syndrom beschreibt das Vorhandensein von allgemeinen, nicht spezifischen Symptomen (z.B. Kopfschmerzen, Muedigkeit, Atembeschwerden, Augenreizungen, Schwindelgefuehl, Uebelkeit, unspezifische Ueberempfindlichkeit), assoziiert mit einer besonderen Innenraumumgebung. Deutlich hiervon abzugrenzen ist die ``Building related illness``, bei der ein klinisch definiertes Krankheitsbild vorliegt, das durch den Aufenthalt im Gebaeude verursacht wird und fuer das im allgemeinen eine Ursache ermittelt werden kann. Das Beschwerdebild beim Sick-Building-Syndrom ist vielfaeltig, und gesicherte, objektivierbare Befunde liegen hierzu bisher kaum vor. Dennoch gibt es einige organbezogenen Methoden zur Befundabsicherung, z.B. fuer das

Energy Efficiency, Building Productivity and the Commercial Buildings Market

Energy Technology Data Exchange (ETDEWEB)

Jones, D.W.

2002-05-16

The energy-efficiency gap literature suggests that building buyers are often short-sighted in their failure to apply life-cycle costing principles to energy efficient building technologies, with the result that under investment in these advanced technology occurs. This study examines the reasons this behavior may occur, by analyzing the pressures that market forces place on purchasers of buildings. Our basic conclusion is that the fundamental manner in which the buildings sector does business creates pressures to reduce initial capital outlays and to hedge against a variety of risks, including the ability of building owners to capture benefits from energy efficiency. Starting from the position that building buyers' willingness to pay drives choices over building attributes, we examine basic market principles, the structure of the buildings market, including the role of lenders, and policies that promote penetration of energy efficient technologies. We conclude that greater attention to buyers, and to the incentives and constraints they face, would promote a better understanding of building investment choices and contribute to better policies to promote the penetration of these technologies into markets.

Local failure after radical radiotherapy of non-small cell lung cancer in relation to the planning FDG-PET/CT

DEFF Research Database (Denmark)

Kandi, M; Hoffmann, L; Sloth Moeller, D

2018-01-01

OBJECTIVES: Local recurrence (rec) in lung cancer is associated with poor survival. This study examined whether the pattern of failure is associated with the most PET avid volume in the planning-FDG-PET/CT scan (p-PET/CT). METHODS: 162 consecutive inoperable NSCLC patients (pts) receiving...... 50% of SUVpeak on p-PET/CT and the volume of T-rec was calculated: OF = (SUVp50∩T-rec)/min(SUVp50, T-rec). Similarly for the GTV on the p-CT: OF = (GTV∩T-rec)/min(GTV, T-rec). OF was based on a rigid registration between p-PET/CT and rec-CT with PET guided delineation of T- rec. For lymph nodes (LN...... in these stations; 4R (55%) and 7 (83%). CONCLUSIONS: This study indicates that the most PET active volume on p-PET-CT is a driver for rec at T-site. LN-recurrences predominantly appear in station 2R, 4R, 7 and right hilum. Additional confirmatory studies regarding lymph node mapping and selective lymph node...

Efficiency improvement of an all-vanadium redox flow battery by harvesting low-grade heat

Science.gov (United States)

Reynard, Danick; Dennison, C. R.; Battistel, Alberto; Girault, Hubert H.

2018-06-01

Redox flow batteries (RFBs) are rugged systems, which can withstand several thousand cycles and last many years. However, they suffer from low energy density, low power density, and low efficiency. Integrating a Thermally Regenerative Electrochemical Cycle (TREC) into the RFB, it is possible to mitigate some of these drawbacks. The TREC takes advantage of the temperature dependence of the cell voltage to convert heat directly into electrical energy. Here, the performance increase of a TREC-RFB is investigated using two kinds of all-vanadium electrolyte chemistries: one containing a typical concentration of sulfuric acid and one containing a large excess of hydrochloric acid. The results show that the energy density of the system was increased by 1.3Wh L-1 and 0.8Wh L-1, respectively and the overall energy efficiency also increased by 9 and 5 percentage points, respectively. The integration of the heat exchangers necessary to change the battery temperature is readily facilitated by the design of the redox flow battery, which already utilizes fluid circulation loops.

Irregular Shaped Building Design Optimization with Building Information Modelling

Directory of Open Access Journals (Sweden)

Lee Xia Sheng

2016-01-01

Full Text Available This research is to recognise the function of Building Information Modelling (BIM in design optimization for irregular shaped buildings. The study focuses on a conceptual irregular shaped “twisted” building design similar to some existing sculpture-like architectures. Form and function are the two most important aspects of new buildings, which are becoming more sophisticated as parts of equally sophisticated “systems” that we are living in. Nowadays, it is common to have irregular shaped or sculpture-like buildings which are very different when compared to regular buildings. Construction industry stakeholders are facing stiff challenges in many aspects such as buildability, cost effectiveness, delivery time and facility management when dealing with irregular shaped building projects. Building Information Modelling (BIM is being utilized to enable architects, engineers and constructors to gain improved visualization for irregular shaped buildings; this has a purpose of identifying critical issues before initiating physical construction work. In this study, three variations of design options differing in rotating angle: 30 degrees, 60 degrees and 90 degrees are created to conduct quantifiable comparisons. Discussions are focused on three major aspects including structural planning, usable building space, and structural constructability. This research concludes that Building Information Modelling is instrumental in facilitating design optimization for irregular shaped building. In the process of comparing different design variations, instead of just giving “yes or no” type of response, stakeholders can now easily visualize, evaluate and decide to achieve the right balance based on their own criteria. Therefore, construction project stakeholders are empowered with superior evaluation and decision making capability.

Family-Style Dining: Focusing on the Importance of Rituals in Building Relationships.

Science.gov (United States)

Parr, Jerry

2002-01-01

Discusses the importance of family-style dining in early childhood education and care settings for child nutrition, socialization, and cognitive development. Illustrates how family dining experiences build family relationships and provide a context for defining family roles and responsibilities. Shows how easily television can become a mealtime…

Multiple Learning Strategies Project. Building Maintenance & Engineering. Low Reader. [Vol. 1.

Science.gov (United States)

Smith, Dwight; And Others

This instructional package is one of two designed for low reader students (those reading at a 3-6 grade level) in the vocational area of building maintenance and engineering. The forty-six learning modules are organized into three units: floor care; general maintenance tasks; and restrooms. Each module includes these elements: a performance…

Multi-objective optimization of a continuous thermally regenerative electrochemical cycle for waste heat recovery

International Nuclear Information System (INIS)

Long, Rui; Li, Baode; Liu, Zhichun; Liu, Wei

2015-01-01

An optimization analysis of a continuous TREC (thermally regenerative electrochemical cycle) was conducted with maximum power output and exergy efficiency as the objective functions simultaneously. For comparison, the power output, exergy efficiency, and thermal efficiency under the corresponding single-objective optimization schematics were also calculated. Under different optimization methods it was observed that the power output and the thermal efficiency increase with increasing inlet temperature of the heat source, whereas the exergy efficiency increases with increasing inlet temperature, reaches a maximum value, and then decreases. Results revealed that the optimal power output under the multi-objective optimization turned out to be slightly less than that obtained under the single-objective optimization for power output. However, the exergy and thermal efficiencies were much greater. Furthermore, the thermal exergy and exergy efficiency by single-objective optimization for energy efficiency shows no dominant advantage than that obtained under multi-objective optimization, comparing with the increase amplitude of the power output. This suggests that the multi-objective optimization could coordinate well both the power output and the exergy efficiency of the TREC system, and may serve as a more promising guide for operating and designing TREC systems. - Highlights: • An optimal analysis of a continuous TREC is conducted based on multi-objective optimization. • Performance under corresponding single-objective optimizations has also been calculated and compared. • Power under multi-objective optimization is slightly less than the maximum power. • Exergy and thermal efficiencies are much larger than that under the single-objective optimization.

Applying Lean Six Sigma for innovative change to the post-anesthesia care unit.

Science.gov (United States)

Haenke, Roger; Stichler, Jaynelle F

2015-04-01

Many healthcare organizations are building or renovating patient care facilities. Using Lean Six Sigma methods, nurse leaders can eliminate unnecessary waste and improve work and patient care environments. Starting with a key department like the post-anesthesia care unit is a good way to expose staff and leaders to the potential of Lean.

Various methods of heat supply for a building which is operated periodically during the year

Science.gov (United States)

Małetka, Marek; Laska, Marta

2017-11-01

Stand-alone buildings operated periodically require heat supply for hot water and heating purposes to be carefully analyzed in terms of the technical capabilities, the energy and financial outlays. The paper presents the analysis of heat supply for hot water purposes and central heating in the stand-alone cloakroom building located in Poland. The analysis is undertaken for different variants of heat delivery for a building from electric heaters, gas boiler and district heating solutions to renewable sources applications, namely solar panels and heat pumps. For each solution, usage of usable, final and primary energy was calculated. Also the financial analysis for investments and energy costs were carried out. This analysis has been done in according to SPBT and NPV method for different levels of building use.

Illinois hospital using Web to build database for relationship marketing.

Science.gov (United States)

Rees, T

2000-01-01

Silver Cross Hospital and Medical Centers, Joliet, Ill., is promoting its Web site as a tool for gathering health information about patients and prospective patients in order to build a relationship marketing database. The database will enable the hospital to identify health care needs of consumers in Joliet, Will County and many southwestern suburbs of Chicago. The Web site is promoted in a multimedia advertising campaign that invites residents to participate in a Healthy Living Quiz that rewards respondents with free health screenings. The effort is part of a growing planning and marketing strategy in the health care industry called customer relationship management (CRM). Not only does a total CRM plan offer health care organizations the chance to discover the potential for meeting consumers' needs; it also helps find any marketplace gaps that may exist.

Danish building typologies

DEFF Research Database (Denmark)

Wittchen, Kim Bjarne; Kragh, Jesper

The objective of TABULA is to develop a harmonised building typology for European countries. Each national building typology will consist of a set of residential model buildings with characteristic energy-related properties (element areas of the thermal building envelope, U-values, supply system...... efficiencies). The model buildings will each represent a specific construction period of the country in question and a specific building size. Furthermore the number of buildings, flats and the overall floor areas will be given, which are represented by the different building types of the national typologies....

Against dichotomies: On mature care and self-sacrifice in care ethics.

Science.gov (United States)

van Nistelrooij, Inge; Leget, Carlo

2017-09-01

In previous issues of this journal, Carol Gilligan's original concept of mature care has been conceptualized by several (especially Norwegian) contributors. This has resulted in a dichotomous view of self and other, and of self-care and altruism, in which any form of self-sacrifice is rejected. Although this interpretation of Gilligan seems to be quite persistent in care-ethical theory, it does not seem to do justice to either Gilligan's original work or the tensions experienced in contemporary nursing practice. A close reading of Gilligan's concept of mature care leads to a view that differs radically from any dichotomy of self-care and altruism. Instead of a dichotomous view, a dialectical view on self and other is proposed that builds upon connectedness and might support a care-ethical view of nursing that is more consistent with Gilligan's own critical insights such as relationality and a practice-based ethics. A concrete case taken from nursing practice shows the interconnectedness of professional and personal responsibility. This underpins a multilayered, complex view of self-realization that encompasses sacrifices as well. When mature care is characterized as a practice of a multilayered connectedness, caregivers can be acknowledged for their relational identity and nursing practices can be recognized as multilayered and interconnected. This view is better able to capture the tensions that are related to today's nursing as a practice, which inevitably includes sacrifices of self. In conclusion, a further discussion on normative conceptualizations of care is proposed that starts with a non-normative scrutiny of caring practices.

A pilot study on the effects of a team building process on the perception of work environment in an integrative hospital for neurological rehabilitation.

Science.gov (United States)

Ostermann, Thomas; Bertram, Mathias; Büssing, Arndt

2010-03-09

Neurological rehabilitation is one of the most care-intensive challenges in the health care system requiring specialist therapeutic and nursing knowledge. In this descriptive pilot study, we investigated the effects of a team building process on perceived work environment, self-ascribed professional competence, life satisfaction, and client satisfaction in an anthroposophic specialized hospital for neurological rehabilitation. The team-building process consisted of didactic instruction and training in problem-solving, teambuilding and constructive conflict resolution. Seventy seven staff members and 44 patients' relatives were asked to complete a survey that included the Work Environment Scale (WES-10), a Life Satisfaction Scale (BMLSS), the Conviction of Therapeutic Competency (CTC) scale and the Client Satisfaction Questionnaire (CSQ-8). To evaluate the outcome of the team building process, we analyzed changes over time in the WES-10 subscales. Additionally the interrelationship between the WES-10 subscales with other subscales and with sociodemographic parameters like age, gender was calculated by means of a bivariate correlation analysis. The team building process had a significant positive effect on perceived work environment in only one area. There was a significant improvement in the ward staffs' perception of their ability to constructively resolve conflicts 3 years after inception of the team building process than there was before inception. However, even in a unit that utilized holistic treatment and nursing in the care of severely disable patients, such care necessitating a very heavy workload, the measurements on the Self Realization, Life Satisfaction and Conviction of Therapeutic Competency scales remained high and unchanged over the three year time period of the study. Strategic interventions might be an option to improve interpersonal relationships and finally quality of patient care.

Monitoring the Energy-Use Effects of Cool Roofs on California Commercial Buildings

Energy Technology Data Exchange (ETDEWEB)

Akbari, Hashem; Levinson, Ronnen; Konopaki, Steve; Rainer, Leo

2004-07-01

Solar-reflective roofs stay cooler in the sun than solar-absorptive roofs. Such ''cool'' roofs achieve lower surface temperatures that reduce heat conduction into the building and the building's cooling load. The California Energy Commission has funded research in which Lawrence Berkeley National Laboratory (LBNL) has measured the electricity use and peak demand in commercial buildings to document savings from implementing the Commission's Cool Roofs program. The study seeks to determine the savings achieved by cool roofs by monitoring the energy use of a carefully selected assortment of buildings participating in the Cool Roofs program. Measurements were needed because the peak savings resulting from the application of cool roofs on different types of buildings in the diverse California climate zones have not been well characterized to date. Only a few occupancy categories (e.g., office and retail buildings) have been monitored before this, and those were done under a limited number of climatic conditions. To help rectify this situation, LBNL was tasked to select the buildings to be monitored, measure roof performance before and after replacing a hot roof by a cool roof, and document both energy and peak demand savings resulting from installation of cool roofs. We monitored the effects of cool roofs on energy use and environmental parameters in six California buildings at three different sites: a retail store in Sacramento; an elementary school in San Marcos (near San Diego); and a 4-building cold storage facility in Reedley (near Fresno). The latter included a cold storage building, a conditioning and fruit-palletizing area, a conditioned packing area, and two unconditioned packing areas (counted as one building).

Relationship marketing in health care.

Science.gov (United States)

Wagner, H C; Fleming, D; Mangold, W G; LaForge, R W

1994-01-01

Building relationships with patients is critical to the success of many health care organizations. The authors profile the relationship marketing program for a hospital's cardiac center and discuss the key strategic aspects that account for its success: a focus on a specific hospital service, an integrated marketing communication strategy, a specially designed database, and the continuous tracking of results.

Multiple Learning Strategies Project. Building Maintenance & Engineering. Educable Mentally Impaired. [Vol. 2.

Science.gov (United States)

Constantini, Debra; And Others

This instructional package is one of three designed for educable mentally impaired students in the vocational area of building maintenance and engineering. The thirty-four learning modules are organized into six units: general maintenance tasks; restrooms; chalkboards; carpet care; office cleaning; and grounds. Each module includes these elements:…

Building skills in organizational and systems changes: a DNP-FNP clinical curriculum.

Science.gov (United States)

Hoyle, Christine; Johnson, Gail

2015-04-13

DNP-prepared nurse practitioner leaders play a pivotal role in organizational change and quality improvement consistent with the IHI Triple Aim: improving quality of care, health of populations, and reducing cost. A DNP-FNP curriculum is described, designed to build students' leadership competencies for systems change in healthcare settings.

Building a culture of safety through team training and engagement.

Science.gov (United States)

Thomas, Lily; Galla, Catherine

2013-05-01

Medical errors continue to occur despite multiple strategies devised for their prevention. Although many safety initiatives lead to improvement, they are often short lived and unsustainable. Our goal was to build a culture of patient safety within a structure that optimised teamwork and ongoing engagement of the healthcare team. Teamwork impacts the effectiveness of care, patient safety and clinical outcomes, and team training has been identified as a strategy for enhancing teamwork, reducing medical errors and building a culture of safety in healthcare. Therefore, we implemented Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based framework which was used for team training to create transformational and/or incremental changes; facilitating transformation of organisational culture, or solving specific problems. To date, TeamSTEPPS (TS) has been implemented in 14 hospitals, two Long Term Care Facilities, and outpatient areas across the North Shore LIJ Health System. 32 150 members of the healthcare team have been trained. TeamSTEPPS was piloted at a community hospital within the framework of the health system's organisational care delivery model, the Collaborative Care Model to facilitate sustainment. AHRQ's Hospital Survey on Patient Safety Culture, (HSOPSC), was administered before and after implementation of TeamSTEPPS, comparing the perception of patient safety by the heathcare team. Pilot hospital results of HSOPSC show significant improvement from 2007 (pre-TeamSTEPPS) to 2010. System-wide results of HSOPSC show similar trends to those seen in the pilot hospital. Valuable lessons for organisational success from the pilot hospital enabled rapid spread of TeamSTEPPS across the rest of the health system.

BREEAM [Building Research Establishment Environmental Assessment Method] BRE [Building Research Establishment] assessment method for buildings

International Nuclear Information System (INIS)

Baldwin, R.

1994-01-01

Buildings account for a large share of environmental impacts in their construction, use, and demolition. In western Europe, buildings account for ca 50% of primary energy use (hence CO 2 output), far outweighing the contribution of the transport and industrial sectors. Other impacts from building energy use include the use of chemicals such as chlorofluorocarbons for cooling. In the United Kingdom, the Building Research Establishment (BRE) has developed a certificate system for environmental labelling of buildings so that the performance of the building against a set of defined environmental criteria can be made visible to clients. This system thus rewards positive actions to improve the environmental performance of buildings and assists in marketing to an environmentally aware clientele. Issues included in assessments for awarding the certificate are addressed under three main headings: global issues and use of resources, local issues, and indoor issues. Global issues include ozone depletion and CO 2 emissions; local issues include public health and water conservation; and indoor issues include air quality and lighting. 8 refs., 1 tab

Building 2000

International Nuclear Information System (INIS)

Den Ouden, C.; Steemers, T.C.

