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Sample records for ambulatory source factores

  1. Gamma factors of an ambulatory source; Factores gamma de una fuente ambulatoria

    Energy Technology Data Exchange (ETDEWEB)

    Arcos P, A.; Vega C, H.R.; Manzanares A, E.; Salas L, M.A.; Hernandez D, V.M. [Unidades Academicas de Estudios Nucleares e Ingenieria Electrica, Universidad Autonoma de Zacatecas, C. Cipres 10, Fracc. La Penuela, 98068 Zacatecas (Mexico); Barquero, R. [Hospital Universitario del Rio Hortega, E-47010 Valladolid (Spain)

    2007-07-01

    Some of the procedures for diagnostic or treatment used in the medicine use radioactive materials as the I{sup 131}. By means of Monte Carlo methods were calculated the doses in the internal organs of a woman, with three months of pregnancy, due to the radioiodine captured by her thyroid, as well as to 1 meter of the gland. A three-dimensional mathematical model of the body of a woman was used and by means of Monte Carlo, the radioiodine photons were transported isotropically from the thyroid toward the whole body and was calculated the absorbed dose by their internal organs, also the Kerma in air (K) was determined and the environmental equivalent dose (H{sup *}(10)) at 1 m of the gland. Two activity factors at dose were determined, Gamma Factors that it allows to estimate the dose that the patient produces to people to its around. Of the gamma radiation that emits the I{sup 131} in the thyroid was found that the thymus receives the biggest dose while the uterus is the organ that smaller dose receives. The determined gamma factors were: {gamma}{sub KAire} = 56 {mu}Gy-m{sup 2}-h{sup -1}-GBq{sup -1}, and {gamma}{sub H}{sup *}{sub (10)} = 73 {mu}Sv-m{sup 2}-h{sup -1}-GBq{sup -1}. The distribution of the absorbed dose by the internal organs is attributed to the relative distance among the thyroid and the other organs, to the inter-organs shielding, its size and to its elementary composition. The {gamma}{sub KAire} and {gamma}{sub H}{sup *}{sub (10)} factors allow to estimate the exposure that the patient produces on the personnel to its around. With this, the nuclear medicus, the medical physicist or the one responsible of the radiological safety in the hospital can give more precise indications on the behavior of people around the patient. (Author)

  2. Ambulatory blood pressure status in children: comparing alternate limit sources.

    Science.gov (United States)

    Bell, Cynthia S; Poffenbarger, Tim S; Samuels, Joshua A

    2011-12-01

    The American Heart Association has included alternate ambulatory blood pressure (ABP) limits for children published by Wühl in 2002. These updated limits employ the same pediatric cohort data as the previous ABP limits published by Soergel in 1997 but differ in analysis technique. The implications of changing ABP limit source on the diagnosis of hypertension has yet to be examined in a large pediatric cohort. We reviewed 741 ABP monitorings performed in children referred to our hypertension clinic between 1991-2007. Hypertension was defined as 24-h mean blood pressure ≥ 95 th percentile or 24-h blood pressure load ≥ 25%, by Soergel and Wühl limits separately. Six hundred seventy-three (91%) children were classified the same by both limit sources. Wühl limits were more likely than Soergel to classify a child as hypertensive (443 vs. 409, respectively). There was an increased classification of prehypertension and decreased white-coat hypertension by the Wühl method, whereas ambulatory and severe hypertension counts remained relatively the same by both limits sources. The use of either limit source will not significantly affect most clinical outcomes but should remain consistent over long-term research projects. Collection of new normative data from a larger, multiethnic population is needed for better measurement of ABP in children.

  3. An analysis of risk factors and adverse events in ambulatory surgery

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    Kent C

    2014-06-01

    Full Text Available Christopher Kent, Julia Metzner, Laurent BollagDepartment of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USAAbstract: Care for patients undergoing ambulatory procedures is a broad and expanding area of anesthetic and surgical practice. There were over 35 million ambulatory surgical procedures performed in the US in 2006. Ambulatory procedures are diverse in both type and setting, as they span the range from biopsies performed under local anesthesia to intra-abdominal laparoscopic procedures, and are performed in offices, freestanding ambulatory surgery centers, and ambulatory units of hospitals. The information on adverse events from these varied settings comes largely from retrospective reviews of sources, such as quality-assurance databases and closed malpractice claims. Very few if any ambulatory procedures are emergent, and in comparison to the inpatient population, ambulatory surgical patients are generally healthier. They are still however subject to most of the same types of adverse events as patients undergoing inpatient surgery, albeit at a lower frequency. The only adverse events that could be considered to be unique to ambulatory surgery are those that arise out of the circumstance of discharging a postoperative patient to an environment lacking skilled nursing care. There is limited information on these types of discharge-related adverse events, but the data that are available are reviewed in an attempt to assist the practitioner in patient selection and discharge decision making. Among ambulatory surgical patients, particularly those undergoing screening or cosmetic procedures, expectations from all parties involved are high, and a definition of adverse events can be expanded to include any occurrence that interrupts the rapid throughput of patients or interferes with early discharge and optimal patient satisfaction. This review covers all types of adverse events, but focuses on the more

  4. Risk factors for the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis patients.

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    Xiaoguang Fan

    Full Text Available The first episode of peritonitis affects survival of the peritoneal membrane as a medium for dialysis as well as survival of patients. The aim of this study is to investigate risk factors associated with the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD patients.This is a single-center, retrospective, cohort study. All incident CAPD patients from 1 January 2006 to 31 December 2010 were recruited, and followed up until their first episode of peritonitis or 31 December, 2012. Baseline demographic, socioeconomic, clinical and laboratory data were collected. Cox proportional model was used to determine the factors associated with the first episode of peritonitis.In a cumulative 30756.5 patient-months follow-up (the median vintage 26.1 months of 1117 CAPD patients, 309(27.7% patients presented the first episodes of peritonitis. The cumulative peritonitis-free survival was 86.2%, 78.1%, 71.4% and 57.8% at 1, 2, 3 and 5 year, respectively. The multivariate analysis showed that factors associated with risk for the first episode of peritonitis were elderly patients (>65 years [hazard ratio (HR = 1.427, 95% confidence interval (CI = 1.051 to 1.938, P = 0.023], male(HR = 1.315, 95% CI = 1.028 to 1.684, P = 0.030, lower education level (HR = 1.446, 95% CI: 1.127 to 1.855, P = 0.004 and albumin <38g/L (HR = 1.425, 95% CI: 1.112 to 1.825, P = 0.005.Older age, male, lower educational level and hypoalbuminemia at the commencement of PD were the risk factors associated with the first episode of peritonitis in Southern Chinese CAPD patients.

  5. Effect of tumor necrosis factor-α inhibitors on ambulatory 24-h blood pressure.

    Science.gov (United States)

    Grossman, Chagai; Bornstein, Gil; Leibowitz, Avshalom; Ben-Zvi, Ilan; Grossman, Ehud

    2017-02-01

    Tumor necrosis factor alpha (TNF-α) inhibitors are increasingly being used in inflammatory rheumatic diseases (IRD). The risk of cardiovascular disease is elevated in patients with IRD and TNF-α inhibitors reduce this risk. We assessed whether the beneficial effect of TNF-α inhibitors on cardiovascular risk is mediated by blood pressure reduction. We measured blood pressure levels with 24-h ambulatory blood pressure measurements device in patients with IRD before and 3 months after treatment with TNF-α inhibitors. The study population consisted of 15 subjects (6 men; mean age 45.9 ± 14.1 years). Most patients had either rheumatoid arthritis or psoriatic arthritis and adalimumab was the most common TNF-α inhibitor used. Mean 24-h systolic and diastolic blood pressure levels remained the same after treatment (121 ± 12/66 ± 7 before and 123 ± 11/67 ± 10 mm Hg after; p = 0.88 and 0.66, respectively). The study demonstrates that TNF-α inhibitors have no effect on blood pressure levels.

  6. Factors associated with health information exchange system usage in a safety-net ambulatory care clinic setting.

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    Vest, Joshua R; Gamm, Larry D; Ohsfeldt, Robert L; Zhao, Hongwei; Jasperson, 'Jon Sean

    2012-08-01

    The Meaningful Use criteria promises to make health information exchange (HIE) much more widespread. However, the usage of the information systems made available by existing HIE efforts tends to be very low. This study sought to examine the factors associated with usage of an operational HIE system during ambulatory care visits to safety-net clinics. Overall the HIE system was accessed for 21% of encounters. However, system access took on two distinct forms. In general, usage was more likely for patients with recent emergency department visits and chronic conditions. This study indicates the organizational commitment to engage in HIE does not necessarily mean that the information systems will be always used. In addition, system usage will take on various forms for different reasons. These results reveal considerations for the development, operation and evaluation of HIE efforts.

  7. SURVIVAL OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CATHETERS: AN EVALUATION OF SURGICAL AND NON-SURGICAL FACTORS (SINGLE CENTER STUDY

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    A. Keshvari

    2006-06-01

    Full Text Available Peritoneal dialysis is an established form of renal replacement therapy used in many patients with end-stage renal disease. The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. This study was conducted in order to evaluate the catheter survival and its related factors in Imam Khomeini Hospital. A total of 80 catheters were inserted into 69 patients (52 men and 28 women with end-stage chronic renal failure during a period of 84 months. Retrospectively the correlation between catheter survival (overall and event free with demographic factors (sex and age, surgical factors (surgeons and surgical methods, nephrologic factors (the causes of peritoneal dialysis selection and the history of hemodialysis and peritonitis factors (the history and number of peritonitis has been evaluated. The mean age of the patients was 48.35 years (16 to 79 years. The overall survival of catheters or the probability of having a functioning catheter after one, two and three years was 53%, 41%, 22%, respectively. The event free survival of the catheter or the probability of having a functioning catheter without any problems after one year was 14%. It has been found out that among all factors in this study only history of hemodialysis had statistically significant effect on the overall survival of continuous ambulatory peritoneal dialysis catheter (P = 0.04. It seems that the overall survival of catheters is better when CAPD is started before any other attempts for hemodialysis.

  8. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, encourages research ... 6620 | E-mail: info@sambahq.org Copyright | 2016 Society for Ambulatory Anesthesia Home | Search | Terms | Privacy Policy | ...

  9. [Risk factors of serious bleeding among ambulatory patients taking antivitamin K aged 75 and over].

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    Blas-Châtelain, C; Chauvelier, S; Foti, P; Debure, C; Hanon, O

    2014-05-01

    The benefits of anti-vitamin K (AVK) drugs have been acknowledged in several indications. Such indications increasing with increasing age, AVK prescriptions also increases with age. At the same time, conditions involving significant bleeding are common in this elderly population. It is thus essential to recognize the determining factors. This study included all patients taking AVK drugs aged 75 years and older who sought emergency care at the Cochin Hospital from January to December 2011 for significant bleeding. These patients were compared with a cohort of patients aged 75 years or older who were taking AVK drugs and who were admitted to the same unit during the same time period for other reasons. The case-control comparison included demographic data, comorbidity factors, multiple medications, emergency measured INR, and CHA2DS2VASC level. The hemorrhagic risk was evaluated by HEMORR2HAGES and HAS-BLED. A total of 34 patients were studied and compared with 70 case-controls. The Charlson comorbidity index was higher in patients than case-controls (PAVK drugs is related to their higher comorbidity and hemorrhagic levels which need to be evaluated before starting or stopping AVK treatment.

  10. Risk factors and outcomes of high peritonitis rate in continuous ambulatory peritoneal dialysis patients: A retrospective study.

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    Tian, Yuanshi; Xie, Xishao; Xiang, Shilong; Yang, Xin; Zhang, Xiaohui; Shou, Zhangfei; Chen, Jianghua

    2016-12-01

    Peritonitis remains a major complication of peritoneal dialysis (PD). A high peritonitis rate (HPR) affects continuous ambulatory peritoneal dialysis (CAPD) patients' technique survival and mortality. Predictors and outcomes of HPR, rather than the first peritonitis episode, were rarely studied in the Chinese population. In this study, we examined the risk factors associated with HPR and its effects on clinical outcomes in CAPD patients.This is a single center, retrospective, observational cohort study. A total of 294 patients who developing at least 1 episode of peritonitis were followed up from March 1st, 2002, to July 31, 2014, in our PD center. Multivariate logistic regression was used to determine the factors associated with HPR, and the Cox proportional hazard model was conducted to assess the effects of HPR on clinical outcomes.During the study period of 2917.5 patient-years, 489 episodes of peritonitis were recorded, and the total peritonitis rate was 0.168 episodes per patient-year. The multivariate analysis showed that factors associated with HPR include a quick occurrence of peritonitis after CAPD initiation (shorter than 12 months), and a low serum albumin level at the start of CAPD. In the Cox proportional hazard model, HPR was a significant predictor of technique failure. There were no differences between HPR and low peritonitis rate (LPR) group for all-cause mortality. However, when the peritonitis rate was considered as a continuous variable, a positive correlation was observed between the peritonitis rate and mortality.We found the quick peritonitis occurrence after CAPD and the low serum albumin level before CAPD were strongly associated with an HPR. Also, our results verified that HPR was positively correlated with technique failure. More importantly, the increase in the peritonitis rate suggested a higher risk of all-cause mortality.These results may help to identify and target patients who are at higher risk of HPR at the start of CAPD and to

  11. Factors contributing to nonadherence to oral hypoglycemic medications among ambulatory type 2 diabetes patients in Southwestern Nigeria

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    Adisa R

    2009-09-01

    Full Text Available Objective: The overall goal of the study was to evaluate the probable reasons for patients’ nonadherence to prescribed oral hypoglycemic medications in an ambulatory care setting in Nigeria with a view to identifying points for necessary intervention to improve adherence and treatment outcomes. Also, the recommended non-drug management options for diabetes patients with emphasis on self monitoring of blood glucose were assessed.Methods: A cross-sectional study was conducted at a 200-bed secondary health care facility in Southwestern Nigeria between 2nd April and 31st May 2008. Copies of pre-tested questionnaire were administered directly to 121 ambulatory patients with type 2 diabetes at the study site. Information on socio-demographic characteristic, probable barriers that affect adherence to prescribed oral hypoglycemic medications, non-drug treatment options for diabetes, and patients’ self management efforts were obtained. Descriptive and chi-square statistics were used to evaluate the distribution of respondents’ opinion.Results: The response rate was almost 100%. The commonly cited intentional nonadherence practice included dose omission (70.2%. Almost 50% respondents were fed up with daily ingestion of drugs and 19.8% were inconvenienced with taking medications outside home and gave these as reasons for the dose omission. Forgetfulness (49.6% and high cost of medication (35.5% were mentioned as major non-intentional reasons for nonadherence. Aside oral medications, 82.6% and 95.0% of respondents respectively, reported moderate exercise and dietary restrictions as part of the prescribed treatment modalities. More than two third of respondents (81.8% had never monitored blood glucose by themselves. Significant association exist between sex, occupation and patients’ tendencies to forget doses of prescribed oral medications (p<0.05. Conclusion: Nonadherence behaviors among ambulatory patients with type 2 diabetes occur mostly, as

  12. Communication in acute ambulatory care.

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    Dean, Marleah; Oetzel, John; Sklar, David P

    2014-12-01

    Effective communication has been linked to better health outcomes, higher patient satisfaction, and treatment adherence. Communication in ambulatory care contexts is even more crucial, as providers typically do not know patients' medical histories or have established relationships, conversations are time constrained, interruptions are frequent, and the seriousness of patients' medical conditions may create additional tension during interactions. Yet, health communication often unduly emphasizes information exchange-the transmission and receipt of messages leading to a mutual understanding of a patient's condition, needs, and treatments. This approach does not take into account the importance of rapport building and contextual issues, and may ultimately limit the amount of information exchanged.The authors share the perspective of communication scientists to enrich the current approach to medical communication in ambulatory health care contexts, broadening the under standing of medical communication beyond information exchange to a more holistic, multilayered viewpoint, which includes rapport and contextual issues. The authors propose a socio-ecological model for understanding communication in acute ambulatory care. This model recognizes the relationship of individuals to their environment and emphasizes the importance of individual and contextual factors that influence patient-provider interactions. Its key elements include message exchange and individual, organizational, societal, and cultural factors. Using this model, and following the authors' recommendations, providers and medical educators can treat communication as a holistic process shaped by multiple layers. This is a step toward being able to negotiate conflicting demands, resolve tensions, and create encounters that lead to positive health outcomes.

  13. SURGICAL PROFILE AND DETERMINING FACTORS OF THE SUSPENSIONS OF THE AMBULATORIAL GENERALSURGERIES: CONTRIBUTIONS TO THE NURSING ASSISTANCE

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    Carlos Eduardo Peres Sampaio

    2012-04-01

    Full Text Available OBJETIVOS: identificar o perfil dos usuários do ambulatório de cirurgia geral; determinar os procedimentos cirúrgicos gerais realizados; analisar os fatores determinantes de suspensão de cirurgias gerais. MÉTODO: abordagem quantitativa do tipo exploratório-descritivo retrospectivo. A pesquisa foi realizada na Unidade Cirurgia Ambulatorial de uma Policlínica situada no Município do Rio de Janeiro. Coleta de dados utilizou-se os registros dos atendimentos cirúrgicos a pacientes submetidos à cirurgia geral RESULTADOS: o número de pacientes adultos do sexo feminino foi de 136(39,4%, enquanto os pacientes do sexo masculino foram de 209(60,6%. Dentre os variados procedimentos cirúrgicos, os mais realizados foram: as herniorrafias, cistos sebáceos, tumorações e lipomas. Foram propostas 427 cirurgias, 345(81% foram realizadas, enquanto 82(19% foram suspensas. CONCLUSÃO: os motivos da suspensão com maior freqüência foram: a falta do paciente e crise hipertensiva, visto que devem ser evitadas as suspensões cirúrgicas, por acarretar prejuízo para o paciente, profissionais de saúde e instituição hospitalar. 

  14. On the Lorentz Factor of Superluminal Sources

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    Onuchukwu, Chika Christian

    2013-01-01

    We investigate the properties of features seen within superluminal sources often referred to as components. Our result indicates a fairly strong correlation of r=0.6 for quasars, r=0.4 for galaxies, and r=0.8 for BL Lac objects in our sample between component sizes and distances from the stationary core. Assumption of free adiabatic expanding plasma enabled us to constrain in general the Lorentz factor for superluminal sources. Ourestimated Lorentz factor of 7 - 17 for quasars, 6 - 13 for galaxies and 4- 9 for BL Lac objects indicate that BL Lac have the lowest range of Lorentz factor.

  15. Ambulatory Surgical Measures - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  16. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  17. Ambulatory anesthesia: optimal perioperative management of the diabetic patient

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    Polderman JAW

    2016-05-01

    Full Text Available Jorinde AW Polderman, Robert van Wilpe, Jan H Eshuis, Benedikt Preckel, Jeroen Hermanides Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Abstract: Given the growing number of patients with diabetes mellitus (DM and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery. Keywords: diabetes mellitus, perioperative period, ambulatory surgery, insulin, complications, GLP-1 agonist, DPP-4 inhibitor

  18. On the Lorentz factor of superluminal sources

    Institute of Scientific and Technical Information of China (English)

    Chika Christian Onuchukwu; Augustine A.Ubachukwu

    2013-01-01

    We investigate the properties of features seen within superluminal sources often referred to as components.Our result indicates a fairly strong correlation of r ~ 0.5 for quasars,r ~ 0.4 for galaxies and r ~ 0.7 for BL Lac objects in our sample between component sizes and distances from the stationary core.The assumption of free adiabatic expanding plasma enables us to constrain the Lorentz factor for superluminal sources.Our estimated Lorentz factor of γ ~ 9-13 for quasars,γ ~ 7-11for galaxies and γ ~ 4-9 for BL Lac objects indicates that BL Lacs have the lowest range of Lorentz factors.

  19. 高血压患者颈动脉硬化与动态脉压、动态脉压指数的关系及其危险因素分析%Relationship of carotid atherosclerosis with ambulatory pulse pressure and ambulatory pulse pressure index and its risk factors in patients with essential hypertension

    Institute of Scientific and Technical Information of China (English)

    李晖; 袁建明; 张源明

    2011-01-01

    目的 探讨动态脉压(ambulatory pulse pressure,APP)、动态脉压指数(ambulatory pulse pressure index,APPI)对原发性高血压(essential hypertension,EH)患者颈动脉硬化的影响.方法 对274例EH患者进行动态血压监测(ABPM)和颈动脉超声检查,分析APP、APPI与颈动脉内膜中层厚度(intimamedia thickness,IMT)关系及颈动脉硬化的相关危险因素.所有病人分为两组:APP(24 hAPP)<60 mmHg组157例和APP≥60 mmHg组117例.结果 274例患者中APP≥60 mmHg组颈动脉IMT明显大于APP<60 mmHg组(P<0.05).颈动脉IMT斑块阳性和阴性组比较,24 hSBP、24 hMAP、24 hPP差异具有统计学意义.多元Logistic回归分析表明,24 hAPP(OR=1.033,95%CI:1.018-1.048,P=0.000 1)、男性患者(OR=2.07,95%CI:1.183-3.613,P=0.011)及吸烟(OR=1.808,95%CI:1.073-3.046,P=0.026)是颈动脉IMT增加的独立预测指标.结论 随着APP的逐渐增大,颈动脉IMT明显增加,24 hAPP、男性及吸烟是颈动脉IMT增加的独立预测指标.%Objective To investigate the effect of ambulatory pulse pressure( APP )and ambulatory pulse pressure index on carotid intimamedia thickness in essential hypertension( EH ) patients. Methods A total of 274 patients were enrolled in this study. All patients underwent ambulatory blood pressure monitoring ( ABPM ) and B-mode Doppler ultrasonography. The patients were divided into two groups : APP <60 mmHg group( n = 157 )and APP ≥ 60 mmHg group ( n = 117 ). The relationships between carotid IMT and APP or APPI were analyzed, and the risk factors of carotid atherosclerosis were analyzed in EH patients. Results Compared with APP < 60 mmHg group ,IMT significantly increased in APP ≥60 mmHg group [ ( 0. 61 ±0. 35 ) cm vs ( 0. 79 ± 0. 37 )cm , P < 0. 05]. Between positive and negative carotid IMT patients,24 hSBP,24 hMAP and 24 hAPP were statistically different. Multiple logistic regression analysis showed that the 24 hAPP ( OR = 1. 033 .95% CI ∶ 1. 018 - 1. 048 ,P = 0. 000 1

  20. Advances in ambulatory monitoring: regulatory considerations.

    Science.gov (United States)

    Buckles, David; Aguel, Felipe; Brockman, Randall; Cheng, James; Demian, Cindy; Ho, Charles; Jensen, Donald; Mallis, Elias

    2004-01-01

    Conventional ambulatory electrocardiogram (ECG) (Holter) monitoring involves 2 or 3 surface leads recorded with electrode positions and signal characteristics that are different from diagnostic quality 12-lead ECGs due to the limitations imposed by technology on the ambulatory recorders. The rapid pace of technological development for medical devices, particularly electrocardiography, has now enabled the recording of diagnostic quality 12-lead ECG waveforms for extended time periods. This capability allows Holter recording to become another source for diagnostic 12-lead ECG records on a par with other modalities such as resting ECG and exercise stress testing. Additionally, other diagnostic techniques such as S-T segment analysis and Q-T interval analysis that rely on diagnostic quality waveforms can now be applied. All of these enhancements to the traditional Holter modality have altered the regulatory perspective of these devices, since the enhancements may represent a new intended use for the device.

  1. Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

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    Montano, Maria F; Mehdi, Harshal; Nash, David B

    2016-11-01

    The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting.

  2. Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis.

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    Rinke, Michael L; Jan, Dominique; Nassim, Janelle; Choi, Jaeun; Choi, Steven J

    2016-08-01

    OBJECTIVE To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. DESIGN Retrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition. SETTING Urban pediatric tertiary care center April 1, 2009-March 31, 2014. METHODS SSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case-rest of cohort, and case-control, designs. RESULTS In 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2-6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (Psurgeries. Almost half of patients with an SSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%-91.33%) and specificity was 99.94% (99.89%-99.97%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938.

  3. Factors associated with the prevalence of Otodectes cynotis in an ambulatory population of dogs Fatores associados à prevalência da infestação por Otodectes cynotis em uma população ambulatorial

    Directory of Open Access Journals (Sweden)

    Clarissa P. Souza

    2008-08-01

    Full Text Available The objective was to evaluate the factors associated with the prevalence of Otodectes cynotis infestations in dogs assisted at the Dermatology Service of the Veterinary Hospital, Universidade Federal Rural do Rio de Janeiro. A total of 250 dogs were examined through direct smear of ear samples using a stereoscopic microscope, for the parasitological diagnostic. All dog owners were interviewed and data regarding the animals and their environments were individually recorded. Mite infestation was observed in 15 animals, with a prevalence of 6%. The variables were tested regarding their association with the mites, using the χ2 test and, when appropriate, the Fisher exact test. There were no evidences that age (p = 0,20, sex (p = 0,31, breed (p = 0,50, shape of ear (p = 0,66, type (p = 0,19 and length of hair (p = 0,14 and contact with other animals (p = 0,06 could act as potential risk factors for O. cynotis infestation. However, living environment (p = 0,03 and frequency of environmental cleaning (p = 0,005 may facilitate the infestation. The occurrence of pruritus was associated to the presence of mites (pO objetivo deste estudo foi avaliar os fatores associados à prevalência da infestação por Otodectes cynotis em cães atendidos no Setor de Dermatologia do Hospital Veterinário de Pequenos Animais, Universidade Federal Rural do Rio de Janeiro. Foram atendidos 250 cães, sendo o diagnóstico feito através de visualização do ácaro, presente no cerumem coletado e examinado sob microscopia esterioscópica. Todos os proprietários dos cães foram entrevistados para preenchimento de fichas individuais com dados dos animais e do ambiente em que estes viviam. A infestação por O. cynotis foi observada em 15 animais, sendo a prevalência de 6%. A associação entre as variáveis e a presença dos ácaros foi testada através do χ2 e quando pertinente pelo teste de Fisher exato. Não houve evidências que permitissem concluir que a idade (p = 0

  4. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting.

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    Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M

    2016-01-01

    Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.

  5. Ambulatory position and orientation tracking fusing magnetic and inertial sensing

    NARCIS (Netherlands)

    Roetenberg, Daniel; Slycke, Per J.; Veltink, Peter H.