1992-01-01

This is the second volume of Building 2000, a pilot project of the Commission's R and D-programme 'Solar Energy Applications to Buildings' with the purpose of encouraging the adoption of solar architecture in large buildings. In this second rich illustrated volume the results of the design studies illustrating passive solar architecture in buildings in the European Community are presented in particular for the building categories as mentioned in the subtitle. In the first volume, a similar series of studies is presented for the building categories: schools, laboratories and universities, and sports and educational centres. Several Design Support Workshops were organized during the Building 2000 programme during which Building 2000 design teams could directly exchange ideas with the various design advice experts represented at these workshops. In the second part of the Building 2000 final report a summary of a selection of many reports is presented (11 papers), as produced by Design Support experts. Most of the design support activities resulted in changes of the various designs, as have been reported by the design teams in the brochures presented in the first part of this book. It is to be expected that design aids and simulation tools for passive solar options, daylighting concepts, comfort criteria etc., will be utilized more frequently in the future. This will result in a better exchange of information between the actual design practitioners and the European R and D community. This technology transfer will result in buildings with a higher quality with respect to energy and environmental issues

Building 2000

Energy Technology Data Exchange (ETDEWEB)

Den Ouden, C [EGM Engineering BV, Dordrecht (Netherlands); Steemers, T C [Commission of the European Communities, Brussels (Belgium)

1992-01-01

This is the second volume of Building 2000, a pilot project of the Commission's R and D-programme 'Solar Energy Applications to Buildings' with the purpose of encouraging the adoption of solar architecture in large buildings. In this second rich illustrated volume the results of the design studies illustrating passive solar architecture in buildings in the European Community are presented in particular for the building categories as mentioned in the subtitle. In the first volume, a similar series of studies is presented for the building categories: schools, laboratories and universities, and sports and educational centres. Several Design Support Workshops were organized during the Building 2000 programme during which Building 2000 design teams could directly exchange ideas with the various design advice experts represented at these workshops. In the second part of the Building 2000 final report a summary of a selection of many reports is presented (11 papers), as produced by Design Support experts. Most of the design support activities resulted in changes of the various designs, as have been reported by the design teams in the brochures presented in the first part of this book. It is to be expected that design aids and simulation tools for passive solar options, daylighting concepts, comfort criteria etc., will be utilized more frequently in the future. This will result in a better exchange of information between the actual design practitioners and the European R and D community. This technology transfer will result in buildings with a higher quality with respect to energy and environmental issues.

[Care between ethics, work and political].

Science.gov (United States)

Svandra, Philippe

2015-09-01

Down to the roots, the ethics of care have stood up a "different voice". Building on Carol Gilligan's works, the concept was developed widely in opposition with the rational and universalist aspect of Kant's moral philosophy. However, it also appears that this vision of care runs counter sets the three other main dominant moral theories, ie, utilitarism, John Rawls' procedural ethics and the Aristotelian virtue ethics. We may assert that the care theory presents itself as a contextualized moral theory aiming at taking into account others' vulnerability, in a practical way. Hence, the general term of "care" may encompass the notions of "help", "support" and "healing process", which, in France, for have often been opposed for varied reasons--historical, economical, psychological, professional etc... Switching from a moral position to a professional and practical activity, the concept of care has now undeniably taken on now a social and political dimension.

Building founding method

International Nuclear Information System (INIS)

Tateno, Seiya; Hirako, Shizuka.

1996-01-01

The lower portion of a reactor building is buried at a level of a base rock. In the step of building construction, the base rock around the building is dug of keeping a construction space. The base rock present between the digging line and the building is replaced with an artificial base rock comprising aggregates and cement having a building constraining force substantially equal with that of the lower supporting base rock to obtain constraining force for the side portion of the building. The building itself is made of concrete steels. As the material for replacing the base rock between the digging line and the building, non-reinforced concrete having no steels may provide sufficient function. The burying depth is determined so as to align the surface of the base rock with the level of the base floor of the building. With such procedures, since it is not necessary to increase the area of the lower portion of the building, the amount of the materials for the building can be reduced. In addition, the earthquakes stability can be ensured without changing the shape of the building. (I.N.)

Performance indices and evaluation of algorithms in building energy efficient design optimization

International Nuclear Information System (INIS)

Si, Binghui; Tian, Zhichao; Jin, Xing; Zhou, Xin; Tang, Peng; Shi, Xing

2016-01-01

Building energy efficient design optimization is an emerging technique that is increasingly being used to design buildings with better overall performance and a particular emphasis on energy efficiency. To achieve building energy efficient design optimization, algorithms are vital to generate new designs and thus drive the design optimization process. Therefore, the performance of algorithms is crucial to achieving effective energy efficient design techniques. This study evaluates algorithms used for building energy efficient design optimization. A set of performance indices, namely, stability, robustness, validity, speed, coverage, and locality, is proposed to evaluate the overall performance of algorithms. A benchmark building and a design optimization problem are also developed. Hooke–Jeeves algorithm, Multi-Objective Genetic Algorithm II, and Multi-Objective Particle Swarm Optimization algorithm are evaluated by using the proposed performance indices and benchmark design problem. Results indicate that no algorithm performs best in all six areas. Therefore, when facing an energy efficient design problem, the algorithm must be carefully selected based on the nature of the problem and the performance indices that matter the most. - Highlights: • Six indices of algorithm performance in building energy optimization are developed. • For each index, its concept is defined and the calculation formulas are proposed. • A benchmark building and benchmark energy efficient design problem are proposed. • The performance of three selected algorithms are evaluated.

Relationship between Quality of Building Maintenance Management Services for Indoor Environmental Quality and Occupant Satisfaction: Case Study of Bus Terminal Buildings in Penang

Directory of Open Access Journals (Sweden)

Full Chong Choon

2014-01-01

Full Text Available Maintenance is often defined as the series of activities undertaken to take care of the building structure and services to ensure the intended functions and optimal performance of a building life cycle. The management department of a building is usually responsible for the enhancement of the indoor environment quality by service delivery and for boosting occupant productivity and satisfaction. Thus, a salient point of this study is to determine the current level of the building’s maintenance management service for indoor environmental quality in Penang bus terminals, along with its occupant satisfaction with regards to the services provided in the building. The assessment of the indoor environmental quality includes the evaluation of thermal comfort, lighting condition, air quality and cleanliness. Apart from that, qualitative and quantitative methodologies were applied during the process of data collection and analysis. A questionnaire survey was distributed to 500 of the targeted population for each bus terminal, including passengers and the staff. In this study, the conclusion was drawn in which the maintenance management service level of the bus terminal was directly proportional to occupant satisfaction. However, the current quality of maintenance management services in the bus terminals are still not up to the level of the occupants’ satisfaction.

Integrating Responsive Building Elements in Buildings

DEFF Research Database (Denmark)

Haase, Matthias; Amato, Alex; Heiselberg, Per

2006-01-01

energy strategies to develop guidelines and procedures for estimation of environmental performance of responsive building elements and integrated building concepts This paper introduces the ideas of this collaborative work and discusses its usefulness for Hong Kong and China. Special focus was put...

Global building physics

DEFF Research Database (Denmark)

Rode, Carsten

2013-01-01

High ambitions are set for the building physics performance of buildings today. No single technology can achieve fulfilment of these ambitions alone. Integrated, multi-facetted solutions and optimization are necessary. A holistic, or ‘global’, technological perspective is needed, which includes all...... aspects of the building as defined in building engineering. We live in an international society and building solutions are developed across country borders. Building physics is a global theme. The International Association of Building Physics has global appeal. This brief article reports the keynote...

Global Building Physics

DEFF Research Database (Denmark)

Rode, Carsten

2012-01-01

High ambitions are set for the building physics performance of buildings today. No single technology can achieve fulfilment of these ambitions alone. Integrated, multi-facetted solutions and optimization are necessary. A holistic, or “global”, technological perspective is needed, which includes all...... aspects of the building as defined in building engineering. We live in an international society and building solutions are developed across country borders. Building physics is a global theme. The International Association of Building Physics has global appeal. The keynote lecture and this brief paper...

Health care logistics and space: accounting for the physical build environment

NARCIS (Netherlands)

Boucherie, Richardus J.; Hans, Elias W.; Hartmann, Timo; Larqoque, C.; Himmelspach, J.; Pasupathy, R.; Rose, O.; Uhrmacher, A.M.

2012-01-01

Planning and scheduling of health care processes has improved considerably using operations research techniques. Besides analytical and optimization tools, a substantial amount of sophisticated discrete event simulation tools supporting (re-)design of existing logistical processes in and around

Care Network For The Elderly With Alzheimer’s Disease In The View Of Primary Care Nurses

Directory of Open Access Journals (Sweden)

Matheus Figuereido Nogueira

2017-05-01

Full Text Available Objective: to build a care network for the elderly with Alzheimer’s disease from the view of nurses of the Family Health Strategy (FHS. Method: exploratory qualitative study, developed with seven nurses from the FHS in the city of Santa Cruz, state of Rio Grande do Norte, Brazil. After obtaining a favorable opinion of the Ethics Committee of the Alcides Carneiro University Hospital (CAAE nº 31307314.9.0000.5182, data were collected through semi-structured interviews and analyzed according to the Collective Subject Discourse. Results: for an effective care network to the elderly with Alzheimer, some elements are necessary, such as: care in the three levels of complexity, family support, complementary diagnostic center, pharmaceutical services, continuing education, intersectionality and group of caregivers. Conclusions: when the care to the elderly with Alzheimer’s disease is performed in an articulated manner between the multiples axes that compose the network, it clarifies the caring process, facilitates the decision making, directs care, guarantee a comprehensive care and greatly reduce the deficits associated with this disease. Key-Words: Alzheimer’s disease; Family Health Strategy; Health Care Network.

Building Languages

Science.gov (United States)

... Glossary Contact Information Information For… Media Policy Makers Building Languages Recommend on Facebook Tweet Share Compartir Communicating ... any speech and only very loud sounds. Close × “Building Blocks” “Building Blocks” refers to the different skills ...

ORGANIZATIONAL STRUCTURE FOR BUILDINGS RECONSTRUCTION OF HISTORICAL BUILDING OF ODESSA

Directory of Open Access Journals (Sweden)

POSTERNAK I. М.

2016-12-01

Full Text Available Formulation of the problem. As one of perspective forms of integration various complexes act in town-planning structure. In the course of formation of plans of social and economic development of large cities even more often there is a situation when for increase of efficiency of used resources concentration of efforts is necessary not simply, but also new progressive forms of the organization of building manufacture. Purpose. To offer the organizational structure using in practice the saved up scientific and technical potential for reconstruction of buildings of historical building of Odessa 1820 … 1920 years under standards power efficiency and to execute researches engineering architectonics residential buildings of historical building of a city of Odessa. Conclusion. It is offered to create in the city of Odessa "the Corporate scientific and technical complex town-planning power reconstruction "CSTC T-PPR", as innovative organizational structure which uses in practice the saved up scientific and technical potential for reconstruction of buildings of historical building of Odessa under standards power efficiency. It is considered engineering architectonics residential buildings of historical building of a city of Odessa, in particular, not looking on diverse buildings of inhabited appointment of Odessa, for them there are defining factors on which probably to make their grouping and at the same time to allocate the general lines inherent to a housing estate as a whole. It is resulted a general characteristic and classification of residential buildings of historical building of a city of Odessa ХІХ … beginnings ХХ centuries It is allocated and expanded classification of such buildings of inhabited appointment by duration of residing at them.

ORGANIZATIONAL STRUCTURE FOR RECONSTRUCTION OF BUILDINGS HISTORICAL BUILDING OF ODESSA

Directory of Open Access Journals (Sweden)

POSTERNAK I. М.

2017-05-01

Full Text Available Summary. Raising of problem. As one of perspective forms of integration various complexes act in town- planning structure. In the course of formation of plans of social and economic development of large cities even more often there is a situation when for increase of efficiency of used resources concentration of efforts is necessary not simply, but also new progressive forms of the organization of building manufacture. Purpose. To offer the organizational structure using in practice the saved up scientific and technical potential for reconstruction of buildings of historical building of Odessa 1820 … 1920 years under standards power efficiency and to execute researches engineering architectonics residential buildings of historical building of a city of Odessa. Conclusion. It is offered to create in the city of Odessa "the Corporate scientific and technical complex town-planning power reconstruction "CSTC T-PPR", as innovative organizational structure which uses in practice the saved up scientific and technical potential for reconstruction of buildings of historical building of Odessa under standards power efficiency. It is considered engineering architectonics residential buildings of historical building of a city of Odessa, in particular, not looking on diverse buildings of inhabited appointment of Odessa, for them there are defining factors on which probably to make their grouping and at the same time to allocate the general lines inherent to a housing estate as a whole. It is resulted a general characteristic and classification of residential buildings of historical building of a city of Odessa ХІХ beginnings ХХ centuries It is allocated and expanded classification of such buildings of inhabited appointment by duration of residing at them.

Multiple Learning Strategies Project. Building Maintenance & Engineering. Educable Mentally Impaired. [Vol. 1.

Science.gov (United States)

Smith, Dwight; And Others

This instructional package is one of three designed for educable mentally impaired students in the vocational area of building maintenance and engineering. The thirty learning modules are organized into two units: floor care and general maintenance tasks. Each module includes these elements: a performance objective page which tells the student…

Application of the Reina Trust and Betrayal Model to the experience of pediatric critical care clinicians.

Science.gov (United States)

Rushton, Cynda Hylton; Reina, Michelle L; Francovich, Christopher; Naumann, Phyllis; Reina, Dennis S

2010-07-01

Trust is essential in the workplace, yet no systematic studies of trust among pediatric critical care professionals have been done. To determine the feasibility of measuring trust in a pediatric intensive care unit by using established scales from the corporate world and to determine what behaviors build, break, and rebuild trust. The Reina Trust and Betrayal Model was used to explore contractual, competence, and communication trust. Nurses and physicians in a pediatric intensive care unit completed online surveys to measure organizational, team, and patient trust. Quantitative data from 3 standard survey instruments and qualitative responses to 3 open-ended questions were analyzed and compared. Quantitative data from all 3 instruments indicated moderate to high levels of trust; scores for competence and contractual trust were higher than scores for communication trust. Scores indicated agreement on behaviors that build trust, such as pointing out risky situations to each other, actively striving to build supportive and productive relationships, and giving and receiving constructive feedback. Foremost among trust-breaking behaviors was gossip, which was more troublesome to respondents with longer experience in critical care. Responses to the open-ended questions underscored these themes. The most frequently cited items included encouraging mutually serving intentions, sharing information, and involving and seeking the input of others. The Reina trust scales and open-ended questions are feasible and applicable to pediatric critical care units, and data collected with these instruments are useful in determining what behaviors build, break, and rebuild trust among staff.

Reactor building

International Nuclear Information System (INIS)

Ebata, Sakae.

1990-01-01

At least one valve rack is disposed in a reactor building, on which pipeways to a main closure valve, valves and bypasses of turbines are placed and contained. The valve rack is fixed to the main body of the building or to a base mat. Since the reactor building is designed as class A earthquake-proofness and for maintaining the S 1 function, the valve rack can be fixed to the building main body or to the base mat. With such a constitution, the portions for maintaining the S 1 function are concentrated to the reactor building. As a result, the dispersion of structures of earthquake-proof portion corresponding to the reference earthquake vibration S 1 can be prevented. Accordingly, the conditions for the earthquake-proof design of the turbine building and the turbine/electric generator supporting rack are defined as only the class B earthquake-proof design conditions. In view of the above, the amount of building materials can be saved and the time for construction can be shortened. (I.S.)

FEM Updating of Tall Buildings using Ambient Vibration Data

DEFF Research Database (Denmark)

Ventura, C. E.; Lord, J. F.; Turek, M.

2005-01-01

Ambient vibration testing is the most economical non-destructive testing method to acquire vibration data from large civil engineering structures. The purpose of this paper is to demonstrate how ambient vibration Modal Identification techniques can be effectively used with Model Updating tools...... to develop reliable finite element models of large civil engineering structures. A fifteen story and a forty-eight story reinforced concrete buildings are used as case studies for this purpose. The dynamic characteristics of interest for this study were the first few lateral and torsional natural frequencies...... the information provided in the design documentation of the building. Different parameters of the model were then modified using an automated procedure to improve the correlation between measured and calculated modal parameters. Careful attention was placed to the selection of the parameters to be modified...

Enhancing resilience in registered aged care nurses.

Science.gov (United States)

Cameron, Fiona; Brownie, Sonya

2010-06-01

To identify the factors that impact the resilience of registered aged care nurses, that is their capacity to adapt to the physical, mental and emotional demands of working in aged care facilities. This study explored the lived experience of nine registered nurses working in residential aged care facilities on the Sunshine Coast, Queensland, who were asked to reflect on the phenomenon of resilience in the workplace. This study found that clinical expertise, a sense of purpose in a holistic care environment, a positive attitude and work-life balance are important determinants of resilience in aged care nurses. Resilience in nurses in residential aged care facilities is enhanced when they are able to maintain long-term, meaningful relationships with residents. Collegial support that provides opportunities to debrief and validate experiences as well as the use of humour to defuse stress promotes well-being and builds resilience in the workplace.

Building integrated photovoltaics

NARCIS (Netherlands)

Ritzen, M.J.; Vroon, Z.A.E.P.; Geurts, C.P.W.; Reinders, Angèle; Verlinden, Pierre; Sark, Wilfried; Freundlich, Alexandre

2017-01-01

Photovoltaic (PV) installations can be realized in different situations and on different scales, such as at a building level. PV installations at the building level can either be added to the building envelope, which is called building added PV (BAPV), or they can be integrated into the building

Building social participation with a support group users: challenges of care qualification in a Psychosocial Care Center (CAPS

Directory of Open Access Journals (Sweden)

Vitor Corrêa Detomini

2015-09-01

Full Text Available The literature points out a lack of studies describing practical experiences approaching the role of social participation, even though, the subject Brazilian Health System (SUS as a principle is valued by theoretical-conceptual works. The lack of studies is especially observed in mental health care services, where the existing studies focus on the users’ management engagement as part of psychosocial rehabilitation. Thus, this article introduces an experience developed in a Center for Psycho-Social Attention (CAPS, in the state of Mato Grosso do Sul, aiming to address the issue of social participation in care qualification, in accordance to legislation and technical standards. Thisstudy focused on two types of sources. 1 Internship Final Report of a Psycology Student including 54 sessions of a support group, 2 technical and legal documents concerning the SUS and the National Mental Health Policy and Humanization. The service aspects were analyzed through technical and legislative foundations - focusing the needs and claims on group discussions, classified as structure and process, used to assess the health care quality. Most concerns were listed on normative Ordinances and Regulations. Achieving social participation was not an institutional premise and, among the main difficulties was the medical/outpatient centered model and the representation of “crazy”/”CAPS users” as incapable. It requires: i integration of “clinic” and “politics”; ii intensification of interdisciplinary and psychological care; iii respect the citizenship of mental health users, and, finally, iv that the collective participation spaces do not exhaust themselves. Therefore, the collective participation spaces need practical recommendations in order to improve the structures and work processes and meet the users’ needs.

Better Buildings Neighborhood Program: BetterBuildings Lowell Final Report

Energy Technology Data Exchange (ETDEWEB)

Heslin, Thomas

2014-01-31

The City of Lowell set four goals at the beginning of the Better Buildings Neighborhood Program: 1. Improve the Downtown Historic Park District’s Carbon Footprint 2. Develop a sustainable and replicable model for energy efficiency in historic buildings 3. Create and retain jobs 4. Promote multi-stakeholder partnerships The City of Lowell, MA was awarded $5 million in May 2010 to conduct energy efficiency retrofits within the downtown National Historical Park (NHP). The City’s target was to complete retrofits in 200,000 square feet of commercial space and create 280 jobs, while adhering to the strict historical preservation regulations that govern the NHP. The development of a model for energy efficiency in historic buildings was successfully accomplished. BetterBuildings Lowell’s success in energy efficiency in historic buildings was due to the simplicity of the program. We relied strongly on the replacement of antiquated HVAC systems and air sealing and a handful of talented energy auditors and contractors. BetterBuildings Lowell was unique for the Better Buildings Neighborhood Program because it was the only program that focused solely on commercial properties. BetterBuildings Lowell did target multi-family properties, which were reported as commercial, but the majority of the building types and uses were commercial. Property types targeted were restaurants, office buildings, museums, sections of larger buildings, mixed use buildings, and multifamily buildings. This unique fabric of building type and use allows for a deeper understanding to how different properties use energy. Because of the National Historical Park designation of downtown Lowell, being able to implement energy efficiency projects within a highly regulated historical district also provided valuable research and precedent proving energy efficiency projects can be successfully completed in historical districts and historical buildings. Our program was very successful in working with the local

Building Maintenance in Old Buildings Conservation Approach: An Overview of Related Problems

Directory of Open Access Journals (Sweden)

Brit Kayan

2006-12-01

Full Text Available Building maintenance in conservation of old buildings is one of the approaches applied within the built environment of Malaysia. For instance, it is realised that these old buildings contribute an important significance to our nation's priceless heritage and unique historical development. However, most of these buildings' maintenance is influenced by related problems that affect the overall building conservation approach. Therefore, these old buildings face problems which greatly affect their overall condition and performance: building structure; building appearance and aesthetic; building materials and building character. In most critical situations, there is a greater possibility that we could lose the cultural significance and heritage values of these old buildings through ignoring the related problems. This paper tries to identify the related problems, reveal the findings and discuss suitable approaches to conserving these old buildings.

Improving primary care for persons with spinal cord injury: Development of a toolkit to guide care.

Science.gov (United States)

Milligan, James; Lee, Joseph; Hillier, Loretta M; Slonim, Karen; Craven, Catharine

2018-05-07

To identify a set of essential components for primary care for patients with spinal cord injury (SCI) for inclusion in a point-of-practice toolkit for primary care practitioners (PCP) and identification of the essential elements of SCI care that are required in primary care and those that should be the focus of specialist care. Modified Delphi consensus process; survey methodology. Primary care. Three family physicians, six specialist physicians, and five inter-disciplinary health professionals completed surveys. Importance of care elements for inclusion in the toolkit (9-point scale: 1 = lowest level of importance, 9 = greatest level of importance) and identification of most responsible physician (family physician, specialist) for completing key categories of care. Open-ended comments were solicited. There was consensus between the respondent groups on the level of importance of various care elements. Mean importance scores were highest for autonomic dysreflexia, pain, and skin care and lowest for preventive care, social issues, and vital signs. Although, there was agreement across all respondents that family physicians should assume responsibility for assessing mental health, there was variability in who should be responsible for other care categories. Comments were related to the need for shared care approaches and capacity building and lack of knowledge and specialized equipment as barriers to optimal care. This study identified important components of SCI care to be included in a point-of-practice toolkit to facilitate primary care for persons with SCI.

Courthouse Prototype Building

Energy Technology Data Exchange (ETDEWEB)

Malhotra, Mini [ORNL; New, Joshua Ryan [ORNL; Im, Piljae [ORNL

2018-02-01

As part of DOE's support of ANSI/ASHRAE/IES Standard 90.1 and IECC, researchers at Pacific Northwest National Laboratory (PNNL) apply a suite of prototype buildings covering 80% of the commercial building floor area in the U.S. for new construction. Efforts have started on expanding the prototype building suite to cover 90% of the commercial building floor area in the U.S., by developing prototype models for additional building types including place of worship, public order and safety, public assembly. Courthouse is courthouse is a sub-category under the “Public Order and Safety" building type category; other sub-categories include police station, fire station, and jail, reformatory or penitentiary.ORNL used building design guides, databases, and documented courthouse projects, supplemented by personal communication with courthouse facility planning and design experts, to systematically conduct research on the courthouse building and system characteristics. This report documents the research conducted for the courthouse building type and proposes building and system characteristics for developing a prototype building energy model to be included in the Commercial Building Prototype Model suite. According to the 2012 CBECS, courthouses occupy a total of 436 million sqft of floor space or 0.5% of the total floor space in all commercial buildings in the US, next to fast food (0.35%), grocery store or food market (0.88%), and restaurant or cafeteria (1.2%) building types currently included in the Commercial Prototype Building Model suite. Considering aggregated average, courthouse falls among the larger with a mean floor area of 69,400 sqft smaller fuel consumption intensity building types and an average of 94.7 kBtu/sqft compared to 77.8 kBtu/sqft for office and 80 kBtu/sqft for all commercial buildings.Courthouses range in size from 1000 sqft to over a million square foot building gross square feet and 1 courtroom to over 100 courtrooms. Small courthouses

Various methods of heat supply for a building which is operated periodically during the year

Directory of Open Access Journals (Sweden)

Małetka Marek

2017-01-01

Full Text Available Stand-alone buildings operated periodically require heat supply for hot water and heating purposes to be carefully analyzed in terms of the technical capabilities, the energy and financial outlays. The paper presents the analysis of heat supply for hot water purposes and central heating in the stand-alone cloakroom building located in Poland. The analysis is undertaken for different variants of heat delivery for a building from electric heaters, gas boiler and district heating solutions to renewable sources applications, namely solar panels and heat pumps. For each solution, usage of usable, final and primary energy was calculated. Also the financial analysis for investments and energy costs were carried out. This analysis has been done in according to SPBT and NPV method for different levels of building use.

Building a leadership brand.

Science.gov (United States)

Ulrich, Dave; Smallwood, Norm

2007-01-01

How do some firms produce a pipeline of consistently excellent managers? Instead of concentrating merely on strengthening the skills of individuals, these companies focus on building a broad organizational leadership capability. It's what Ulrich and Smallwood--cofounders of the RBL Group, a leadership development consultancy--call a leadership brand. Organizations with leadership brands take an "outside-in" approach to executive development. They begin with a clear statement of what they want to be known for by customers and then link it with a required set of management skills. The Lexus division of Toyota, for instance, translates its tagline--"The pursuit of perfection"--into an expectation that its leaders excel at managing quality processes. The slogan of Bon Secours Health System is "Good help to those in need." It demands that its managers balance business skills with compassion and caring. The outside-in approach helps firms build a reputation for high-quality leaders whom customers trust to deliver on the company's promises. In examining 150 companies with strong leadership capabilities, the authors found that the organizations follow five strategies. First, make sure managers master the basics of leadership--for example, setting strategy and grooming talent. Second, ensure that leaders internalize customers' high expectations. Third, incorporate customer feedback into evaluations of executives. Fourth, invest in programs that help managers hone the right skills, by tapping customers to participate in such programs. Finally, track the success of efforts to build leadership bench strength over the long-term. The result is outstanding management that persists even when individual executives leave. In fact, companies with the strongest leadership brands often become "leader feeders"--firms that regularly graduate leaders who go on to head other companies.

Improving care coordination using organisational routines.

Science.gov (United States)

Prætorius, Thim

2016-01-01

The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can be replicated, the way they are influenced by the organisation and the way they influence health care professionals. Theory of routines is systematically applied to care pathways in order to develop theoretically derived propositions. Care pathways mirror routines by being recurrent, collective and embedded and specific to an organisation. In particular, care pathways resemble standard operating procedures that can give rise to recurrent collective action patterns. In all, 11 propositions related to five categories are proposed by building on these insights: care pathways and coordination, change, replication, the organisation and health care professionals. Research limitations/implications - The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research. The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals. Originality/value - Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.

Building a clinical leadership community to drive improvement: a multi-case educational study to inform 21st century clinical commissioning, professional capability and patient care.

Science.gov (United States)

Lynch, Marion; Verner, Elizabeth

2013-01-01

The new NHS requires transformational leadership; people with the knowledge and motivation to make effective change combined with an understanding of the system they work in. The aim of the Practice Leaders' Programme (PLP) is to generate the conditions needed to focus the energy and collaborative creativity required for innovation to enhance leadership skills across the health economy improving patient care. The PLP engaged 60 local leaders from central England in a new approach enabling them to influence others. It has informed educational policy and practice and helped change professional behaviours. Each participant implemented improvements in care and participated in six action learning sets (ALS) and up to six coaching sessions. Evidence of progress, learning and impact was identified in project reports, reflective diaries and evaluations. The ALS brought together key individuals from clinical and management disciplines across a diverse organisation to redesign a system by developing a shared vision for improving the quality of patient care. The links forged, the projects initiated, and the skills cultivated through the PLP produced ongoing benefits and outcomes beyond the course itself. Coaching sessions helped participants focus their efforts to achieve maximum impact and to become resilient in managing service change effectively. The programme has evolved over four years, building on recommendations from external evaluation which identified statistically significant increases in leadership competences. Further enhancement of this programme secured an International Health Improvement Award. Three key findings of positive impact have emerged; personal growth, service improvement, and legacy and sustainability.

NETWORKS OF HEALTH CARE: A CHALLENGE TO SUS MANAGEMENT

Directory of Open Access Journals (Sweden)

Camila Dubow

2013-09-01

Full Text Available The article proposes a critical reflection, based on national law, scholarly, scientific, on the current development of Networks of Health Care, as a strategy for strengthening the Single Health System (SUS. Are weighted inefficiency of traditional ways of organizing care and management, the challenge of Network Health Care for comprehensive care and management mechanisms used in this process. The work provides subsidies for the care practices and health management are reflected, pointing strategies that result in disruptions of paradigms through a refocusing of attention in existing models. For networks of health care can be consolidated, is fundamental to political sensitivity of health managers with a commitment to build a new model of care, through the struggle to consolidate the SUS and the realization of the principles of universality, comprehensiveness and equity.

Relaying experiences for care home design

DEFF Research Database (Denmark)

Raudaskoski, Pirkko Liisa

2014-01-01

stakeholders (researchers, family members, etc.) could put forward their ideas and wishes about the facilities of a soon-to-be-built care home for people with brain injury. In other words, the seminar was part of a wider diagnostic endeavor that was to be started in a specially designed building. The future...

ImBuild: Impact of building energy efficiency programs

Energy Technology Data Exchange (ETDEWEB)

Scott, M.J.; Hostick, D.J.; Belzer, D.B.

1998-04-01

As part of measuring the impact of government programs on improving the energy efficiency of the Nation`s building stock, the Department of Energy Office of Building Technology, State and Community Programs (BTS) is interested in assessing the economic impacts of its portfolio of programs, specifically the potential impact on national employment and income. The special-purpose version of the IMPLAN model used in this study is called ImBuild. In comparison with simple economic multiplier approaches, such as Department of Commerce RIMS 2 system, ImBuild allows for more complete and automated analysis of the economic impacts of energy efficiency investments in buildings. ImBuild is also easier to use than existing macroeconomic simulation models. The authors conducted an analysis of three sample BTS energy programs: the residential generator-absorber heat exchange gas heat pump (GAX heat pump), the low power sulfur lamp (LPSL) in residential and commercial applications, and the Building America program. The GAX heat pump would address the market for the high-efficiency residential combined heating and cooling systems. The LPSL would replace some highly efficient fluorescent commercial lighting. Building America seeks to improve the energy efficiency of new factory-built, modular, manufactured, and small-volume, site-built homes through use of systems engineering concepts and early incorporation of new products and processes, and by increasing the demand for more energy-efficient homes. The authors analyze a scenario for market penetration of each of these technologies devised for BTS programs reported in the BTS GPRA Metrics Estimates, FY99 Budget Request, December 19, 1997. 46 figs., 4 tabs.

Environmental effect of structural solutions and building materials to a building

International Nuclear Information System (INIS)

Haapio, Appu; Viitaniemi, Pertti

2008-01-01

The field of building environmental assessment tools has become a popular research area over the past decade. However, how the service life of a building affects the results of the environmental assessment of a building has not been emphasised previously. The aim of this study is to analyse how different structural solutions and building materials affect the results of the environmental assessment of a whole building over the building's life cycle. Furthermore, how the length of the building's service life affects the results is analysed. The environmental assessments of 78 single-family houses were calculated for this study. The buildings have different wall insulations, claddings, window frames, and roof materials, and the length of the service life varies from 60 years up to 160 years. The current situation and the future of the environmental assessment of buildings are discussed. In addition, topics for further research are suggested; for example, how workmanship affects the service life and the environmental impact of a building should be studied

Solar building

OpenAIRE

Zhang, Luxin

2014-01-01

In my thesis I describe the utilization of solar energy and solar energy with building integration. In introduction it is also mentioned how the solar building works, trying to make more people understand and accept the solar building. The thesis introduces different types of solar heat collectors. I compared the difference two operation modes of solar water heating system and created examples of solar water system selection. I also introduced other solar building applications. It is conv...

Building envelope

CSIR Research Space (South Africa)

Gibberd, Jeremy T

2009-01-01

Full Text Available for use in the building. This is done through photovoltaic and solar water heating panels and wind turbines. Ideally these are integrated in the design of the building envelope to improve the aesthetic quality of the building and minimise material... are naturally ventilated. Renewable energy The building envelope includes renewable energy generation such as photovoltaics, wind turbines and solar water heaters and 10% of the building’s energy requirements are generated from these sources. Views All...

Home health care nurses' perceptions of empowerment.

Science.gov (United States)

Williamson, Kathleen M

2007-01-01

This exploratory study involved the triangulation of qualitative (interview and observation) and quantitative methods (Psychological Empowerment Instrument). This study examined the individual home care nurses' perception of empowerment and how it influences decisions in the home clinical setting. Fifteen nurses were self-selected to participate. All completed an interview, and were observed and given Likert Instrument to complete. A framework analysis was performed to identify mutually exclusive and exhaustive emergent themes and patterns within the data. Home care nurses described that enpowerment is in the interaction between nurse and patient, and nurse and health care provider. Empowered is defined as being independent, confident, trusting, and comfortable with providing quality care. Home health care nurses believe that having the ability to practice collaboratively and build professional relationships was essential. Nurses in this study perceived empowerment as having meaning, choice, and competence in their job.

Challenges in Commercial Buildings | Buildings | NREL

Science.gov (United States)

systems Assessing the energy and economic impacts of various technologies, giving priority to those that standardized language for commercial building energy audit data that can be used by software developers to exchange data between audit tools, and can be required by building owners and audit program managers to

Building energy analysis tool

Science.gov (United States)

Brackney, Larry; Parker, Andrew; Long, Nicholas; Metzger, Ian; Dean, Jesse; Lisell, Lars

2016-04-12

A building energy analysis system includes a building component library configured to store a plurality of building components, a modeling tool configured to access the building component library and create a building model of a building under analysis using building spatial data and using selected building components of the plurality of building components stored in the building component library, a building analysis engine configured to operate the building model and generate a baseline energy model of the building under analysis and further configured to apply one or more energy conservation measures to the baseline energy model in order to generate one or more corresponding optimized energy models, and a recommendation tool configured to assess the one or more optimized energy models against the baseline energy model and generate recommendations for substitute building components or modifications.

Early Childhood Behavioral Health Integration in Pediatric Primary Care: Serving Refugee Families in the Healthy Steps Program

Science.gov (United States)

Buchholz, Melissa; Fischer, Collette; Margolis, Kate L.; Talmi, Ayelet

2016-01-01

Primary care settings are optimal environments for providing comprehensive, family-centered care to young children and their families. Primary care clinics with integrated behavioral health clinicians (BHCs) are well-positioned to build trust and create access to care for marginalized and underserved populations. Refugees from around the world are…

U.S.– India Joint Center for Building Energy Research and Development (CBERD) Caring for the Energy Health of Healthcare Facilities

Energy Technology Data Exchange (ETDEWEB)

Singh, Reshma [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Mathew, Paul [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Granderson, Jessica [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Srivastava, Rohini [Carnegie Mellon Univ., Pittsburgh, PA (United States); Shukla, Rash [Center for Environmental Planning and Technology (India)

2016-03-01

The U.S.-India Joint Center for Building Energy Research & Development (CBERD), created through the Partnership to Accelerate Clean Energy (PACE) agreement between the United States and India, is a research and development (R&D) center with over 30 institutional and industry partners from both nations. This five-year presidential initiative is jointly funded by the U.S. Department of Energy and the Government of India. CBERD aims to build upon a foundation of collaborative knowledge, tools, and technologies, and human capabilities that will increase development of high-performance buildings. To reach this goal, the R&D focuses on energy use reduction throughout the entire life cycle of buildings—i.e., design, construction, and operations. During the operations phase of buildings, even with best-practice energy-efficient design, actual energy use can be much higher than the design intent. Every day, much of the energy consumed by buildings serves no purpose (Roth et al. 2005). Building energy information systems (EIS) are commercially available systems that building owners and facility managers use to assess their building operations, measure, visualize, analyze, and report energy cost and consumption. Energy information systems can enable significant energy savings by tracking energy use, identifying consumption patterns, and benchmarking performance against similar buildings, thereby identifying improvement opportunities. The CBERD team has identified potential energy savings of approximately 2 quads of primary energy in the United States, while industry building energy audits in India have indicated potential energy savings of up to 30 percent in commercial buildings such as offices. Additionally, the CBERD team has identified healthcare facilities (e.g., hospitals, clinics), hotels, and offices as the three of the highest-growth sectors in India that have significant energy consumption, and that would benefit the most from implementation of EIS.

A pilot study on the effects of a team building process on the perception of work environment in an integrative hospital for neurological rehabilitation

Directory of Open Access Journals (Sweden)

Büssing Arndt

2010-03-01

Full Text Available Abstract Background Neurological rehabilitation is one of the most care-intensive challenges in the health care system requiring specialist therapeutic and nursing knowledge. In this descriptive pilot study, we investigated the effects of a team building process on perceived work environment, self-ascribed professional competence, life satisfaction, and client satisfaction in an anthroposophic specialized hospital for neurological rehabilitation. The team-building process consisted of didactic instruction and training in problem-solving, teambuilding and constructive conflict resolution. Methods Seventy seven staff members and 44 patients' relatives were asked to complete a survey that included the Work Environment Scale (WES-10, a Life Satisfaction Scale (BMLSS, the Conviction of Therapeutic Competency (CTC scale and the Client Satisfaction Questionnaire (CSQ-8. To evaluate the outcome of the team building process, we analyzed changes over time in the WES-10 subscales. Additionally the interrelationship between the WES-10 subscales with other subscales and with sociodemographic parameters like age, gender was calculated by means of a bivariate correlation analysis. Results The team building process had a significant positive effect on perceived work environment in only one area. There was a significant improvement in the ward staffs' perception of their ability to constructively resolve conflicts 3 years after inception of the team building process than there was before inception. However, even in a unit that utilized holistic treatment and nursing in the care of severely disable patients, such care necessitating a very heavy workload, the measurements on the Self Realization, Life Satisfaction and Conviction of Therapeutic Competency scales remained high and unchanged over the three year time period of the study. Conclusions Strategic interventions might be an option to improve interpersonal relationships and finally quality of patient care.