    2007-01-01

    This paper presents the design and testing of a portable magnetic system combined with miniature inertial sensors for ambulatory 6 degrees of freedom ( DOF) human motion tracking. The magnetic system consists of three orthogonal coils, the source, fixed to the body and 3-D magnetic sensors, fixed to

  6. Herniorrafia ambulatorial comparada à convencional Ambulatory versus conventional herniorraphy

    Directory of Open Access Journals (Sweden)

    Daniel Nunes e Silva

    2004-10-01

    Full Text Available OBJETIVO: O tratamento cirúrgico ambulatorial de hérnias inguinais é uma tendência em muitos serviços de saúde. No entanto, em nosso meio, tal procedimento ainda não perfaz uma rotina. Objetivamos analisar os benefícios e complicações da herniorrafia inguinal ambulatorial comparada à convencional. MÉTODO: Realizamos uma análise retrospectiva envolvendo, inicialmente, 105 pacientes submetidos a herniorrafia inguinal ambulatorial (HIA e internação convencional (IC de fevereiro a outubro de 2002 no Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA. Foram avaliados os benefícios e complicações no 15º, 90º e 180º dias de pós-operatório. Além disso, foi realizada avaliação dos custos hospitalares. Os métodos de análise incluíram o teste t de Fischer e X² . Foram considerados estatisticamente significativos resultados com pBACKGROUND: Ambulatory inguinal herniorraphy is performed worldwide. However, this procedure is not performed routinely in our reality. Our objetive is to analyze the benefits and complications of ambulatory inguinal herniorraphy in comparison to conventional intervention in our Service. METHODS: A retrospective analysis was performed with 105 patients who uwderwent ambulatorial or conventional inguinal herniorraphy between February and October of 2002. Variables, including costs, were analyzed at the 15th, 90th and 180th postoperative days. The Fischer's t test and chi-square test were used. Statistical significance was considered for a p value of p<0.05. RESULTS: From 105 patients, seven were excluded. The total rate complication was 36.08%. There was no significative statistical difference between groups at any time. The most common complication was local pain (24.7%. The costs decreased 20% when surgery was performed in an ambulatory basis as well as the waiting time which was also reduced. CONCLUSION: The ambulatory herniorraphy is a safe procedure, decreases hospital stay, costs and it has a

  7. National Hospital Ambulatory Medical Care Survey

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...

  8. Biomedical Wireless Ambulatory Crew Monitor

    Science.gov (United States)

    Chmiel, Alan; Humphreys, Brad

    2009-01-01

    A compact, ambulatory biometric data acquisition system has been developed for space and commercial terrestrial use. BioWATCH (Bio medical Wireless and Ambulatory Telemetry for Crew Health) acquires signals from biomedical sensors using acquisition modules attached to a common data and power bus. Several slots allow the user to configure the unit by inserting sensor-specific modules. The data are then sent real-time from the unit over any commercially implemented wireless network including 802.11b/g, WCDMA, 3G. This system has a distributed computing hierarchy and has a common data controller on each sensor module. This allows for the modularity of the device along with the tailored ability to control the cards using a relatively small master processor. The distributed nature of this system affords the modularity, size, and power consumption that betters the current state of the art in medical ambulatory data acquisition. A new company was created to market this technology.

  9. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Shah U

    2015-04-01

    Full Text Available Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA. Patient satisfaction is a complex concept that is influenced by multiple factors. A patient's viewpoint and knowledge plays an influential role in patient satisfaction with ambulatory surgery. Medical optimization and psychological preparation of the patient plays a pivotal role in the success of ambulatory surgery. Postoperative pain, nausea, and vomiting are the most important symptoms for the patient and can be addressed by multimodal drug regimens. Shared decision making, patient–provider relationship, communication, and continuity of care form the main pillars of patient satisfaction. Various psychometrically developed instruments are available to measure patient satisfaction, such as the Iowa Satisfaction with Anesthesia Scale and Evaluation du Vecu de I'Anesthesie Generale, but none have been developed specifically for ambulatory surgery. The ASA has made recommendations for data collection for patient satisfaction surveys and emphasized the importance of reporting the data to the Anesthesia Quality Institute. Future research is warranted to develop a validated tool to measure patient satisfaction in ambulatory surgery. Keywords: patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  10. Predictors of exercise participation in ambulatory and non-ambulatory older people with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Michelle Ploughman

    2015-08-01

    Full Text Available Background. Exercise at moderate intensity may confer neuroprotective benefits in multiple sclerosis (MS, however it has been reported that people with MS (PwMS exercise less than national guideline recommendations. We aimed to determine predictors of moderate to vigorous exercise among a sample of older Canadians with MS who were divided into ambulatory (less disabled and non-ambulatory (more disabled groups.Methods. We analysed data collected as part of a national survey of health, lifestyle and aging with MS. Participants (n = 743 were Canadians over 55 years of age with MS for 20 or more years. We identified ‘a priori’ variables (demographic, personal, socioeconomic, physical health, exercise history and health care support that may predict exercise at moderate to vigorous intensity (>6.75 metabolic equivalent hours/week. Predictive variables were entered into stepwise logistic regression until best fit was achieved.Results. There was no difference in explanatory models between ambulatory and non-ambulatory groups. The model predicting exercise included the ability to walk independently (OR 1.90, 95% CI [1.24–2.91]; low disability (OR 1.50, 95% CI [1.34–1.68] for each 10 point difference in Barthel Index score, perseverance (OR 1.17, 95% CI [1.08–1.26] for each additional point on the scale of 0–14, less fatigue (OR 2.01, 95% CI [1.32–3.07] for those in the lowest quartile, fewer years since MS diagnosis (OR 1.58, 95% CI [1.11–2.23] below the median of 23 years and fewer cardiovascular comorbidities (OR 1.55 95% CI [1.02–2.35] one or no comorbidities. It was also notable that the factors, age, gender, social support, health care support and financial status were not predictive of exercise.Conclusions. This is the first examination of exercise and exercise predictors among older, more disabled PwMS. Disability is a major predictor of exercise participation (at moderate to vigorous levels in both ambulatory and non-ambulatory

  11. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2016-06-01

    opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed. Keywords: outpatient surgery analgesia, ambulatory surgery pain control, acute pain, ­ambulatory surgery center, opioids, substance abuse

  12. Features of ambulatory blood pressure in 540 patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    王成

    2013-01-01

    Objective To explore the features and influencing factors of ambulatory blood pressure in chronic kidney disease(CKD)patients.Methods A total of 540 CKD patients from May 2010 to May 2012 in our department

  13. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations

    DEFF Research Database (Denmark)

    Fan, Hong-Qi; Li, Yan; Thijs, Lutgarde;

    2010-01-01

    We and other investigators previously reported that isolated nocturnal hypertension on ambulatory measurement (INH) clustered with cardiovascular risk factors and was associated with intermediate target organ damage. We investigated whether INH might also predict hard cardiovascular endpoints....

  14. Modular Open-Source Software for Item Factor Analysis

    Science.gov (United States)

    Pritikin, Joshua N.; Hunter, Micheal D.; Boker, Steven M.

    2015-01-01

    This article introduces an item factor analysis (IFA) module for "OpenMx," a free, open-source, and modular statistical modeling package that runs within the R programming environment on GNU/Linux, Mac OS X, and Microsoft Windows. The IFA module offers a novel model specification language that is well suited to programmatic generation…

  15. Towards ambulatory mental stress measurement from physiological parameters

    NARCIS (Netherlands)

    Wijsman, Jacqueline; Vullers, Ruud; Polito, Salvatore; Agell, Carlos; Penders, Julien; Hermens, Hermie

    2013-01-01

    Ambulatory mental stress monitoring requires longterm physiological measurements. This paper presents a data collection protocol for ambulatory recording of physiological parameters for stress measurement purposes. We present a wearable sensor system for ambulatory recording of ECG, EMG, respiration

  16. The ten successful elements of an ambulatory care center.

    Science.gov (United States)

    Watkins, G

    1997-01-01

    Experts in healthcare predict that in the future, over 80% of all care will be provided either in the home or ambulatory care centers. How radiology facilities position themselves for this shifting market is critical to their long-term success, even though it appears there are endless opportunities for providing care in this atmosphere. The ten most critical elements that healthcare providers must address to ensure their preparedness are discussed. Location is critical, particularly since patients no longer want to travel to regional medical centers. The most aggressive providers are building local care centers to serve specific populations. Ambulatory care centers should project a high tech, high touch atmosphere. Patient comfort and the appeal of the overall environment must be considered. Centers need to focus on their customers' needs in multiple areas of care. A quick and easy registration process, providing dressing gowns in patient areas, clear billing functions--these are all important areas that centers should develop. Physicians practicing in the ambulatory care center are key to its overall success and can set the tone for all staff members. Staff members must be friendly and professional in their work with patients. The hours offered by the center must meet the needs of its client base, perhaps by offering evening and weekend appointments. Keeping appointments on schedule is critical if a center wants satisfied customers. It's important to identify the target before developing your marketing plan. Where do your referrals come from? Look to such sources as referring physicians, managed care plans and patients themselves. Careful billing is critical for survival in the ambulatory care world. Costs are important and systems that can track cost per exam are useful. Know your bottom line. Service remains the central focus of all successful ambulatory care center functions.

  17. Ambulatory spine surgery: a survey study.

    Science.gov (United States)

    Baird, Evan O; Brietzke, Sasha C; Weinberg, Alan D; McAnany, Steven J; Qureshi, Sheeraz A; Cho, Samuel K; Hecht, Andrew C

    2014-08-01

    Study Design Cross-sectional study. Objective To assess the current practices of spine surgeons performing ambulatory surgery in the United States. Methods An electronic survey was distributed to members of the International Society for the Advancement of Spine Surgery. Data were initially examined in a univariate manner; variables with a p value ambulatory spine surgery, and 49.1% were investors in an ambulatory surgery center. Surgeon investors in ambulatory surgery centers were more likely to perform procedures of increased complexity than noninvestors, though limited data precluded a statistical correlation. Surgeons in private practice were more likely to perform ambulatory surgery (94.3%; p = 0.0176), and nonacademic surgeons were both more likely to invest in ambulatory surgery centers (p = 0.0024) and perform surgery at least part of the time in a surgery center (p = 0.0039). Conclusions Though the numbers were too few to calculate statistical significance, there was a trend toward the performance of high-risk procedures on an ambulatory basis being undertaken by those with investment status in an ambulatory center. It is possible that this plays a role in the decision to perform these procedures in this setting versus that of a hospital, where a patient may have better access to care should a complication arise requiring emergent assessment and treatment by a physician. This decision should divest itself of financial incentives and focus entirely on patient safety.

  18. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin

    2007-01-01

    textabstractAmbulatory surgery refers to the process of admitting patients, administering anesthesia and surgical care, and discharging patients home following an appropriate level of recovery on the same day. The word ambulatory is derived from the latin word ambulare, which means ''to walk''. This

  19. Nurses’ working motivation sources and related factors: A questionnaire survey

    Directory of Open Access Journals (Sweden)

    Said Bodur

    2015-01-01

    Full Text Available Background: Motivation is an important issue for personnel management in health care settings, as it is related to both performance and intention to quit. Objectives: The study was aimed to determine nurses’ working motivation sources and related factors in hospitals. Design: Descriptive study. Settings: A state university hospital and a public hospital in Turkey. Participants: Two hundred and two nurses were randomly selected from each department in a university and in a public hospital. Methods: Data were collected using a socio-demographic questionnaire and the Motivation Sources Inventory and were analyzed using descriptive and inferential statistics. Results: Among five motivation sources, internal self-concept-based motivation was the highest and intrinsic process motivation was the lowest in nurses. There was a significant relation between scores of some motivation sources and managerial experience, income level, satisfaction from the unit, staff roles, and perception of work stress. Conclusions: Intrinsic process motivation, instrumental motivation, and external self-concept-based motivation sources may be improved to increase nurses’ total motivation.

  20. 老年维持性血液透析患者透析间期血压节律的影响因素分析%Investigation of factors of circadian rhythm of interdialytic ambulatory blood pressure in elderly maintenance hemodialysis patients

    Institute of Scientific and Technical Information of China (English)

    王莹; 牛建英; 范伟锋; 罗丽红; 钱英俊; 张绮; 顾勇

    2011-01-01

    目的 探讨老年维持性血液透析(MHD)患者透析间期动态血压节律的影响因素.方法 选择28例老年MHD患者,均丁透析间期进行24 h动态血压监测,同时完善血液生化指标和心脏超声检查,根据动态血压监测中夜间收缩压下降率情况将患者分为2组:血压节律正常组和血压节律异常组.采用独立样本t检验或Fisher确切概率法比较两组患者一般情况、血液生化指标、动态血压参数、心脏结构及功能的差异;采用多因素Logistic回归分析老年MHD患者透析间期血压节律的影响因素,结果(1)血压节律异常组甲状旁腺激素水平、动态动脉硬化指数、对称性动态动脉硬化指数、左室质量指数高于血压节律正常组(P<0.05),差异有统计学意义.(2)多因素Logistic回归分析结果显示,甲状旁腺激素、对称性动念动脉硬化指数、左室肥大是动态血压节律异常的独立危险因素,结论继发性甲状腺机能亢进、动脉硬化、左室肥大是老年MHD患者透析间期动念血压节律异常的独市危险因素.%Objective To investigate factors that influence circadian rhythm of interdialytic ambulatory blood pressure in elderly patients with maintenance hemodialysis (MHD). Methods Ambulatory blood pressure monitoring (ABPM) was conducted in twenty-eight elderly MHD patients between two dialysis sessions. The data of ABPM as well as echocardio-graphy and serum biochemical indicators were examined. Two groups were identified with different ranges of decline rate of nocturnal systolic blood pressure: normal and abnormal blood pressure rhythm groups. Clinical records on epidemiologic, hematological, ABPM and cardiac ultrasonic aspects of the two groups were compared by independent-samples T test or Fisher exact method. Logistic regression model was used to analysis the risk factors influencing circadian rhythm of interdialytic ambulatory blood pressure in elderly MHD patients. Results (1) The

  1. Blood cultures in ambulatory outpatients

    Directory of Open Access Journals (Sweden)

    Laupland Kevin B

    2005-05-01

    Full Text Available Abstract Background Blood cultures are a gold standard specific test for diagnosing many infections. However, the low yield may limit their usefulness, particularly in low-risk populations. This study was conducted to assess the utility of blood cultures drawn from ambulatory outpatients. Methods Blood cultures drawn at community-based collection sites in the Calgary Health Region (population 1 million in 2001 and 2002 were included in this study. These patients were analyzed by linkages to acute care health care databases for utilization of acute care facilities within 2 weeks of blood culture draw. Results 3102 sets of cultures were drawn from 1732 ambulatory outpatients (annual rate = 89.4 per 100,000 population. Significant isolates were identified from 73 (2.4% sets of cultures from 51 patients, including Escherichia coli in 18 (35% and seven (14% each of Staphylococcus aureus and Streptococcus pneumoniae. Compared to patients with negative cultures, those with positive cultures were older (mean 49.6 vs. 40.1 years, p Conclusion Blood cultures drawn in outpatient settings are uncommonly positive, but may define patients for increased intensity of therapy. Strategies to reduce utilization without excluding patients with positive cultures need to be developed for this patient population.

  2. Sharks: a potential source of antiangiogenic factors and tumor treatments.

    Science.gov (United States)

    Cho, Jung; Kim, Young

    2002-12-01

    Since angiogenesis is a key feature of tumor growth, inhibiting this process is one way to treat cancer. Cartilage is a natural source of material with strong antiangiogenic activity. This report reviews knowledge of the anticancer properties of shark cartilage and clinical information on drugs such as neovastat and squalamine. Because their entire endoskeleton is composed of cartilage, sharks are thought to be an ideal source of angiogenic and tumor growth inhibitors. Shark cartilage extract has shown antiangiogenic and antitumor activities in animals and humans. The oral administration of cartilage extract was efficacious in reducing angiogenesis. Purified antiangiogenic factors from shark cartilage, such as U-995 and neovastat (AE-941), also showed antiangiogenic and antitumor activity. AE-941 is under phase III clinical investigation. Squalamine, a low molecular weight aminosterol, showed strong antitumor activity when combined with chemotherapeutic materials. The angiogenic tissue inhibitor of metalloprotease 3 (TIMP-3) and tumor suppressor protein (snm23) genes from shark cartilage were cloned and characterized.

  3. National Ambulatory Medical Care Survey (NAMCS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Ambulatory Medical Care Survey (NAMCS) is a national survey designed to meet the need for objective, reliable information about the provision and use of...

  4. Twenty-five years of ambulatory laparoscopic cholecystectomy.

    Science.gov (United States)

    Bueno Lledó, José; Granero Castro, Pablo; Gomez I Gavara, Inmaculada; Ibañez Cirión, Jose L; López Andújar, Rafael; García Granero, Eduardo

    2016-10-01

    It is accepted by the surgical community that laparoscopic cholecystectomy (LC) is the technique of choice in the treatment of symptomatic cholelithiasis. However, more controversial is the standardization of system implementation in Ambulatory Surgery because of its different different connotations. This article aims to update the factors that influence the performance of LC in day surgery, analyzing the 25 years since its implementation, focusing on the quality and acceptance by the patient. Individualization is essential: patient selection criteria and the implementation by experienced teams in LC, are factors that ensure high guarantee of success.

  5. Regional variations in ambulatory care and incidence of cardiovascular events

    Science.gov (United States)

    Tu, Jack V.; Chu, Anna; Maclagan, Laura; Austin, Peter C.; Johnston, Sharon; Ko, Dennis T.; Cheung, Ingrid; Atzema, Clare L.; Booth, Gillian L.; Bhatia, R. Sacha; Lee, Douglas S.; Jackevicius, Cynthia A.; Kapral, Moira K.; Tu, Karen; Wijeysundera, Harindra C.; Alter, David A.; Udell, Jacob A.; Manuel, Douglas G.; Mondal, Prosanta; Hogg, William

    2017-01-01

    BACKGROUND: Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of cardiovascular disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in cardiovascular event rates. METHODS: We conducted a cohort study involving 5.5 million patients aged 40 to 79 years in Ontario, Canada, with no hospital stays for cardiovascular disease as of January 2008, through linkage of multiple population-based health databases. The primary outcome was the occurrence of a major cardiovascular event (myocardial infarction, stroke or cardiovascular-related death) over the following 5 years. We compared patient demographics, cardiac risk factors and ambulatory health care services across the province’s 14 health service regions, known as Local Health Integration Networks (LHINs), and evaluated the contribution of these variables to regional variations in cardiovascular event rates. RESULTS: Cardiovascular event rates across LHINs varied from 3.2 to 5.7 events per 1000 person-years. Compared with residents of high-rate LHINs, those of low-rate health regions received physician services more often (e.g., 4.2 v. 3.5 mean annual family physician visits, p value for LHIN-level trend = 0.01) and were screened for risk factors more often. Low-rate LHINs were also more likely to achieve treatment targets for hypercholes-terolemia (51.8% v. 49.6% of patients, p = 0.03) and controlled hypertension (67.4% v. 53.3%, p = 0.04). Differences in patient and health system factors accounted for 74.5% of the variation in events between LHINs, of which 15.5% was attributable to health system factors alone. INTERPRETATION: Preventive ambulatory health care services were provided more frequently in health regions with lower cardiovascular event rates. Health system interventions to improve equitable access to preventive care might improve cardiovascular outcomes. PMID

  6. Factors determining family planning in Catalonia. Sources of inequity

    Directory of Open Access Journals (Sweden)

    Saurina Carme

    2012-07-01

    Full Text Available Abstract Introduction In recent decades, the foreign population in Spain has increased significantly, particularly for Catalonia, an autonomous region of Spain (2.90% in 2000 and 15.95% in 2010 and in particular Girona province (6.18% in 2000 and 21.55% in 2010. Several studies have shown a lower use of family planning methods by immigrants. This same trend is observed in Spain. The objective of this paper is to determine the existence of differences and possible sources of inequity in the use of family planning methods among health service users in Catalonia (Spain by sex, health status, place of birth and socioeconomic conditions. Methods Data were taken from an ad-hoc questionnaire which was compiled following a qualitative stage of individual interviews. Said questionnaire was administered to 1094 Catalan public health service users during 2007. A complete descriptive analysis was carried out for variables related to public health service users’ sociodemographic characteristics and variables indicating knowledge and use of family planning methods, and bivariate relationships were analysed by means of chi-square contrasts. Considering the use (or non-use of family planning methods as a dependent variable and a set of demographic, socioeconomic and health status variables as explanatory factors, the relationship was modelled using mixed models. Results The analysed sample is comprised of 54.3% women and 45.7% men, with 74.3% natives (or from the EU and 25.7% economic immigrants. 54.8% use some method of family planning, the condom (46.7% and the pill (28.0% being the two most frequently used methods. Statistical modelling indicates that those factors which most influence the use of family planning methods are level of education (30.59% and 39.29% more likelihood and having children over 14 (35.35% more likelihood. With regard to the origin of the user, we observe that patients from North Africa,sub. Saharan Africa and Asia are less likely to

  7. Limits to Ambulatory Displacement of Coconut Mites in Absence and Presence of Food-Related Cues

    NARCIS (Netherlands)

    Melo, J.W.S.; Lima, D.B.; Sabelis, M.W.; Pallini, A.; Gondim Jr., M.G.C.

    2014-01-01

    Ambulatory movement of plant-feeding mites sets limits to the distances they can cover to reach a new food source. In absence of food-related cues these limits are determined by survival, walking activity, walking path tortuosity and walking speed, whereas in presence of food the limits are also det

  8. HCUP State Ambulatory Surgery Databases (SASD) - Restricted Access Files

    Data.gov (United States)

    U.S. Department of Health & Human Services — The State Ambulatory Surgery Databases (SASD) contain the universe of hospital-based ambulatory surgery encounters in participating States. Some States include...

  9. Ambulatory ST segment monitoring after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1994-01-01

    ischaemia provides prognostic information in different subsets of patients with previous myocardial infarction, but there is considerable disagreement about how this is expressed in terms of cardiac events. Small patient numbers, patient selection, and different timing of ambulatory monitoring are proposed...... as important reasons for the inconsistent findings. The precise role of ambulatory ST segment monitoring in clinical practice has yet to be established. Direct comparisons with exercise stress testing may not be appropriate for two reasons. Firstly, the main advantage of ambulatory monitoring may...... be that it can be performed early after infarction at the time of maximum risk. Secondly, it can be performed in most patients after infarction, including those recognised as being at high risk who are unable to perform an exercise stress test....

  10. EMISSION FACTORS FOR IRON AND STEEL SOURCES: CRITERIA AND TOXIC POLLUTANTS

    Science.gov (United States)

    The report provides a comprehensive set of emission factors for sources of both criteria and toxic air pollutants in integrated iron and steel plants and specialty electric arc shops (minimills). Emission factors are identified for process sources, and process and open source fug...

  11. Coping with a life event in bipolar disorder : ambulatory measurement, signalling and early treatment

    NARCIS (Netherlands)

    Knapen, Stefan E; Riemersma-van der Lek, Rixt F; Haarman, Bartholomeus C M; Schoevers, Robert A

    2016-01-01

    Disruption of the biological rhythm in patients with bipolar disorder is a known risk factor for a switch in mood. This case study describes how modern techniques using ambulatory assessment of sleep parameters can help in signalling a mood switch and start early treatment. We studied a 40-year-old

  12. Survival in Mediterranean Ambulatory Patients With Chronic Heart Failure. A Population-based Study

    NARCIS (Netherlands)

    Frigola Capell, E.; Comin-Colet, J.; Davins-Miralles, J.; Gich-Saladich, I.J.; Wensing, M.; Verdu-Rotellar, J.M.

    2013-01-01

    INTRODUCTION AND OBJECTIVES: Scarce research has been performed in ambulatory patients with chronic heart failure in the Mediterranean area. Our aim was to describe survival trends in our target population and the impact of prognostic factors. METHODS: We carried out a population-based retrospective

  13. Scoping Analysis of Source Term and Functional Containment Attenuation Factors

    Energy Technology Data Exchange (ETDEWEB)

    Pete Lowry

    2012-02-01

    In order to meet future regulatory requirements, the Next Generation Nuclear Plant (NGNP) Project must fully establish and validate the mechanistic modular high temperature gas-cooled reactor (HTGR) source term. This is not possible at this stage in the project, as significant uncertainties in the final design remain unresolved. In the interim, however, there is a need to establish an approximate characterization of the source term. The NGNP team developed a simplified parametric model to establish mechanistic source term estimates for a set of proposed HTGR configurations.

  14. Scoping Analysis of Source Term and Functional Containment Attenuation Factors

    Energy Technology Data Exchange (ETDEWEB)

    Pete Lowry

    2012-10-01

    In order to meet future regulatory requirements, the Next Generation Nuclear Plant (NGNP) Project must fully establish and validate the mechanistic modular high temperature gas-cooled reactor (HTGR) source term. This is not possible at this stage in the project, as significant uncertainties in the final design remain unresolved. In the interim, however, there is a need to establish an approximate characterization of the source term. The NGNP team developed a simplified parametric model to establish mechanistic source term estimates for a set of proposed HTGR configurations.

  15. Scoping Analysis of Source Term and Functional Containment Attenuation Factors

    Energy Technology Data Exchange (ETDEWEB)

    Pete Lowry

    2012-01-01

    In order to meet future regulatory requirements, the Next Generation Nuclear Plant (NGNP) Project must fully establish and validate the mechanistic modular high temperature gas-cooled reactor (HTGR) source term. This is not possible at this stage in the project, as significant uncertainties in the final design remain unresolved. In the interim, however, there is a need to establish an approximate characterization of the source term. The NGNP team developed a simplified parametric model to establish mechanistic source term estimates for a set of proposed HTGR configurations.

  16. Strategies to reduce medication errors in pediatric ambulatory settings

    Directory of Open Access Journals (Sweden)

    S Mehndiratta

    2012-01-01

    Full Text Available Worldwide, a large number of children are prescribed drugs on an outpatient basis. Medication errors are fairly common in these settings. Though this matter has been well recognized as a cause of concern, limited data is available from ambulatory settings. Medication errors can be defined as errors that may occur at any step, starting from ordering a medication, to dispensing, administration of the drug and the subsequent monitoring. The outcomes of such errors are variable and may range between those that are clinically insignificant to a life-threatening event. The reasons for these medication errors are multi-factorial. Children are unable to administer medications to themselves and also require a strict weight-based dosing regimen. The risk factors associated with medication errors include complex regimens with multiple medications. Overdosing and under-dosing (10-fold calculation errors, an increased or a decreased frequency of dosing or an inappropriate duration of administration of the medication, are frequently detected errors. The lack of availability of proper formulations adds to the confusion. The low level of literacy among the caregivers can aggravate this problem. There is a lack of proper reporting and monitoring mechanisms in most ambulatory settings, hence these errors remain unrecognized and often go unreported. This article summarizes the current available literature on medication errors in ambulatory settings and the possible strategies that can be adopted to reduce the burden of these errors in order to improve child care and patient safety. Voluntary, anonymous reporting can be introduced in the healthcare institutions to determine the incidence of these errors.