Sustainable Building Operation

DEFF Research Database (Denmark)

Jensen, Jesper Ole

2009-01-01

of sustainable building operation and a survey amongst building administrators from the private and the social housing sector. Our results show that there are many good examples on sustainable building operation in Danish housing estates, where local building managers, residents etc. have gained impressive......Energy-savings in the existing building stock have becomes a main goal in national and international policies. Often focus is on building-renovations, whereas the potential of sustainable building operation to a large extent has been neglected. Nevertheless, international research as well...... as practical experiences from Danish housing estates indicates that there are large potentials for energy savings by focusing on the operation of the buildings. We suggest that in order to achieve sustainability in the existing housing, renovation and operations should be seen as integrated parts...

Sick building syndrome

Directory of Open Access Journals (Sweden)

Tjandra Y. Aditama

2002-06-01

Full Text Available Sick building syndrome describes a number of mostly unspesific complaints of some occupants of the building. The exact pathophysiological mechanism remains elusive. It is a multi factorial event which may include physical, chemical, biological as well as psycological factors. In many cases it is due to insufficient maintenance of the HVAC (heating, ventilation, air conditioning system in the building. Sign and symptoms can be uncomfortable and even disabling, which may include mucus membrane irritation, neurotoxic symptoms, asthma like symptoms, skin complaints, gastrointestinal symptoms and other related symptoms. There are various investigation methods to diagnose sick building syndrome, and on site assessment of the building is extremely useful. Prevention through a proactive air quality monitoring program is far more desirable than dealing with an actual sick building. Indoor air and the sick building symdrome serves as a paradigm of modern occupational and environmental medicine. (Med J Indones 2002; 11:124-31Keywords: indoor air pollution, sick building syndrome, building related illness

Early Childhood Education and Care Educators Supporting Parent-Child Relationships: A Systematic Literature Review

Science.gov (United States)

O'Connor, Amanda; Nolan, Andrea; Bergmeier, Heidi; Hooley, Merrilyn; Olsson, Craig; Cann, Warren; Williams-Smith, Janet; Skouteris, Helen

2017-01-01

Building strong relationships between children and parents is vital for children's social and emotional development. A majority of children attend early childhood education and care (ECEC) settings where they experience a range of relationships (educator-child, educator-parent, parent-child). Educators build relationships with children and…

Building when the climate gets warmer

International Nuclear Information System (INIS)

Brunner, C. U.; Steinemann, U.; Nipkow, J.

2007-01-01

This final report for the Swiss Federal Office of Energy (SFOE), takes a look at how the building process will have to take account of climate change with higher summer temperatures in Switzerland. The authors consider the situation as being in strong contrast to the past in Switzerland, when attention was devoted to energy demand in buildings during the winter. Today there is a new focus with the anticipation of increasingly frequent, extended hot spells in summer. The goal of this investigation is to analyse and present economic measures to assure a high level of summer comfort with a reduced demand for electricity under these changing conditions. Strategies with respect to construction, technology and operation are addressed. The current spread of technically questionable and inefficient room air conditioning units in residential and commercial buildings is considered as being strongly reminiscent of a dangerous, analogous case in the past, when small electric heaters became widespread. A largely untapped potential exists for increasing the efficiency of air conditioning and chiller technologies for both central systems and room units by the careful use of small temperature differences. Several new and unconventional solution paths are discussed, including high-efficiency room air conditioners, solar cooling equipment, balanced mechanical ventilation, phase-change materials, thermal storage, etc., all aimed at reducing electricity consumption. The expected additional electricity demand of around 1.9 TWh annually for ventilation and air conditioning is commented on.

Applied building physics

CERN Document Server

Hens, Hugo S L C

2012-01-01

The energy crises of the 1970s, persisting moisture problems, complaints about sick buildings, thermal, visual and olfactory discomfort, and the move towards more sustainability in building construction have pushed Building Physics to the forefront of building innovation. The societal pressure to diminish energy consumption in buildings without impairing usability acted as a trigger to activate the whole notion of performance based design and construction. As with all engineering sciences, Building Physics is oriented towards application, which is why, after a first book on fundamentals this s

Assessment Framework of Building Facade in Optimizing Indoor Thermal Comfort of Green Building Index (GBI Certified Office Building

Directory of Open Access Journals (Sweden)

Abdul Tharim Asniza Hamimi

2016-01-01

Full Text Available During the past decade, the construction industry has seen a new trend in the development of “green” or “sustainable” construction concept around the world with vast support from prominent organization, together with the introduction of sustainable building codes. The establishment of green building certification systems worldwide is seen as one of the most efforts in the emerging green building movement. In order to support the development of the “green” and “sustainable” concept in Malaysia, Green Building Index (GBI was launched by the government on 21 May 2009 that created to promote sustainability in the built environment and raise awareness of environmental issues. However, the construction industry seems to have focused only on findings the “right mechanism” for an environmentally sustainable “final result” in order for the building to be certified as green with the lacking of continuous assessment on the building performance after the certifications. This study is purposely conducted to investigate the performance of various rated Green Building Index (GBI Non-Residential New Construction office buildings and the influence on Indoor Thermal Comfort (ITC of the selected buildings. The aim is to develop an assessment framework for optimum green building architectural façade to be used for office buildings in Malaysia as well as to analyse the occupants’ perception, satisfaction and performance in the selected Green Building Index (GBI rated office indoor environment. This research is still in its infancy; therefore the paper is focused on research aims, research scope and methodology, and expected deliverables for the proposed research.

Building Performance Simulation for Sustainable Energy Use in Buildings

NARCIS (Netherlands)

Hensen, J.L.M.

2010-01-01

This paper aims to provide a general view of the background and current state of building performance simulation, which has the potential to deliver, directly or indirectly, substantial benefits to building stakeholders and to the environment. However the building simulation community faces many

Building performance simulation for sustainable building design and operation

NARCIS (Netherlands)

Hensen, J.L.M.

2011-01-01

This paper aims to provide a general view of the background and current state of building performance simulation, which has the potential to deliver, directly or indirectly, substantial benefits to building stakeholders and to the environment. However the building simulation community faces many

The Denver Federal Courthouse: Energy-efficiency in a new Federal building

Energy Technology Data Exchange (ETDEWEB)

Jacobs, P.C.; Holtz, M.J.; Digert, N.; Starkweather, S.; Porter, F.; Clevenger, C.

1999-07-01

The US Federal Courthouse Expansion in Denver, Colorado is twelve story, 16,112 m{sup 2} project to be constructed adjacent to several existing Courthouse and Federal buildings in downtown Denver. The project has been designated a sustainable design showcase by the General Services Administration, and additional funds were made available to the project for sustainable design features. The design achieves a high level of energy efficiency through a combination of strategies that seek first to reduce building lighting and HVAC loads as low as possible, and then satisfy the remaining, loads through a combination of state-of-the-art, high-efficiency mechanical, electrical, and renewable energy systems. The unique attributes of the Denver climate--sunny skies and low humidity, are utilized throughout the design to minimize energy consumption. The resulting building provides a visible expression of sustainability through the incorporation of a set of features that are designed to work together in an integrated energy-efficient building system. Careful life-cycle assessment of materials and building practices results in minimized use of natural resources as well as a healthier environment for the occupants. The use of local materials is emphasized and the building is designed to have a 100-year life. Issues addressed in material selection include sustainability, recyclability, toxicity, and maintenance. The criteria used to establish the success of the design are contained in the Leadership in Energy and Environmental Design (LEED) rating system. Although the building is currently entering final design, a LEED gold rating is expected.

49 CFR 41.110 - New DOT owned buildings and additions to buildings.

Science.gov (United States)

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false New DOT owned buildings and additions to buildings....110 New DOT owned buildings and additions to buildings. (a) DOT Operating Administrations responsible for the design and construction of new DOT Federally owned buildings will ensure that each building is...

Conflict Management Strategies in the ICU Differ Between Palliative Care Specialists and Intensivists.

Science.gov (United States)

Chiarchiaro, Jared; White, Douglas B; Ernecoff, Natalie C; Buddadhumaruk, Praewpannarai; Schuster, Rachel A; Arnold, Robert M

2016-05-01

Conflict is common between physicians and surrogate decision makers around end-of-life care in ICU. Involving experts in conflict management improve outcomes, but little is known about what differences in conflict management styles may explain the benefit. We used simulation to examine potential differences in how palliative care specialists manage conflict with surrogates about end-of-life treatment decisions in ICUs compared with intensivists. Subjects participated in a high-fidelity simulation of conflict with a surrogate in an ICU. In this simulation, a medical actor portrayed a surrogate decision maker during an ICU family meeting who refuses to follow an advance directive that clearly declines advanced life-sustaining therapies. We audiorecorded the simulation encounters and applied a coding framework to quantify conflict management behaviors, which was organized into two categories: task-focused communication and relationship building. We used negative binomial modeling to determine whether there were differences between palliative care specialists' and intensivists' use of task-focused communication and relationship building. Single academic medical center ICU. Palliative care specialists and intensivists. None. We enrolled 11 palliative care specialists and 25 intensivists. The palliative care specialists were all attending physicians. The intensivist group consisted of 11 attending physicians, 9 pulmonary and critical care fellows, and 5 internal medicine residents rotating in the ICU. We excluded five residents from the primary analysis in order to reduce confounding due to training level. Physicians' mean age was 37 years with a mean of 8 years in practice. Palliative care specialists used 55% fewer task-focused communication statements (incidence rate ratio, 0.55; 95% CI, 0.36-0.83; p = 0.005) and 48% more relationship-building statements (incidence rate ratio, 1.48; 95% CI, 0.89-2.46; p = 0.13) compared with intensivists. We found that palliative care

Revolutionizing Climate Science: Using Teachers as Communicators

Science.gov (United States)

Warburton, J.; Crowley, S.; Wood, J.

2012-12-01

PolarTREC (Teachers and Researchers Exploring and Collaborating) is a National Science Foundation (NSF) funded program in which K-12 teachers participate in hands-on field research experiences in the Polar Regions. Teachers are the dynamic conduits for communicating climate science. In the PolarTREC final report, researchers found that teachers were vital in refining the language of their science and have shaped the goals of the scientific project. Program data demonstrates that science in classrooms is better understood when teachers have a full-spectrum grasp of project intricacies from defining the project, to field data collection, encountering situations for creativity and critical thinking, as well as participating in data and project analysis. Teachers' translating the authentic scientific process is integral in communicating climate science to the broader public. Teachers playing a major role in polar science revolutionize the old paradigm of "in-school learning". Through daily online journaling and forums, social media communication, live webinars with public, and professional development events, these teachers are moving beyond classrooms to communicate with society. Through teachers, climate policy can be shaped for the future by having scientifically literate students as well as assessable science. New paradigms come as teachers attain proficient levels of scientific understanding paired with the expert abilities for communication with years of experience. PolarTREC teachers are a model for new interactions peer-to-peer learning and mentorship for young scientists. Our programmatic goal is to expand the opportunities for PolarTREC teachers to share their involvement in science with additional formal and informal educators. 'Teaching the teachers' will reach exponential audiences in media, policy, and classrooms. Modeling this program, we designed and conducted a teacher training on climate science in Denali National Park. Utilizing expert university

Energy consumption program: A computer model simulating energy loads in buildings

Science.gov (United States)

Stoller, F. W.; Lansing, F. L.; Chai, V. W.; Higgins, S.

1978-01-01

The JPL energy consumption computer program developed as a useful tool in the on-going building modification studies in the DSN energy conservation project is described. The program simulates building heating and cooling loads and computes thermal and electric energy consumption and cost. The accuracy of computations are not sacrificed, however, since the results lie within + or - 10 percent margin compared to those read from energy meters. The program is carefully structured to reduce both user's time and running cost by asking minimum information from the user and reducing many internal time-consuming computational loops. Many unique features were added to handle two-level electronics control rooms not found in any other program.

Virtual building environments (VBE) - Applying information modeling to buildings

Energy Technology Data Exchange (ETDEWEB)

Bazjanac, Vladimir

2004-06-21

A Virtual Building Environment (VBE) is a ''place'' where building industry project staffs can get help in creating Building Information Models (BIM) and in the use of virtual buildings. It consists of a group of industry software that is operated by industry experts who are also experts in the use of that software. The purpose of a VBE is to facilitate expert use of appropriate software applications in conjunction with each other to efficiently support multidisciplinary work. This paper defines BIM and virtual buildings, and describes VBE objectives, set-up and characteristics of operation. It informs about the VBE Initiative and the benefits from a couple of early VBE projects.

A Participatory Model of the Paradox of Primary Care

Science.gov (United States)

Homa, Laura; Rose, Johnie; Hovmand, Peter S.; Cherng, Sarah T.; Riolo, Rick L.; Kraus, Alison; Biswas, Anindita; Burgess, Kelly; Aungst, Heide; Stange, Kurt C.; Brown, Kalanthe; Brooks-Terry, Margaret; Dec, Ellen; Jackson, Brigid; Gilliam, Jules; Kikano, George E.; Reichsman, Ann; Schaadt, Debbie; Hilfer, Jamie; Ticknor, Christine; Tyler, Carl V.; Van der Meulen, Anna; Ways, Heather; Weinberger, Richard F.; Williams, Christine

2015-01-01

PURPOSE The paradox of primary care is the observation that primary care is associated with apparently low levels of evidence-based care for individual diseases, but systems based on primary care have healthier populations, use fewer resources, and have less health inequality. The purpose of this article is to explore, from a complex systems perspective, mechanisms that might account for the effects of primary care beyond disease-specific care. METHODS In an 8-session, participatory group model-building process, patient, caregiver, and primary care clinician community stakeholders worked with academic investigators to develop and refine an agent-based computer simulation model to test hypotheses about mechanisms by which features of primary care could affect health and health equity. RESULTS In the resulting model, patients are at risk for acute illness, acute life-changing illness, chronic illness, and mental illness. Patients have changeable health behaviors and care-seeking tendencies that relate to their living in advantaged or disadvantaged neighborhoods. There are 2 types of care available to patients: primary and specialty. Primary care in the model is less effective than specialty care in treating single diseases, but it has the ability to treat multiple diseases at once. Primary care also can provide disease prevention visits, help patients improve their health behaviors, refer to specialty care, and develop relationships with patients that cause them to lower their threshold for seeking care. In a model run with primary care features turned off, primary care patients have poorer health. In a model run with all primary care features turned on, their conjoint effect leads to better population health for patients who seek primary care, with the primary care effect being particularly pronounced for patients who are disadvantaged and patients with multiple chronic conditions. Primary care leads to more total health care visits that are due to more disease

T-cell receptor and K-deleting recombination excision circles in newborn screening of T- and B-cell defects: review of the literature and future challenges

Directory of Open Access Journals (Sweden)

Marco Chiarini

2013-05-01

Full Text Available Since its introduction as a public health programme in the United States in the early 1960s, newborn blood screening (NBS has evolved from the detection of phenylalanine levels on filter paper to the application of DNA-based technologies to identify T-cell lymphopenia in infants with severe combined immunodeficiency. This latter use of NBS has required the development of an assay for T-cell lymphopenia based on the quantification of T-cell receptor excision circles (TRECs that could be performed on dried blood spots routinely collected from newborn infants. The TREC-based NBS was developed six years ago, and there have already been 7 successful pilot studies since then. Similarly, efforts are now being made to establish a screen for B-cell defects, in particular agammaglobulinaemia, taking advantage of the introduction of the method for the quantification of K-deleting recombination excision circles (KRECs. A further achievement of NBS could be the simultaneous recognition of T- and B-cell defects using the combined quantification of TRECs and KRECs from Guthrie card blood spots. This approach may help the early identification of infants with T- and B-cell deficiencies so that they can then be referred to specialised paediatric centres, where a precise diagnosis of severe combined immunodeficiency and agammaglobulinaemia can be performed, and where then they can immediately receive specific therapy. Simultaneous TREC and KREC quantification should also allow classification of patients into subgroups and help identify children with less serious primary immunodeficiencies. This would help avoid the opportunistic infections and frequent hospitalisations that result from a late or lack of diagnosis.

Care home design for people with dementia: What do people with dementia and their family carers value?

Science.gov (United States)

Innes, Anthea; Kelly, Fiona; Dincarslan, Ozlem

2011-07-01

To report on the views of people with dementia who live in care homes and their family carers on aspects of design that are important to them, and discuss these in relation to developing physical care environments that respond to the wishes of people with dementia and their family carers. Six focus groups were held: two in Northern Ireland and four in Scotland. A total of 40 people participated in the focus groups. Twenty nine people were with dementia (24 female and five male), and 11 were family carers (10 female and one male). Carers discussed the features of a building they took into account when selecting a care home, and discussed this in relation to 'bricks and mortar versus people'. Key themes reported by people with dementia and their family carers included how the space in the environment is used, for example, what happens in the building and the presence or absence of certain design features. Outside space and wayfinding aids were identified as positive features of the home, along with a general lack of concern about ensuite provision. The results demonstrate the complexity of building design as it must provide living space acceptable to people with dementia living there and family members who visit, as well as provide a workable environment for staff. The findings highlight areas that should be considered by care home teams involved in the build of a new home or the redevelopment of an existing care home.

Building mobile technologies to improve transitions of care in adolescents with congenital heart disease

Science.gov (United States)

Congenital heart diseases (CHDs) are the most common type of birth defects. Improvements in CHD care have led to roughly 1.4 million survivors reaching adulthood. This emerging "survivor" population are often palliated but not cured. Thus successful transition from pediatric to adult care for CHD pa...

Long-Term Mentors' Perceptions of Building Mentoring Relationships with At-Risk Youth

Science.gov (United States)

Smith, Cindy Ann; Newman-Thomas, Cathy; Stormont, Melissa

2015-01-01

Youth mentoring, defined within this study, as the pairing of a youth at risk with a caring adult, is an intervention that is often used for youth at risk for academic and social failure. We sought to understand mentors' perspectives of the fundamental elements that foster positive mentor--mentee relationships that build resiliency and increase…

Information management for aged care provision in Australia: development of an aged care minimum dataset and strategies to improve quality and continuity of care.

Science.gov (United States)

Davis, Jenny; Morgans, Amee; Burgess, Stephen

2016-04-01

Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes. To determine key information needs in aged care settings to improve information quality, information transfer, safety, quality and continuity of care to meet the complex needs of aged care clients. Modified Delphi methods involving five stages were employed by one aged care provider in Victoria, Australia, to establish stakeholder consensus for a derived minimum data set and address barriers to data quality. Eleven different aged care programs were identified; with five related data dictionaries, three minimum data sets, five program standards or quality frameworks. The remaining data collection frameworks related to diseases classification, funding, service activity reporting, and statistical standards and classifications. A total of 170 different data items collected across seven internal information systems were consolidated to a derived set of 60 core data items and aligned with nationally consistent data collection frameworks. Barriers to data quality related to inconsistencies in data items, staff knowledge, workflow, system access and configuration. The development an internal aged care minimum data set highlighted the critical role of primary data quality in the upstream and downstream use of client information; and presents a platform to build national consistency across the sector.

Republished: Building a culture of safety through team training and engagement.

Science.gov (United States)

Thomas, Lily; Galla, Catherine

2013-07-01

Medical errors continue to occur despite multiple strategies devised for their prevention. Although many safety initiatives lead to improvement, they are often short lived and unsustainable. Our goal was to build a culture of patient safety within a structure that optimised teamwork and ongoing engagement of the healthcare team. Teamwork impacts the effectiveness of care, patient safety and clinical outcomes, and team training has been identified as a strategy for enhancing teamwork, reducing medical errors and building a culture of safety in healthcare. Therefore, we implemented Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based framework which was used for team training to create transformational and/or incremental changes; facilitating transformation of organisational culture, or solving specific problems. To date, TeamSTEPPS (TS) has been implemented in 14 hospitals, two Long Term Care Facilities, and outpatient areas across the North Shore LIJ Health System. 32 150 members of the healthcare team have been trained. TeamSTEPPS was piloted at a community hospital within the framework of the health system's organisational care delivery model, the Collaborative Care Model to facilitate sustainment. AHRQ's Hospital Survey on Patient Safety Culture, (HSOPSC), was administered before and after implementation of TeamSTEPPS, comparing the perception of patient safety by the heathcare team. Pilot hospital results of HSOPSC show significant improvement from 2007 (pre-TeamSTEPPS) to 2010. System-wide results of HSOPSC show similar trends to those seen in the pilot hospital. Valuable lessons for organisational success from the pilot hospital enabled rapid spread of TeamSTEPPS across the rest of the health system.

Building a Sustainable Global Surgery Nonprofit Organization at an Academic Institution.

Science.gov (United States)

Frisella, Margaret M

Surgical Outreach for the Americas is a 501(c)3 nonprofit organization providing surgical care to those in need in developing countries of the Western Hemisphere. Every year since its inception in 2008, teams of surgeons, nurses, and allied health professionals have traveled to areas of need and performed primarily hernia repair surgeries for those without access to affordable health care. Surgical Outreach for the Americas (SOfA) began as a general concept based on World Health Organization statistics claiming that 11% of the global burden of disease can be resolved via surgery. Armed with this information, a group of compassionate and selfless health care professionals planned the first trip, to the Dominican Republic, in January 2009. Building on what was first just an ambition to help others, we now also train surgeons, surgery residents, and nurses in the countries we serve. To date, SOfA has successfully treated 734 patients, with 899 total surgical procedures performed (693 of these under general anesthesia). These procedures include inguinal hernia, umbilical hernia, testicular masses, orchiectomies, and various general surgical procedures. Through the efforts of a great many talented individuals and robust fundraising efforts, the SOfA message continues to gain momentum. SOfA not only considers the health and well-being of the disadvantaged through capacity-building efforts but strives to educate and improve the skills of health care professionals in the countries we visit. Our goal is to increase the number of missions each year and begin a 2-fold educational program that (a) provides surgical resident education through participation in mission work and (b) provides local surgeon education in the areas served. Copyright © 2016. Published by Elsevier Inc.

Pastoral care: marketing "high touch".

Science.gov (United States)

Finn, M

1986-01-01

Marketing pastoral care skills is important both within and without the health care organization. To increase administrators' awareness of the value of the pastoral care department, for example, chaplains must be able to demonstrate that their activities can affect the bottom line. They must therefore develop a system of accountability that defines and measures their services in objective terms. Such a system would include the reporting of monthly visit statistics as well as the collection of data from patients and personnel on the adequacy of pastoral care services. Other awareness-building activities could include participation in nursing practice rounds, in-service presentations, involvement in hospital social events, and placement of articles about pastoral care in hospital publications. Activities that would help to foster good community relations and thereby improve census include participation in the area clergy association, work with local church groups that visit the sick and the homebound, providing speakers to community organizations, and sponsoring a memorial Mass for families of patients who have died at the hospital. Pastoral care staff should not feel threatened by the changing health care environment. Instead they must recognize the opportunity it provides to create ways to minister to a new mix of patients and to reach new groups.

Building National Infrastructures for Patient-Centred Digital Services

DEFF Research Database (Denmark)

Thorseng, Anne; Jensen, Tina Blegind

2015-01-01

Patient-centred digital services are increasingly gaining impact in the healthcare sector. The premise is that patients will be better equipped for taking care of their own health through instant access to relevant information and by enhanced electronic communication with healthcare providers. One...... infrastructure theory, we highlight the enabling and constraining dynamics when designing and building a national infrastructure for patient-centred digital services. Furthermore, we discuss how such infrastructures can accommodate further development of services. The findings show that the Danish national e...

The classification, recording, databasing and use of information about building damage caused by subsidence and landslides

OpenAIRE

Cooper, Anthony

2008-01-01

Building damage as a result of subsidence and lateral movement can be caused by numerous mechanisms including mining, dissolution of soluble rocks, shrink–swell of clays and landslides. In many instances, the distribution and severity of the damage caused can be diagnostic of the underlying geological condition and can be used as an aid to geological and geomorphological mapping. Many rigid buildings are sensitive to movement, meaning that careful surveys can delineate fine details that can b...

OpenBAN: An Open Building ANalytics Middleware for Smart Buildings

Directory of Open Access Journals (Sweden)

Pandarasamy Arjunan

2016-03-01

Full Text Available Towards the realization of smart building applications, buildings are increasingly instrumented with diverse sensors and actuators. These sensors generate large volumes of data which can be analyzed for optimizing building operations. Many building energy management tasks such as energy forecasting, disaggregation, among others require complex analytics leveraging collected sensor data. While several standalone and cloud-based systems for archiving, sharing and visualizing sensor data have emerged, their support for analyzing sensor data streams is primitive and limited to rule-based actions based on thresholds and simple aggregation functions. We develop OpenBAN, an open source sensor data analytics middleware for buildings, to make analytics an integral component of modern smart building applications. OpenBAN provides a framework of extensible sensor data processing elements for identifying various building context, which different applications can leverage. We validate the capabilities of OpenBAN by developing three representative real-world applications which are deployed in our test-bed buildings: (i household energy disaggregation, (ii detection of sprinkler usage from water meter data, and (iii electricity demand forecasting. We also provide a preliminary system performance of OpenBAN when deployed in the cloud and locally.

Bore pile foundation tall buildings closed in the heritage building

Science.gov (United States)

Triastuti, Nusa Setiani

2017-11-01

Bore pile foundation for high building surroundings heritage building should be not damage. Construction proses must good, no necking, no mixed deep water, no sliding soil, nonporous concrete. Objective the execution of bore pile so that heritage buildings and neighboring buildings that are old do not experience cracks, damage and tilting. The survey methodology was observe the process of the implementation of the dominant silt, clay soil, in addition a limited space and to analyze the results of loading tests, investigations of soil and daily reports. Construction process determines the success of the structure bore pile in high building structure bearing, without damaging a heritage building. Attainment the hard soil depth, density concrete, observable clean reinforcement in the implementation. Monitoring the implementation of, among others, the face of the ground water little reduce in the area and outside the footprint of the building, no impact of vibration drilling equipment, watching the mud content on the water coming out at the time of drilling, concrete volume was monitored each 2 m bore depth of pile, The result researched heritage building was not damage. The test results bore pile axial, lateral analyzed the results have the appropriate force design required.

MillionTreesNYC, Green infrastructure, and urban ecology: building a research agenda

Science.gov (United States)

Jacqueline W.T. Lu; Megan Shane; Erika Svendsen; Lindsay Campbell; Cristiana Fragola; Marianne Krasny; Gina Lovasl; David Maddox; Simon McDonnell; P. Timon McPhearson; Franco Montalto; Andrew Newman; Ellen Pehek; Ruth A. Rae; Richard Stedman; Keith G. Tidball; Lynne Westphal; Tom Whitlow

2009-01-01

MillionTreesNYC is a citywide, public-private initiative with an ambitious goal: to plant and care for one million new trees across New York City's five boroughs by 2017. The Spring 2009 workshop MillionTreesNYC, Green Infrastructure, and Urban Ecology: Building a Research Agenda brought together more than 100 researchers, practitioners and New York City...

Quotidian of accompanying family members in an environment of care: the emergence of hospital tribes

Directory of Open Access Journals (Sweden)

Silvia da Silva Santos Passos

2016-06-01

Full Text Available ABSTRACT OBJECTIVE Understand the quotidian relationships of accompanying family members in an environment of care, which are close to the metaphor of a tribe in hospital environment. METHODQualitative study with data gathered from semi-structured interviews and observations with 16 family members accompanying hospitalized individuals with dependence on self-care. Data were submitted to thematic analysis, and analyzed through the metaphor of "tribe" proposed by comprehensive sociology. RESULTS Family members build up social clusters around caring, where we find traits typical of tribes: emotional ambience; solidarity based on links of sympathy and mutual assistance; an affectual nebula in the process of interaction; a logic of fusion in tactile relations; and communion/religiosity in the process of connecting in a collective identity. CONCLUSION In the presence of tragedy, families build social clusters similar to tribes having care as a totem.

Retrofitting Listed Buildings

DEFF Research Database (Denmark)

Rasmussen, Torben Valdbjørn

2011-01-01

The paper presents a case study where the energy demand for a listed building constructed in 1900 is reduced. Many older buildings are listed and have restrictions that include the entire building or that include only its exterior. For the building presented, only its exterior facade is listed. T...

Multidisciplinary Energy Assessment of Tertiary Buildings: Automated Geomatic Inspection, Building Information Modeling Reconstruction and Building Performance Simulation

Directory of Open Access Journals (Sweden)

Faustino Patiño-Cambeiro

2017-07-01

Full Text Available There is an urgent need for energy efficiency in buildings within the European framework, considering its environmental implications, and Europe’s energy dependence. Furthermore, the need for enhancing and increasing productivity in the building industry turns new technologies and building energy performance simulation environments into extremely interesting solutions towards rigorous analysis and decision making in renovation within acceptable risk levels. The present work describes a multidisciplinary approach for the estimation of the energy performance of an educational building. The research involved data acquisition with advanced geomatic tools, the development of an optimized building information model, and energy assessment in Building Performance Simulation (BPS software. Interoperability issues were observed in the different steps of the process. The inspection and diagnostic phases were conducted in a timely, accurate manner thanks to automated data acquisition and subsequent analysis using Building Information Modeling based tools (BIM-based tools. Energy simulation was performed using Design Builder, and the results obtained were compared with those yielded by the official software tool established by Spanish regulations for energy certification. The discrepancies between the results of both programs have proven that the official software program is conservative in this sense. This may cause the depreciation of the assessed buildings.

Sustainable building and local resources

Directory of Open Access Journals (Sweden)

Maria Cristina Forlani

2014-05-01

Full Text Available The research comes from the deepest reasons of the crisis, in order to recognize in such reasons themselves the direction to come out, the new needs and the new challenges. The local resources (material and immaterial were reconsidered as patrimony, precious but limited, of each specific area to trace out a path of supportability able to rebuild new relations between project/production and environmental culture. The industrial production becomes a driving force for the economic renewal through an iterative cycle between research/science and economics aiming to smart building, meant as practice in evolution. This practise is careful to the local, environmental, cultural and economic situation, whose parameters are identity, energy, environment, mobility and economics that give back different scale answers.

[Spiritual Care of Patients With Depression].

Science.gov (United States)

Kao, Chia-Chan; Lin, Yu-Hua

2018-06-01

Spiritual care is a component of holistic care. Patients with depression often experience body-mind-spirit health problems and may suffer from spiritual crises, particularly during the acute stage of a diseases, due to low self-esteem, negative attitudes toward life goals, daily life issues, and beliefs caused by physical, psychological, and occupational dysfunctions. Nonetheless, psychical care is the main treatment for patients with depression. This paper focuses on patients with depression and addresses the concepts of spiritual needs and spiritual care, identifying the factors that influence spiritual needs, the essentials of spiritual intervention, and the health effects of spiritual intervention outcomes on patients with depression. Courses that teach practical spiritual interventions are recommended for nurses. These courses should address topics such as individual approaches, building trusting relationships, setting diverse goals for spiritual interventions based on disease stage, and spiritual interventions involving the body-mind-spiritual aspects for patients with depression.

The Patient Protection and Affordable Care Act: the victory of unorthodox lawmaking.

Science.gov (United States)

Beaussier, Anne-Laure

2012-10-01

The 2010 Patient Protection and Affordable Care Act was a major legislative achievement of the 111th Congress. This law structurally reforms the US health care system by encouraging universal health care coverage through regulated competition among private insurance companies. When looking at the process for reform, what strikes an observer of US health care policy in the first place is that the Democratic majority was able to enact something in a political field characterized by strong resistance to change. This article builds on that observation. Arguments concentrate on the legislative process of the reform and support the idea that it may be partly explained by considering an evolution of US legislative institutions, mostly in the sense of a more centralized legislative process. Based on approximately one hundred semidirected interviews, I argue that the Democratic majority, building on lessons from both President Bill Clinton's health care reform attempt and the Republicans' strategy of using strong congressional leadership to pass social reforms, was able to overcome institutional constraints that have long prevented comprehensive change. A more centralized legislative process, which has been described as "unorthodox lawmaking," enabled the Democratic leadership to overcome multiple institutional and political veto players.

Cost recovery of NGO primary health care facilities: a case study in Bangladesh

OpenAIRE

Alam, Khurshid; Ahmed, Shakil

2010-01-01

Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Give...

Building human resources capability in health care: a global analysis of best practice--Part III.

Science.gov (United States)

Zairi, M

1998-01-01

This is the last part of a series of three papers which discussed very comprehensively best practice applications in human resource management by drawing special inferences to the healthcare context. It emerged from parts I and II that high performing organisations plan and intend to build sustainable capability through a systematic consideration of the human element as the key asset and through a continuous process of training, developing, empowering and engaging people in all aspects of organisational excellence. Part III brings this debate to a close by demonstrating what brings about organisational excellence and proposes a road map for effective human resource development and management, based on world class standards. Healthcare human resource professionals can now rise to the challenge and plan ahead for building organisational capability and sustainable performance.

Village Building Identification Based on Ensemble Convolutional Neural Networks

Science.gov (United States)

Guo, Zhiling; Chen, Qi; Xu, Yongwei; Shibasaki, Ryosuke; Shao, Xiaowei

2017-01-01

In this study, we present the Ensemble Convolutional Neural Network (ECNN), an elaborate CNN frame formulated based on ensembling state-of-the-art CNN models, to identify village buildings from open high-resolution remote sensing (HRRS) images. First, to optimize and mine the capability of CNN for village mapping and to ensure compatibility with our classification targets, a few state-of-the-art models were carefully optimized and enhanced based on a series of rigorous analyses and evaluations. Second, rather than directly implementing building identification by using these models, we exploited most of their advantages by ensembling their feature extractor parts into a stronger model called ECNN based on the multiscale feature learning method. Finally, the generated ECNN was applied to a pixel-level classification frame to implement object identification. The proposed method can serve as a viable tool for village building identification with high accuracy and efficiency. The experimental results obtained from the test area in Savannakhet province, Laos, prove that the proposed ECNN model significantly outperforms existing methods, improving overall accuracy from 96.64% to 99.26%, and kappa from 0.57 to 0.86. PMID:29084154

Energy conservation and management system using efficient building automation

Science.gov (United States)

Ahmed, S. Faiz; Hazry, D.; Tanveer, M. Hassan; Joyo, M. Kamran; Warsi, Faizan A.; Kamarudin, H.; Wan, Khairunizam; Razlan, Zuradzman M.; Shahriman A., B.; Hussain, A. T.

2015-05-01

In countries where the demand and supply gap of electricity is huge and the people are forced to endure increasing hours of load shedding, unnecessary consumption of electricity makes matters even worse. So the importance and need for electricity conservation increases exponentially. This paper outlines a step towards the conservation of energy in general and electricity in particular by employing efficient Building Automation technique. It should be noted that by careful designing and implementation of the Building Automation System, up to 30% to 40% of energy consumption can be reduced, which makes a huge difference for energy saving. In this study above mentioned concept is verified by performing experiment on a prototype experimental room and by implementing efficient building automation technique. For the sake of this efficient automation, Programmable Logic Controller (PLC) is employed as a main controller, monitoring various system parameters and controlling appliances as per required. The hardware test run and experimental findings further clarifies and proved the concept. The added advantage of this project is that it can be implemented to both small and medium level domestic homes thus greatly reducing the overall unnecessary load on the Utility provider.

The New Jersey Nursing Initiative: building sustainable collaboration.

Science.gov (United States)

Bakewell-Sachs, Susan; Mertz, Lynn M; Egreczky, Dana; Ladden, Maryjoan

2011-01-01

The New Jersey Nursing Initiative was publically launched in 2009 as a 5-year, $22 million program of the Robert Wood Johnson Foundation based at the New Jersey Chamber of Commerce Foundation. It was reauthorized in 2011 through 2016 for an additional $8.5 million. The initiative includes a faculty preparation program and strategic tracks of work focusing on building education capacity, increasing current faculty capacity, making nurse faculty a preferred career, leading policy initiatives, creating sustainable funding in support of nursing education, and ultimately, building local, regional, and statewide collaborative networks. The tagline, "So a Nurse will be there for You," emphasizes both the reality of an aging nursing workforce needing replacement and the expected health care transformation that will result in the need for new knowledge and skills in the future nursing workforce. The purpose of this article was to describe the New Jersey Nursing Initiative, emphasizing the partnerships that have resulted from the project to date. Copyright © 2011 Elsevier Inc. All rights reserved.

Caring for one and all - Exploring ethical challenges in an ICU.

Science.gov (United States)

Jones, Jennifer; Mitchell, Marion; Milligan, Eleanor

2016-08-01

This discussion paper explores some of the complex ethical and moral issues confronting contemporary critical care nurses. In contemporary healthcare discussions, there is an increased appreciation of the complexity of ethical challenges, the multiplicity of stakeholders and that a broad range of possible and practical outcomes exist. Furthermore, many scholars also acknowledge the limitations of principle based ethical frameworks. In seeking to build critical care nurses' capacity to negotiate the complex - and often conflicting - ethical challenges, the authors have adopted a person-centred, values-based approach in this case study. Furthermore, by exploring these complex issues, this paper supports and builds upon critical care nurses' decision making capacities in the clinical area. This case study has been purposefully left open-ended with the aim of inviting the reader to consider the questions posed in a collegial, collaborative manner within the particular context in which she/he is embedded. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

The institutional logic of integrated care: an ethnography of patient transitions.