  17. Clinical Assessment Applications of Ambulatory Biosensors

    Science.gov (United States)

    Haynes, Stephen N.; Yoshioka, Dawn T.

    2007-01-01

    Ambulatory biosensor assessment includes a diverse set of rapidly developing and increasingly technologically sophisticated strategies to acquire minimally disruptive measures of physiological and motor variables of persons in their natural environments. Numerous studies have measured cardiovascular variables, physical activity, and biochemicals…

  18. Ambulatory Care Skills: Do Residents Feel Prepared?

    Directory of Open Access Journals (Sweden)

    Denise Bonds

    2002-10-01

    Full Text Available Objective: To determine resident comfort and skill in performing ambulatory care skills. Methods: Descriptive survey of common ambulatory care skills administered to internal medicine faculty and residents at one academic medical center. Respondents were asked to rate their ability to perform 12 physical exam skills and 6 procedures, and their comfort in performing 7 types of counseling, and obtaining 6 types of patient history (4 point Likert scale for each. Self-rated ability or comfort was compared by gender, status (year of residency, faculty, and future predicted frequency of use of the skill. Results: Residents reported high ability levels for physical exam skills common to both the ambulatory and hospital setting. Fewer felt able to perform musculoskeletal, neurologic or eye exams easily alone. Procedures generally received low ability ratings. Similarly, residents’ comfort in performing common outpatient counseling was also low. More residents reported feeling very comfortable in obtaining history from patients. We found little variation by gender, year of training, or predicted frequency of use. Conclusion: Self-reported ability and comfort for many common ambulatory care skills is low. Further evaluation of this finding in other training programs is warranted.

  19. Planning an ambulatory care joint venture.

    Science.gov (United States)

    Harpster, L M

    1988-01-01

    This article discusses ambulatory care joint ventures by hospitals and selected members of their medical staffs and emphasizes the resolution of problems in the early planning stages. Failure to follow an orderly and thoughtful planning process not only risks valuable resources of the venture partners, but also jeopardizes the working relationship between the hospital and its medical staff.

  20. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  1. Predicting recovery at home after Ambulatory Surgery

    Directory of Open Access Journals (Sweden)

    Ayala Guillermo

    2011-10-01

    Full Text Available Abstract The correct implementation of Ambulatory Surgery must be accompanied by an accurate monitoring of the patient post-discharge state. We fit different statistical models to predict the first hours postoperative status of a discharged patient. We will also be able to predict, for any discharged patient, the probability of needing a closer follow-up, or of having a normal progress at home. Background The status of a discharged patient is predicted during the first 48 hours after discharge by using variables routinely used in Ambulatory Surgery. The models fitted will provide the physician with an insight into the post-discharge progress. These models will provide valuable information to assist in educating the patient and their carers about what to expect after discharge as well as to improve their overall level of satisfaction. Methods A total of 922 patients from the Ambulatory Surgery Unit of the Dr. Peset University Hospital (Valencia, Spain were selected for this study. Their post-discharge status was evaluated through a phone questionnaire. We pretend to predict four variables which were self-reported via phone interviews with the discharged patient: sleep, pain, oral tolerance of fluid/food and bleeding status. A fifth variable called phone score will be built as the sum of these four ordinal variables. The number of phone interviews varies between patients, depending on the evolution. The proportional odds model was used. The predictors were age, sex, ASA status, surgical time, discharge time, type of anaesthesia, surgical specialty and ambulatory surgical incapacity (ASI. This last variable reflects, before the operation, the state of incapacity and severity of symptoms in the discharged patient. Results Age, ambulatory surgical incapacity and the surgical specialty are significant to explain the level of pain at the first call. For the first two phone calls, ambulatory surgical incapacity is significant as a predictor for all

  2. Applying to Higher Education: Information Sources and Choice Factors

    Science.gov (United States)

    Simoes, Claudia; Soares, Ana Maria

    2010-01-01

    Higher education institutions are facing increasingly complex challenges, which demand a deeper understanding of the sources prospective students use when applying to a higher education institution. This research centres on students' decision-making process for higher education institutions, focusing on the pre-purchase period, and, in particular,…

  3. Probabilistic inference of transcription factor binding from multiple data sources.

    Directory of Open Access Journals (Sweden)

    Harri Lähdesmäki

    Full Text Available An important problem in molecular biology is to build a complete understanding of transcriptional regulatory processes in the cell. We have developed a flexible, probabilistic framework to predict TF binding from multiple data sources that differs from the standard hypothesis testing (scanning methods in several ways. Our probabilistic modeling framework estimates the probability of binding and, thus, naturally reflects our degree of belief in binding. Probabilistic modeling also allows for easy and systematic integration of our binding predictions into other probabilistic modeling methods, such as expression-based gene network inference. The method answers the question of whether the whole analyzed promoter has a binding site, but can also be extended to estimate the binding probability at each nucleotide position. Further, we introduce an extension to model combinatorial regulation by several TFs. Most importantly, the proposed methods can make principled probabilistic inference from multiple evidence sources, such as, multiple statistical models (motifs of the TFs, evolutionary conservation, regulatory potential, CpG islands, nucleosome positioning, DNase hypersensitive sites, ChIP-chip binding segments and other (prior sequence-based biological knowledge. We developed both a likelihood and a Bayesian method, where the latter is implemented with a Markov chain Monte Carlo algorithm. Results on a carefully constructed test set from the mouse genome demonstrate that principled data fusion can significantly improve the performance of TF binding prediction methods. We also applied the probabilistic modeling framework to all promoters in the mouse genome and the results indicate a sparse connectivity between transcriptional regulators and their target promoters. To facilitate analysis of other sequences and additional data, we have developed an on-line web tool, ProbTF, which implements our probabilistic TF binding prediction method using multiple

  4. Source geometry factors for HDR 192Ir brachytherapy secondary standard well-type ionization chamber calibrations

    Science.gov (United States)

    Shipley, D. R.; Sander, T.; Nutbrown, R. F.

    2015-03-01

    Well-type ionization chambers are used for measuring the source strength of radioactive brachytherapy sources before clinical use. Initially, the well chambers are calibrated against a suitable national standard. For high dose rate (HDR) 192Ir, this calibration is usually a two-step process. Firstly, the calibration source is traceably calibrated against an air kerma primary standard in terms of either reference air kerma rate or air kerma strength. The calibrated 192Ir source is then used to calibrate the secondary standard well-type ionization chamber. Calibration laboratories are usually only equipped with one type of HDR 192Ir source. If the clinical source type is different from that used for the calibration of the well chamber at the standards laboratory, a source geometry factor, ksg, is required to correct the calibration coefficient for any change of the well chamber response due to geometric differences between the sources. In this work we present source geometry factors for six different HDR 192Ir brachytherapy sources which have been determined using Monte Carlo techniques for a specific ionization chamber, the Standard Imaging HDR 1000 Plus well chamber with a type 70010 HDR iridium source holder. The calculated correction factors were normalized to the old and new type of calibration source used at the National Physical Laboratory. With the old Nucletron microSelectron-v1 (classic) HDR 192Ir calibration source, ksg was found to be in the range 0.983 to 0.999 and with the new Isodose Control HDR 192Ir Flexisource ksg was found to be in the range 0.987 to 1.004 with a relative uncertainty of 0.4% (k = 2). Source geometry factors for different combinations of calibration sources, clinical sources, well chambers and associated source holders, can be calculated with the formalism discussed in this paper.

  5. Continuous ambulatory peritoneal dialysis: nurses' experiences of teaching patients.

    Science.gov (United States)

    Shubayra, Amnah

    2015-03-01

    Nine nurses were interviewed to determine nurses' experiences of teaching patients to use continuous ambulatory peritoneal dialysis (CAPD). The material was analyzed using content analysis. Data were sorted into four themes and ten subthemes. The themes were presented as follows: Importance of language, individualized teaching, teaching needs and structure of care in teaching. The findings highlighted important insights into how nurses experience teaching patients to perform CAPD. The study revealed some barriers for the nurses during teaching. The major barrier was shortage of Arabic speaking nursing staff. Incidental findings involved two factors that played an important role in teaching, retraining and a special team to perform pre-assessments, including home visits. In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching.

  6. Perceptual factors contribute more than acoustic factors to sound localization abilities with virtual sources

    Directory of Open Access Journals (Sweden)

    Guillaume eAndeol

    2015-01-01

    Full Text Available Human sound localization abilities rely on binaural and spectral cues. Spectral cues arise from interactions between the sound wave and the listener’s body (head related transfer function, HRTF. Large individual differences were reported in localization abilities, even in young normal-hearing adults. Several studies have attempted to determine whether localization abilities depend mostly on acoustic cues or on perceptual processes involved in the analysis of these cues. These studies have yielded inconsistent findings, which could result from methodological issues. Here, we measured sound localization performance with normal and modified acoustic cues (i.e., with individual and non-individual HRTFs, respectively in 20 naïve listeners. Test conditions were chosen to address most methodological issues from past studies. Procedural training was provided prior to sound localization tests. The results showed no direct relationship between behavioral results and an acoustical metric (spectral-shape prominence of individual HRTFs. Despite uncertainties due to technical issues with the normalization of the HRTFs, large acoustic differences between individual and non-individual HRTFs seemed to be needed to produce behavioral effects. A subset of 15 listeners then trained in the sound localization task with individual HRTFs. Training included either visual correct-answer feedback (for the test group or no feedback (for the control group, and was assumed to elicit perceptual learning for the test group only. Few listeners from the control group, but most listeners from the test group, showed significant training-induced learning. For the test group, learning was related to pre-training performance (the poorer the pre-training performance, the greater the learning amount and was retained after one month.The results are interpreted as being in favor of a larger contribution of perceptual factors than of acoustic factors to sound localization abilities

  7. [Family practice diagnosis of patients with venous diseases in relation to severity, diagnosis and practice facilities. Results of the ASAM study "Physician status and factor evaluation study of ambulatory patient management"].

    Science.gov (United States)

    Hoopmann, M; Klein-Lange, M; Busse, R; Schwartz, F W; Weber, J

    1996-01-01

    Although venous diseases are very common and represent frequent reasons for consultations in general practices, little is known about the actual ambulatory care for these patients. In a sentinel network consisting of general practitioners, 385 contacts with patients suffering from venous diseases (64% with varicose veins, 24% with phlebitis and 11% with ulcers) were documented. In 9% of the cases, the functional disability was "severe". The diagnostic procedures included laboratory tests in 23%, ECG in 11%, Doppler sonography in 8% and X-ray or angiography in 5%. The frequency of these diagnostic procedures correlated significantly with the degree of severity. The probability of a Doppler sonography in practices with ultrasound equipment compared to practices without it, was-stratified for the degree of severity, the unequal distribution of diseases and the level of acquaintance with the patient-between 2.2 and 2.6 (p always < 0.05), the probability of laboratory tests between 2.4 and 2.6 (p always < 0.001). This significant dependence of diagnostic procedures from the available equipment calls for the introduction of diagnostic standards as measures of quality assurance even for so-called trivial diseases.

  8. Investigating the effects of different factors on development of open source enterprise resources planning software packages

    Directory of Open Access Journals (Sweden)

    Mehdi Ghorbaninia

    2014-08-01

    Full Text Available This paper investigates the effects of different factors on development of open source enterprise resources planning software packages. The study designs a questionnaire in Likert scale and distributes it among 210 experts in the field of open source software package development. Cronbach alpha has been calculated as 0.93, which is well above the minimum acceptable level. Using Pearson correlation as well as stepwise regression analysis, the study determines three most important factors including fundamental issues, during and after implementation of open source software development. The study also determines a positive and strong relationship between fundamental factors and after implementation factors (r=0.9006, Sig. = 0.000.

  9. Cochlear implant in an ambulatory surgery center.

    Science.gov (United States)

    Joseph, Aimee M; Lassen, L Frederick

    2013-02-01

    Presbycusis, or sensorineural hearing loss in the elderly population, affects approximately 40% to 50% of people over the age of 75. A variety of devices are available to those with hearing loss. Cochlear implants, for example, are especially useful for those with severe-to-profound hearing loss. The population is aging, so the demand for cochlear implantation in ambulatory surgery centers will likely increase. Ambulatory surgery centers (ASC) can provide a more convenient and less expensive location for cochlear implant surgery than hospital-based operating facilities. Patient selection using standard ASC criteria, coupled with an understanding of the unique surgical and anesthetic needs of cochlear implant patients, are key to bringing this once exotic inpatient procedure into the ASC.

  10. Anticoagulation management in the ambulatory surgical setting.

    Science.gov (United States)

    Eisenstein, Diana Hill

    2012-04-01

    Many people receiving maintenance anticoagulation therapy require surgery each year in ambulatory surgery centers. National safety organizations focus attention toward improving anticoagulation management, and the American College of Chest Physicians has established guidelines for appropriate anticoagulation management to balance the risk of thromboembolism when warfarin is discontinued with the risk of bleeding when anticoagulation therapy is maintained. The guidelines recommend that patients at high or moderate risk for thromboembolism should be bridged with subcutaneous low-molecular-weight heparin or IV unfractionated heparin with the interruption of warfarin, and low-risk patients may require subcutaneous low-molecular-weight heparin or no bridging with the interruption of warfarin. The guidelines recommend the continuation of warfarin for patients who are undergoing minor dermatologic or dental procedures or cataract removal. The literature reveals, however, that there is not adequate adherence to these recommendations and guidelines. Management of anticoagulation therapy by a nurse practitioner may improve compliance and safety in ambulatory surgery centers.

  11. Postoperative Ambulatory Performance Status Significantly Affects Implant Failure Rate Among Surgical Treatment Strategies in Patients With Proximal Femur Metastasis.

    Science.gov (United States)

    Tsai, Shang-Wen; Wu, Po-Kuei; Chen, Cheng-Fong; Chang, Ming-Chau; Chen, Wei-Ming

    2016-11-08

    Surgical treatment strategies for proximal femur metastasis have been reported with mixed results. Little is known about risk factor for implant failure except for longer patient survival. Therefore, we determined whether implant survivorship differed among treatment strategies, as well as risk factors for implant failure. We retrospectively reviewed a consecutive 106 patients with proximal femur metastasis treated with prosthesis replacement (n = 38), intramedullary nail (n = 32), and dynamic hip screw (DHS) (n = 36). Eastern Cooperative Oncology Group (ECOG) scale and Karnofsky index were used to evaluate functional outcome. Patient characteristics and postoperative ambulatory performance status were assessed for their values in determining implant failure. Overall implant failure rate was 11.3% (12 of 106). Prosthesis replacement was related to better implant survivorship (P = 0.041), without mechanical failures. On the contrary, 7 of the 10 implant failures in the fixation group were considered mechanical failures. Better postoperative ambulatory status (ECOG ≤ 2) was a risk factor for implant failure (P = 0.03). Notably, for patients with poor ambulatory status (ECOG ≥ 3), implant survivorship was not different among choice of implants. In conclusion, prosthesis replacement would be a more durable option in the treatment of proximal femur metastasis. Postoperative ambulatory status could be an additional consideration. For patients with poor expected ambulatory performance status, fixation with intramedullary nail or DHS might be considered for a less technical demanding procedure.

  12. Amniotic fluid: Source of trophic factors for the developingintestine

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    The gastrointestinal tract (GIT) is a complex system,which changes in response to requirements of the body.GIT represents a barrier to the external environment.To achieve this, epithelial cells must renew rapidly. Thisrenewal of epithelial cells starts in the fetal life underthe influence of many GIT peptides by swallowingamniotic fluid (AF). Development and maturation of GITis a very complex cascade that begins long before birthand continues during infancy and childhood by breastfeeding.Many factors like genetic preprogramming,local and systemic endocrine secretions and manytrophic factors (TF) from swallowed AF contribute andmodulate the development and growth of the GIT.GIT morphogenesis, differentiation and functionaldevelopment depend on the activity of various TF in theAF. This manuscript will review the role of AF borne TFin the development of GIT.

  13. Ambulatory Assessment of Depression in Primary Care

    Science.gov (United States)

    2016-06-29

    Statement The auth~r hereby certifies that the use of any copyrighted material in the thesis manuscript entitled: "AMBULATORY ASSESSMENT OF DEPRESSION IN...Department Medical and Clinical Psychology Uniformed Services University of the Health Sciences 11 iii Abstract Depression is common among individuals in...primary care. Despite the prevalence of depression in primary care, patients are usually not adequately treated for depression . Often the treatment

  14. Ambulatory Blood Pressure Monitoring in the Elderly

    OpenAIRE

    Juan Diego Mediavilla García; Fernando Jaén Águila; Celia Fernández Torres; Blas Gil Extremera; Juan Jiménez Alonso

    2012-01-01

    The incidence of hypertension is high in the elderly and is present in 2/3 of the patients older than 65 years. Prevalence can reach 90% in patients older than 80 years. The presence of isolated systolic hypertension (ISH) is characteristic of this population. However, the prevalence of hypertension by ambulatory blood pressure monitoring (ABPM) is not well known. In this study, we analyzed the special characteristics of hypertension in this population, giving special emphasis on ABPM readings.

  15. The evolution of ambulatory ECG monitoring.

    Science.gov (United States)

    Kennedy, Harold L

    2013-01-01

    Ambulatory Holter electrocardiographic (ECG) monitoring has undergone continuous technological evolution since its invention and development in the 1950s era. With commercial introduction in 1963, there has been an evolution of Holter recorders from 1 channel to 12 channel recorders with increasingly smaller storage media, and there has evolved Holter analysis systems employing increasingly technologically advanced electronics providing a myriad of data displays. This evolution of smaller physical instruments with increasing technological capacity has characterized the development of electronics over the past 50 years. Currently the technology has been focused upon the conventional continuous 24 to 48 hour ambulatory ECG examination, and conventional extended ambulatory monitoring strategies for infrequent to rare arrhythmic events. However, the emergence of the Internet, Wi-Fi, cellular networks, and broad-band transmission has positioned these modalities at the doorway of the digital world. This has led to an adoption of more cost-effective strategies to these conventional methods of performing the examination. As a result, the emergence of the mobile smartphone coupled with this digital capacity is leading to the recent development of Holter smartphone applications. The potential of point-of-care applications utilizing the Holter smartphone and a vast array of new non-invasive sensors is evident in the not too distant future. The Holter smartphone is anticipated to contribute significantly in the future to the field of global health.

  16. Effective analgesic modalities for ambulatory patients.

    Science.gov (United States)

    Redmond, Martin; Florence, Barry; Glass, Peter S A

    2003-06-01

    The introduction of government-mandated standards for pain management has focused our attention on postoperative pain. With the recent JACHO standards' for ambulatory surgery, it is imperative that all health care workers who care for these patients are familiar with appropriate pain management. Developments in our understanding of the pathophysiology of acute pain have further enhanced our ability to improve pain management for postoperative ambulatory patients. This has led to the concept of preventive analgesia (inhibition of physiological and pathological secondary inflammatory pain). Extensive work has shown that this is best achieved using a multimodel approach usually consisting of an NSAID, opioid, and local anesthetic. NMDA antagonists (ketamine, dextromethorphan) and alpha-2 agnoists (clonodine) show potential supplements to further enhance pain management, especially if given preemptively. Nonpharmacological intervention such as cold therapy or acupuncture may also be considered. The armanentarium for effective pain management has improved substantially over the past few years. The challenge is for health care workers to implement these therapies to obtain optimum pain management in ambulatory surgical patients.

  17. Science reporting in Accra, Ghana: Sources, barriers and motivational factors

    Science.gov (United States)

    Gastel, Barbara; Burdine, James N.; Russell, Leon H.

    2014-01-01

    In Ghana, as in many other developing countries, most science reporting is done by general reporters. However, few studies have investigated science reporting in such a situation. To understand better the dynamics of science reporting in such context, we surveyed 151 general reporters in Ghana. Respondents’ demographic characteristics resembled those found in studies elsewhere. Respondents perceived health professionals and scientists as very important sources of information for reporting science. There was an inverse correlation between journalism experience and the number of science feature stories reported in the past 12 months (p = .017). Most respondents indicated that science journalism training would motivate them to report science more. Likewise, most reported that easier access to research findings would do so. We identify characteristics of reporters, media, scientific, and training institutions that are important influences of Ghanaian reporters’ coverage of science. We provide recommendations for advancing science reporting in Ghana. PMID:25193967

  18. Science reporting in Accra, Ghana: sources, barriers and motivational factors.

    Science.gov (United States)

    Appiah, Bernard; Gastel, Barbara; Burdine, James N; Russell, Leon H

    2015-01-01

    In Ghana, as in many other developing countries, most science reporting is done by general reporters. However, few studies have investigated science reporting in such a situation. To understand better the dynamics of science reporting in such context, we surveyed 151 general reporters in Ghana. Respondents' demographic characteristics resembled those found in studies elsewhere. Respondents perceived health professionals and scientists as very important sources of information for reporting science. There was an inverse correlation between journalism experience and the number of science feature stories reported in the past 12 months (p=.017). Most respondents indicated that science journalism training would motivate them to report science more. Likewise, most reported that easier access to research findings would do so. We identify characteristics of reporters, media, scientific, and training institutions that are important influences of Ghanaian reporters' coverage of science. We provide recommendations for advancing science reporting in Ghana.

  19. Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review

    OpenAIRE

    Turner, J. Rick; Viera, Anthony J.; Shimbo, Daichi

    2014-01-01

    Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not on antihypertensive medication show elevated blood pressure in a clinical setting but show non-elevated blood pressure averages when assessed by ambulatory blood pressure monitoring. Additionally, readings ca...

  20. Ambulatory anesthesia: optimal perioperative management of the diabetic patient

    OpenAIRE

    Polderman JAW; van Wilpe R; Eshuis JH; Preckel B; Hermanides J

    2016-01-01

    Jorinde AW Polderman, Robert van Wilpe, Jan H Eshuis, Benedikt Preckel, Jeroen Hermanides Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Abstract: Given the growing number of patients with diabetes mellitus (DM) and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients wi...

  1. Sources of cumulus expansion enabling factor (CEEF) in porcine follicles

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    It was shown that expansion of porcine cumulus did not depend on oocyte-secreted factor(s), and it is therefore presumed that porcine CEEF may not be produced exclusively by the oocyte. In this experiment, we used mouse oocytectomized complexes (OOX), which were incapable of CEEF production, to assess the secretion of CEEF by evacuated zona, oocytes of different quality and somatic cells in the porcine follicles. The results showed that: (ⅰ) Evacuated zonae from both porcine and mouse oocytes did not produce CEEF. (ⅱ) Porcine oocytes of A, B and C types from 3 - 6 mm follicles were not significantly different in both production and activity of CEEF. (ⅲ) Both porcine OOX from 3 - 6 mm follicles and granulose cells from < 1 mm follicles secreted CEEF in a large quantity, independent of gonadotropins; mural granulose cells from 3-6 mm follicles, however, produced neglectable amount of CEEF. (ⅳ) The follicular fluid from 3-6 mm porcine follicles contained CEEF activity that was concentration-dependent, and thus it enabled cumulus expansion in 60% mouse OOX when used at 10% of concentration, but the expansion rate of mouse OOX decreased to 9% when the concentration was increased to 50%. (ⅴ) Mouse OOX cultured in porcine CEEF-containing M199 expanded only in the presence of gonadotropins, suggesting that the activity of porcine CEEF is hormone-de- pendent.

  2. Informal Information Sources and Information Seeking Behavior: Investigating the Causes and Factors Affecting Users’ Inclination towards Informal Information Sources

    Directory of Open Access Journals (Sweden)

    Reza Mokhtarpour

    2009-07-01

    Full Text Available Research within Library and Information Sciences bespeaks of the significant tendency of (expert and non-expert users towards informal information sources. Nevertheless, it seems that the literature have not dealt adequately with causes and factors affecting such tendency. The present paper provides a retrospect on some of the researches conducted with respect to the typology of information resources used by searchers. It further attempts to enunciate the most important reasons for users preference toward informal information sources. The author maintains that the very social nature of man, the principle of least effort, human sense of credulity, economic considerations as well as information overloads are among the most important reasons for using informal resources. Author maintains that the increasing tendency of users towards informal sources would in not too distant future result in user apathy towards such traditional information sources as book and library.

  3. Acupuncture in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Norheim AJ

    2015-09-01

    Full Text Available Arne Johan Norheim,1 Ingrid Liodden,1 Terje Alræk1,2 1National Research Center in Complementary and Alternative Medicine (NAFKAM, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø – The Arctic University of Norway, Tromsø, 2The Norwegian School of Health Sciences, Institute of Acupuncture, Kristiania University College, Oslo, NorwayBackground: Post-anesthetic morbidities remain challenging in our daily practice of anesthesia. Meta-analyses and reviews of acupuncture and related techniques for postoperative nausea and vomiting (POVN and postoperative vomiting (POV show promising results while many clinicians remain skeptical of the value of acupuncture. Given the interest in finding safe non-pharmacological approaches toward postoperative care, this body of knowledge needs to be considered. This review critically appraises and summarizes the research on acupuncture and acupressure in ambulatory anesthesia during the last 15 years.Methods: Articles were identified through searches of Medline, PubMed, and Embase using the search terms “acupuncture” or “acupuncture therapy” in combination with “ambulatory anesthesia” or “ambulatory surgery” or “day surgery” or “postoperative”. A corresponding search was done using “acupressure” and “wristbands”. The searches generated a total of 104, 118, and 122 references, respectively.Results: Sixteen studies were included; eight studies reported on acupuncture and eight on acupressure. Nine studies found acupuncture or acupressure effective on primary endpoints including postoperative nausea and vomiting, postoperative pain, sore throat, and emergence agitation. Four studies found acupuncture had a similar effect to antiemetic medication.Conclusion: Overall, the studies were of fairly good quality. A large proportion of the reviewed papers highlights an effect of acupuncture or acupressure on postoperative morbidities in an ambulatory setting

  4. Can Positive Matrix Factorization identify sources of organic trace gases at the continental GAW site Hohenpeissenberg?