Science.gov (United States)

Shaw, James A; Kontos, Pia; Martin, Wendy; Victor, Christina

2017-03-20

Purpose The purpose of this paper is to use theories of institutional logics and institutional entrepreneurship to examine how and why macro-, meso-, and micro-level influences inter-relate in the implementation of integrated transitional care out of hospital in the English National Health Service. Design/methodology/approach The authors conducted an ethnographic case study of a hospital and surrounding services within a large urban centre in England. Specific methods included qualitative interviews with patients/caregivers, health/social care providers, and organizational leaders; observations of hospital transition planning meetings, community "hub" meetings, and other instances of transition planning; reviews of patient records; and analysis of key policy documents. Analysis was iterative and informed by theory on institutional logics and institutional entrepreneurship. Findings Organizational leaders at the meso-level of health and social care promoted a partnership logic of integrated care in response to conflicting institutional ideas found within a key macro-level policy enacted in 2003 (The Community Care (Delayed Discharges) Act). Through institutional entrepreneurship at the micro-level, the partnership logic became manifest in the form of relationship work among health and social care providers; they sought to build strong interpersonal relationships to enact more integrated transitional care. Originality/value This study has three key implications. First, efforts to promote integrated care should strategically include institutional entrepreneurs at the organizational and clinical levels. Second, integrated care initiatives should emphasize relationship-building among health and social care providers. Finally, theoretical development on institutional logics should further examine the role of interpersonal relationships in facilitating the "spread" of logics between macro-, meso-, and micro-level influences on inter-organizational change.

Building Process and Architectural Planning Characteristics of Daehan Hospital Main Building

Directory of Open Access Journals (Sweden)

Geauchul LEE

2016-04-01

Full Text Available This paper explores the introduction process of Daehan Hospital from Japan as the modern medical facility in Korea, and the architectural planning characteristics as a medical facility through the detailed building process of Daehan Hospital main building. The most noticeable characteristic of Daehan Hospital is that it was designed and constructed not by Korean engineers but by Japanese engineers. Therefore, Daehan Hospital was influenced by Japanese early modern medical facility, and Japanese engineers modeled Daehan Hospital main building on Tokyo Medical School main building which was constructed in 1876 as the first national medical school and hospital. The architectural type of Tokyo Medical School main building was a typical school architecture in early Japanese modern period which had a middle corridor and a pseudo Western-style tower, but Tokyo Medical School main building became the model of a medical facility as the symbol of the medical department in Tokyo Imperial University. This was the introduction and transplantation process of Japanese modern ‘model’ like as other modern systems and technologies during the Korean modern transition period. However, unlike Tokyo Medical School main building, Daehan Hospital main building was constructed not as a wooden building but as a masonry building. Comparing with the function of Daehan Hospital main building, its architectural form and construction costs was excessive scale, which was because Japanese Resident-General of Korea had the intention of ostentation that Japanese modernity was superior to Korean Empire.

[Building Process and Architectural Planning Characteristics of Daehan Hospital Main Building].

Science.gov (United States)

Lee, Geauchul

2016-04-01

This paper explores the introduction process of Daehan Hospital from Japan as the modern medical facility in Korea, and the architectural planning characteristics as a medical facility through the detailed building process of Daehan Hospital main building. The most noticeable characteristic of Daehan Hospital is that it was designed and constructed not by Korean engineers but by Japanese engineers. Therefore, Daehan Hospital was influenced by Japanese early modern medical facility, and Japanese engineers modeled Daehan Hospital main building on Tokyo Medical School main building which was constructed in 1876 as the first national medical school and hospital. The architectural type of Tokyo Medical School main building was a typical school architecture in early Japanese modern period which had a middle corridor and a pseudo Western-style tower, but Tokyo Medical School main building became the model of a medical facility as the symbol of the medical department in Tokyo Imperial University. This was the introduction and transplantation process of Japanese modern 'model' like as other modern systems and technologies during the Korean modern transition period. However, unlike Tokyo Medical School main building, Daehan Hospital main building was constructed not as a wooden building but as a masonry building. Comparing with the function of Daehan Hospital main building, its architectural form and construction costs was excessive scale, which was because Japanese Resident-General of Korea had the intention of ostentation that Japanese modernity was superior to Korean Empire.

Essential competencies for the education of nursing assistants and care helpers in elderly care.

Science.gov (United States)

Oeseburg, Barth; Hilberts, Rudi; Roodbol, Petrie F

2015-10-01

The Dutch health care system faces huge challenges with regard to the demand on elderly care and the competencies of professionals required to meet this demand. However, a recent study showed that the curricula in vocational education for nursing assistants and care helpers remains inadequate to prepare them for the social and healthcare needs of the elderly. To determine the essential competencies for the initial education of nursing assistants and care helpers in elderly care. First, a draft version of essential competencies for the education of nursing assistants and care helpers in elderly care (N=120) was developed and approved by experts, also members of the project steering committee. Second, a Delphi survey was conducted to determine the essential competencies. The Delphi panel consisted of eleven field experts (teachers/educational developers) working for different vocational education training colleges in the Netherlands. Ten panel members participated in a two-round consensus building process via email. A definitive set of 116 essential competencies for the initial education of nursing assistants and 42 essential competencies for the initial education of care helpers were determined. The competencies in the definitive set are more in line with social and healthcare needs of the elderly like: autonomy, daily functioning prevention of health problems, healthy ageing and wellbeing, involvement of informal care, collaboration between professionals and informal care. The main challenge now is to translate these competencies into educational programmes for vocational education training colleges for care helpers and nursing assistants. Recommendations are made for the implementation of these competencies in the Dutch vocational education training colleges for care helpers and nursing assistants. Copyright © 2015 Elsevier Ltd. All rights reserved.

Building control. Technical building systems: Automation and management; Building Control. Technische Gebaeudesysteme: Automation und Bewirtschaftung

Energy Technology Data Exchange (ETDEWEB)

Kranz, H.R.; Baenninger, M.; Bieler, P.; Brettschneider, J.P.; Damnig, A.; Fassbender, H.W.; Friedrichs, K.; Gauchel, J.; Hegewald, B.; Kaelin, W.; Lezius, A.; Markert, H.; Oehler, A.; Otto, J.; Puettmer, M. Jr.; Rohrbacher, H.; Schuerdt, K.; Vogt, D.; Wittling, J.

1995-12-31

Cost-optimised management and maintenance of buildings can no longer be carried out without electronic data processing. The present anthology gives a comprehensive overview of the planning and operation of building automation systems. The following topics are discussed: ecological cooling and facade concepts, facility management, jeopardy alarm technology, building automation, communication technology, open communication and networks, building system technology, norms and directives, building right and law. A special abstract has been prepared for each of the 23 chapters. (BWI). 260 figs., 161 refs. [Deutsch] Kostenoptimiertes Management, Bewirtschaftung und Instandhaltung von Gebaeuden sind ohne EDV nicht mehr denkbar. Das vorliegende Buch gibt einen umfassenden Ueberblick ueber Planung und Betrieb von Gebaeudeautomationssystemen. Es wird dabei auf folgende Themenkomplexe eingegangen: Oekologische Kuehl- und Fassadenkonzepte; Facility Management, Gefahrenmeldetechnik, Gebaeudeautomation; Kommunikationstechnik, offenen Kommunikation und Netzwerke; Gebaeudesystemtechnik und Installationsbus; Energiemanagement; Betreibererfahrungen; Normen und Richtlinien; Baurecht und Gesetz. Fuer alle 23 Einzelkapitel wurde eine gesonderte inhaltliche Erschliessung durchgefuehrt. (BWI)

The waterfront windmill project and TREC's windshare model for community-based renewables development

International Nuclear Information System (INIS)

Young, B.

2002-01-01

Plans have been developed for building two wind turbines on Toronto's waterfront, on the grounds of the exhibition for the project called Waterfront Windmill Project. The electricity generated by each individual turbine, 1,400,000 kilowatt hours per year, could meet the needs of 250 four-person homes. This project represents an emissions-free power generation, and the energy will be distributed to the hydropower grid of the City of Toronto. The requirement for nuclear and coal-generated energy will therefore be reduced while reducing the emissions of carbon dioxide and other greenhouse gases into the atmosphere. The creation of an urban-based community-owned turbine fits well with the policy of the Toronto Renewable Energy Coop, which is committed to working with the marketplace. The lower cost to the consumer of the market deregulation coal generated energy is a concern. figs

Improving Broader Impacts through Researcher-Educator Partnerships

Science.gov (United States)

Timm, K.; Warburton, J.; Larson, A. M.

2009-12-01

Since 1998, the Arctic Research Consortium of the United States (ARCUS) has designed and implemented successful Teacher Research Experience (TRE) programs enabling teachers to work directly with polar scientists in the field and bring their experience back to their classrooms and communities. The PolarTREC TRE model, administered during the International Polar Year (2007-2009), is most effective, exhibiting far-reaching broader impacts when ideas are shared, each partners’ expertise is respected, and both work toward the common goal of delivering high-quality information. Between 2004 and 2009, ARCUS has selected, trained, and supported 77 teachers on polar teacher research experiences. Although a limited number of teachers are able to participate in a field experience, selected teachers have expertise in translating research approaches and results into widely shared learning tools and programs. Between 2007-2009, PolarTREC teachers have constructed nearly 100 classroom lesson plans and activities as a result of their experience. Selected teachers are usually well connected within their schools, communities, and professions, bringing the science to numerous followers during their expedition. Live events with teachers and researchers in the field have attracted over 11,000 participants, primarily K-12 students. The PolarTREC TRE Model includes numerous methods to support outreach activities while teachers and researchers are in the field. These include web-based communications, journals, discussion forums, multimedia, and live events—all easily replicable activities with the potential to affect large numbers of people. In addition, the TRE experience continues to produce broader impacts far into the future of the teacher and researcher’s careers through ongoing communications, presentations at professional conferences, and continued support of each other’s work through activities including classroom visits, joint proposal development, and much more

Empirical assessment of the Hellenic non-residential building stock, energy consumption, emissions and potential energy savings

International Nuclear Information System (INIS)

Gaglia, Athina G.; Balaras, Constantinos A.; Mirasgedis, Sevastianos; Georgopoulou, Elena; Sarafidis, Yiannis; Lalas, Dimitris P.

2007-01-01

Comprehensive information and detailed data for the non-residential (NR) building stock is rather limited, although it is the fastest growing energy demand sector. This paper elaborates the approach used to determine the potential energy conservation in the Hellenic NR building stock. A major obstacle that had to be overcome was the need to make suitable assumptions for missing detailed primary data. A qualitative and quantitative assessment of scattered national data resulted in a realistic assessment of the existing NR building stock and energy consumption. Different energy conservation scenarios and their impact on the reduction of CO 2 emissions were evaluated. Accordingly, the most effective energy conservation measures are: addition of thermal insulation of exposed external walls, primarily in hotels and hospitals; installation of energy efficient lamps; installation of solar collectors for sanitary hot water production, primarily in hotels and health care; installation of building management systems in office/commercial and hotel buildings; replacement of old inefficient boilers; and regular maintenance of central heating boilers

Potential Retrofit of Existing Sultan Ismail Parliament Building, Johor to Green Building

Directory of Open Access Journals (Sweden)

Yasin Mohd Norazam

2017-01-01

Full Text Available The concept of retrofitting an existing building towards green building was introduced to move towards greener development. This paper investigates the benefits of retrofitting an existing building to green building. The potential retrofit of the existing Sultan Ismail Parliament building was also determined and later the elements of the building to be retrofitted were proposed. The Sultan Ismail Parliament building is one of the newest development that serves as the Johor state administrative center under Iskandar Malaysia. Therefore, this paper focuses on whether the existing building has fulfilled all of the green building elements. A set of questionnaire was distributed to the targeted respondents who were the engineers, architects, technicians, staffs and those who were involved in the development of the Sultan Ismail Parliament building. A total of 60 respondents was involved. Based on the analyzed data, it shows that the existing building has fulfilled only one of the green building elements which is the Indoor Environmental Quality. The items that scored 3.5 and above mean index under this element include the daylight glare is not bothering, the ventilation in the building is adequate, inspections are done regularly, smoking regulation is implemented and the number of openings of windows and doors is sufficient. While it shows that other elements were only partially fulfilled. The criteria that achieved below 3.5 mean index values is considered to be the potential elements that could be used for future retrofitting initiative.

Togetherness--A Manifestation of Day Care Life.

Science.gov (United States)

Hannikainen, Maritta

1999-01-01

This study used observations of quality of 5-year olds' lives in Danish, Finnish, and Swedish day-care centers to examine impact of adults on development of togetherness. Findings suggest that togetherness has to do with positive emotional relations. Article hypothesizes that togetherness may contribute to building of a real community of learners…

Heroes of health care: a window on caregiver burden.

Science.gov (United States)

1994-08-01

On Wednesday, March 23, 51 older Americans came to Washington, DC, to deliver their unique messages concerning the need for long-term care and a health care system responsive to the needs of older Americans. HealthRIGHT, a coalition created to capture Americans' views on the health care system and what needs to be done to improve it, orchestrated the event. In an extraordinary briefing session in the Rayburn House Office Building, First Lady Hillary Rodham Clinton was present with congressional leaders to hear these stories. Several of the witnesses focused on Alzheimer's patients or their caregivers. CARING is pleased to include their stories here, as testimony to the major effect this terrible disease can have on a family.

Auxiliary buildings

International Nuclear Information System (INIS)

Lakner, I.; Lestyan, E.

1979-01-01

The nuclear power station represents a complicated and a particular industrial project. Consequently, the design of the auxiliary buildings serving the power station (offices, kitchen, refreshment room, workshops, depots, water treatment plant building, boiler houses, etc.) requires more attention than usual. This chapter gives a short survey of the auxiliary buildings already completed and discusses the problems of their design, location and structure. (author)

Building thermography as a tool in energy audits and building commissioning procedure

Science.gov (United States)

Kauppinen, Timo

2007-04-01

A Building Commissioning-project (ToVa) was launched in Finland in the year 2003. A comprehensive commissioning procedure, including the building process and operation stage was developed in the project. This procedure will confirm the precise documentation of client's goals, definition of planning goals and the performance of the building. It is rather usual, that within 1-2 years after introduction the users complain about the defects or performance malfunctions of the building. Thermography is one important manual tool in verifying the thermal performance of the building envelope. In this paper the results of one pilot building (a school) will be presented. In surveying the condition and energy efficiency of buildings, various auxiliary means are needed. We can compare the consumption data of the target building with other, same type of buildings by benchmarking. Energy audit helps to localize and determine the energy saving potential. The most general and also most effective auxiliary means in monitoring the thermal performance of building envelopes is an infrared camera. In this presentation some examples of the use of thermography in energy audits are presented.

Inquery and TREC-9

National Research Council Canada - National Science Library

Allan, James; Connell, Margaret E; Croft, W. B; Feng, Fang-Fang; Fisher, David; Li, Xiaoyan

2000-01-01

...: the Inquery search engine, query processing, and a query expansion technique known as LCA. All three tracks used Inquery as the search engine, sometimes for training, and always for generating the final ranked lists for the test...

Trajectories of At-Homeness and Health in Usual Care and Small House Nursing Homes

Science.gov (United States)

Molony, Sheila L.; Evans, Lois K.; Jeon, Sangchoon; Rabig, Judith; Straka, Leslie A.

2011-01-01

Background: Long-term care providers across the United States are building innovative environments called "Green House" or small-house nursing homes that weave humanistic person-centered philosophies into clinical care, organizational policies, and built environments. Purpose: To compare and contrast trajectories of at-homeness and health over…

Challenges for the surgical capacity building of township hospitals among the Central China: a retrospective study.

Science.gov (United States)

Li, Zhong; Yang, Jian; Wu, Yue; Pan, Zijin; He, Xiaoqun; Li, Boyang; Zhang, Liang

2018-05-02

China's rapid transition in healthcare service system has posed considerable challenges for the primary care system. Little is known regarding the capacity of township hospitals (THs) to deliver surgical care in rural China with over 600 million lives. We aimed to ascertain its current performance, barriers, and summary lessons for its re-building in central China. This study was conducted in four counties from two provinces in central China. The New Rural Cooperative Medical System (NRCMS) claim data from two counties in Hubei province was analyzed to describe the current situation of surgical care provision. Based on previous studies, self-administered questionnaire was established to collect key indicators from 60 THs from 2011 to 2015, and social and economic statuses of the sampling townships were collected from the local statistical yearbook. Semi-structured interviews were conducted among seven key administrators in the THs that did not provide appendectomy care in 2015. Determinants of appendectomy care provision were examined using a negative binominal regression model. First, with the rapid increase in inpatient services provided by the THs, their proportion of surgical service provision has been nibbled by out-of-county facilities. Second, although DY achieved a stable performance, the total amount of appendectomy provided by the 60 THs decreased to 589 in 2015 from 1389 in 2011. Moreover, their proportion reduced to 26.77% in 2015 from 41.84% in 2012. Third, an increasing number of THs did not provide appendectomy in 2015, with the shortage of anesthesiologists and equipment as the most mentioned reasons (46.43%). Estimation results from the negative binomial model indicated that the annual average per capita disposable income and tightly integrated delivery networks (IDNs) negatively affected the amount of appendectomy provided by THs. By contrast, the probability of appendectomy provision by THs was increased by performance-related payment (PRP). Out

Community involvement in constructing village health buildings in Uganda and Sierra Leone.

Science.gov (United States)

Mitchell, M

1995-11-01

Three public health projects in Uganda and Sierra Leone are used to illustrate a new approach to construction of health buildings in villages. Emphasis is placed on community involvement. The health projects were comprehensive and relied on health education, employment of local village health workers, and establishment of village health committees. The objective of community involvement was described as encouragement of people to change their own diets and living conditions. This approach to primary health care is considered to be a strong basis for sustainable social development. Each of the three communities initiated the building projects slightly differently. There was a range of structures: traditional meeting halls, simple rooms with imported materials and a pit latrine, new buildings combining local and imported materials and labor, new nontraditional buildings, rehabilitated existing nontraditional buildings with imported labor and materials, and temporary mobile clinics. Community involvement was at different levels. All three projects were the result of a combined effort of national governments or mission hospitals, nongovernmental organizations, and the host community. The following should be considered before beginning construction: a suitable site, appropriate staff accommodation, the likely motivation of the host community, seasonality, local materials available, availability of skilled labor, and design. A plan of work during construction should include a building design, site supervision, transportation of local and non-local materials, unskilled labor, and skilled labor. Village health committees with or without government help would be responsible for maintenance of buildings after construction. A key feature of this approach is the assessment of the community's ability and capacity to contribute.

The motivation to care: application and extension of motivation theory to professional nursing work.

Science.gov (United States)

Moody, Roseanne C; Pesut, Daniel J

2006-01-01

The purpose of this research is to describe a model of nurses' work motivation relevant to the human caring stance of professional nursing work. The model was derived from selected theories of behavioral motivation and work motivation. Evidence-based theory addressing nurses' work motivation and nurses' motivational states and traits in relation to characteristics of organizational culture and patient health outcomes is suggested in an effort to make a distinct contribution to health services research. An integrated review of selected theories of motivation is presented, including conceptual analyses, theory-building techniques, and the evidence supporting the theoretical propositions and linkages among variables intrinsic to nurses' work motivation. The model of the Motivation to Care for Professional Nursing Work is a framework intended for empirical testing and theory building. The model proposes specific leadership and management strategies to support a culture of motivational caring and competence in health care organizations. Attention to motivation theory and research provides insights and suggests relationships among nurses' motivation to care, motivational states and traits, individual differences that influence nurses' work motivation, and the special effects of nurses' work motivation on patient care outcomes. Suggestions for nursing administrative direction and research are proposed.