    Directory of Open Access Journals (Sweden)

    M. Leuchner

    2014-03-01

    Full Text Available From the rural Global Atmosphere Watch (GAW site Hohenpeissenberg in the pre-alpine area of Southern Germany, a dataset of 24 C2–C8 non-methane hydrocarbons over a period of seven years was analyzed. Receptor modeling was performed by Positive Matrix Factorization (PMF and the resulting factors were compared to literature source profiles. Photochemical aging during transport to the relatively remote site violates the PMF prerequisite of mass conservation from source to receptor. However, previous studies showed plausible results with this method at remote sites; the applicability and restrictions of the PMF model to such a remote dataset and the influence of photochemical processing on the interpretability of the results are discussed. A six factor solution showed a high stability and the most plausible results. In addition to biogenic sources and remote sources of very stable compounds – reflecting the continental background – four additional anthropogenic factors were resolved that could be divided into two short- and two long-lived patterns from evaporative sources and incomplete combustion processes, respectively. A method to increase the uncertainty for each individual compound by including photochemical reactivity did not improve the results, but decreased the stability of the model output. The contribution of the different source categories at the site over the entire period was, in decreasing order: remote sources, long-lived evaporative sources, residential heating and long-lived combustion sources, short-lived evaporative sources, short-lived combustion sources, and biogenic sources. Despite a low overall impact, biogenic sources played an important role during summer, in particular in terms of reactivity.

  5. Empirical Study on Factors Influencing Residents' Behavior of Separating Household Wastes at Source

    Institute of Scientific and Technical Information of China (English)

    Qu Ying; Zhu Qinghua; Murray Haight

    2007-01-01

    Source separation is the basic premise for making effective use of household wastes. In eight cities of China, however, several pilot projects of source separation finally failed because of the poor participation rate of residents. In order to solve this problem, identifying those factors that influence residents' behavior of source separation becomes crucial. By means of questionnaire survey, we conducted descriptive analysis and exploratory factor analysis. The results show that trouble-feeling, moral notion, environment protection, public education, environment value and knowledge deficiency are the main factors that play an important role for residents in deciding to separate their household wastes. Also, according to the contribution percentage of the six main factors to the total behavior of source separation, their influencing power is analyzed, which will provide suggestions on household waste management for policy makers and decision makers in China.

  6. Single-channel source separation using non-negative matrix factorization

    DEFF Research Database (Denmark)

    Schmidt, Mikkel Nørgaard

    , in which a number of methods for single-channel source separation based on non-negative matrix factorization are presented. In the papers, the methods are applied to separating audio signals such as speech and musical instruments and separating different types of tissue in chemical shift imaging.......Single-channel source separation problems occur when a number of sources emit signals that are mixed and recorded by a single sensor, and we are interested in estimating the original source signals based on the recorded mixture. This problem, which occurs in many sciences, is inherently under......-determined and its solution relies on making appropriate assumptions concerning the sources. This dissertation is concerned with model-based probabilistic single-channel source separation based on non-negative matrix factorization, and consists of two parts: i) three introductory chapters and ii) five published...

  7. Renal disease in pregnancy ambulatory issues.

    Science.gov (United States)

    Phelan, Sharon T

    2012-09-01

    Acute and chronic renal disease will complicate prenatal care. Normal physiological changes during pregnancy make the urinary tract system more vulnerable to infectious complications or worsening of preexisting disease. Much of the focus of prenatal care includes screening for these concerns both at the onset of prenatal care and through the pregnancy and postpartum course. With careful and attentive care, the pregnancy outcome for women with significant renal disease has improved and the occurrence of renal injury or obstetric complications due to infectious insults has decreased. This manuscript reviews the current ambulatory prenatal care as it relates to the urinary tract in pregnancy.

  8. TauFactor: An open-source application for calculating tortuosity factors from tomographic data

    Directory of Open Access Journals (Sweden)

    S.J. Cooper

    2016-01-01

    Full Text Available TauFactor is a MatLab application for efficiently calculating the tortuosity factor, as well as volume fractions, surface areas and triple phase boundary densities, from image based microstructural data. The tortuosity factor quantifies the apparent decrease in diffusive transport resulting from convolutions of the flow paths through porous media. TauFactor was originally developed to improve the understanding of electrode microstructures for batteries and fuel cells; however, the tortuosity factor has been of interest to a wide range of disciplines for over a century, including geoscience, biology and optics. It is still common practice to use correlations, such as that developed by Bruggeman, to approximate the tortuosity factor, but in recent years the increasing availability of 3D imaging techniques has spurred interest in calculating this quantity more directly. This tool provides a fast and accurate computational platform applicable to the big datasets (>108 voxels typical of modern tomography, without requiring high computational power.

  9. [Hospitalisations for ambulatory care sensitive conditions in Germany

    NARCIS (Netherlands)

    Freund, T.; Heller, G.; Szecsenyi, J.

    2014-01-01

    BACKGROUND: On the basis of the assumption that a significant proportion of hospitalisations for so-called ambulatory care sensitive conditions (ACSCs) are potentially avoidable by ambulatory care measures, hospitalisation rates for ACSCs are used internationally as population based indicators for a

  10. An Ambulatory Program for Surgical Residents and Medical Students.

    Science.gov (United States)

    Levy, Margaret

    1988-01-01

    A pilot program based in a freestanding ambulatory surgery center at the Chicago Medical School Department of Surgery is described, its curriculum outlined, and the daily activities of the residents and medical students are detailed. A brief history of ambulatory surgery is given. (Author/MLW)

  11. [25 years of organized ambulatory heart sport in Luxembourg. The development of a sustained rehabilitation model].

    Science.gov (United States)

    Delagardelle, Charles; Feiereisen, Patrick

    2011-01-01

    underlying atherosclerotic processes, thereby reducing morbidity and mortality". The responsible ESC cardiologists agree with the international community that fighting CVD risk factors is at least as important as the whole arsenal of modern heart surgery and interventional cardiology. The core activity of ambulatory heart sport groups remains physical activity, and nowadays 6 different activities can be offered (one activity each day of the week): exercise lesson, swimming, walking, cycling, Nordic Walking and water gymnastics On the other hand comprehensive prevention programs, especially concerning CVD risk factors are also endorsed by the ambulatory heart sport groups of Luxembourg via regular meetings, conferences, brochures and symposia. One advantage of the ambulatory heart sport movement in Luxembourg, in contrast to the German model, is the direct financial allowance of the health ministry, which permits a lifelong activity to all the active members. Another advantage is that all the regional groups are directed by clinical cardiologists knowing the patients very closely. One weak point is that only about 5-10% of all potential candidates adhere to the ambulatory heart sport groups but nearly 50% of the active members are practicing for more than 5 years. These regularly active patients are a positive selection of well committed cardiac patients who, most of the time, control CVD risk factors with scrutiny. The ESC has recommended creating so called "Heart Houses" where all the aspects of comprehensive prevention and rehabilitation can be offered. Their main concern is to develop a sustained strategy which is desperately missing for the moment. A lot of the active members of the heart sport groups of Luxembourg achieve such a sustained activity and, therefore, these heart sport groups can be considered as very cost effective models of sustained rehabilitation. After a 25 years activity the ambulatory heart sport movement of Luxemburg has reached the outstanding goal

  12. Review of NO/sub x/ emission factors for stationary fossil fuel combustion sources. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Milligan, R.J.; Sailor, W.C.; Wasilewski, J.; Kuby, W.C.

    1979-09-01

    A review of recent NOx test data was performed, and summaries of emission factors presented for various types of stationary source combustion and for various fossil fuels. The effects of combustion modifications on NOx emissions are quantified. Background data are given to help the user determine the reliability of each factor in particular applications.

  13. Hepatic Dysfunction in Ambulatory Patients With Heart Failure

    Science.gov (United States)

    Farr, Maryjane; Wu, Christina; Givens, Raymond C.; Collado, Ellias; Mancini, Donna M.; Schulze, P. Christian

    2013-01-01

    Objectives This study evaluated the Model for End-Stage Liver Disease (MELD) score and its modified versions, which are established measures of liver dysfunction, as a tool to assess heart transplantation (HTx) urgency in ambulatory patients with heart failure. Background Liver abnormalities have a prognostic impact on the outcome of patients with advanced heart failure. Methods We retrospectively evaluated 343 patients undergoing HTx evaluation between 2005 and 2009. The prognostic effectiveness of MELD and 2 modifications (MELDNa [includes serum sodium levels] and MELD-XI [does not include international normalized ratio]) for endpoint events, defined as death/HTx/ventricular assist device requirement, was evaluated in our cohort and in subgroups of patients on and off oral anticoagulation. Results The MELD and MELDNa scores were excellent predictors for 1-year endpoint events (areas under the curve: 0.71 and 0.73, respectively). High scores (>12) were strongly associated with poor survival at 1 year (MELD 69.3% vs. 90.4% [p < 0.0001]; MELDNa 70.4% vs. 96.9% [p < 0.0001]). Increased scores were associated with increased risk for HTx (hazard ratio: 1.10 [95% confidence interval: 1.06 to 1.14]; p < 0.0001 for both scores), which was independent of other known risk factors (MELD p = 0.0055; MELDNa p = 0.0083). Anticoagulant use was associated with poor survival at 1 year (73.7% vs. 86.4%; p = 0.0118), and the statistical significance of MELD/MELDNa was higher in patients not receiving oral anticoagulation therapy. MELD-XI was a fair but limited predictor of the endpoint events in patients receiving oral anticoagulation therapy. Conclusions Assessment of liver dysfunction according to the MELD scoring system provides additional risk information in ambulatory patients with heart failure. PMID:23563127

  14. Specific factors influencing information system/information and communication technology sourcing strategies in healthcare facilities.

    Science.gov (United States)

    Potančok, Martin; Voříšek, Jiří

    2016-09-01

    Healthcare facilities use a number of information system/information and communication technologies. Each healthcare facility faces a need to choose sourcing strategies most suitable to ensure provision of information system/information and communication technology services, processes and resources. Currently, it is possible to observe an expansion of sourcing possibilities in healthcare informatics, which creates new requirements for sourcing strategies. Thus, the aim of this article is to identify factors influencing information system/information and communication technology sourcing strategies in healthcare facilities. The identification was based on qualitative research, namely, a case study. This study provides a set of internal and external factors with their impact levels. The findings also show that not enough attention is paid to these factors during decision-making.

  15. Online blind source separation using incremental nonnegative matrix factorization with volume constraint.

    Science.gov (United States)

    Zhou, Guoxu; Yang, Zuyuan; Xie, Shengli; Yang, Jun-Mei

    2011-04-01

    Online blind source separation (BSS) is proposed to overcome the high computational cost problem, which limits the practical applications of traditional batch BSS algorithms. However, the existing online BSS methods are mainly used to separate independent or uncorrelated sources. Recently, nonnegative matrix factorization (NMF) shows great potential to separate the correlative sources, where some constraints are often imposed to overcome the non-uniqueness of the factorization. In this paper, an incremental NMF with volume constraint is derived and utilized for solving online BSS. The volume constraint to the mixing matrix enhances the identifiability of the sources, while the incremental learning mode reduces the computational cost. The proposed method takes advantage of the natural gradient based multiplication updating rule, and it performs especially well in the recovery of dependent sources. Simulations in BSS for dual-energy X-ray images, online encrypted speech signals, and high correlative face images show the validity of the proposed method.

  16. 76 FR 6572 - Non-Ambulatory Disabled Veal Calves and Other Non-Ambulatory Disabled Livestock at Slaughter...

    Science.gov (United States)

    2011-02-07

    ... inspection regulations to prohibit the slaughter of non-ambulatory disabled pigs, sheep, goats, and other... the mother's colostrum, iron deficient diets, intensive confinement, and lack of activity, result in... to require that non- ambulatory disabled pigs, sheep, goats, and other amenable livestock species...

  17. Ambulatory blood pressure values in healthy children

    Directory of Open Access Journals (Sweden)

    Paripović Dušan

    2006-01-01

    Full Text Available Ambulatory blood pressure monitoring (ABPM is an important tool in the diagnosis and management of childhood hypertension. Normal ambulatory blood pressure (ABP values in children with body heights between 100 and 120 cm have not been reported. The aim of the study was to establish the normal range of values for ABPM in these children. 24-hour ABPM was performed in 40 normotensive (auscultatory casual blood pressure was obtained before ABPM subjects, aged from 4 to 6 years (26 males, 14 females with body heights between 95 and 125 cm. ABPM was carried out on non-dominant arm using the oscillometric device (SpaceLab 90207 with appropriate cuff size. The monitor was programmed to measure BP every 15 min. during the day (6 a.m. to 10 p.m. and every 30 min. during the night (10 p.m. to 6 a.m.. The mean daytime SBP/DBP in boys and girls was 108+/-6/67+/-5 and 105+/-5/66+/-1, respectively. The mean nighttime SBP/DBP in boys and girls was 98+/-6/56+/-5 and 97+/-7/56+/-4, respectively. There was a significant difference between day and night readings of SBP, DBP and heart rate (nocturnal fall was observed. The distribution of ABP noted in this study could serve as preliminary reference. A multicenter study should be performed to provide normal ranges of ABP.

  18. CO2 emission factors for waste incineration: Influence from source separation of recyclable materials

    DEFF Research Database (Denmark)

    Larsen, Anna Warberg; Astrup, Thomas

    2011-01-01

    CO2-loads from combustible waste are important inputs for national CO2 inventories and life-cycle assessments (LCA). CO2 emissions from waste incinerators are often expressed by emission factors in kg fossil CO2 emitted per GJ energy content of the waste. Various studies have shown considerable...... variations between emission factors for different incinerators, but the background for these variations has not been thoroughly examined. One important reason may be variations in collection of recyclable materials as source separation alters the composition of the residual waste incinerated. The objective...... of this study was to quantify the importance of source separation for determination of emission factors for incineration of residual household waste. This was done by mimicking various source separation scenarios and based on waste composition data calculating resulting emission factors for residual waste...

  19. The predictive value of selected job rewards on occupational therapists' job satisfaction in ambulatory care settings.

    Science.gov (United States)

    Painter, J; Akroyd, D; Wilson, S; Figuers, C

    1995-01-01

    Using a perceived reward model of overall job satisfaction, this study utilized a correlational research design with multiple regression analysis to determine the predictive power of extrinsic rewards and intrinsic rewards, collectively and individually, as determinants of overall job satisfaction among registered occupational therapists (OTR) working full-time in ambulatory care settings. The intrinsic rewards (task involvement and task autonomy), collectively and individually, were perceived to be significant overall job satisfaction determinants. General working conditions was the only significant extrinsic reward. Given the demand for OTRs in ambulatory care settings, a better understanding of factors that influence overall job satisfaction among OTRs could prove beneficial in developing appropriate recruitment and retention job design strategies.

  20. Investigation of Power Factor on Harmonic Effect due to Types of Voltage Source

    Directory of Open Access Journals (Sweden)

    C.B. Risnidar

    2011-01-01

    Full Text Available This paper discussed about power factor on harmonic effect due to types of voltage source. Usually, the voltage source is sinusoidal. But in actual condition the load that has voltage sources through the elements where the output voltage of element as input to load is not pure sinusoidal, for example at Power of Common Coupling (PCC between transformer and linear load and nonlinear load. The research has been done with Schhafner Power Quality Analyzer and was focused to power factor (p.f., Total Harmonic Distortion (THD, and harmonic energy losses cost from measurement where load is Induction motor and Adjustable Speed Drive (ASD. As voltage source in this research are sine wave, square wave and combinations of 3rd, 5th and 7th harmonic order like harmonic 313, and harmonic 357.

  1. Computer database of ambulatory EEG signals.

    Science.gov (United States)

    Jayakar, P B; Brusse, E; Patrick, J P; Shwedyk, E; Seshia, S S

    1987-01-01

    The paper describes an ambulatory EEG database. The database contains segments of AEEGs done on 45 subjects. Each epoch (1/8th second or more) of AEEG data has been annotated into 1 of 40 classes. The classes represent background activity, paroxysmal patterns and artifacts. The majority of classes have over 200 discrete epochs. The structure is flexible enough to allow additional epochs to be readily added. The database is stored on transportable media such as digital magnetic tape or hard disk and is thus available to other researchers in the field. The database can be used to design, evaluate and compare EEG signal processing algorithms and pattern recognition systems. It can also serve as an educational medium in EEG laboratories.

  2. [Ambulatory ureteral lithotripsy with "Modulith SL-20"].

    Science.gov (United States)

    González Enguita, C; Calahorra Fernández, F J; García de la Peña, E; Rodríguez-Miñón Cifuentes, J L; Vela Navarrete, R

    1993-03-01

    Analysis of our experience in 'in situ' ambulatory shockwave extracorporeal lithofragmentation of ureteral stones in 104 patients seen in the Lithotrity Unit, Urology Service, Fundación "Jiménez Díaz". Using Modulith SL 20, a third generation lithotripter, 'in situ' disintegration was achieved in 82.69% of cases, 51.92% of which were fragmented in a single lithotrity session. As a first choice, no ureteral handling was used in any of the patients prior to lithotrity. In 9.62% of patients it was necessary to place a 'double J' by-pass catheter, due to the disease presenting with a septic picture. The patient's position was either dorsal or ventral decubitus depending on the lithiatic site, while location and focusing of the stones was done radiologically. All patients were treated ambulatory without hospitalization. Only 18% was given oral or i.v. anaesthesia. Fursemide 40 mg was administered to all patients shortly before starting the session. Each patient received an average of 3,200 shockwaves per session (14-18 Kv, average 16 Kv). Haematuria was the single and modest side effect that happened during the 24 hours following lithofragmentation in 30% of patients, while 20% reported slight discomfort at the time of eliminating the gritted stones. We conclude stating that 'in situ' shockwave extracorporeal lithotrity of ureteral stones with Modulith SL 20 allows for elective disintegration of ureteral stones in whatever location they are found, due to the patient's easy positioning. The simple location and focusing of ureteral stones has allowed us to treat and solve some cases of ureteral lithiasis at the precise moment of the nephritic colic painful emergency, thus speeding up and facilitating the resolution of the condition. Our results and our strategy imply a new change of direction in the management of these lithiasis, as opposed to the well established and historical doctrines in existence regarding stones with ureteral location.

  3. The relation of ambulatory heart rate with all-cause mortality among middle-aged men: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Mette Korshøj

    Full Text Available The aim of this study was to investigate the association between average 24-hour ambulatory heart rate and all-cause mortality, while adjusting for resting clinical heart rate, cardiorespiratory fitness, occupational and leisure time physical activity as well as classical risk factors. A group of 439 middle-aged male workers free of baseline coronary heart disease from the Belgian Physical Fitness Study was included in the analysis. Data were collected by questionnaires and clinical examinations from 1976 to 1978. All-cause mortality was collected from the national mortality registration with a mean follow-up period of 16.5 years, with a total of 48 events. After adjustment for all before mentioned confounders in a Cox proportional hazards regression analysis, a significant increased risk for all-cause mortality was found among the tertile of workers with highest average ambulatory heart rate compared to the tertile with lowest ambulatory heart rate (Hazard ratio = 3.21, 95% confidence interval: 1.22-8.44. No significant independent association was found between resting clinic heart rate and all-cause mortality. The study indicates that average 24-hour ambulatory heart rate is a strong predictor of all-cause mortality independent from resting clinic heart rate, cardiorespiratory fitness, occupational and leisure time physical activity and other classical risk factors among healthy middle-aged workers.

  4. Computerized adaptive testing--ready for ambulatory monitoring?

    DEFF Research Database (Denmark)

    Rose, Matthias; Bjørner, Jakob; Fischer, Felix

    2012-01-01

    Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted....

  5. Ambulatory Pessary Trial Unmasks Occult Stress Urinary Incontinence

    Directory of Open Access Journals (Sweden)

    Bilal Chughtai

    2012-01-01

    Conclusion. An ambulatory pessary trial is an effective, easy, and inexpensive method to approximate anatomic results achieved by surgery under real-life conditions. In our series, 20% of patients with occult SUI were identified by pessary trial alone.

  6. Blind source separation of fMRI data by means of factor analytic transformations

    NARCIS (Netherlands)

    Langers, Dave R. M.

    2009-01-01

    In this study, the application of factor analytic (FA) rotation methods in the context of neuroimaging data analysis was explored. Three FA algorithms (ProMax, QuartiMax, and VariMax) were employed to carry out blind source separation in a functional magnetic resonance imaging (fMRI) experiment that

  7. Influence of some factors on alpha energy spectrum of 241Am fire alarm source

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    Several primary factors influencing the alpha energy spectrum of 241Am fire alarm source have been studied in order to get betteralpha energy spectrum.The results show that the homogeneity andthe thickness of metal surface coat and the size of active area of thesource have considerable influence on the alpha energy spectrum of thesource.

  8. Exploring the business case for ambulatory electronic health record system adoption.

    Science.gov (United States)

    Song, Paula H; McAlearney, Ann Scheck; Robbins, Julie; McCullough, Jeffrey S

    2011-01-01

    Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made. This is of concern, as the lack of a business case can influence decision making about EHR investments. The purpose of this study was to examine the role of business case analysis in healthcare organizations' decisions to invest in ambulatory EHR systems, and to identify what factors organizations considered when justifying an ambulatory EHR. Using a qualitative case study approach, we explored how five organizations that are considered to have best practices in ambulatory EHR system implementation had evaluated the business case for EHR adoption. We found that although the rigor of formal business case analysis was highly variable, informants across these organizations consistently reported perceiving that a positive business case for EHR system adoption existed, especially when they considered both financial and non-financial benefits. While many consider EHR system adoption inevitable in healthcare, this viewpoint should not deter managers from conducting a business case analysis. Results of such an analysis can inform healthcare organizations' understanding about resource allocation needs, help clarify expectations about financial and clinical performance metrics to be monitored through EHR systems, and form the basis for ongoing organizational support to ensure successful system implementation.

  9. Difficult airway management of children in ambulatory anesthesia: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Huang AS

    2016-11-01

    Full Text Available Andrea S Huang,1 Lindsey Rutland,2 John Hajduk,1 Narasimhan Jagannathan1,2 1Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children’s Hospital of Chicago, 2Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Abstract: As the field of pediatric ambulatory anesthesia expands, anesthesiologists can anticipate encountering an increasing number of patients with expected and unexpected difficult airways. This unique setting and patient population both present challenges in making a decision whether and how to safely proceed in the case of a child with a difficult airway. A host of patient, provider, procedure, and facility-specific factors should be considered. Providers should understand the differences between the pediatric and adult airway, recognize common features and syndromes associated with difficult airways, and be comfortable with different airway equipment and techniques available in the ambulatory setting. Early anticipation, a comprehensive patient assessment, and a clear decision-making algorithm with multiple airway management plans are all critical in safely and effectively managing these patients. These issues and recommendations will be discussed in this comprehensive narrative review. Keywords: difficult airway, pediatrics, ambulatory surgery, airway devices, children

  10. Emotions beyond the laboratory: theoretical fundaments, study design, and analytic strategies for advanced ambulatory assessment.

    Science.gov (United States)

    Wilhelm, Frank H; Grossman, Paul

    2010-07-01

    Questionnaire and interview assessment can provide reliable data on attitudes and self-perceptions on emotion, and experimental laboratory assessment can examine functional relations between stimuli and reactions under controlled conditions. On the other hand, ambulatory assessment is less constrained and provides naturalistic data on emotion in daily life, with the potential to (1) assure external validity of laboratory findings, (2) provide normative data on prevalence, quality and intensity of real-life emotion and associated processes, (3) characterize previously unidentified emotional phenomena, and (4) model real-life stimuli for representative laboratory research design. Technological innovations now allow for detailed ambulatory study of emotion across domains of subjective experience, overt behavior and physiology. However, methodological challenges abound that may compromise attempts to characterize biobehavioral aspects of emotion in the real world. For example, emotional effects can be masked by social engagement, mental and physical workloads, as well as by food intake and circadian and quasi-random variation in metabolic activity. The complexity of data streams and multitude of factors that influence them require a high degree of context specification for meaningful data interpretation. We consider possible solutions to typical and often overlooked issues related to ambulatory emotion research, including aspects of study design decisions, recording devices and channels, electronic diary implementation, and data analysis.

  11. Effects of dietary fish and weight reduction on ambulatory blood pressure in overweight hypertensives.

    Science.gov (United States)

    Bao, D Q; Mori, T A; Burke, V; Puddey, I B; Beilin, L J

    1998-10-01

    Obesity is a major factor contributing to hypertension and increased risk of cardiovascular disease. Regular consumption of dietary fish and omega3 fatty acids of marine origin can lower blood pressure (BP) levels and reduce cardiovascular risk. This study examined the potential effects of combining dietary fish rich in omega3 fatty acids with a weight loss regimen in overweight hypertensive subjects, with ambulatory BP levels as the primary end point. Using a factorial design, 69 overweight medication-treated hypertensives were randomized to a daily fish meal (3.65 g omega3 fatty acids), weight reduction, the 2 regimens combined, or a control regimen for 16 weeks. Sixty-three subjects with a mean+/-SEM body mass index of 31.6+/-0.5 kg/m2 completed the study. Weight fell by 5.6+/-0.8 kg with energy restriction. Dietary fish and weight loss had significant independent and additive effects on 24-hour ambulatory BP. Effects were greatest on awake systolic and diastolic BP (Phour (-3.1+/-1.4 bpm, P=0.036) and awake (-4.2+/-1.6 bpm, P=0. 013) ambulatory heart rates. Weight reduction had a significant effect on sleeping heart rate only (-3.2+/-1.7 bpm, P=0.037). Combining a daily fish meal with a weight-reducing regimen led to additive effects on ambulatory BP and decreased heart rate. The effects were large, suggesting that cardiovascular risk and antihypertensive drug requirements are likely to be reduced substantially by combining dietary fish meals rich in omega3 fatty acids with weight-loss regimens in overweight medication-treated hypertensives. The reduction in heart rate seen with dietary fish suggests a cardiac/autonomic component, as well as vascular effects, of increased consumption of omega3 fatty acid from fish.

  12. Pros and cons of the ambulatory surgery center joint venture.

    Science.gov (United States)

    Giannini, Deborah

    2008-01-01

    If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture.

  13. Source Apportionment of Stack Emissions from Research and Development Facilities Using Positive Matrix Factorization

    Energy Technology Data Exchange (ETDEWEB)

    Ballinger, Marcel Y. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Larson, Timothy V. [Univ. of Washington, Seattle, WA (United States)

    2014-08-19

    Emissions from research and development (R&D) facilities are difficult to characterize due to the wide variety of processes used, changing nature of research, and large number of chemicals. Positive matrix factorization (PMF) was applied to volatile organic compounds (VOCs) concentrations measured in the main exhaust stacks of four different R&D buildings to identify the number and composition of major contributing sources. PMF identified from 9-11 source-related factors contributing to the stack emissions depending on the building. The factors that were similar between buildings were major contributors to trichloroethylene (TCE), acetone, and ethanol emissions. Several other factors had similar profiles for two or more buildings but not for all four. One factor for each building was a combination of p/m-xylene, o-xylene and ethylbenzene. At least one factor for each building was identified that contained a broad mix of many species and constraints were used in PMF to modify the factors to resemble more closely the off-shift concentration profiles. PMF accepted the constraints with little decrease in model fit. Although the PMF model predicted the profiles of the off-shift samples, the percent of total emissions was under-predicted by the model versus the measured data.

  14. A factor analysis-multiple regression model for source apportionment of suspended particulate matter

    Science.gov (United States)

    Okamoto, Shin'ichi; Hayashi, Masayuki; Nakajima, Masaomi; Kainuma, Yasutaka; Shiozawa, Kiyoshige

    A factor analysis-multiple regression (FA-MR) model has been used for a source apportionment study in the Tokyo metropolitan area. By a varimax rotated factor analysis, five source types could be identified: refuse incineration, soil and automobile, secondary particles, sea salt and steel mill. Quantitative estimations using the FA-MR model corresponded to the calculated contributing concentrations determined by using a weighted least-squares CMB model. However, the source type of refuse incineration identified by the FA-MR model was similar to that of biomass burning, rather than that produced by an incineration plant. The estimated contributions of sea salt and steel mill by the FA-MR model contained those of other sources, which have the same temporal variation of contributing concentrations. This symptom was caused by a multicollinearity problem. Although this result shows the limitation of the multivariate receptor model, it gives useful information concerning source types and their distribution by comparing with the results of the CMB model. In the Tokyo metropolitan area, the contributions from soil (including road dust), automobile, secondary particles and refuse incineration (biomass burning) were larger than industrial contributions: fuel oil combustion and steel mill. However, since vanadium is highly correlated with SO 42- and other secondary particle related elements, a major portion of secondary particles is considered to be related to fuel oil combustion.

  15. Blind source separation for groundwater pressure analysis based on nonnegative matrix factorization

    Science.gov (United States)

    Alexandrov, Boian S.; Vesselinov, Velimir V.

    2014-09-01

    The identification of the physical sources causing spatial and temporal fluctuations of aquifer water levels is a challenging, yet a very important hydrogeological task. The fluctuations can be caused by variations in natural and anthropogenic sources such as pumping, recharge, barometric pressures, etc. The source identification can be crucial for conceptualization of the hydrogeological conditions and characterization of aquifer properties. We propose a new computational framework for model-free inverse analysis of pressure transients based on Nonnegative Matrix Factorization (NMF) method for Blind Source Separation (BSS) coupled with k-means clustering algorithm, which we call NMFk. NMFk is capable of identifying a set of unique sources from a set of experimentally measured mixed signals, without any information about the sources, their transients, and the physical mechanisms and properties controlling the signal propagation through the subsurface flow medium. Our analysis only requires information about pressure transients at a number of observation points, m, where m≥r, and r is the number of unknown unique sources causing the observed fluctuations. We apply this new analysis on a data set from the Los Alamos National Laboratory site. We demonstrate that the sources identified by NMFk have real physical origins: barometric pressure and water-supply pumping effects. We also estimate the barometric pressure efficiency of the monitoring wells. The possible applications of the NMFk algorithm are not limited to hydrogeology problems; NMFk can be applied to any problem where temporal system behavior is observed at multiple locations and an unknown number of physical sources are causing these fluctuations.

  16. Ambulatory teaching: Do approaches to learning predict the site and preceptor characteristics valued by clerks and residents in the ambulatory setting?

    Directory of Open Access Journals (Sweden)

    Kirby John R

    2005-10-01

    Full Text Available Abstract Background In a study to determine the site and preceptor characteristics most valued by clerks and residents in the ambulatory setting we wished to confirm whether these would support effective learning. The deep approach to learning is thought to be more effective for learning than surface approaches. In this study we determined how the approaches to learning of clerks and residents predicted the valued site and preceptor characteristics in the ambulatory setting. Methods Postal survey of all medical residents and clerks in training in Ontario determining the site and preceptor characteristics most valued in the ambulatory setting. Participants also completed the Workplace Learning questionnaire that includes 3 approaches to learning scales and 3 workplace climate scales. Multiple regression analysis was used to predict the preferred site and preceptor characteristics as the dependent variables by the average scores of the approaches to learning and perception of workplace climate scales as the independent variables. Results There were 1642 respondents, yielding a 47.3% response rate. Factor analysis revealed 7 preceptor characteristics and 6 site characteristics valued in the ambulatory setting. The Deep approach to learning scale predicted all of the learners' preferred preceptor characteristics (β = 0.076 to β = 0.234, p Direction was more strongly associated with the Surface Rational approach (β = .252, p Surface Disorganized approach to learning (β = .154, p Deep approach. The Deep approach to learning scale predicted valued site characteristics of Office Management, Patient Logistics, Objectives and Preceptor Interaction (p Surface Rational approach to learning predicted valuing Learning Resources and Clinic Set-up (β = .09, p = .001; β = .197, p Surface Disorganized approach to learning weakly negatively predicted Patient Logistics (β = -.082, p = .003 and positively the Learning Resources (β = .088, p = .003. Climate

  17. Correction factors for source strength determination in HDR brachytherapy using the in-phantom method

    Energy Technology Data Exchange (ETDEWEB)

    Ubrich, Frank; Engenhart-Cabillic, Rita [University Hospital Giessen-Marburg, Marburg (Germany). Dept. of Radiotherapy and Radiation Oncology; Wulff, Joerg [University of Applied Sciences (THM) Giessen (Germany). Inst. of Medical Physics and Radiation Protection (IMPS); Zink, Klemens [University Hospital Giessen-Marburg, Marburg (Germany). Dept. of Radiotherapy and Radiation Oncology; University of Applied Sciences (THM) Giessen (Germany). Inst. of Medical Physics and Radiation Protection (IMPS)

    2014-09-01

    For the purpose of clinical source strength determination for HDR brachytherapy sources, the German society for Medical Physics (DGMP) recommends in their report 13 the usage of a solid state phantom (Krieger-phantom) with a thimble ionization chamber. In this work, the calibration chain for the determination of the reference air-kerma rate K{sub a,100} and reference dose rate to water D{sub w,1} by ionization chamber measurement in the Krieger-phantom was modeled via Monte Carlo simulations. These calculations were used to determine global correction factors k{sub tot}, which allows a user to directly convert the reading of an ionization chamber calibrated in terms of absorbed dose to water, into the desired quantity K{sub a,100} or D{sub w,1}. The factor k{sub tot} was determined for four available {sup 192}Ir sources and one {sup 60}Co source with three different thimble ionization chambers. Finally, ionization chamber measurements on three μSelectron V2 HDR sources within the Krieger-phantom were performed and K{sub a,100} was determined according to three different methods: (1) using a calibration factor in terms of absorbed dose to water wth the global correction factor (k{sub tot}){sub K{sub a{sub ,{sub 1{sub 0{sub 0}}}}}} according DGMP 13 (2) using a global correction factor calculated via Monte Carlo (3) using a direct reference air-kerma rate calibration factor determined by the national metrology institute PTB. The comparison of Monte Carlo based (k{sub tot}){sub K{sub a{sub ,{sub 1{sub 0{sub 0}}}}}} with those from DGMP 13 showed that the DGMP data were systematically smaller by about 2-2.5%. The experimentally determined (k{sub tot}){sub K{sub a{sub ,{sub 1{sub 0{sub 0}}}}}}, based on the direct K{sub a,100} calibration were also systematically smaller by about 1.5%. Despite of these systematical deviations, the agreement of the different methods was in almost all cases within the 1σ level of confidence of the interval of their respective

  18. Non Infectious Complications of Continuous Ambulatory Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    K. Flayou

    2015-02-01

    Full Text Available Introduction: Continuous ambulatory peritoneal dialysis has proven to be as effective as hemodialysis. However, it is associated with several complications. The aim of this study is to evaluate the prevalence and outcome of complications in patients treated with peritoneal dialysis at our center. Material and methods: A retrospective study between January 2007 and February 2015 at the nephrology, dialysis and renal transplantation department of Ibn Sina university. Predisposing factors and long-term outcomes were analyzed. Results: Fifty two mechanical complications were noted among thirty eight patients between June 2007 and February 2015. Migration was the most common (23 cases followed by obstruction, hernia and dialysate leakes in respectively 9, 7 and 6 cases. We have also noted 2 cases of hemoperitoneum, 3 catheter perforation and 2 cases of externalization. Onset time of complications was 25,4 ± 12,7 months. Conclusion: this study proves the interest of the prevention of mechanical complications in peritoneal dialysis. This requires a periodic retraining of patients and caregivers.

  19. Kidney volume and ambulatory blood pressure in children.

    Science.gov (United States)

    Gurusinghe, Shari; Palvanov, Arkadiy; Bittman, Mark E; Singer, Pamela; Frank, Rachel; Chorny, Nataliya; Infante, Lulette; Sethna, Christine B

    2016-12-16

    Low nephron number has been shown to be a risk factor for hypertension (HTN) in adulthood. Kidney volume may serve as a surrogate marker for nephron mass. The relationship between kidney volume and ambulatory blood pressure (BP) in the pediatric population is not known. A retrospective chart review of children younger than 21 years who were evaluated for HTN was performed. Twenty-four-hour BP and ultrasonography data were obtained. Multiple regression was used to examine associations between BP and kidney volume. Of 84 children (mean age 13.87 years, 72.6% males), 54 had HTN. Systolic BP index during the awake, sleep, and 24-hour periods (all P≤.05) was found to be positively correlated with total kidney volume. Greater total kidney volume was found to be a positive predictor of 24-hour and sleep systolic index (P≤.05). It failed to serve as a predictor of HTN, pre-HTN, or white-coat HTN. Contrary to expectation, total kidney volume was positively associated with systolic BP indices.

  20. Continuous ambulatory peritoneal dialysis: Indian scenario.

    Science.gov (United States)

    Abraham, Georgi; Mathew, Milli; Hinduja, Anish; Padma, G

    2002-03-01

    Chronic peritoneal dialysis (CPD) has been initiated as a treatment modality for chronic renal failure patients in the Indian subcontinent since 1990. Over a period of 9 years both continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD) have emerged as accepted forms of renal replacement therapy in our country. Although there were government restrictions on import of dialysis fluid until 1993, the availability of locally manufactured fluid in collapsible bags had facilitated the expansion of the programme to the far corners of the country and in neighbouring countries. Initially majority (78%) of the patients who were started on this programme were diabetics with other comorbid conditions who were drop-outs from haemodialysis and unfit for transplantation. Both CAPD and CCPD have been used for all age groups and for men and women. Majority of the patients do 3 x 2 l exchanges a day on CAPD; 8-10 l using a cycler at night those who are onCCPD. Peritonitis rate was 1 episode every 18 patient months. With the introduction of new connection and disposable sets the incidence of peritonitis is dropping down. The major cause of drop-out is cardiovascular death followed by peritonitis. Malnutrition is a major problem in both CAPD and haemodialysis patients. The programme has been expanded and there are over one thousand patients on this treatment in the country. The introduction of CPD had a major impact on the treatment of renal failure in India.

  1. Cuff inflation during ambulatory blood pressure monitoring and heart rate

    Directory of Open Access Journals (Sweden)

    Mia Skov-Madsen

    2008-11-01

    Full Text Available Mia Skov-Madsen, My Svensson, Jeppe Hagstrup ChristensenDepartment of Nephrology, Aarhus University Hospital, Aalborg, DenmarkIntroduction: Twenty four-hour ambulatory blood pressure monitoring is a clinically validated procedure in evaluation of blood pressure (BP. We hypothesised that the discomfort during cuff inflation would increase the heart rate (HR measured with 24-h ambulatory BP monitoring compared to a following HR measurement with a 24-h Holter monitor.Methods: The study population (n = 56 were recruited from the outpatient’s clinic at the Department of Nephrology, Aalborg Hospital, Aarhus University Hospital at Aalborg, Denmark. All the patients had chronic kidney disease (CKD. We compared HR measured with a 24-h Holter monitor with a following HR measured by a 24-h ambulatory BP monitoring.Results: We found a highly significant correlation between the HR measured with the Holter monitor and HR measured with 24-h ambulatory blood pressure monitoring (r = 0.77, p < 0.001. Using the Bland-Altman plot, the mean difference in HR was only 0.5 beat/min during 24 hours with acceptable limits of agreement for both high and low HR levels. Dividing the patients into groups according to betablocker treatment, body mass index, age, sex, angiotensin-converting enzyme inhibitor treatment, statins treatment, diuretic treatment, or calcium channel blocker treatment revealed similar results as described above.Conclusion: The results indicate that the discomfort induced by cuff inflation during 24-h ambulatory BP monitoring does not increase HR. Thus, 24-h ambulatory BP monitoring may be a reliable measurement of the BP among people with CKD.Keywords: ambulatory blood pressure monitoring, Holter monitoring, heart rate, chronic kidney disease, hypertension

  2. Source Energy and Emission Factors for Energy Use in Buildings (Revised)

    Energy Technology Data Exchange (ETDEWEB)

    Deru, M.; Torcellini, P.

    2007-06-01

    This document supports the other measurement procedures and all building energy-monitoring projects by providing methods to calculate the source energy and emissions from the energy measured at the building. Energy and emission factors typically account for the conversion inefficiencies at the power plant and the transmission and distribution losses from the power plant to the building. The energy and emission factors provided here also include the precombustion effects, which are the energy and emissions associated with extracting, processing, and delivering the primary fuels to the point of conversion in the electrical power plants or directly in the buildings.

  3. Power factor controller used as DC-DC converter for photovoltaic sources

    Energy Technology Data Exchange (ETDEWEB)

    Mukerjee, A.K.; Dasgupta, Nivedita [Centre for Energy Studies, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016 (India)

    2008-06-15

    An active power factor controller (PFC) integrated circuit, normally used in AC circuits, has been used for DC-to-DC boost conversion with a stable output voltage for a variable DC input voltage as obtained from photovoltaic (PV) sources. The circuit described here uses a power factor controller MC 34262 to give approximately 400 V{sub DC} output for an input variation from 90 to 280 V{sub DC}. The maximum efficiency achieved was 98% at 450 W. Comparisons between AC and DC operations have been made. (author)

  4. Relationship Between Non-Point Source Pollution and Korean Green Factor

    OpenAIRE

    Seung Chul Lee; In-Hyeok Park; Byung Sik Kim; and Sung Ryong Ha

    2015-01-01

    In determining the relationship between the rational event mean concentration (REMC) which is a volume-weighted mean of event mean concentrations (EMCs) as a non-point source (NPS) pollution indicator and the green factor (GF) as a low impact development (LID) land use planning indicator, we constructed at runoff database containing 1483 rainfall events collected from 107 different experimental catchments from 19 references in Korea. The collected data showed that EMCs were not correlated wit...

  5. The wall correction factor for a spherical ionization chamber used in brachytherapy source calibration

    Energy Technology Data Exchange (ETDEWEB)

    Piermattei, A [Istituto di Fisica, Universita Cattolica S Cuore, Rome (Italy); Azario, L [Istituto di Fisica, Universita Cattolica S Cuore, Rome (Italy); Fidanzio, A [Istituto di Fisica, Universita Cattolica S Cuore, Rome (Italy); Viola, P [Istituto di Fisica, Universita Cattolica S Cuore, Rome (Italy); Dell' Omo, C [Istituto di Fisica, Universita Cattolica S Cuore, Rome (Italy); Iadanza, L [Centro di Riferimento Oncologico della Basilicata-Rionero in Vulture, Pz (Italy); Fusco, V [Centro di Riferimento Oncologico della Basilicata-Rionero in Vulture, Pz (Italy); Lagares, J I [Universidad de Sevilla, Facultad de Medicina, Dpto Fisiologia Medica y Biofisica, Sevilla (Spain); Capote, R [Universidad de Sevilla, Facultad de Medicina, Dpto Fisiologia Medica y Biofisica, Sevilla (Spain)

    2003-12-21

    The effect of wall chamber attenuation and scattering is one of the most important corrections that must be determined when the linear interpolation method between two calibration factors of an ionization chamber is used. For spherical ionization chambers the corresponding correction factors A{sub w} have to be determined by a non-linear trend of the response as a function of the wall thickness. The Monte Carlo and experimental data here reported show that the A{sub w} factors obtained for an Exradin A4 chamber, used in the brachytherapy source calibration, in terms of reference air kerma rate, are up to 1.2% greater than the values obtained by the linear extrapolation method for the studied beam qualities. Using the A{sub w} factors derived from Monte Carlo calculations, the accuracy of the calibration factor N{sub K,Ir} for the Exradin A4, obtained by the interpolation between two calibration factors, improves about 0.6%. The discrepancy between the new calculated factor and that obtained using the complete calibration curve of the ion-chamber and the {sup 192}Ir spectrum is only 0.1%.

  6. Source Identification of Polycyclic Aromatic Hydrocarbons by Diagnostic Ratios and Positive Matrix Factorization

    Science.gov (United States)

    Dvorska, A.; Jarkovsky, J.; Lammel, G.; Klanova, J.

    2009-04-01

    Although polycyclic aromatic hydrocarbons (PAHs) are also of natural origin, in many regions their environmental concentrations have strongly increased due to human activities. These semivolatile organic compounds are generally formed during incomplete combustion. Other sources include volatilization from unburned petroleum or tire abrasion in road traffic. Among all pollutants PAHs pose the highest human health hazard in Europe (WHO, 2003). A multivariate statistical method, positive matrix factorization (PMF; Paatero, 1997), and diagnostic ratios of individual PAHs (e.g. Yunker et al., 2002) are used for PAH source identification in central Europe. To minimise confounding factors such as differences in volatility, water solubility, adsorption etc., diagnostic ratios should be restricted to PAHs of similar molecular mass (Readman et al., 1987). Furthermore, different reactivities are limiting. Nevertheless, the application of PAH diagnostic ratios is often inconclusive, because substance patterns (profiles) have not been reported for all sources and ranges for various sources overlap. The complete profiles are made use of by statistical methods such as factor analysis, UNMIX and PMF (Tauler et al., 2006). However, these methods can be unreliable, because of incomplete knowledge of source profiles and the analysis' sensitivity to the data distribution. A unique 12-year data set of concentrations of PAHs (16 individual substances, 2 phases, weekly) in air, measured at the regional observatory Košetice, Czech Republic, is examined, together with shorter time series from Leipzig (urban background) and Schwartenberg (subalpine mountain background), Germany. Also, retene and coronene as specific source markers measured in Košetice from 2006 on are included into the analysis. An extensive literature search on PAH emission profiles was conducted. This data set was accomplished by measurements at sites in the Zlínsko region, Czech Republic, which are strongly dominated

  7. Advances in the use of intravenous techniques in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Eng MR

    2015-07-01

    Full Text Available Matthew R Eng,1 Paul F White1,2 1Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2White Mountain Institute, The Sea Ranch, CA, USA Summary statement: Advances in the use of intravenous techniques in ambulatory anesthesia has become important for the anesthesiologist as the key perioperative physician in outpatient surgery. Key techniques and choices of anesthetics are important in accomplishing fast track goals of ambulatory surgery. Purpose of review: The anesthesiologist in the outpatient environment must focus on improving perioperative efficiency and reducing recovery times while accounting for patients' well-being and safety. This review article focuses on recent intravenous anesthetic techniques to accomplish these goals. Recent findings: This review is an overview of techniques in intravenous anesthesia for ambulatory anesthesia. Intravenous techniques may be tailored to accomplish outpatient surgery goals for the type of surgical procedure and individual patient needs. Careful anesthetic planning and the application of the plans are critical to an anesthesiologist's success with fast-track ambulatory surgery. Conclusion: Careful planning and application of intravenous techniques are critical to an anesthesiologist's success with fast-track ambulatory surgery. Keywords: intravenous anesthesia, outpatient anesthesia, fast-track surgery

  8. Ambulatory anesthesia in plastic surgery: opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Facque AR

    2015-10-01

    Full Text Available Alexander R Facque, Peter J Taub Division of Plastic and Reconstructive Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY, USA Abstract: In 2013, there were 17 million procedures performed by plastic and reconstructive surgeons in the United States in the private office or ambulatory “surgicenter” setting, as well as additional operations performed in hospitals on an outpatient basis. As interest in performing increasingly complex surgical procedures on an outpatient basis continues to grow, the surgeon and anesthesiologist alike must be prepared to offer safe and reliable anesthesia and analgesia in the ambulatory setting. Surgeons must be aware of the possible techniques that will be employed in their surgeries in order to anticipate and prepare patients for possible postoperative side effects, and anesthesiologists must be prepared to offer such techniques in order to ensure a relatively rapid return to normal activity despite potentially having undergone major surgery. The following is a review of the specific considerations that should be given to ambulatory plastic surgery patients with comments on recent developments in the techniques used to safely administer agreeable and effective anesthesia. Keywords: ambulatory surgery, cosmetic anesthesia, outpatient, ambulatory anesthesia

  9. sources

    Directory of Open Access Journals (Sweden)

    Shu-Yin Chiang

    2002-01-01

    Full Text Available In this paper, we study the simplified models of the ATM (Asynchronous Transfer Mode multiplexer network with Bernoulli random traffic sources. Based on the model, the performance measures are analyzed by the different output service schemes.

  10. Ambulatory laparoscopic cholecystectomy: A single center experience

    Directory of Open Access Journals (Sweden)

    Cagri Tiryaki

    2016-01-01

    Full Text Available Aim: To evaluate the demographic and clinical parameters affecting the outcomes of ambulatory laparoscopic cholecystectomy (ALC in terms of pain, nausea, anxiety level, and satisfaction of patients in a tertiary health center. Materials and Methods: ALC was offered to 60 patients who met the inclusion criteria. Follow-up (questioning for postoperative pain or discomfort, nausea or vomiting, overall satisfaction was done by telephone contact on the same day at 22:00 p.m. and the first day after surgery at 8: 00 a.m. and by clinical examination one week after operation. STAI I and II data were used for proceeding to the level of anxiety of patients before and/or after the operation. Results: Sixty consecutive patients, with a mean age of 40.6 ± 8.1 years underwent ALC. Fifty-five (92% patients could be sent to their homes on the same day but five patients could not be sent due to anxiety, pain, or social indications. Nausea was reported in four (6.7% cases and not associated with any demographic or clinical features of patients. On the other hand, pain has been reported in 28 (46.7% cases, and obesity and shorter duration of gallbladder disease were associated with the increased pain perception (P = 0.009 and 0.004, respectively. Preopereative anxiety level was significantly higher among patients who could not complete the ALC procedure (P = 0.018. Conclusion: Correct management of these possible adverse effects results in the increased satisfaction of patients and may encourage this more cost-effective and safe method of laparoscopic cholecystectomy.

  11. Source geometry factors for HDR ¹⁹²Ir brachytherapy secondary standard well-type ionization chamber calibrations.

    Science.gov (United States)

    Shipley, D R; Sander, T; Nutbrown, R F

    2015-03-21

    Well-type ionization chambers are used for measuring the source strength of radioactive brachytherapy sources before clinical use. Initially, the well chambers are calibrated against a suitable national standard. For high dose rate (HDR) (192)Ir, this calibration is usually a two-step process. Firstly, the calibration source is traceably calibrated against an air kerma primary standard in terms of either reference air kerma rate or air kerma strength. The calibrated (192)Ir source is then used to calibrate the secondary standard well-type ionization chamber. Calibration laboratories are usually only equipped with one type of HDR (192)Ir source. If the clinical source type is different from that used for the calibration of the well chamber at the standards laboratory, a source geometry factor, k(sg), is required to correct the calibration coefficient for any change of the well chamber response due to geometric differences between the sources. In this work we present source geometry factors for six different HDR (192)Ir brachytherapy sources which have been determined using Monte Carlo techniques for a specific ionization chamber, the Standard Imaging HDR 1000 Plus well chamber with a type 70010 HDR iridium source holder. The calculated correction factors were normalized to the old and new type of calibration source used at the National Physical Laboratory. With the old Nucletron microSelectron-v1 (classic) HDR (192)Ir calibration source, ksg was found to be in the range 0.983 to 0.999 and with the new Isodose Control HDR (192)Ir Flexisource k(sg) was found to be in the range 0.987 to 1.004 with a relative uncertainty of 0.4% (k = 2). Source geometry factors for different combinations of calibration sources, clinical sources, well chambers and associated source holders, can be calculated with the formalism discussed in this paper.

  12. Pediatric ambulatory blood pressure monitoring: indications and interpretations.

    Science.gov (United States)

    Flynn, Joseph T; Urbina, Elaine M

    2012-06-01

    The prevalence of hypertension in children and adolescents is increasing, especially in obese and ethnic children. The adverse long-term effects of hypertension beginning in youth are known; therefore, it is important to identify young patients who need intervention. Unfortunately, measuring blood pressure (BP) is difficult due to the variety of techniques available and innate biologic variation in BP levels. Ambulatory BP monitoring may overcome some of the challenges clinicians face when attempting to categorize a young patient's BP levels. In this article, the authors review the use of ambulatory BP monitoring in pediatrics, discuss interpretation of ambulatory BP monitoring, and discuss gaps in knowledge in usage of this technique in the management of pediatric hypertension.

  13. Abordagem ambulatorial do nutricionista em anemia hemolítica Nutritional ambulatory approach in hemolytic anemia

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Vieira

    1999-04-01

    Full Text Available Descreve a atuação do nutricionista em ambulatório de Hematologia Pediátrica em um hospital escola e relata as condutas dietéticas necessárias na abordagem de crianças com anemia hemolítica com e sem sobrecarga de ferro, e também as atitudes mais freqüentes dos familiares em relação à alimentação desses pacientes.The Authors describe the performance of the Dietitian in a Pediatric Hematology Ambulatory. They emphasize the necessary dietetic procedures for adequate management of children with hemolytic anemia, with and without iron overload. Furthermore, they approach the family's attitude towards the patient's nutrition.

  14. Generic Uniqueness of a Structured Matrix Factorization and Applications in Blind Source Separation

    Science.gov (United States)

    Domanov, Ignat; Lathauwer, Lieven De

    2016-06-01

    Algebraic geometry, although little explored in signal processing, provides tools that are very convenient for investigating generic properties in a wide range of applications. Generic properties are properties that hold "almost everywhere". We present a set of conditions that are sufficient for demonstrating the generic uniqueness of a certain structured matrix factorization. This set of conditions may be used as a checklist for generic uniqueness in different settings. We discuss two particular applications in detail. We provide a relaxed generic uniqueness condition for joint matrix diagonalization that is relevant for independent component analysis in the underdetermined case. We present generic uniqueness conditions for a recently proposed class of deterministic blind source separation methods that rely on mild source models. For the interested reader we provide some intuition on how the results are connected to their algebraic geometric roots.

  15. Traffic induced particle resuspension in Paris: Emission factors and source contributions

    Science.gov (United States)

    Amato, F.; Favez, O.; Pandolfi, M.; Alastuey, A.; Querol, X.; Moukhtar, S.; Bruge, B.; Verlhac, S.; Orza, J. A. G.; Bonnaire, N.; Le Priol, T.; Petit, J.-F.; Sciare, J.