Building Comprehensive and Sustainable Health Informatics Institutions in Developing Countries: Moi University Experience.

Science.gov (United States)

Were, Martin C; Siika, Abraham; Ayuo, Paul O; Atwoli, Lukoye; Esamai, Fabian

2015-01-01

Current approaches for capacity building in Health Informatics (HI) in developing countries mostly focus on training, and often rely on support from foreign entities. In this paper, we describe a comprehensive and multidimensional capacity-building framework by Lansang & Dennis, and its application for HI capacity building as implemented in a higher-education institution in Kenya. This framework incorporates training, learning-by-doing, partnerships, and centers of excellence. At Moi University (Kenya), the training dimensions include an accredited Masters in HI Program, PhD in HI, and HI short courses. Learning-by-doing occurs through work within MOH facilities at the AMPATH care and treatment program serving 3 million people. Moi University has formed strategic HI partnerships with Regenstrief Institute, Inc. (USA), University of Bergen (Norway), and Makerere University (Uganda), among others. The University has also created an Institute of Biomedical Informatics to serve as an HI Center of Excellence in the region. This Institute has divisions in Training, Research, Service and Administration. The HI capacity-building approach by Moi provides a model for adoption by other institutions in resource-limited settings.

Laboratory Building

Energy Technology Data Exchange (ETDEWEB)

Herrera, Joshua M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2015-03-01

This report is an analysis of the means of egress and life safety requirements for the laboratory building. The building is located at Sandia National Laboratories (SNL) in Albuquerque, NM. The report includes a prescriptive-based analysis as well as a performance-based analysis. Following the analysis are appendices which contain maps of the laboratory building used throughout the analysis. The top of all the maps is assumed to be north.

Diagramming Transactive Building Business Cases: Using Principles of e3 Value to Document Valuation Studies

Energy Technology Data Exchange (ETDEWEB)

Hammerstrom, Donald J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Makhmalbaf, Atefe [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Marinovici, Maria C. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

2016-12-30

Energy management in buildings is becoming more transactive. Pacific Northwest National Laboratory and the U.S. Department of Energy Building Technologies Office recently defined innovative use cases wherein market-like mechanisms are used to manage energy within buildings, between buildings, and between buildings and third-party entities, such as power utilities. A next step toward defining a set of transactive use cases in the buildings domain is to carefully diagram the corresponding business cases to capture details of transactions among all stakeholders and their economic value propositions. The principles of e3-value diagramming are applied in this report toward creating business value diagrams. These principles are extended to be consistent with Universal Modeling Language use-case diagrams. Example diagrams are presented for a subset of buildings-domain use cases that were introduced in an earlier Pacific Northwest National Laboratory report. The diagrams are intended to clearly represent an understanding of the transactions through which individual entities accumulate value in their respective use cases, and the diagrams should therefore support economic valuation studies. The report reviews some of the foundational principles of e3 value and includes authors’ insights concerning the formulation of these diagrams using Universal Modeling Language as a more systematic modeling approach.

Establishing community-based integrated care for elderly patients through interprofessional teamwork: a qualitative analysis

Directory of Open Access Journals (Sweden)

Asakawa T

2017-10-01

Full Text Available Tomohiro Asakawa,1 Hidenobu Kawabata,1 Kengo Kisa,2 Takayoshi Terashita,3 Manabu Murakami,4 Junji Otaki1 1Department of Medical Education and General Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, 2Kutchan-Kosei General Hospital, Kutchan, Hokkaido, 3Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences, Kamioki-machi, Maebashi, Gunma, 4International Relations Office, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan Background: Working in multidisciplinary teams is indispensable for ensuring high-quality care for elderly people in Japan’s rapidly aging society. However, health professionals often experience difficulty collaborating in practice because of their different educational backgrounds, ideas, and the roles of each profession. In this qualitative descriptive study, we reveal how to build interdisciplinary collaboration in multidisciplinary teams. Methods: Semi-structured interviews were conducted with a total of 26 medical professionals, including physicians, nurses, public health nurses, medical social workers, and clerical personnel. Each participant worked as a team member of community-based integrated care. The central topic of the interviews was what the participants needed to establish collaboration during the care of elderly residents. Each interview lasted for about 60 minutes. All the interviews were recorded, transcribed verbatim, and subjected to content analysis. Results: The analysis yielded the following three categories concerning the necessary elements of building collaboration: 1 two types of meeting configuration; 2 building good communication; and 3 effective leadership. The two meetings described in the first category – “community care meetings” and “individual care meetings” – were aimed at bringing together the disciplines and discussing individual cases, respectively. Building good communication referred to the activities

Building a Privacy, Ethics, and Data Access Framework for Real World Computerised Medical Record System Data: A Delphi Study. Contribution of the Primary Health Care Informatics Working Group.

Science.gov (United States)

Liyanage, H; Liaw, S-T; Di Iorio, C T; Kuziemsky, C; Schreiber, R; Terry, A L; de Lusignan, S

2016-11-10

Privacy, ethics, and data access issues pose significant challenges to the timely delivery of health research. Whilst the fundamental drivers to ensure that data access is ethical and satisfies privacy requirements are similar, they are often dealt with in varying ways by different approval processes. To achieve a consensus across an international panel of health care and informatics professionals on an integrated set of privacy and ethics principles that could accelerate health data access in data-driven health research projects. A three-round consensus development process was used. In round one, we developed a baseline framework for privacy, ethics, and data access based on a review of existing literature in the health, informatics, and policy domains. This was further developed using a two-round Delphi consensus building process involving 20 experts who were members of the International Medical Informatics Association (IMIA) and European Federation of Medical Informatics (EFMI) Primary Health Care Informatics Working Groups. To achieve consensus we required an extended Delphi process. The first round involved feedback on and development of the baseline framework. This consisted of four components: (1) ethical principles, (2) ethical guidance questions, (3) privacy and data access principles, and (4) privacy and data access guidance questions. Round two developed consensus in key areas of the revised framework, allowing the building of a newly, more detailed and descriptive framework. In the final round panel experts expressed their opinions, either as agreements or disagreements, on the ethics and privacy statements of the framework finding some of the previous round disagreements to be surprising in view of established ethical principles. This study develops a framework for an integrated approach to ethics and privacy. Privacy breech risk should not be considered in isolation but instead balanced by potential ethical benefit.

Improving building energy efficiency in India: State-level analysis of building energy efficiency policies

Energy Technology Data Exchange (ETDEWEB)

Yu, Sha; Tan, Qing; Evans, Meredydd; Kyle, Page; Vu, Linh; Patel, Pralit L.

2017-11-01

India is expected to add 40 billion m2 of new buildings till 2050. Buildings are responsible for one third of India’s total energy consumption today and building energy use is expected to continue growing driven by rapid income and population growth. The implementation of the Energy Conservation Building Code (ECBC) is one of the measures to improve building energy efficiency. Using the Global Change Assessment Model, this study assesses growth in the buildings sector and impacts of building energy policies in Gujarat, which would help the state adopt ECBC and expand building energy efficiency programs. Without building energy policies, building energy use in Gujarat would grow by 15 times in commercial buildings and 4 times in urban residential buildings between 2010 and 2050. ECBC improves energy efficiency in commercial buildings and could reduce building electricity use in Gujarat by 20% in 2050, compared to the no policy scenario. Having energy codes for both commercial and residential buildings could result in additional 10% savings in electricity use. To achieve these intended savings, it is critical to build capacity and institution for robust code implementation.

The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal

Science.gov (United States)

Gaspar, Heloisa Amaral; Morhy, Samira Saady

2015-01-01

Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU). Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged. PMID:26605333

Building midwifery educator capacity using international partnerships: Findings from a qualitative study.

Science.gov (United States)

West, Florence; Dawson, Angela; Homer, Caroline S E

2017-07-01

Midwifery educators play a critical role in strengthening the midwifery workforce globally, including in low and lower-middle income countries (LMIC) to ensure that midwives are adequately prepared to deliver quality midwifery care. The most effective approach to building midwifery educator capacity is not always clear. The aim of this study was to determine how one capacity building approach in Papua New Guinea (PNG) used international partnerships to improve teaching and learning. A qualitative exploratory case study design was used to explore the perspectives of 26 midwifery educators working in midwifery education institutions in PNG. Seven themes were identified which provide insights into the factors that enable and constrain midwifery educator capacity building. The study provides insights into strategies which may aid institutions and individuals better plan and implement international midwifery partnerships to strengthen context-specific knowledge and skills in teaching. Further research is necessary to assess how these findings can be transferred to other contexts. Copyright © 2017 Elsevier Ltd. All rights reserved.

Practical multimodal care for cancer cachexia.

Science.gov (United States)

Maddocks, Matthew; Hopkinson, Jane; Conibear, John; Reeves, Annie; Shaw, Clare; Fearon, Ken C H

2016-12-01

Cancer cachexia is common and reduces function, treatment tolerability and quality of life. Given its multifaceted pathophysiology a multimodal approach to cachexia management is advocated for, but can be difficult to realise in practice. We use a case-based approach to highlight practical approaches to the multimodal management of cachexia for patients across the cancer trajectory. Four cases with lung cancer spanning surgical resection, radical chemoradiotherapy, palliative chemotherapy and no anticancer treatment are presented. We propose multimodal care approaches that incorporate nutritional support, exercise, and anti-inflammatory agents, on a background of personalized oncology care and family-centred education. Collectively, the cases reveal that multimodal care is part of everyone's remit, often focuses on supported self-management, and demands buy-in from the patient and their family. Once operationalized, multimodal care approaches can be tested pragmatically, including alongside emerging pharmacological cachexia treatments. We demonstrate that multimodal care for cancer cachexia can be achieved using simple treatments and without a dedicated team of specialists. The sharing of advice between health professionals can help build collective confidence and expertise, moving towards a position in which every team member feels they can contribute towards multimodal care.

ICT Enhanced Buildings Potentials

DEFF Research Database (Denmark)

Christiansson, Per

2007-01-01

component systems that are accessed and integrated in the real world of building use in different contexts. The ICT systems may be physically or virtually embedded in the building. Already in 1982 AT&T established the 'intelligent buildings', IB, concept due to marketing reasons and the Informart building...... with focus on virtual building models support, new services and user environment definitions and development, virtual spaces and augmented reality, intelligent building components, application ontologies, and ICT systems integration to illustrate ICT enhanced buildings potentials and R&D needs.  ...

BIM. Building Information Model. Special issue; BIM. Building Information Model. Themanummer

Energy Technology Data Exchange (ETDEWEB)

Van Gelder, A.L.A. [Arta and Consultancy, Lage Zwaluwe (Netherlands); Van den Eijnden, P.A.A. [Stichting Marktwerking Installatietechniek, Zoetermeer (Netherlands); Veerman, J.; Mackaij, J.; Borst, E. [Royal Haskoning DHV, Nijmegen (Netherlands); Kruijsse, P.M.D. [Wolter en Dros, Amersfoort (Netherlands); Buma, W. [Merlijn Media, Waddinxveen (Netherlands); Bomhof, F.; Willems, P.H.; Boehms, M. [TNO, Delft (Netherlands); Hofman, M.; Verkerk, M. [ISSO, Rotterdam (Netherlands); Bodeving, M. [VIAC Installatie Adviseurs, Houten (Netherlands); Van Ravenswaaij, J.; Van Hoven, H. [BAM Techniek, Bunnik (Netherlands); Boeije, I.; Schalk, E. [Stabiplan, Bodegraven (Netherlands)

2012-11-15

A series of 14 articles illustrates the various aspects of the Building Information Model (BIM). The essence of BIM is to capture information about the building process and the building product. [Dutch] In 14 artikelen worden diverse aspecten m.b.t. het Building Information Model (BIM) belicht. De essentie van BIM is het vastleggen van informatie over het bouwproces en het bouwproduct.

Analysis of Embodied Environmental Impacts of Korean Apartment Buildings Considering Major Building Materials

Directory of Open Access Journals (Sweden)

Seungjun Roh

2018-05-01

Full Text Available Because the reduction in environmental impacts (EIs of buildings using life-cycle assessment (LCA has been emphasized as a practical strategy for the sustainable development of the construction industry, studies are required to analyze not only the operational environmental impacts (OEIs of buildings, but also the embodied environmental impacts (EEIs of building materials. This study aims to analyze the EEIs of Korean apartment buildings on the basis of major building materials as part of research with the goal of reducing the EIs of buildings. For this purpose, six types of building materials (ready-mixed concrete, reinforcement steel, concrete bricks, glass, insulation, and gypsum for apartment buildings were selected as major building materials, and their inputs per unit area according to the structure types and plans of apartment buildings were derived by analyzing the design and bills of materials of 443 apartment buildings constructed in South Korea. In addition, a life-cycle scenario including the production, construction, maintenance, and end-of-life stage was constructed for each major building material. The EEIs of the apartment buildings were quantitatively assessed by applying the life-cycle inventory database (LCI DB and the Korean life-cycle impact assessment (LCIA method based on damage-oriented modeling (KOLID, and the results were analyzed.

Diagnosis of immunodeficiency caused by a purine nucleoside phosphorylase defect by using tandem mass spectrometry on dried blood spots.

Science.gov (United States)

la Marca, Giancarlo; Canessa, Clementina; Giocaliere, Elisa; Romano, Francesca; Malvagia, Sabrina; Funghini, Silvia; Moriondo, Maria; Valleriani, Claudia; Lippi, Francesca; Ombrone, Daniela; Della Bona, Maria Luisa; Speckmann, Carsten; Borte, Stephan; Brodszki, Nicholas; Gennery, Andrew R; Weinacht, Katja; Celmeli, Fatih; Pagel, Julia; de Martino, Maurizio; Guerrini, Renzo; Wittkowski, Helmut; Santisteban, Ines; Bali, Pawan; Ikinciogullari, Aydan; Hershfield, Michael; Notarangelo, Luigi D; Resti, Massimo; Azzari, Chiara

2014-07-01

Purine nucleoside phosphorylase (PNP) deficiency is a rare form of autosomal recessive combined primary immunodeficiency caused by a enzyme defect leading to the accumulation of inosine, 2'-deoxy-inosine (dIno), guanosine, and 2'-deoxy-guanosine (dGuo) in all cells, especially lymphocytes. Treatments are available and curative for PNP deficiency, but their efficacy depends on the early approach. PNP-combined immunodeficiency complies with the criteria for inclusion in a newborn screening program. This study evaluate whether mass spectrometry can identify metabolite abnormalities in dried blood spots (DBSs) from affected patients, with the final goal of individuating the disease at birth during routine newborn screening. DBS samples from 9 patients with genetically confirmed PNP-combined immunodeficiency, 10,000 DBS samples from healthy newborns, and 240 DBSs from healthy donors of different age ranges were examined. Inosine, dIno, guanosine, and dGuo were tested by using tandem mass spectrometry (TMS). T-cell receptor excision circle (TREC) and kappa-deleting recombination excision circle (KREC) levels were evaluated by using quantitative RT-PCR only for the 2 patients (patients 8 and 9) whose neonatal DBSs were available. Mean levels of guanosine, inosine, dGuo, and dIno were 4.4, 133.3, 3.6, and 3.8 μmol/L, respectively, in affected patients. No indeterminate or false-positive results were found. In patient 8 TREC levels were borderline and KREC levels were abnormal; in patient 9 TRECs were undetectable, whereas KREC levels were normal. TMS is a valid method for diagnosis of PNP deficiency on DBSs of affected patients at a negligible cost. TMS identifies newborns with PNP deficiency, whereas TREC or KREC measurement alone can fail. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

To the Extremes! A Teacher Research Experience Program in the Polar Regions

Science.gov (United States)

Warburton, J.; Bartholow, S.

2014-12-01

PolarTREC-Teachers and Researchers Exploring and Collaborating, a teacher professional development program, began with the International Polar Year in 2004 and continues today in the United States. In 2007, the National Science Foundation designated PolarTREC as potentially transformative, meaning that the "research results often do not fit within established models or theories and may initially be unexpected or difficult to interpret; their transformative nature and utility might not be recognized until years later." PolarTREC brings U.S. K-12 educators and polar researchers together through an innovative teacher research experience model. Teachers spend three to six weeks in remote arctic and Antarctic field camps. Since 2007, over 100 teachers have been placed in field experiences throughout the Arctic and Antarctic and with half of them participating in field experiences in Antarctica. During their experience, teachers become research team members filling a variety of roles on the team. They also fulfil a unique role of public outreach officer, conducting live presentations about their field site and research as well as journaling, answering questions, and posting photos. Evaluation data collected over the past eight years on program participants shows that PolarTREC has clearly achieved it goals and strongly suggests programs that link teachers and researchers can have the potential to transform the nature of science education. By giving teachers the content knowledge, pedagogical tools, confidence, understanding of science in the broader society, and experiences with scientific inquiry, participating teachers are using authentic scientific research in their classrooms. Not surprisingly this has also led to increases in student interest and knowledge about the Polar Regions. In this presentation, we will highlight the best practices of teacher research experiences as well as discuss why it is vital to have teachers and researchers work together to communicate

The Voices of Youth in Out-of-Home Care regarding Developing Healthy Dating Relationships

Science.gov (United States)

Duppong Hurley, Kristin; Trout, Alexandra; Wheaton, Nikki; Buddenberg, Laura; Howard, Brigid; Weigel, Megan

2013-01-01

Minimal attention has been focused on difficulties for youth in residential care regarding building healthy dating relationships, despite the significant risks to this group of adolescents. This study provided a unique opportunity to conduct focus groups with youth in residential care on issues surrounding dating relationships. The majority of…

Analyzing and Forecasting Electrical Load Consumption in Healthcare Buildings

Directory of Open Access Journals (Sweden)

Rodolfo Gordillo-Orquera

2018-02-01

Full Text Available Healthcare buildings exhibit a different electrical load predictability depending on their size and nature. Large hospitals behave similarly to small cities, whereas primary care centers are expected to have different consumption dynamics. In this work, we jointly analyze the electrical load predictability of a large hospital and that of its associated primary care center. An unsupervised load forecasting scheme using combined classic methods of principal component analysis (PCA and autoregressive (AR modeling, as well as a supervised scheme using orthonormal partial least squares (OPLS, are proposed. Both methods reduce the dimensionality of the data to create an efficient and low-complexity data representation and eliminate noise subspaces. Because the former method tended to underestimate the load and the latter tended to overestimate it in the large hospital, we also propose a convex combination of both to further reduce the forecasting error. The analysis of data from 7 years in the hospital and 3 years in the primary care center shows that the proposed low-complexity dynamic models are flexible enough to predict both types of consumption at practical accuracy levels.

Building our future: a plea for leadership.

Science.gov (United States)

Souba, Wiley W

2004-05-01

In recent years the spastic nature of the health care marketplace has continued to increase, which has greatly escalated the demands of leadership in academic medical centers. The expectations of leaders, including surgery chairs, have increased considerably, whereas their capacity for independent action has undeniably diminished. In such a predicament, it is useful to revisit fundamentals, using them as a guide to build a sound future. Five leadership principles are critical to building a better future: (1) recognizing that the work of leadership involves an inward journey of self-discovery and self-development; (2) establishing clarity around a set of core values that guide the organization as it pursues its goals; (3) communicating a clear sense of purpose and vision that inspires widespread commitment to a shared sense of destiny; (4) building a culture of excellence and accountability throughout the entire organization; and (5) creating a culture that emphasizes the development of leaders and leadership as an organizational capacity. Leadership and learning are inextricably linked. We must change the perception that learning in academic surgery is about correcting a deficit rather than a natural part of human growth and development. Our ability to learn, grow, and contribute to an organization is what provides each of us with meaning and identity. This feeling of being part of something special that is larger than ourselves is a powerful force and an important dividend of great leadership.

Sustainable Buildings in Interaction

DEFF Research Database (Denmark)

Elle, Morten

2007-01-01

The first attempts to build sustainable buildings in Denmark were typically located on the countryside. The basic idea was to create buildings that were independent of the technical infrastructure. District heating has, however, been the dominating solution to heating in buildings in Denmark......, and the focus on sustainable building have gradually turned from special houses on the countryside to normally looking houses in the urban fabric, integrated in the technical infrastructure. Some new built urban areas in Denmark will, however, not have to be supplied with district heating – these developments...... are going to consist of passive houses. The first sustainable buildings were built by their users, and the user – building interaction still play a decisive role for the performance of the present sustainable buildings. The users have to understand how the building functions. Urban design is essential...

Current status of palliative care--clinical implementation, education, and research.

Science.gov (United States)

Grant, Marcia; Elk, Ronit; Ferrell, Betty; Morrison, R Sean; von Gunten, Charles F

2009-01-01

Palliative and end-of-life care is changing in the United States. This dynamic field is improving care for patients with serious and life-threatening cancer through creation of national guidelines for quality care, multidisciplinary educational offerings, research endeavors, and resources made available to clinicians. Barriers to implementing quality palliative care across cancer populations include a rapidly expanding population of older adults who will need cancer care and a decrease in the workforce available to give care. Methods of integrating current palliative care knowledge into care of patients include multidisciplinary national education and research endeavors, and clinician resources. Acceptance of palliative care as a recognized medical specialty provides a valuable resource for improvement of care. Although compilation of evidence for the importance of palliative care specialities is in its initial stages, national research grants have provided support to build the knowledge necessary for appropriate palliative care. Opportunities are available to clinicians for understanding and applying appropriate palliative and end-of-life care to patients with serious and life-threatening cancers. (c) 2009 American Cancer Society, Inc.

End-of-Life Care in Nunavik, Quebec: Inuit Experiences, Current Realities, and Ways Forward.

Science.gov (United States)

Hordyk, Shawn Renee; Macdonald, Mary Ellen; Brassard, Paul

2017-06-01

Increasing longevity for Inuit living in Nunavik, northern Quebec, has resulted in heightened rates of cancers and chronic diseases necessitating complex treatments. Consequently, end-of-life (EOL) care, once the domain of Inuit families and communities, has come to include professionalized healthcare providers with varying degrees of awareness of factors to consider in providing care to Inuit populations. To better understand the factors shaping EOL care in Nunavik to support the development of a sustainable model of care. Using focused ethnography, we conducted participant observations and informal and semistructured interviews with 103 participants (community members, healthcare practitioners, and administrators) across Nunavik and in Montreal, the affiliated tertiary care center. Data domains included the following: care trajectories; patient and family experiences receiving and providing EOL care; local and urban resources and challenges; and ways forward. Sociocultural, historical, and geographic factors shape EOL care in Nunavik, presenting a complex set of challenges for Inuit patients, families, and healthcare providers. A sustainable model of EOL care requires building on shared initiatives, capitalizing on the existing strengths in communities, and attending to the multiple bereavement needs in the region. Building a sustainable model of EOL care requires respectful collaboration among governing structures, healthcare institutions, and community members. It must centrally value local knowledge and initiatives. To ensure Inuit families and patients are supported throughout the dying process, future initiatives must centrally include local stakeholders in both the design and evaluation of any changes to the current healthcare system.

Green Buildings and Health.

Science.gov (United States)

Allen, Joseph G; MacNaughton, Piers; Laurent, Jose Guillermo Cedeno; Flanigan, Skye S; Eitland, Erika Sita; Spengler, John D

2015-09-01

Green building design is becoming broadly adopted, with one green building standard reporting over 3.5 billion square feet certified to date. By definition, green buildings focus on minimizing impacts to the environment through reductions in energy usage, water usage, and minimizing environmental disturbances from the building site. Also by definition, but perhaps less widely recognized, green buildings aim to improve human health through design of healthy indoor environments. The benefits related to reduced energy and water consumption are well-documented, but the potential human health benefits of green buildings are only recently being investigated. The objective of our review was to examine the state of evidence on green building design as it specifically relates to indoor environmental quality and human health. Overall, the initial scientific evidence indicates better indoor environmental quality in green buildings versus non-green buildings, with direct benefits to human health for occupants of those buildings. A limitation of much of the research to date is the reliance on indirect, lagging and subjective measures of health. To address this, we propose a framework for identifying direct, objective and leading "Health Performance Indicators" for use in future studies of buildings and health.

Energy Performance of Three Residential College Buildings in University of Malaya Campus, Kuala Lumpur

Directory of Open Access Journals (Sweden)

Adi Ainurzaman Jamaludin

2011-12-01

Full Text Available Three residential colleges located in Kuala Lumpur, Malaysia, were selected for energy performance analysis in regards to its implementation of bioclimatic design strategies. Specifically, passive design strategies on daylighting and natural ventilation were examined. In Malaysia, the residential college or hostel is a multi-residential building providing accommodation to university students. The three residential colleges in this study, namely C1, C2 and C3, were built in different years with different designs and forms, particularly with regards to enclosure and facade design, solar control devices, passive daylight concepts, and natural ventilation strategies. The building designs were carefully studied and an electric consumption analysis was carried out in each residential college. This study revealed that the wide-scale implementation of bioclimatic design strategies in college C2 help reduced the annual energy consumption. The building bioclimatic design features that are accountable to reduce energy consumption are the internal courtyard and balconies on each unit of floor area, as shown in C3.Results from this study highly recommend internal courtyard and balcony building combination for multi residential building design, especially in tropical urban regions.

Kayenta Township Building & Safety Department, Tribal Green Building Code Summit Presentation

Science.gov (United States)

Tribal Green Building Code Summit Presentation by Kayenta Township Building & Safety Department showing how they established the building department, developed a code adoption and enforcement process, and hired staff to carry out the work.

Green buildings pay

DEFF Research Database (Denmark)

Naboni, Emanuele; Edwards, Brian

The new edition of ‘Green Buildings Pay’ authored by Brian Edwards and Emanuele Naboni explores the business and professional benefits which derive from architectural design driven by sustainability. With a new sub-title ‘Green Buildings Pay: design, productivity and ecology’ the book argues...... that environmental design has altered how we design, construct and manage buildings. The book has relevance to those who not only design and engineer buildings but to those who commission architecture and those who occupy the products of this process. Hence, the user is a key consideration. The book examines via...... a number of LEED and BREEAM cases the buildings which flow from corporate environmental responsibility. A number of office and university buildings are examined from three main perspectives- the architect, client and user. One key finding is that architectural innovation has been driven by ecological...

Integrated community-based dementia care: the Geriant model

Directory of Open Access Journals (Sweden)

Ludo Glimmerveen

2015-09-01

Full Text Available This article gives an in-depth description of the service delivery model of Geriant, a Dutch organization providing community-based care services for people suffering from dementia. Core to its model is the provision of clinical case management, embedded in multidisciplinary dementia care teams. As Geriant's client group includes people from the first presumption of dementia until they can no longer live at home, its care model provides valuable lessons about how different mechanisms of integration are flexibly put to use if the complexity of clients” care needs increases. It showcases how the integration of services for a specific sub-population is combined with alignment of these services with generalist network partners. After a detailed description of the programme and its results, this article builds on the work of Walter Leutz for a conceptual discussion of Geriant's approach to care integration. 

Refurbishment and school buildings management in a smart building environment

Science.gov (United States)

Di Giuda, Giuseppe Martino; Villa, Valentina; Tagliabue, Lavinia Chiara; Giana, Paolo Ettore; Rinaldi, Stefano; Ciribini, Angelo Luigi Camillo

2018-05-01

Building Information Modelling is a methodology, which is able to take into account many data, both geometrical and non-geometrical, in order to evaluate at the actual condition of the asset. The project has the scope of evaluating the conditions of different school buildings, in order to develop a way to choose the best-tailored management solution to the owner. A further step is the management and planning of design solutions during the life cycle customized on monitored buildings' conditions. The research work focuses on providing a support decisions concerning the gap between the present building state laws and the current state of the existing buildings. The process will be developed in an expanded BIM environment, using sensors, which will give back the state of the consistency of the actual conditions to enable the buildings to adapt themselves in the best way into their specific constraints and boundaries. The results of the study are (i) a complete workflow to make decision and the possibility to shape the decision process on an objective through a scientific approach, (ii) evaluate the current state of the asset and (iii) manage maintenance in the lifespan. Further development will take in consideration all the aspects related to management of big data environment generated by a smart buildings system.

Building America

Energy Technology Data Exchange (ETDEWEB)

Brad Oberg

2010-12-31

IBACOS researched the constructability and viability issues of using high performance windows as one component of a larger approach to building houses that achieve the Building America 70% energy savings target.

Creative market development : marketing on a shoestring

International Nuclear Information System (INIS)

McLeod, D.

2004-01-01

The initiatives that led to the development, construction and financing of Toronto's wind turbine by the Toronto Renewable Energy Co-op (TREC) were outlined in this PowerPoint presentation. The initiative for this first urban-based turbine in North America stemmed from a lack of green power in Ontario's energy market and a strong push from the public for more green power. TREC researched a variety of potential wind tower sites in Toronto and submitted a pre-feasibility report. The construction of the wind turbine involved a joint venture between WindShare and Toronto Hydro Energy Services. The basic principals behind co-operative financing were reviewed along with the challenges of marketing the project

Vasopressin and the Neurogenetics of Parental Care.

Science.gov (United States)

Snyder-Mackler, Noah; Tung, Jenny

2017-07-05

Making robust connections between genetic variation, neurophysiology, and social behavior remains a challenge. A study by Bendesky et al. (2017) tackles this challenge by dissecting the genetic architecture of parental care in deer mice to discover an important contribution of vasopressin signaling to the evolution of nest building. Copyright © 2017 Elsevier Inc. All rights reserved.

Building nurse leaders through the Institute for Healthcare Improvement Open School Student Quality Leadership Academy.

Science.gov (United States)

May, Cattleya; Cutting, Katharine N

2014-01-01

The Institute for Healthcare Improvement is an independent not-for-profit organization based in Cambridge, Massachusetts. It is a leading innovator in health and health care improvement with a global following.One important part of the IHI is the development and evolution of the "Open School." Launched in September 2008, the online community currently includes hundreds of thousands of students worldwide. The goals of the Open School are consistent with the IHI initial concepts: to build will for change, seek out innovation, share expertise, and build leaders. Each year, the Open School awards scholarships to select students to attend a Leadership Academy.The Student Quality Leadership Academy allows students to network with other future nurses, physicians, and health care administrators and explores how they feel about leadership. This is important to nursing as we will need to replace many leadership positions in the future, but often new nurses are uncertain about leadership roles.

Changes in patient satisfaction related to hospital renovation: experience with a new clinical building.

Science.gov (United States)

Siddiqui, Zishan K; Zuccarelli, Rebecca; Durkin, Nowella; Wu, Albert W; Brotman, Daniel J

2015-03-01

There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences with the physical environment from positive experience with care, an improved hospital environment leads to higher satisfaction with physicians, nursing, food service, housekeeping, and higher overall satisfaction. To characterize changes in patient satisfaction that occurred when clinical services (comprised of stable nursing, physician, and unit teams) were relocated to a new clinical building with patient-centered features. We hypothesized that new building features would positively impact provider, ancillary staff, and overall satisfaction, as well as improved satisfaction with the facility. Natural experiment utilizing a pre-post design with concurrent controls. Academic tertiary care hospital. We included all patients discharged from 12 clinical units that relocated to the new clinical building who returned surveys in the 7.5-month period following the move. Premove baseline data were captured from the year prior to the move. Patients on unmoved clinical units who returned satisfaction surveys served as concurrent controls. Patient-centered design features incorporated into the new clinical building. All patients during the baseline period and control patients during the study period were located in usual patient rooms with standard hospital amenities. The primary outcome was satisfaction scores on the Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems survey, dichotomized at highest category versus lower categories. We performed logistic regression to identify predictors of "top-box" scores. The move was associated with improved room- and visitor-related satisfaction without significant improvement in satisfaction with clinical

10 CFR 455.141 - Grant awards for units of local government, public care institutions, and coordinating agencies.

Science.gov (United States)

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Grant awards for units of local government, public care... CONSERVATION GRANT PROGRAMS FOR SCHOOLS AND HOSPITALS AND BUILDINGS OWNED BY UNITS OF LOCAL GOVERNMENT AND PUBLIC CARE INSTITUTIONS Grant Awards § 455.141 Grant awards for units of local government, public care...

The Impact of Grid on Health Care Digital Repositories

CERN Document Server

Donno, Flavia; CERN. Geneva. IT Department

2008-01-01

Grid computing has attracted worldwide attention in a variety of applications like Health Care. In this paper we identified the Grid services that could facilitate the integration and interoperation of Health Care data and frameworks world-wide. While many of the current Health Care Grid projects address issues such as data location and description on the Grid and the security aspects, the problems connected to data storage, integrity, preservation and distribution have been neglected. We describe the currently available Grid storage services and protocols that can come in handy when dealing with those problems. We further describe a Grid infrastructure to build a cooperative Health Care environment based on currently available Grid services and a service able to validate it.

A "Fundamentals" Train-the-Trainer Approach to Building Pediatric Critical Care Expertise in the Developing World.

Science.gov (United States)

Crow, Sheri S; Ballinger, Beth A; Rivera, Mariela; Tsibadze, David; Gakhokidze, Nino; Zavrashvili, Nino; Ritter, Matthew J; Arteaga, Grace M

2018-01-01

Pediatric Fundamental Critical Care Support (PFCCS) is an educational tool for training non-intensivists, nurses, and critical care practitioners in diverse health-care settings to deal with the acute deterioration of pediatric patients. Our objective was to evaluate the PFCCS course as a tool for developing a uniform, reproducible, and sustainable model for educating local health-care workers in the optimal management of critically ill children in the Republic of Georgia. Over a period of 18 months and four visits to the country, we worked with Georgian pediatric critical care leadership to complete the following tasks: (1) survey health-care needs within the Republic of Georgia, (2) present representative PFCCS lectures and simulation scenarios to evaluate interest and obtain "buy-in" from key stakeholders throughout the Georgian educational infrastructure, and (3) identify PFCCS instructor candidates. Georgian PFCCS instructor training included the following steps: (1) US PFCCS consultant and content experts presented PFCCS course to Georgian instructor candidates. (2) Simulation learning principles were taught and basic equipment was acquired. (3) Instructor candidates presented PFCCS to Georgian learners, mentored by PFCCS course consultants. Objective evaluation and debriefing with instructor candidates concluded each visit. Between training visits Georgian instructors translated PFCCS slides to the Georgian language. Six candidates were identified and completed PFCCS instructor training. These Georgian instructors independently presented the PFCCS course to 15 Georgian medical students. Student test scores improved significantly from pretest results ( n  = 14) (pretest: 38.7 ± 7 vs. posttest 62.7 ± 6, p  fundamentals of pediatric critical care. Future collaborations will evaluate the clinical impact of PFCCS throughout the Georgian health-care system.

Quality of Cardiac Care in Canada: Recommendations for Building a Sustainable Future.

Science.gov (United States)

Young, Courtney; Lambert, Laurie; Abel, James; O'Neill, Blair J

2018-06-01

Cardiovascular (CV) disease continues to present a significant disease and economic burden in Canada. To improve the quality of care and ensure sustainability of services, a national quality improvement initiative is required. The purpose of this analysis was to review the evidence for public reporting (PR) and external benchmarking (EB) to improve patient outcomes, and to recommend a strategy to improve CV care in Canada. To incorporate recent literature, the Canadian Cardiovascular Society (CCS) commissioned the Institute of Health Economics to provide a rapid update on the literature of PR and EB. The review showed that EB is more likely to promote positive effects, such as improved mortality, morbidity, and evidence-based clinical practice, and to limit negative effects, such as access restrictions or unintended provider behaviour associated with some forms of "top-down" PR. On the basis of these findings, this we recommend the following: (1) secure funding for the provincial collection of CV quality indicators and the creation of annual National CV Quality Reports; (2) enhance the culture of using CV quality indicator data for continuous quality improvement and opportunities for national or regional EB and sharing best practices; and (3) implement ongoing evaluation and revision of CCS clinical practice guidelines incorporating key quality indicators. This is already under way to a limited extent by the CCS with its Quality Project, but intentional, sustained support needs to be secured to enhance this ongoing effort and improve the quality of CV care for all Canadians. Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Environmentally friendly health care food services: a survey of beliefs, behaviours, and attitudes.

Science.gov (United States)

Wilson, Elisa D; Garcia, Alicia C

2011-01-01

There is increasing global interest in sustainability and the environment. A hospital/health care food service facility consumes large amounts of resources; therefore, efficiencies in operation can address sustainability. Beliefs, attitudes, and behaviours about environmentally friendly practices in hospital/health care food services were explored in this study. Questionnaires addressed environmentally friendly initiatives in building and equipment, waste management, food, and non-food procurement issues. The 68 participants included hospital food service managers, clinical dietitians, dietary aides, food technicians, and senior management. Data analysis included correlation analysis and descriptive statistics. Average scores for beliefs were high in building and equipment (90%), waste management (94%), and non-food procurement (87%), and lower in food-related initiatives (61%) such as buying locally, buying organic foods, buying sustainable fish products, and reducing animal proteins. Average positive scores for behaviours were positively correlated with beliefs (waste management, p=0.001; food, p=0.000; non-food procurement, p=0.002). Average positive scores for attitude in terms of implementing the initiatives in health care were 74% for building and equipment, 81% for waste management, 70% for non-food procurement, and 36% for food. The difference in food-related beliefs, behaviours, and attitudes suggests the need for education on environmental impacts of food choices. Research is recommended to determine facilitators and barriers to the implementation of green strategies in health care. As food experts, dietitians can lead changes in education, practice, and policy development.