    2016-03-01

    Gaining knowledge on the process of particle resuspension from urban paved roads is of particular importance considering the increasing relevance of this source in urban air quality management and the lack of basic information on emission factors and source contributions. In this study we performed extensive field measurements for the quantification of the emission factors from different types of road in the city of Paris, and investigated the causes of their variability and the contributions to the ambient air PM10 observed across one year at one traffic monitoring site in the ring road of Paris. Results show agreement between lower road dust loadings (RD10: 0.7-2.2 mg m-2) and emission factors (5.4-9.0 mg vehicle-1 km-1) at inner-roads of Paris, compared to the ring road (2.4 mg m-2 and 17 mg vehicle-1 km-1, respectively), where the two parameters are estimated independently. The higher values in the ring road were likely caused by the poor state of pavement and higher share of heavy duty vehicles. Road wear, brake wear and a carbonaceous source, were almost equally responsible for 96% of RD10. At the traffic monitoring site located at the ring road (220,000 vehicle/day), the contributions of road dust emissions were estimated by receptor modeling to be 13% of PM10 on an annual mean (6.3 μg m-3), while the sum of vehicle exhaust and wear accounted for 47% resulting in a total traffic contribution of 60% of PM10. Road salting resulted to be a minor contributor (1% of annual mean) also in winter time (2%).

  16. Equine wellness care in ambulatory practice.

    Science.gov (United States)

    Sandoval, Claudia; True, Claudia

    2012-04-01

    Clients want dependable veterinary care and to understand how the services will benefit and meet their horse’s needs. Wellness visits provide ambulatory practitioners with great opportunities to strengthen the doctor-client-patient bond; effective communication with clients during wellness visits, where new literature or facts can be presented, can offer opportunities for demonstrating the value of having the veterinarian maintain a primary role in disease control. The criteria for selecting vaccines, interpreting FECs, and diagnosing dental pathology require the continued need for veterinary involvement. When providing wellness services, veterinarians should discuss those services, the reasons for them, as well as the possibility of adverse reactions. In so doing, the veterinarian is able to clearly distinguish himself or herself from a technician who is merely giving a "shot." Although some of these services can be performed by clients and lay professionals, the knowledge and training that veterinarians bring to these tasks add benefits to the horse beyond the services provided. For example, by targeting treatment and conveying the goals and limitations of FECs and deworming to clients, the speed at which anthelmintic resistance occurs will be diminished, and veterinarians will regain control over equine parasite management. Additional client education, such as demonstrating dental pathology to clients and how veterinary treatment benefits their horse, will not only improve the health of the horse further but also solidify the veterinarian’s role in preventative medicine. While all components of a wellness program were not detailed here, services such as nutritional consultation, blood work, and lameness evaluation should be offered based on the practice’s equine population. With the increasing population of geriatric horses, dentistry, nutrition, blood work, and lameness should be assessed annually or biannually. Each practice has its own set of criteria

  17. Mutagenicity and Pollutant Emission Factors of Solid-Fuel Cookstoves: Comparison with Other Combustion Sources

    Science.gov (United States)

    Mutlu, Esra; Warren, Sarah H.; Ebersviller, Seth M.; Kooter, Ingeborg M.; Schmid, Judith E.; Dye, Janice A.; Linak, William P.; Gilmour, M. Ian; Jetter, James J.; Higuchi, Mark; DeMarini, David M.

    2016-01-01

    JJ, Higuchi M, DeMarini DM. 2016. Mutagenicity and pollutant emission factors of solid-fuel cookstoves: comparison with other combustion sources. Environ Health Perspect 124:974–982; http://dx.doi.org/10.1289/ehp.1509852 PMID:26895221

  18. Identifying the Source of a Humoral Factor of Remote (PreConditioning Cardioprotection.

    Directory of Open Access Journals (Sweden)

    Svetlana Mastitskaya

    Full Text Available Signalling pathways underlying the phenomenon of remote ischaemic preconditioning (RPc cardioprotection are not completely understood. The existing evidence agrees that intact sensory innervation of the remote tissue/organ is required for the release into the systemic circulation of preconditioning factor(s capable of protecting a transplanted or isolated heart. However, the source and molecular identities of these factors remain unknown. Since the efficacy of RPc cardioprotection is critically dependent upon vagal activity and muscarinic mechanisms, we hypothesized that the humoral RPc factor is produced by the internal organ(s, which receive rich parasympathetic innervation. In a rat model of myocardial ischaemia/reperfusion injury we determined the efficacy of limb RPc in establishing cardioprotection after denervation of various visceral organs by sectioning celiac, hepatic, anterior and posterior gastric branches of the vagus nerve. Electrical stimulation was applied to individually sectioned branches to determine whether enhanced vagal input to a particular target area is sufficient to establish cardioprotection. It was found that RPc cardioprotection is abolished in conditions of either total subdiaphragmatic vagotomy, gastric vagotomy or sectioning of the posterior gastric branch. The efficacy of RPc cardioprotection was preserved when hepatic, celiac or anterior gastric vagal branches were cut. In the absence of remote ischaemia/reperfusion, electrical stimulation of the posterior gastric branch reduced infarct size, mimicking the effect of RPc. These data suggest that the circulating factor (or factors of RPc are produced and released into the systemic circulation by the visceral organ(s innervated by the posterior gastric branch of the vagus nerve.

  19. Factoring out natural and indirect human effects on terrestrial carbon sources and sinks

    Energy Technology Data Exchange (ETDEWEB)

    Canadell, J.G. [Global Carbon Project, CSIRO Marine and Atmospheric Research, GPO Box 3023, Canberra, ACT 2601 (Australia); Kirschbaum, M.U.F. [Environmental Biology Group, RSBS, Australian National University, GPO Box 475, Canberra, ACT 2601 (Australia); Kurz, W.A. [Natural Resources Canada, Canadian Forest Service, 506 West Burnside Road, Victoria, BC V8Z 1M5 (Canada); Sanz, M.J. [Fundacion CEAM, Parque Tecnologico, Charles H. Darwin 14, 46980 Paterna, Valencia (Spain); Schlamadinger, B. [Joanneum Research, Elisabethstrasse 11, Graz A-8010 (Austria); Yamagata, Y. [Center for Global Environmental Research, National Institute of Environmental Studies, 16-2 Onogawa, Tsukuba 305-8506 (Japan)

    2007-06-15

    The capacity to partition natural, indirect, and direct human-induced effects on terrestrial carbon (C) sources and sinks is necessary to be able to predict future terrestrial C dynamics and thus their influence on atmospheric CO2 growth. However, it will take a number of years before we can better attribute quantitative estimates of the contribution of various C processes to the net C balance. In a policy context, factoring out natural and indirect human-induced effects on C sources and sinks from the direct human-induced influences, is seen as a requirement of a C accounting approach that establishes a clear and unambiguous connection between human activities and the assignment of C credits and debits. We present options for factoring out various groups of influences including climate variability, CO2 and N fertilization, and legacies from forest management. These are: (1) selecting longer accounting or measurement periods to reduce the effects of inter-annual variability; (2) correction of national inventories for inter-annual variability; (3) use of activity-based accounting and C response curves; (4) use of baseline scenarios or benchmarks at the national level; (5) stratification of the landscape into units with distinct average C stocks. Other, more sophisticated modeling approaches (e.g., demographic models in combination with forest inventories; process-based models) are possible options for future C accounting systems but their complexity and data requirements make their present adoption more difficult in an inclusive international C accounting system.

  20. Factors underlying students’ appropriate or inappropriate use of scholarly sources in academic writing, and instructors’ responses

    Directory of Open Access Journals (Sweden)

    John Sivell

    2013-07-01

    Full Text Available At first glance it is surprising that – in remarkable contrast to grammatical or lexical failings which, while certainly not viewed as insignificant, are rarely greeted with outright anger or hostility – inappropriate documentation of scholarly sources so frequently provokes very harsh penalties. Rather than the constructively pedagogical approach that one would expect with regard to other defects in writing, why do we so often witness a rush to negative evaluation of what may, after all, be evidence of nothing more culpable than misinformation, confusion, or oversight? Much has of course been written about possible remedies for ineffective use of scholarly sources and, on the other hand, about available monitoring and punishment for deliberate plagiarism; so, in a sense, the alternatives appear quite simple. However, decisions about when to adopt a more pedagogical or a more disciplinary viewpoint are complicated by difficult and potentially emotional factors that can disrupt calm, confident and well-reasoned judgment. Thus, this paper will focus not on pedagogical or disciplinary strategies, whichever may be considered suitable in a given case, but on a framework for thorough reflection earlier in the thinking process. It will explore multiple perspectives on possible origins for the innocent if maladroit mishandling of scholarly sources, with a view to highlighting a number of informative but potentially neglected reference points – a cognitive psychological perspective on human error and error management, plausible ambiguities in determining what actually constitutes plagiarism, and communication challenges – that may enter into the instructor’s final determination.

  1. Source Apportionment of PM10 by Positive Matrix Factorization in Urban Area of Mumbai, India

    Directory of Open Access Journals (Sweden)

    Indrani Gupta

    2012-01-01

    Full Text Available Particulate Matter (PM10 has been one of the main air pollutants exceeding the ambient standards in most of the major cities in India. During last few years, receptor models such as Chemical Mass Balance, Positive Matrix Factorization (PMF, PCA–APCS and UNMIX have been used to provide solutions to the source identification and contributions which are accepted for developing effective and efficient air quality management plans. Each site poses different complexities while resolving PM10 contributions. This paper reports the variability of four sites within Mumbai city using PMF. Industrial area of Mahul showed sources such as residual oil combustion and paved road dust (27%, traffic (20%, coal fired boiler (17%, nitrate (15%. Residential area of Khar showed sources such as residual oil combustion and construction (25%, motor vehicles (23%, marine aerosol and nitrate (19%, paved road dust (18% compared to construction and natural dust (27%, motor vehicles and smelting work (25%, nitrate (16% and biomass burning and paved road dust (15% in Dharavi, a low income slum residential area. The major contributors of PM10 at Colaba were marine aerosol, wood burning and ammonium sulphate (24%, motor vehicles and smelting work (22%, Natural soil (19%, nitrate and oil burning (18%.

  2. Reproducibility of the ambulatory arterial stiffness index in hypertensive patients

    DEFF Research Database (Denmark)

    Dechering, D.G.; Steen, M.S. van der; Adiyaman, A.;

    2008-01-01

    BACKGROUND: We studied the repeatability of the ambulatory arterial stiffness index (AASI), which can be computed from 24-h blood pressure (BP) recordings as unity minus the regression slope of diastolic on systolic BP. METHODS: One hundred and fifty-two hypertensive outpatients recruited...

  3. Ambulatory Estimation of Relative Foot Positions using Ultrasound

    NARCIS (Netherlands)

    Weenk, Dirk; Coelen, van der Michiel; Geessink, Arno A.G.; Hoek, van der Frank J.; Verstoep, Bart; Kortier, Henk G.; Meulen, van Fokke B.; Beijnum, van Bert-Jan F.; Veltink, Peter H.

    2013-01-01

    The recording of human movement is used for biomedical applications like physical therapy and sports training. Over the last few years inertial sensors have been proven to be a useful ambulatory alternative to traditional optical systems. An example of a successful application is the instrumented sh

  4. Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery

    Science.gov (United States)

    Ishman, Stacey L.; Tawfik, Kareem O.; Smith, David F.; Cheung, Kristin; Pringle, Lauren M.; Stephen, Matthew J.; Everett, Tiffany L.; Stierer, Tracey L.

    2015-01-01

    Purpose: The American Society of Anesthesia practice guidelines recommend that pediatric and adult patients who undergo ambulatory surgery be screened for obstructive sleep apnea (OSA). With this in mind, our objective was to assess the frequency of screening by anesthesia providers for the signs and symptoms of OSA in children undergoing surgery in an ambulatory setting. Methods: Prospective single-blinded observational study of anesthesia providers' preoperative interview of caregivers of consecutive patients younger than age 18 who were scheduled for ambulatory surgery. Results: One hundred one children (30 females) were identified, with a mean age of 6.9 ± 5.0 years; 54 were classified as white, 33 as black, and 14 as other. Total OSA-18 scores ranged from 18 to 97, with a mean of 33.1 ± 14.8. The mean score for adenotonsillectomy patients was higher than that for children who underwent procedures other than adenotonsillectomy. Thirty-one percent of children were screened for OSA, and snoring was the most common symptom recorded (28%). Patients who were screened for OSA were more likely to have snoring (p Tawfik KO, Smith DF, Cheung K, Pringle LM, Stephen MJ, Everett TL, Stierer TL. Screening for pediatric obstructive sleep apnea before ambulatory surgery. J Clin Sleep Med 2015;11(7):751–755. PMID:25902820

  5. School burnout: increased sympathetic vasomotor tone and attenuated ambulatory diurnal blood pressure variability in young adult women.

    Science.gov (United States)

    May, Ross W; Sanchez-Gonzalez, Marcos A; Fincham, Frank D

    2015-01-01

    Two studies examined autonomic and cardiovascular functioning that may link school burnout to cardiovascular risk factors in young healthy adult females. Study 1 (N = 136) investigated whether school burnout was related to resting values of blood pressure (BP) and blood pressure variability (BPV) through laboratory beat-to-beat BP assessment. Study 2 (N = 94) examined the link between school burnout and diurnal BPV through ambulatory BP monitoring. Controlling for anxiety and depressive symptomatology, school burnout demonstrated strong positive relationships with indices of cardiac sympathovagal tone, sympathetic vasomotor tone, inefficient myocardial oxygen consumption, increased 24-h ambulatory heart rate and BP, blunted BP diurnal variability, and increased arterial stiffness. These studies establish cardiovascular biomarkers of school burnout and suggest that even in a seemingly healthy sample school burnout may predispose females to increased cardiovascular risk. Several future lines of research are outlined.

  6. Pharmacological treatment of ambulatory schizophrenic patients in Belgium

    Directory of Open Access Journals (Sweden)

    Reginster J-Y

    2006-05-01

    Full Text Available Abstract Background the objective of this study was twofold: 1 Describe the use of antipsychotic treatments in ambulatory patients suffering from schizophrenia in Belgium. 2 Evaluate to which extend antipsychotic treatment prescribing patterns are in accordance with published treatment guidelines. Method A cross-sectional survey was carried out in 16 Belgian hospitals selected from a sample of 67 hospitals. The hospitals were equally distributed between the north and south part of the country and were representative of Belgian practice. During 2 months, participating psychiatrists were asked to record the medication use as well as demographic parameters of all consecutive ambulatory patients seen at their consultation or attending a day-hospital. Data concerning 1000 ambulatory patients with schizophrenia or schizoaffective disorder were collected. Results In Belgium, the use of atypical antipsychotics is frequent (69% in ambulatory patients with schizophrenia. In the overall sample, 73% receive only one antipsychotic drug. The majority of patients are treated with drugs of only one antipsychotic drug group, either first- typical (29.8% or second-generation, atypical antipsychotics (53.2%. 15.8% of patients combine different types of antipsychotics. Antipsychotic dosing is adequate for the majority of patients but about one fifth receives a higher than recommended dose as per package inserts. Polypharmacy remains within reasonable limits. The use of concomitant medication varies according the antipsychotic treatment: patients who take second-generation antipsychotics only, receive the least additional drugs. Conclusion Atypical antipsychotics appear to be the first line treatment for schizophrenic psychosis. Psychiatrists working with ambulatory patients are well aware of treatment guidelines and follow them quite adequately.

  7. Characteristics of ambulatory anticoagulant adverse drug events: a descriptive study

    Directory of Open Access Journals (Sweden)

    Eckstrand Julie

    2010-02-01

    Full Text Available Abstract Background Despite the high frequency with which adverse drug events (ADEs occur in outpatient settings, detailed information regarding these events remains limited. Anticoagulant drugs are associated with increased safety concerns and are commonly involved in outpatient ADEs. We therefore sought to evaluate ambulatory anticoagulation ADEs and the patient population in which they occurred within the Duke University Health System (Durham, NC, USA. Methods A retrospective chart review of ambulatory warfarin-related ADEs was conducted. An automated trigger surveillance system identified eligible events in ambulatory patients admitted with an International Normalized Ratio (INR >3 and administration of vitamin K. Event and patient characteristics were evaluated, and quality/process improvement strategies for ambulatory anticoagulation management are described. Results A total of 169 events in 167 patients were identified from December 1, 2006-June 30, 2008 and included in the study. A median supratherapeutic INR of 6.1 was noted, and roughly half of all events (52.1% were associated with a bleed. Nearly 74% of events resulted in a need for fresh frozen plasma; 64.8% of bleeds were classified as major. A total of 59.2% of events were at least partially responsible for hospital admission. Median patient age was 68 y (range 36-95 y with 24.9% initiating therapy within 3 months prior to the event. Of events with a prior documented patient visit (n = 157, 73.2% were seen at a Duke clinic or hospital within the previous month. Almost 80% of these patients had anticoagulation therapy addressed, but only 60.0% had a follow-up plan documented in the electronic note. Conclusions Ambulatory warfarin-related ADEs have significant patient and healthcare utilization consequences in the form of bleeding events and associated hospital admissions. Recommendations for improvement in anticoagulation management include use of information technology to assist

  8. Management of comorbidities in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Dabu-Bondoc S

    2015-06-01

    Full Text Available Susan Dabu-Bondoc, Kirk Shelley Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, USAAbstract: Advances in medical science now allow people with significant medical issues to live at home. As the outpatient population ages and surgical techniques advance, the ambulatory anesthesiologist has to be prepared to handle these “walking wounded”. The days of restricting ambulatory surgery procedures to American Society of Anesthesiologists class 1 and 2 patients are rapidly fading into the past. To remain competitive and economically viable, the modern ambulatory surgery center needs to expand its practice to include patients with medical comorbidities. In an environment where production and economic pressures exist, maintaining safety and good outcomes in high-risk patients for ambulatory surgery can be arduous. Adding to the complexity of this challenge is the rapid evolution of the therapeutic approaches to a variety of medical issues. For example, there has been a significant increase in the number and types of insulin a diabetic patient might be prescribed in recent years. In the case of the patient with coronary artery disease, the variety of both drug and nondrug eluding stents or new antithrombotic agents has also increased the complexity of perioperative management. Complex patients need careful, timely, and team-based preoperative evaluation by an anesthesia provider who is knowledgeable of outpatient care. Optimizing comorbidities preoperatively is a crucial initial step in minimizing risk. This paper will examine a number of common medical issues and explore their impact on managing outpatient surgical procedures.Keywords: ambulatory surgery, medical comorbidities, diabetes, coronary artery disease, respiratory disease, obesity

  9. How to successfully select and implement electronic health records (EHR in small ambulatory practice settings

    Directory of Open Access Journals (Sweden)

    Detmer Don E

    2009-02-01

    ; and evaluating the implementation process. Summary The EHR implementation experience depends on a variety of factors including the technology, training, leadership, the change management process, and the individual character of each ambulatory practice environment. Sound processes must support both technical and personnel-related organizational components. Additional research is needed to further refine recommendations for the small physician practice and the nuances of specific medical specialties.

  10. Factors Related to the Selection of Information Sources: A Study of Ramkhamhaeng University Regional Campuses Graduate Students

    Science.gov (United States)

    Angchun, Peemasak

    2011-01-01

    This study assessed students' satisfaction with Ramkhamhaeng University regional library services (RURLs) and the perceived quality of information retrieved from other information sources. In particular, this study investigated factors relating to regional students' selection of information sources to meet their information needs. The researcher…

  11. Emission factors and source apportionment for abrasion particles produced by road traffic

    Science.gov (United States)

    Bukowiecki, N.; Lienemann, P.; Figi, R.; Hill, M.; Richard, A.; Furger, M.; Rickers, K.; Cliff, S. S.; Baltensperger, U.; Gehrig, R.

    2009-04-01

    Particle emissions of road traffic are generally associated with fresh exhaust emissions only. However, recent studies identified a clear contribution of non-exhaust emissions to the PM10 load of the ambient air. These emissions consist of particles produced by abrasion from brakes, road wear, tire wear, as well as resuspension of deposited road dust. For many urban environments, quantitative information about the contributions of the individual abrasion processes is still scarce. For effective PM10 reduction scenarios it is of particular interest to know whether road wear, resuspension or fresh abrasion from vehicles is dominating the non-exhaust PM10 contribution. In Switzerland, the emissions of road traffic abrasion particles into the ambient air were characterized in the project APART (Abrasion Particles produced by Road Traffic). The project aimed at finding the contribution of the non-exhaust sources to total traffic-related PM10 and PM2.5 for different traffic conditions, by determining specific elemental fingerprint signatures for the various sources. This was achieved by hourly elemental mass concentration measurements in three size classes (2.5-10, 1-2.5 and 0.1-1 micrometers) with a rotating drum impactor (RDI) and subsequent synchrotron radiation X-ray fluorescence spectrometry (SR-XRF). The elemental fingerprint measurements were embedded into a large set of aerosol, gas phase, meteorological and traffic count measurements. To identify traffic related emissions, measurements were performed upwind and downwind of selected roads. For a better investigation of road wear, a road wear simulator was applied in additional experiments. This allows for the identification and quantification of the different source contributions by means of source-receptor modeling, and for the calculation of real-world emission factors for the individual abrasion sources. The preliminary analysis of hourly resolved trace element measurements in a street canyon in Zürich showed

  12. Source apportionment using positive matrix factorization on daily measurements of inorganic and organic speciated PM 2.5

    Science.gov (United States)

    Dutton, Steven J.; Vedal, Sverre; Piedrahita, Ricardo; Milford, Jana B.; Miller, Shelly L.; Hannigan, Michael P.

    2010-07-01

    Particulate matter less than 2.5 microns in diameter (PM 2.5) has been linked with a wide range of adverse health effects. Determination of the sources of PM 2.5 most responsible for these health effects could lead to improved understanding of the mechanisms of such effects and more targeted regulation. This has provided the impetus for the Denver Aerosol Sources and Health (DASH) study, a multi-year source apportionment and health effects study relying on detailed inorganic and organic PM 2.5 speciation measurements. In this study, PM 2.5 source apportionment is performed by coupling positive matrix factorization (PMF) with daily speciated PM 2.5 measurements including inorganic ions, elemental carbon (EC) and organic carbon (OC), and organic molecular markers. A qualitative comparison is made between two models, PMF2 and ME2, commonly used for solving the PMF problem. Many previous studies have incorporated chemical mass balance (CMB) for organic molecular marker source apportionment on limited data sets, but the DASH data set is large enough to use multivariate factor analysis techniques such as PMF. Sensitivity of the PMF2 and ME2 models to the selection of speciated PM 2.5 components and model input parameters was investigated in depth. A combination of diagnostics was used to select an optimum, 7-factor model using one complete year of daily data with pointwise measurement uncertainties. The factors included 1) a wintertime/methoxyphenol factor, 2) an EC/sterane factor, 3) a nitrate/polycyclic aromatic hydrocarbon (PAH) factor, 4) a summertime/selective aliphatic factor, 5) an n-alkane factor, 6) a middle-oxygenated PAH/alkanoic acid factor and 7) an inorganic ion factor. These seven factors were qualitatively linked with known PM 2.5 emission sources with varying degrees of confidence. Mass apportionment using the 7-factor model revealed the contribution of each factor to the mass of OC, EC, nitrate and sulfate. On an annual basis, the majority of OC and EC

  13. Source Apportionment Using Positive Matrix Factorization on Daily Measurements of Inorganic and Organic Speciated PM(2.5).

    Science.gov (United States)

    Dutton, Steven J; Vedal, Sverre; Piedrahita, Ricardo; Milford, Jana B; Miller, Shelly L; Hannigan, Michael P

    2010-07-01

    Particulate matter less than 2.5 microns in diameter (PM(2.5)) has been linked with a wide range of adverse health effects. Determination of the sources of PM(2.5) most responsible for these health effects could lead to improved understanding of the mechanisms of such effects and more targeted regulation. This has provided the impetus for the Denver Aerosol Sources and Health (DASH) study, a multi-year source apportionment and health effects study relying on detailed inorganic and organic PM(2.5) speciation measurements.In this study, PM(2.5) source apportionment is performed by coupling positive matrix factorization (PMF) with daily speciated PM(2.5) measurements including inorganic ions, elemental carbon (EC) and organic carbon (OC), and organic molecular markers. A qualitative comparison is made between two models, PMF2 and ME2, commonly used for solving the PMF problem. Many previous studies have incorporated chemical mass balance (CMB) for organic molecular marker source apportionment on limited data sets, but the DASH data set is large enough to use multivariate factor analysis techniques such as PMF.Sensitivity of the PMF2 and ME2 models to the selection of speciated PM(2.5) components and model input parameters was investigated in depth. A combination of diagnostics was used to select an optimum, 7-factor model using one complete year of daily data with pointwise measurement uncertainties. The factors included 1) a wintertime/methoxyphenol factor, 2) an EC/sterane factor, 3) a nitrate/polycyclic aromatic hydrocarbon (PAH) factor, 4) a summertime/selective aliphatic factor, 5) an n-alkane factor, 6) a middle oxygenated PAH/alkanoic acid factor and 7) an inorganic ion factor. These seven factors were qualitatively linked with known PM(2.5) emission sources with varying degrees of confidence. Mass apportionment using the 7-factor model revealed the contribution of each factor to the mass of OC, EC, nitrate and sulfate. On an annual basis, the majority of OC

  14. BENEFITS AND SUCCESS FACTORS OF OPEN-SOURCE WEB SERVICES DEVELOPMENT PLATFORMS FOR SMALL SOFTWARE HOUSES

    Directory of Open Access Journals (Sweden)

    Valter de Assis Moreno Jr.

    2012-12-01

    Full Text Available It is usually difficult for companies to keep up with the development of new information technologies and adapt to them in face of the opportunities and threats their advances may represent. This is especially true for small and medium enterprises (SME in emerging economies, where resources tend to be scarce and markets more volatile. This paper describes an action research conducted in a small Brazilian software house that adopted an open-source Web Services development platform in order to improve its software development process. Data analysis revealed critical success factors (CSF in the adoption process, as well as specific benefits and barriers prone to be faced by small software houses in their adoption efforts. In the process of overcoming such barriers, SME may acquire intellectual capital that represents an essential resource to ensure their competitiveness and survival in emerging economies.

  15. Physicochemical factors and sources of particulate matter at residential urban environment in Kuala Lumpur.

    Science.gov (United States)

    Khan, Firoz; Latif, Mohd Talib; Juneng, Liew; Amil, Norhaniza; Mohd Nadzir, Mohd Shahrul; Syedul Hoque, Hossain Mohammed

    2015-08-01

    Long-term measurements (2004-2011) of PM10 (particulate matter with an aerodynamic diameter Kuala Lumpur urban environment. An advanced principal component analysis (PCA) technique coupled with absolute principal component scores (APCS) and multiple linear regression (MLR) has been applied. The average annual concentration of PM10 for 8 yr is 51.3 ± 25.8 μg m⁻³, which exceeds the Recommended Malaysian Air Quality Guideline (RMAQG) and international guideline values. Detail analysis shows the dependency of PM10 on the linear changes of the motor vehicles in use and the amount of biomass burning, particularly from Sumatra, Indonesia, during southwesterly monsoon. The main sources of PM10 identified by PCA-APCS-MLR are traffic combustion (28%), ozone coupled with meteorological factors (20%), and wind-blown particles (1%). However, the apportionment procedure left 28.0 μg m⁻³, that is, 51% of PM10 undetermined.

  16. Sources

    OpenAIRE

    2015-01-01

    SOURCES MANUSCRITES Archives nationales Rôles de taille 1768/71 Z1G-344/18 Aulnay Z1G-343a/02 Gennevilliers Z1G-340/01 Ivry Z1G-340/05 Orly Z1G-334c/09 Saint-Remy-lès-Chevreuse Z1G-344/18 Sevran Z1G-340/05 Thiais 1779/80 Z1G-391a/18 Aulnay Z1G-380/02 Gennevilliers Z1G-385/01 Ivry Z1G-387b/05 Orly Z1G-388a/09 Saint-Remy-lès-Chevreuse Z1G-391a/18 Sevran Z1G-387b/05 Thiais 1788/89 Z1G-451/18 Aulnay Z1G-452/21 Chennevières Z1G-443b/02 Gennevilliers Z1G-440a/01 Ivry Z1G-452/17 Noiseau Z1G-445b/05 ...

  17. Thymus fat as an attractive source of angiogenic factors in elderly subjects with myocardial ischemia.

    Science.gov (United States)

    Coín Aragüez, Leticia; Murri, Mora; Oliva Olivera, Wilfredo; Salas, Julian; Mayas, Maria Dolores; Delgado-Lista, Javier; Tinahones, Francisco; El Bekay, Rajaa

    2013-08-01

    Aging negatively affects angiogenesis which is found to be linked to declined vascular endothelial growth factor (VEGF) production. Adult human thymus degenerates into fat tissue (thymus adipose tissue (TAT)). Recently, we described that TAT from cardiomyopathy ischemic subjects has angiogenic properties. The goal of our study was to analyze whether aging could also impair angiogenic properties in TAT as in other adipose tissue such as subcutaneous (subcutaneous adipose tissue (SAT)). SAT and TAT specimens were obtained from 35 patients undergoing cardiac surgery, making these tissues readily available as a prime source of adipose tissue. Patients were separated into two age-dependent groups; middle-aged (n = 18) and elderly (n = 17). Angiogenic, endothelial, and adipogenic expression markers were analyzed in both tissues from each group and correlations were examined between these parameters and also with age. There were no significant differences in subjects from either group in clinical or biological variables. Angiogenic markers VEGF-A, B, C, and D and adipogenic parameters, peroxisome proliferator-activated receptors (PPARγ2), FABP4, and ADRP showed elevated expression levels in TAT from elderly patients compared to the middle-aged group, while in SAT, expression levels of these isoforms were significantly decreased in elderly patients. VEGF-R1, VEGF-R2, VEGF-R3, Thy1, CD31, CD29, and VLA1 showed increased levels in TAT from the elderly compared to the middle-aged, while in SAT these levels displayed a decline with aging. Also, in TAT, angiogenic and endothelial parameters exhibited strong positive correlations with age. TAT appears to be the most appropriate source of angiogenic and endothelial factors in elderly cardiomyopathy subjects compared to SAT.

  18. Systematic identification of yeast cell cycle transcription factors using multiple data sources

    Directory of Open Access Journals (Sweden)

    Li Wen-Hsiung

    2008-12-01

    Full Text Available Abstract Background Eukaryotic cell cycle is a complex process and is precisely regulated at many levels. Many genes specific to the cell cycle are regulated transcriptionally and are expressed just before they are needed. To understand the cell cycle process, it is important to identify the cell cycle transcription factors (TFs that regulate the expression of cell cycle-regulated genes. Results We developed a method to identify cell cycle TFs in yeast by integrating current ChIP-chip, mutant, transcription factor binding site (TFBS, and cell cycle gene expression data. We identified 17 cell cycle TFs, 12 of which are known cell cycle TFs, while the remaining five (Ash1, Rlm1, Ste12, Stp1, Tec1 are putative novel cell cycle TFs. For each cell cycle TF, we assigned specific cell cycle phases in which the TF functions and identified the time lag for the TF to exert regulatory effects on its target genes. We also identified 178 novel cell cycle-regulated genes, among which 59 have unknown functions, but they may now be annotated as cell cycle-regulated genes. Most of our predictions are supported by previous experimental or computational studies. Furthermore, a high confidence TF-gene regulatory matrix is derived as a byproduct of our method. Each TF-gene regulatory relationship in this matrix is supported by at least three data sources: gene expression, TFBS, and ChIP-chip or/and mutant data. We show that our method performs better than four existing methods for identifying yeast cell cycle TFs. Finally, an application of our method to different cell cycle gene expression datasets suggests that our method is robust. Conclusion Our method is effective for identifying yeast cell cycle TFs and cell cycle-regulated genes. Many of our predictions are validated by the literature. Our study shows that integrating multiple data sources is a powerful approach to studying complex biological systems.

  19. Risk factors during construction of power plants using renewable energy sources

    Directory of Open Access Journals (Sweden)

    Nefedova Lyudmila Veniaminovna

    2016-12-01

    Full Text Available The authors consider main characteristics of modern development of renewable energy sources (RES. It is dedicated that there are some technical and economic barriers to the widespread use of renewable energy. For example, RES are inconstancy in time and space and have low density of energy flow. High capital intensity and cost price, long-term construction, a considerable degree of different kinds of risk, lack of competitiveness with hydrocarbon species generation in the existing regulatory environment are also inherent to RES. The role of the regulatory framework is shown according to perspective plans of construction of power plants using renewable energy sources. The main requirements which are applied to measures of state support of construction industry of renewable energy development are formulated. Current condition of construction industry of RES in Russia is assessed. The problems of risks which arise during construction of renewable energy facilities according to results of practical use of RES are discussed. And it is rather important to use stage assessment for the construction phase of the project during risk analysis of construction of alternative energy sources. The main groups of RES risks are described. The importance of regulatory and resource risks for effective development of renewable energy in Russia according to the method of strategic planning with the identification of the adverse effects of gradation factors are determined. The analysis of financial risks types and methods of its management during construction power generation projects based on different types of renewable energy resources are made. In the end of the article the authors make a conclusion, that the development of projects for the construction of power plants with the use of innovative technical solutions to ensure minimal risks to the environment and safe operation in various climatic conditions is a priority.

  20. Volatile organic compounds over Eastern Himalaya, India: temporal variation and source characterization using Positive Matrix Factorization

    Directory of Open Access Journals (Sweden)

    C. Sarkar

    2014-12-01

    Full Text Available A first ever study on the characterization of volatile organic compounds (VOCs has been made over a Himalayan high altitude station in India. A total of 18 VOCs (mono aromatics-BTEX (benzene, toluene, ethylbenzene, xylene, non-BTEX substituted aromatics and halocarbon have been measured over Darjeeling (27.01° N, 88.15° E, 2200 m a.s.l. in the eastern Himalaya in India during the period of July 2011–June 2012. The annual average concentration of the sum of 18 target VOCs (TVOC was 376.3 ± 857.2 μg m−3. Monoaromatics had the highest contribution (72% followed by other substituted aromatics (22% and halocarbon (6% compounds. Toluene was the most abundant VOC in the atmosphere of Darjeeling with the contribution of ~37% to TVOC followed by benzene (~21%, ethylbenzene (~9% and xylenes (~6%. TVOC concentrations were highest during the postmonsoon season with minimum solar radiation and lowest during the premonsoon season with maximum solar radiation. Anthropogenic activities related mainly to tourists like diesel and gasoline emissions, biomass and coal burning, use of solvent and solid waste emissions were almost equal in both the seasons. Seasonal variation in TVOCs over Darjeeling was mainly governed by the incoming solar radiation rather than the emission sources. Source apportionment study using Positive Matrix Factorization (PMF model indicated that major fraction of (~60% TVOC were contributed by diesel and gasoline exhausts followed by solvent evaporation (18% and other sources. Diesel exhaust was also found to have the maximum potential in tropospheric ozone formation. The atmospheric loading of BTEX over Darjeeling was found to be comparable with several Indian metro cities and much higher than other cities around the world.

  1. Calculated neutron air kerma strength conversion factors for a generically encapsulated Cf-252 brachytherapy source

    CERN Document Server

    Rivard, M J; D'Errico, F; Tsai, J S; Ulin, K; Engler, M J

    2002-01-01

    The sup 2 sup 5 sup 2 Cf neutron air kerma strength conversion factor (S sub K sub N /m sub C sub f) is a parameter needed to convert the radionuclide mass (mu g) provided by Oak Ridge National Laboratory into neutron air kerma strength required by modern clinical brachytherapy dosimetry formalisms indicated by Task Group No. 43 of the American Association of Physicists in Medicine (AAPM). The impact of currently used or proposed encapsulating materials for sup 2 sup 5 sup 2 Cf brachytherapy sources (Pt/Ir-10%, 316L stainless steel, nitinol, and Zircaloy-2) on S sub K sub N /m sub C sub f was calculated and results were fit to linear equations. Only for substantial encapsulation thicknesses, did S sub K sub N /m sub C sub f decrease, while the impact of source encapsulation composition is increasingly negligible as Z increases. These findings are explained on the basis of the non-relativistic kinematics governing the majority of sup 2 sup 5 sup 2 Cf neutron interactions. Neutron kerma and energy spectra resul...

  2. The nature of creativity: The roles of genetic factors, personality traits, cognitive abilities, and environmental sources.

    Science.gov (United States)

    Kandler, Christian; Riemann, Rainer; Angleitner, Alois; Spinath, Frank M; Borkenau, Peter; Penke, Lars

    2016-08-01

    This multitrait multimethod twin study examined the structure and sources of individual differences in creativity. According to different theoretical and metrological perspectives, as well as suggestions based on previous research, we expected 2 aspects of individual differences, which can be described as perceived creativity and creative test performance. We hypothesized that perceived creativity, reflecting typical creative thinking and behavior, should be linked to specific personality traits, whereas test creativity, reflecting maximum task-related creative performance, should show specific associations with cognitive abilities. Moreover, we tested whether genetic variance in intelligence and personality traits account for the genetic component of creativity. Multiple-rater and multimethod data (self- and peer reports, observer ratings, and test scores) from 2 German twin studies-the Bielefeld Longitudinal Study of Adult Twins and the German Observational Study of Adult Twins-were analyzed. Confirmatory factor analyses yielded the expected 2 correlated aspects of creativity. Perceived creativity showed links to openness to experience and extraversion, whereas tested figural creativity was associated with intelligence and also with openness. Multivariate behavioral genetic analyses indicated that the heritability of tested figural creativity could be accounted for by the genetic component of intelligence and openness, whereas a substantial genetic component in perceived creativity could not be explained. A primary source of individual differences in creativity was due to environmental influences, even after controlling for random error and method variance. The findings are discussed in terms of the multifaceted nature and construct validity of creativity as an individual characteristic. (PsycINFO Database Record

  3. Characteristics of hydrocarbon sources and controlling factors of their formation in Pingliang Formation, West Ordos Basin

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    According to organic geochemistry and organic petrology, the hydrocarbon sources in Pingliang Formation, W. Ordos basin, are systematically evaluated. The organic abundance of hydrocarbon source in this research is higher in the upper part of profiles than In the low, and more in mudstone than in carbonate. Most of organic matters become sapropelic, and few are humlc-aapropelic in the regions of Shibangou and Zhuzisan. According to stable isotopes of carbon and oxygen in carbonate rock, boron index and ratios of elements, palaeo-salinity and sedimentary velocity are calculated. The two factors of paleao-salinity and sediment velocity, which control the distribution of organic matters, are discussed.Good relationship is found between water salinity and abundance of organic matter; in contrast, poor correlation is observed between salinity and types of organic matters. The relative sediment velocity in the research regions is also related with organic abundance and types. A low sediment velocity would lead to high abundance and good type of organic matters, and vice versa.

  4. Determinants of Diabetes and Hypertension Control in Ambulatory Healthcare in Al Ain, United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Latifa M. Baynouna

    2014-05-01

    Full Text Available bjectives: This study aims to study determinants for the control of diabetes and hypertension in Al Ain Ambulatory Healthcare patients. Method: This is a cross sectional observational study of patients attending ambulatory healthcare centers in Al Ain, United Arab Emirates in 2009. From a yearly audit evaluating the care of patients with diabetes and hypertension, the determinants for improved diabetes and hypertension outcomes were identified from a total of 512 patients and its association with glycemic and blood pressure control were studied. Results: From all variables studied, only the clinic where the patient was treated helped predict both improved blood sugar and blood pressure control. For patients with diabetes, poor control the year before (p<0.001, the number of chronic disease clinic visits (p=0.042 and triglyceride levels (p=0.007 predicted worse control of diabetes. A predictor of poor control of blood pressure (p<0.001 for patients with hypertension was poor control of blood pressure in the year before. Conclusion: In this population, the healthcare system and the team played major roles as determinants in the control of patient’s diabetes and blood pressure more than any of the other factors examined.

  5. Sleep in healthy elderly subjects: a 24-hour ambulatory polysomnographic study.

    Science.gov (United States)

    Gigli, G L; Placidi, F; Diomedi, M; Maschio, M; Silvestri, G; Scalise, A; Marciani, M G

    1996-04-01

    It is still debated whether the deterioration of the sleep pattern, frequently reported by elderly subjects, is due only to aging per se. Other factors associated with aging or modifications of biological rhythms could also be involved. Elderly subjects frequently complain of daytime sleepiness, but it is not clear whether this actually represents a return to a polyphasic structure of sleep, or only a consequence of a disturbed night sleep. Ten healthy, independent and active elderly subjects (age > 72 years) were elevated by means of 24-hour ambulatory polysomnography. Findings of nocturnal sleep were compared with sleep of the same group in the 24-hour period and with sleep of young healthy controls. We observed a fragmentation of nocturnal sleep, but a fairly good representation of stages and a preservation of cyclicity. Except for three cases, with early or late times of sleep onset and wake-up, sleep disruption did not seem to be related to modification of circadian rhythms. Only three subjects presented undesired daytime naps, whereas the others either did not show daytime sleep at all, or were used to having their siesta after lunch since their young adulthood. In normal aging, daytime sleep does not constitute a social problem. Ambulatory polysomnography is a valid alternative to laboratory recordings in the identification of daytime sleep.

  6. Determining resource intensity weights in ambulatory chemotherapy related to nursing workload.

    Science.gov (United States)

    Green, Esther; Preyra, Colin; Stewart, Janice; McLennan, Cindy; Bland, Rosemary; Dus, Tamara; Langhorn, Marcia; Beattie, Kathy; Cheung, Annie; Hertz, Sherrie; Sechter, Haim; Burns, Judy; Angus, Helen; Sawka, Carol

    2012-01-01

    Ontario cancer programs aim to deliver high-quality nursing care and treatment that is safe for patients and staff. The reality of health care is that financial constraints, inherent in the delivery of care, require that funding mechanisms count not only the cost of drugs, but factors such as pharmacy and nursing human resource costs. While some organizations have developed patient classification systems to measure nursing intensity and workload, these systems apply primarily to inpatient populations, and are fraught with numerous challenges, such as the need for nurses to document to justify the workload required for care. The purpose of this paper is to outline the methodology and engagement of nurses to develop regimen-based resource intensity weights that can be applied to ambulatory chemotherapy suites. The methodology included determination of workload related to nursing time to prepare, teach, counsel and assess patients, as well as time to gather supplies, access lines, monitor, manage adverse reactions, manage symptoms and document care. Resource intensity weights provide better measures of the complexity of care required by cancer patients in ambulatory settings.

  7. Automated measurement of office, home and ambulatory blood pressure in atrial fibrillation.

    Science.gov (United States)

    Kollias, Anastasios; Stergiou, George S

    2014-01-01

    1. Hypertension and atrial fibrillation (AF) often coexist and are strong risk factors for stroke. Current guidelines for blood pressure (BP) measurement in AF recommend repeated measurements using the auscultatory method, whereas the accuracy of the automated devices is regarded as questionable. This review presents the current evidence on the feasibility and accuracy of automated BP measurement in the presence of AF and the potential for automated detection of undiagnosed AF during such measurements. 2. Studies evaluating the use of automated BP monitors in AF are limited and have significant heterogeneity in methodology and protocols. Overall, the oscillometric method is feasible for static (office or home) and ambulatory use and appears to be more accurate for systolic than diastolic BP measurement. 3. Given that systolic hypertension is particularly common and important in the elderly, the automated BP measurement method may be acceptable for self-home and ambulatory monitoring, but not for professional office or clinic measurement. 4. An embedded algorithm for the detection of asymptomatic AF during routine automated BP measurement with high diagnostic accuracy has been developed and appears to be a useful screening tool for elderly hypertensives.

  8. Factors influencing the spatial extent of mobile source air pollution impacts: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Levy Jonathan I

    2007-05-01

    Full Text Available Abstract Background There has been growing interest among exposure assessors, epidemiologists, and policymakers in the concept of "hot spots", or more broadly, the "spatial extent" of impacts from traffic-related air pollutants. This review attempts to quantitatively synthesize findings about the spatial extent under various circumstances. Methods We include both the peer-reviewed literature and government reports, and focus on four significant air pollutants: carbon monoxide, benzene, nitrogen oxides, and particulate matter (including both ultrafine particle counts and fine particle mass. From the identified studies, we extracted information about significant factors that would be hypothesized to influence the spatial extent within the study, such as the study type (e.g., monitoring, air dispersion modeling, GIS-based epidemiological studies, focus on concentrations or health risks, pollutant under study, background concentration, emission rate, and meteorological factors, as well as the study's implicit or explicit definition of spatial extent. We supplement this meta-analysis with results from some illustrative atmospheric dispersion modeling. Results We found that pollutant characteristics and background concentrations best explained variability in previously published spatial extent estimates, with a modifying influence of local meteorology, once some extreme values based on health risk estimates were removed from the analysis. As hypothesized, inert pollutants with high background concentrations had the largest spatial extent (often demonstrating no significant gradient, and pollutants formed in near-source chemical reactions (e.g., nitrogen dioxide had a larger spatial extent than pollutants depleted in near-source chemical reactions or removed through coagulation processes (e.g., nitrogen oxide and ultrafine particles. Our illustrative dispersion model illustrated the complex interplay of spatial extent definitions, emission rates

  9. Impacts of Climatic Factors on Runoff Coefficients in Source Regions of the Huanghe River

    Institute of Scientific and Technical Information of China (English)

    CHEN Liqun; LIU Changming; LI Yanping; WANG Guoqiang

    2007-01-01

    Runoff coefficients of the source regions of the Huanghe River in 1956-2000 were analyzed in this paper. In the 1990s runoff of Tangnaihai Hydrologic Station of the Huanghe River experienced a serious decrease, which had attracted considerable attention. Climate changes have important impact on the water resources availability. From the view of water cycling, runoff coefficients are important indexes of water resources in a particular catchment. Kalinin baseflow separation technique was improved based on the characteristics of precipitation and streamflow. After the separation of runoff coefficient (R/P), baseflow coefficient (Br/P) and direct runoff coefficient (Dr/P) were estimated. Statistic analyses were applied to assessing the impact of precipitation and temperature on runoff coefficients (including Dr/P,Br/P and R/P). The results show that in the source regions of the Huanghe River, mean annual baseflow coefficient was higher than mean annual direct runoff coefficient. Annual runoff coefficients were in direct proportion to annual precipitation and in inverse proportion to annual mean temperature. The decrease of runoff coefficients in the 1990s was closely related to the decrease in precipitation and increase in temperature in the same period. Over different sub-basins of the source regions of the Huanghe River, runoff coefficients responded differently to precipitation and temperature. In the area above Jimai Hydrologic Station where annual mean temperature is -3.9 ℃, temperature is the main factor influencing the runoff coefficients. Runoff coefficients were in inverse relation to temperature, and precipitation had nearly no impact on runoff coefficients. In subbasin between Jimai and Maqu Hydrologic Station Dr/P was mainly affected by precipitation while R/P and Br/P were both significantly influenced by precipitation and temperature. In the area between Maqu and Tangnaihai hydrologic stations all the three runoff coefficients increased with the rising

  10. Cognitive assessment on elderly people under ambulatory care

    Directory of Open Access Journals (Sweden)

    Bruna Zortea

    2015-04-01

    Full Text Available Objective: to evaluate the cognitive state of elderly people under ambulatory care and investigating the connection between such cognitive state and sociodemographic variables, health conditions, number of and adhesion to medicine. Methods: transversal, exploratory, and descriptive study, with a quantitative approach, realized with 107 elderly people under ambulatory care in a university hospital in southern Brazil, in november, 2013. The following variables were used: gender, age, civil status, income, schooling, occupation, preexisting noncommunicable diseases, number and type of prescribed medications, adhesion, mini-mental state examination score, and cognitive status. Data was analyzed through inferential and descriptive statistics. Results: the prevalence of cognitive deficit was of 42.1% and had a statistically significant connection to schooling, income, civil status, hypertension, and cardiopathy. Conclusion: nurses can intervene to avoid the increase of cognitive deficit through an assessment of the elderly person, directed to facilitative strategies to soften this deficit.

  11. Material-specific Conversion Factors for Different Solid Phantoms Used in the Dosimetry of Different Brachytherapy Sources

    Directory of Open Access Journals (Sweden)

    Sedigheh Sina

    2015-07-01

    Full Text Available Introduction Based on Task Group No. 43 (TG-43U1 recommendations, water phantom is proposed as a reference phantom for the dosimetry of brachytherapy sources. The experimental determination of TG-43 parameters is usually performed in water-equivalent solid phantoms. The purpose of this study was to determine the conversion factors for equalizing solid phantoms to water. Materials and Methods TG-43 parameters of low- and high-energy brachytherapy sources (i.e., Pd-103, I-125 and Cs-137 were obtained in different phantoms, using Monte Carlo simulations. The brachytherapy sources were simulated at the center of different phantoms including water, solid water, poly(methyl methacrylate, polystyrene and polyethylene. Dosimetric parameters such as dose rate constant, radial dose function and anisotropy function of each source were compared in different phantoms. Then, conversion factors were obtained to make phantom parameters equivalent to those of water. Results Polynomial coefficients of conversion factors were obtained for all sources to quantitatively compare g(r values in different phantom materials and the radial dose function in water. Conclusion Polynomial coefficients of conversion factors were obtained for all sources to quantitatively compare g(r values in different phantom materials and the radial dose function in water.

  12. [The ambulatory polyclinic institutions in closed administrative territorial municipality].

    Science.gov (United States)

    Fomin, E P

    2014-01-01

    The article presents the results characterizing functioning of ambulatory polyclinic institutions included into medical sanitary unit of closed administrative territorial municipality of lesser towns. The study established the resource support of staff and full-time positions of physician and paramedical personnel, dynamics of indicators from 2005 to 2013, coverage of population of able-bodied age with preventive and target medical examinations for syphilis and tuberculosis. The progression of contingents under dispensary registration was determined.

  13. Redesigning ambulatory care business processes supporting clinical care delivery.

    Science.gov (United States)

    Patterson, C; Sinkewich, M; Short, J; Callas, E

    1997-04-01

    The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care.

  14. Biomechanical investigation of ambulatory training in patients with acetabular dysplasia.

    Science.gov (United States)

    Kanai, Akira; Kiyama, Takahiro; Genda, Eiichi; Suzuki, Yasuo

    2008-07-01

    The purpose of this study was to investigate the effectiveness and safety of ambulatory training in patients with acetabular dysplasia. To achieve this, we studied the hip joint moment in subjects walking with laterally and horizontally elevated arms and changing speeds as a form of training to strengthen hip joint abductor muscles. We studied eight women with pre- or early stage hip disease (center-edge angle of Wieberg 18.5 degrees to -3.0 degrees ) and six healthy women. In exercise task 1 the subjects walked at a rate of 90 steps/min, with abduction of 90 degrees in the shoulder joint ipsilateral or contralateral to the affected hip joint, and either no load or a 1 kg weight in either hand. In exercise task 2, walking speed was changed in three stages from 60 steps/min (s-gait), 90 steps/min (n-gait), and 120 steps/min (f-gait), with both hands swinging freely. Using results from a three-dimensional motion analysis system, the hip joint moments were calculated. In both the healthy and the acetabular dysplasia groups, the abduction moment of the hip joint decreased significantly with ipsilateral elevation and increased significantly with contralateral elevation. There was no significant change in hip flexion moment in either group. The hip extension moment decreased significantly with contralateral elevation, but no significant changes were seen in ipsilateral elevation. In the walking rate variation, the extension hip moment in fast gait was higher than in slow gait. It was concluded that ambulatory training with contralateral horizontal arm elevation may be an effective way of increasing hip joint abductor muscle strength. Ipsilateral arm elevation decreases gluteus medius muscle tension and is an effective way of ambulatory training for people with compensated trendelenburg gait. Variable speed walking is an effective exercise method that can strengthen extensor muscles. Therefore, these ambulatory training methods are useful for acetabular dysplasia patients.

  15. Pathway to Best Practice in Spirometry in the Ambulatory Setting.

    Science.gov (United States)

    Peracchio, Carol

    2016-01-01

    Spirometry performed in the ambulatory setting is an invaluable tool for diagnosis, monitoring, and evaluation of respiratory health in patients with chronic lung disease. If spirometry is not performed according to American Thoracic Society (ATS) guidelines, unnecessary repeated testing, increased expenditure of time and money, and increased patient and family anxiety may result. Two respiratory therapists at Mission Health System in Asheville, NC, identified an increase in patients arriving at the pulmonary function testing (PFT) laboratories with abnormal spirometry results obtained in the ambulatory setting. These abnormal results were due to incorrect testing procedure, not chronic lung disease. Three training methods were developed to increase knowledge of correct spirometry testing procedure in the ambulatory setting. The therapists also created a plan to educate offices that do not perform spirometry on the importance and availability of PFT services at our hospital for the population of patients with chronic lung disease. Notable improvements in posttraining test results were demonstrated. The education process was evaluated by a leading respiratory expert, with improvements suggested and implemented. Next steps are listed.

  16. Role of ambulatory blood pressure monitoring in resistant hypertension.

    Science.gov (United States)

    Grassi, Guido; Bombelli, Michele; Seravalle, Gino; Brambilla, Gianmaria; Dell'oro, Raffaella; Mancia, Giuseppe

    2013-06-01

    Ambulatory blood pressure monitoring has gained growing popularity in the diagnosis and treatment of essential hypertension for several reasons, such as the lack of the so-called white-coat effect, the greater reproducibility as compared with clinic blood pressure, the ability to provide information on blood pressure phenomena of prognostic value and the closer relationship with the risk of cardiovascular morbidity and mortality. All the above-mentioned main features of ambulatory blood pressure monitoring are also true for resistant hypertension. In addition, however, in resistant hypertension, blood pressure monitoring allows one to precisely define the diagnosis of this clinical condition, by excluding the presence of white-coat hypertension, which is responsible for a consistent number of "false" resistant hypertensive cases. The approach also allows one to define the patterns of blood pressure variability in this clinical condition, as well as its relationships with target organ damage. Finally, it allows one to assess the effects of therapeutic interventions, such as renal nerves ablation, aimed at improving blood pressure control in this hypertensive state. The present paper will critically review the main features of ambulatory blood pressure monitoring in resistant hypertension, with particular emphasis on the diagnosis and treatment of this high-risk hypertensive state.

  17. A vision for ambulatory care in the 21st century.

    Science.gov (United States)

    Zuckerman, A M

    1998-01-01

    The 1990's have been a remarkable decade for ambulatory care providers. Ambulatory care services have flourished in an era of rapidly increasing demands and seemingly limitless potential. Will the first decade of the next millennium continue this trend or is something new on the horizon? Ambulatory care's future prospects need to be evaluated within the context of the overall health care delivery environment of the future. At this time, three alternative "futures" seem plausible for the next decade. Managed care dominates. This scenario appears most likely at present with managed care poised to make significant inroads into Medicaid and Medicare populations. National health insurance is instituted. Some believe that this is a logical reaction to the excesses of the current competitive marketplace and is possible following the presidential election of 2004. Slow evolution of current system. This scenario may be viewed as the status quo alternative and is likely in the absence of a crisis or a better, generally agreed upon way in which to improve health care delivery.

  18. Ambulatory Melanoma Care Patterns in the United States

    Directory of Open Access Journals (Sweden)

    Andrew L. Ji

    2013-01-01

    Full Text Available Objective. To examine trends in melanoma visits in the ambulatory care setting. Methods. Data from the National Ambulatory Medical Care Survey (NAMCS from 1979 to 2010 were used to analyze melanoma visit characteristics including number of visits, age and gender of patients, and physician specialty. These data were compared to US Census population estimates during the same time period. Results. The overall rate of melanoma visits increased ( at an apparently higher rate than the increase in population over this time. The age of patients with melanoma visits increased at approximately double the rate (0.47 year per interval year, of the population increase in age (0.23 year per interval year. There was a nonsignificant decline in the proportion of female patients seen over the study interval. Lastly, ambulatory care has shifted towards dermatologists and other specialties managing melanoma patients and away from family/internal medicine physicians and general/plastic surgeons. Conclusions. The number and age of melanoma visits has increased over time with respect to the overall population, mirroring the increase in melanoma incidence over the past three decades. These trends highlight the need for further studies regarding melanoma management efficiency.

  19. Relapsing peritonitis with Bacillus cereus in a patient on continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Magnussen, Eyð Tausen; Vang, Amanda Gratton; á Steig, Torkil; Gaini, Shahin

    2016-04-26

    We present a case where Bacillus cereus was determined to be the causative agent of relapsing peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). The patient, a 70-year-old man from the Faroe Islands, was admitted with relapsing peritonitis four times over a 3-month period. Peritoneal cultures were positive for growth of B. cereus, a rare bacterial cause of peritonitis. The cultures demonstrated susceptibility to vancomycin, and therefore the patient was treated with intraperitoneal vancomycin, intraperitoneal gentamycin and oral ciprofloxacin. As a result of the relapsing B. cereus peritonitis diagnosis and a CT scan showing contraction of the peritoneum after longstanding inflammation, the peritoneal catheter was removed and the patient converted to haemodialysis. To date, the patient has not been readmitted due to peritonitis. A lack of proper hygiene when changing the dialysis bag was the suspected source of infection with B. cereus.

  20. The non-uniformity correction factor for the cylindrical ionization chambers in dosimetry of an HDR 192Ir brachytherapy source

    Directory of Open Access Journals (Sweden)

    Majumdar Bishnu

    2006-01-01

    Full Text Available The aim of this study is to derive the non-uniformity correction factor for the two therapy ionization chambers for the dose measurement near the brachytherapy source. The two ionization chambers of 0.6 cc and 0.1 cc volume were used. The measurement in air was performed for distances between 0.8 cm and 20 cm from the source in specially designed measurement jig. The non-uniformity correction factors were derived from the measured values. The experimentally derived factors were compared with the theoretically calculated non-uniformity correction factors and a close agreement was found between these two studies. The experimentally derived non-uniformity correction factor supports the anisotropic theory.

  1. Relationship Between Non-Point Source Pollution and Korean Green Factor

    Directory of Open Access Journals (Sweden)

    Seung Chul Lee

    2015-01-01

    Full Text Available In determining the relationship between the rational event mean concentration (REMC which is a volume-weighted mean of event mean concentrations (EMCs as a non-point source (NPS pollution indicator and the green factor (GF as a low impact development (LID land use planning indicator, we constructed at runoff database containing 1483 rainfall events collected from 107 different experimental catchments from 19 references in Korea. The collected data showed that EMCs were not correlated with storm factors whereas they showed significant differences according to the land use types. The calculated REMCs for BOD, COD, TSS, TN, and TP showed negative correlations with the GFs. However, even though the GFs of the agricultural area were concentrated in values of 80 like the green areas, the REMCs for TSS, TN, and TP were especially high. There were few differences in REMC runoff characteristics according to the GFs such as recreational facilities areas in suburbs and highways and trunk roads that connect to major roads between major cities. Except for those areas, the REMCs for BOD and COD were significantly related to the GFs. The REMCs for BOD and COD decreased when the rate of natural green area increased. On the other hand, some of the REMCs for TSS, TN, and TP were still high where the catchments encountered mixed land use patterns, especially public facility areas with bare ground and artificial grassland areas. The GF could therefore be used as a major planning indicator when establishing land use planning aimed at sustainable development with NPS management in urban areas if the weighted GF values will be improved.

  2. Limits to ambulatory displacement of coconut mites in absence and presence of food-related cues.

    Science.gov (United States)

    Melo, J W S; Lima, D B; Sabelis, M W; Pallini, A; Gondim, M G C

    2014-04-01

    Ambulatory movement of plant-feeding mites sets limits to the distances they can cover to reach a new food source. In absence of food-related cues these limits are determined by survival, walking activity, walking path tortuosity and walking speed, whereas in presence of food the limits are also determined by the ability to orient and direct the path towards the food source location. For eriophyoid mites such limits are even more severe because they are among the smallest mites on earth, because they have only two pairs of legs and because they are very sensitive to desiccation. In this article we test how coconut mites (Aceria guerreronis Keifer) are constrained in their effective displacement by their ability to survive in absence of food (meristematic tissue under the coconut perianth) and by their ability to walk and orient in absence or presence of food-related cues. We found that the mean survival time decreased with increasing temperature and decreasing humidity. Under climatic conditions representative for the Tropics (27 °C and 75 % relative humidity) coconut mites survived on average for 11 h and covered 0.4 m, representing the effective linear displacement away from the origin. Within a period of 5 h, coconut mites collected from old fruits outside the perianth moved further away from the origin than mites collected under the perianth of young fruits. However, in the presence of food-related cues coconut mites traveled over 30 % larger distances than in absence of these cues. These results show that ambulatory movement of eriophyoid mites may well bring them to other coconuts within the same bunch and perhaps also to other bunches on the same coconut palm, but it is unlikely to help them move from palm to palm, given that palms usually do not touch each other.

  3. Source segregation of food waste in office areas: Factors affecting waste generation rates and quality

    DEFF Research Database (Denmark)

    Edjabou, Vincent Maklawe Essonanawe; Boldrin, Alessio; Scheutz, Charlotte;

    2015-01-01

    and the purity of the source-sorted food waste. The moisture content of source-sorted food waste and residual waste fractions, and potential methane production from source-sorted food waste, was also investigated.Food waste generation equated to 23. ±. 5. kg/employee/year, of which 20. ±. 5. kg...

  4. A Cyclo-dissipativity Condition for Power Factor Improvement in Nonsinusoidal Systems with Significant Source Impedance

    NARCIS (Netherlands)

    del Puerto Flores, Dunstano; Scherpen, Jacquelien M.A.; Ortega, Romeo

    2010-01-01

    Recently, in [1] it has been established that the classical problem in electrical engineering of optimizing energy transfer from an alternating current (ac) source to a load with non-sinusoidal source (but periodic) voltage is equivalent to imposing the property of cyclo-dissipativity to the source

  5. PAHs pollution from traffic sources in air of Hangzhou, China: Trend and influencing factors

    Institute of Scientific and Technical Information of China (English)

    ZHU Li-zhong; WANG Jing

    2005-01-01

    PAHs pollution in air of arterial roads was investigated from October 1998 to October 2001 in Hangzhou, China. The results showed that ∑10 PAHs was 13-36 μg/m3 , among which, BaP, a strong carcinogenic kind ranged from 0.034 μg/m3 to 0. 12 μg/m3 . PAHs pollutions in four seasons were winter > autumn > spring-summer. The annual averages of ∑PAHs concentration were 25 μg/m3 for 1999, 28μg/m3 for 2000, and 29 μg/m3 for 2001, respectively. Leaded gasoline was banned in December 1998 in Hangzhou, thus comparative measurements with PAHs in leaded and lead-free gasoline powered motor exhausts made it certain that the use of lead-free gasoline leaded to a heavier PAHs pollution in roadside air from December, 1998, in China, and ∑PAHs in air samples after the lead-banning were more than twice of that in samples before the action. For the large contribution of vehicle discharge to air pollution in roadside, further research was performed to suggest the factors influencing PAHs distribution in vehicle exhaust in order to control air pollution effectively.Compared to gasoline engines, emissions from diesel engines were less toxic, although they might produce more PAHs. Of the same vehicular and oil type, automobiles of longer mileages produced more toxic PAHs. PAHs distributions in the vehicular exhausts were related to the oil type. Large difference was found in the abundance of 3-, 5- and 6-ring PAHs between exhausts from gasoline and diesel oil engines. Diesel oil engines produced relative lighter PAHs such as NAPH, ACEN, FLUOR, while gasoline engines emitted heavier kinds such as BkF, IN and BP. The automobile produced more PAHs with the increase of mileage especially FLUR, PY, BaP, BP. Some significant ratios for traffic source in Hangzhou such as PHEN/AN, FLUR/PY, IN/BP were 0.50-4.3, 0.58-7.4, 0.51-1.5,respectively. A source fingerprint for vehicle exhausts of a mixture of vehicle and oil types in the city district for light-duty vehicle was the

  6. Anesthesia and analgesia for the ambulatory management of fractures in children.

    Science.gov (United States)

    McCarty, E C; Mencio, G A; Green, N E

    1999-01-01

    The goal of anesthesia in the ambulatory management of fractures in children is to provide analgesia and relieve anxiety in order to facilitate successful closed treatment of the skeletal injury. Numerous techniques short of general anesthesia are available. These methods include blocks (local, regional, and intravenous), sedation (conscious and deep), and dissociative anesthesia (ketamine sedation). Important factors in choosing a particular technique include ease of administration, efficacy, safety, cost, and patient and parent acceptance. Local and regional techniques, such as hematoma, axillary, and intravenous regional blocks, are particularly effective for upper-extremity fractures. Sedation with inhalation agents, such as nitrous oxide, and parenterally administered narcotic-benzodiazepine combinations, are not region-specific and are suitable for patients over a wide range of ages. Ketamine sedation is an excellent choice for children less than 10 years old. With any technique, proper monitoring and adherence to safety guidelines are essential.

  7. General practitioner's reported use of clinical guidelines for hypertension and ambulatory blood pressure.

    LENUS (Irish Health Repository)

    Flynn, E

    2012-03-01

    ABPM is an invaluable clinical tool, as it has been shown to improve blood pressure control in primary care. Many clinical guidelines for hypertension advocate ambulatory blood pressure monitoring. This study aims to quantify the use of clinical guidelines for hypertension and to explore the role of ABPM in Primary Care. A questionnaire survey was sent to GPs working in the West of Ireland. 88% (n=139) of GPs use clinical guidelines that recommend the use of ABPM. 82% (n=130) of GPs find use of clinic blood pressure monitoring insufficient for the diagnosis and monitoring of hypertension. Despite good access to ABPM, GPs report lack of remuneration, 72% (n=116), cost 68% (n=108), and lack of time, 51% (n=83) as the main limiting factors to use of ABPM. GPs recognise the clinical value of ABPM, but this study identifies definite barriers to the use of ABPM in Primary Care.

  8. Air pollution, PM2.5 composition, source factors, and respiratory symptoms in asthmatic and nonasthmatic children in Santiago, Chile.

    Science.gov (United States)

    Prieto-Parra, Laura; Yohannessen, Karla; Brea, Cecilia; Vidal, Daniella; Ubilla, Carlos A; Ruiz-Rudolph, Pablo

    2017-04-01

    The objective of this study was to determine the association of respiratory symptoms and medication use and exposure to various air pollutants, PM2.5 components, and source factors in a panel of asthmatic and nonasthmatic children in Santiago, Chile. To this end, 174 children (90 asthmatics and 84 nonasthmatics) were followed throughout the winter months of 2010 and 2011. During the study period, children filled out daily diaries to record respiratory symptoms and medication use. Air pollution data were obtained from government central site measurements and a PM2.5 characterization campaign. PM2.5 source factors were obtained using positive matrix factorization (PMF). Associations of symptoms and exposure to pollutants and source-factor daily scores were modeled separately for asthmatic and nonasthmatic children using mixed logistic regression models with random intercepts, controlling for weather, day of the week, year, and viral outbreaks. Overall, high concentrations of air pollutants and PM2.5 components were observed. Six source factors were identified by PMF (motor vehicles, marine aerosol, copper smelter, secondary sulfates, wood burning, and soil dust). Overall, single pollutant models showed significant and strong associations between 7-day exposures for several criteria pollutants (PM2.5, NO2, O3), PM2.5 components (OC, K, S, Se, V), and source factors (secondary sulfate) and coughing, wheezing and three other respiratory symptoms in both in asthmatic and nonasthmatic children. No associations were found for use of rescue inhalers in asthmatics. Two-pollutant models showed that several associations remained significant after including PM2.5, and other criteria pollutants, in the models, particularly components and source factors associated with industrial sources. In conclusion, exposure to air pollutants, especially PM2.5, NO2, and O3, were found to exacerbate respiratory symptoms in both asthmatic and nonasthmatic children. Some of the results suggest

  9. Global combustion sources of organic aerosols: model comparison with 84 AMS factor-analysis data sets

    Science.gov (United States)

    Tsimpidi, Alexandra P.; Karydis, Vlassis A.; Pandis, Spyros N.; Lelieveld, Jos

    2016-07-01

    Emissions of organic compounds from biomass, biofuel, and fossil fuel combustion strongly influence the global atmospheric aerosol load. Some of the organics are directly released as primary organic aerosol (POA). Most are emitted in the gas phase and undergo chemical transformations (i.e., oxidation by hydroxyl radical) and form secondary organic aerosol (SOA). In this work we use the global chemistry climate model ECHAM/MESSy Atmospheric Chemistry (EMAC) with a computationally efficient module for the description of organic aerosol (OA) composition and evolution in the atmosphere (ORACLE). The tropospheric burden of open biomass and anthropogenic (fossil and biofuel) combustion particles is estimated to be 0.59 and 0.63 Tg, respectively, accounting for about 30 and 32 % of the total tropospheric OA load. About 30 % of the open biomass burning and 10 % of the anthropogenic combustion aerosols originate from direct particle emissions, whereas the rest is formed in the atmosphere. A comprehensive data set of aerosol mass spectrometer (AMS) measurements along with factor-analysis results from 84 field campaigns across the Northern Hemisphere are used to evaluate the model results. Both the AMS observations and the model results suggest that over urban areas both POA (25-40 %) and SOA (60-75 %) contribute substantially to the overall OA mass, whereas further downwind and in rural areas the POA concentrations decrease substantially and SOA dominates (80-85 %). EMAC does a reasonable job in reproducing POA and SOA levels during most of the year. However, it tends to underpredict POA and SOA concentrations during winter indicating that the model misses wintertime sources of OA (e.g., residential biofuel use) and SOA formation pathways (e.g., multiphase oxidation).

  10. Source segregation of food waste in office areas: Factors affecting waste generation rates and quality

    DEFF Research Database (Denmark)

    Edjabou, Vincent Maklawe Essonanawe; Boldrin, Alessio; Scheutz, Charlotte

    2015-01-01

    Existing legislation mandates that the amount of waste being recycled should be increased. Among others, in its Resource Strategy Plan, the Danish Government decided that at least 60% of food waste generated by the service sector, including in office areas, should be source-sorted and collected...... separately by 2018. To assess the achievability of these targets, source-sorted food waste and residual waste from office areas was collected and weighed on a daily basis during 133 working days. Waste composition analyses were conducted every week to investigate the efficiency of the source-sorting campaign...... and the purity of the source-sorted food waste. The moisture content of source-sorted food waste and residual waste fractions, and potential methane production from source-sorted food waste, was also investigated.Food waste generation equated to 23. ±. 5. kg/employee/year, of which 20. ±. 5. kg...

  11. Sources of methane and nitrous oxide in California's Central Valley estimated through direct airborne flux and positive matrix factorization source apportionment of groundbased and regional tall tower measurements

    Science.gov (United States)

    Guha, Abhinav

    Methane (CH4) and nitrous oxide (N2O) are two major greenhouse gases that contribute significantly to the increase in anthropogenic radiative-forcing causing perturbations to the earth's climate system. In a watershed moment in the state's history of environmental leadership and commitment, California, in 2006, opted for sharp reductions in their greenhouse gas (GHG) emissions and adopted a long-term approach to address climate change that includes regulation of emissions from individual emitters and source categories. There are large CH4 and N2O emissions sources in the state, predominantly in the agricultural and waste management sector. While these two gases account for Transects) study. Next, a one-year continuous field campaign (WGC 2012-13, June 2012 - August 2013) was conducted at the Walnut Grove tall tower near the Sacramento-San Joaquin River Delta in the Central Valley. Through analysis of these field measurements, this dissertation presents the apportionment of observed CH4 and N2O concentration enhancements into major source categories along with direct emissions estimates from airborne observations. We perform high-precision measurements of greenhouse gases using gas analyzers based on absorption spectroscopy, and other source marker volatile organic compounds (VOCs) using state of the art VOC measurement systems (e.g. proton transfer reaction mass spectrometry). We combine these measurements with a statistical source apportionment technique called positive matrix factorization (PMF) to evaluate and investigate the major local sources of CH4 and N2O during CalNex and Walnut Grove campaigns. In the CABERNET study, we combine measurements with an airborne approach to a well-established micrometeorological technique (eddy-covariance method) to derive CH4 fluxes over different source regions in the Central Valley. In the CalNex experiments, we demonstrate that dairy and livestock remains the largest source sector of non-CO2 greenhouse gases in the San

  12. Sources of humic-like substances in the Pearl River Delta, China: positive matrix factorization analysis of PM2.5 major components and source markers

    Directory of Open Access Journals (Sweden)

    B. Y. Kuang

    2014-09-01

    Full Text Available HUmic-LIke Substances (HULIS, the hydrophobic part of water soluble organic carbon (WSOC, account for a significant fraction of PM2.5 mass. Their source studies are so far largely qualitative. In this study, HULIS and WSOC were determined in 100 PM2.5 samples collected in 2009 at an urban site (Guangzhou and a suburban site (Nansha in the Pearl River Delta in South China. The annual average concentration of HULIS was 4.83 and 4.71 μg m−3, constituting 8.5 and 10.2% of the PM2.5 mass, while HULIS-C (the carbon component of HULIS contributed 48 and 57% of WSOC at the two sites, respectively. HULIS was found to correlate with biomass burning (BB tracers (i.e., levoglucosan and K and secondary species (e.g., sulfate and ammonium, suggesting its association with BB emissions and secondary formation processes. Sources of HULIS were investigated using positive matrix factorization analysis of PM2.5 chemical composition data, including major components and source markers. In addition to secondary formation process and BB emissions, residual oil combustion related to shipping was identified for the first time as a significant source of HULIS. Secondary formation process contributed the most, accounting for 49–82% of ambient HULIS at the two sites in different seasons. BB emissions contributed a seasonal average of 8–28%, with more contributions observed in the winter months (November–February due to crop residue burning during harvest season. Residual oil combustion was revealed to be an important source at the suburban site in summer (44% of HULIS-C due to its proximity to one of the ports and the shipping lane in the region. Vehicle emissions were found to contribute little to HULIS but had contributions to the hydrophilic WSOC fraction. The contrast in contributions from different combustion sources to HULIS and hydrophilic WSOC suggests that primary sources of HULIS are linked to inefficient combustion. This source analysis suggests further

  13. Fine particulate matter source apportionment for the chemical speciation trends network site at Birmingham, Alabama, using positive matrix factorization

    Energy Technology Data Exchange (ETDEWEB)

    Baumann, K.; Jayanty, R.K.; Flanagan, J.B. [Research Triangle Institute International, NC (United States). Research Triangle Park

    2008-01-15

    The Positive Matrix Factorization (PMF) receptor model version 1.1 was used with data from the fine particulate matter (PM2.5) Chemical Speciation Trends Network (STN) to estimate source contributions to ambient PM2.5 in a highly industrialized urban setting in the southeastern United States. Model results consistently resolved 10 factors that are interpreted as two secondary, five industrial, one motor vehicle, one road dust, and one biomass burning sources. It was found that most PMF factors did not cleanly represent single source types and instead are 'contaminated' by other sources. Secondary particulate matter formed by atmospheric processes, such as sulfate and secondary OC, contribute the majority of ambient PM2.5 and exhibit strong seasonality 37 {+-} 10% winter vs. 55 {+-} 16% summer average. Motor vehicle emissions constitute the biggest primary PM2.5 mass contribution. In summary, this study demonstrates the utility of the EC tracer method to effectively blank-correct the OC concentrations in the STN dataset. In addition, examination of the effect of input uncertainty estimates on model results indicates that the estimated uncertainties currently being provided with the STN data may be somewhat lower than the levels needed for optimum modeling results. An appendix , available to members on the website www.awma lists stationary sources of PM2.5 within 10 km of the NHBM site and PM2.5 emissions greater than 1 ton per year. 71 refs., 7 figs., 9 tabs.

  14. SOURCE APPORTIONMENT OF PM 2.5 AND CARBON IN SEATTLE USING CHEMICAL MASS BALANCE AND POSITIVE MATRIX FACTORIZATION

    Science.gov (United States)

    Three years of PM2.5 speciated data were collected and chemically analyzed using the IMPROVE protocol at the Beacon Hill site in Seattle. The data were analyzed by the Chemical Mass Balance Version 8 (CMB8) and Positive Matrix Factorization (PMF) source apportionment models. T...

  15. Influence Factors for Hypokalemia in Patients with Continuous Ambulatory Peritoneal Dialysis and Their Correlation%持续非卧床腹膜透析患者低钾血症的影响因素及相关性分析

    Institute of Scientific and Technical Information of China (English)

    潘玲; 黎伟; 廖蕴华

    2014-01-01

    目的:探讨持续非卧床腹膜透析患者低钾血症的临床特征及相关影响因素。方法回顾性分析137例持续非卧床腹膜透析患者的临床资料。结果发生低钾血症37例(27.0%)。低钾组与非低钾组比较,年龄、血钾、血磷、血尿素氮、血清肌酐、血清白蛋白、血浆前白蛋白、血红蛋白及尿素清除率水平差异均有统计学意义( P均<0.05);而血糖、TC、TG、C反应蛋白、血钙、血钠、甲状旁腺素、尿量、超滤量、性别、营养不良发生率及腹膜平衡试验类型差异无统计学意义( P均>0.05)。老年组低钾发生率为41.4%,明显高于非老年组的28.1%(P<0.05)。营养不良组血钾水平低于营养良好组(P<0.05),而低钾患病率高于营养良好组(P<0.05)。血钾与血尿素氮、白蛋白、前白蛋白、血红蛋白、主观综合营养评估法评分、肌酐及血磷呈正相关关系(P<0.05),与年龄、超滤量及尿素清除率呈负相关关系(P<0.05)。结论腹膜透析患者低钾发生率较高。血钾与年龄、营养状态及贫血密切相关,及时纠正低钾血症可以改善患者预后。%Objective To investigate the clinical features of hypokalemia and its related influence factors in patients with continuous ambulatory peritoneal dialysis (CAPD).Methods A clinical data of 137 patients with CAPD were analyzed retrospectively .Results Hypokalemia occurred in 37 cases(27.0%).There were significant differences in age,serum potassium,serum phosphorus,blood urea nitrogen(Bun),serum creatinine(Scr),serum albumin(ALB), prealbumin(PA),hemoglobin ( Hb) and KT/V between hypokalemia and non-hypokalemia groups ( all P0.05 ) .The incidence of hypokalemia in senile patients was 41.4%,which was significantly higher than that (28.1%) in non-senile patients (P<0.05).The serum level of potassium in malnutrition group was lower than that in good

  16. Induction of sexual arousal in women under conditions of institutional and ambulatory laboratory circumstances: a comparative study

    NARCIS (Netherlands)

    J. Bloemers; J. Gerritsen; R. Bults; H. Koppeschaar; W. Everaerd; B. Olivier; A. Tuiten

    2010-01-01

    Introduction. Measuring under naturally occurring circumstances increases ecological validity. We developed an ambulatory psychophysiological laboratory that allows experiments to be performed at home. Aims.  To compare institutional laboratory task measures with ambulatory laboratory task measures.

  17. Diagnosing malignant melanoma in ambulatory care: a systematic review of clinical prediction rules

    Science.gov (United States)

    Harrington, Emma; Clyne, Barbara; Wesseling, Nieneke; Sandhu, Harkiran; Armstrong, Laura; Bennett, Holly; Fahey, Tom

    2017-01-01

    Objectives Malignant melanoma has high morbidity and mortality rates. Early diagnosis improves prognosis. Clinical prediction rules (CPRs) can be used to stratify patients with symptoms of suspected malignant melanoma to improve early diagnosis. We conducted a systematic review of CPRs for melanoma diagnosis in ambulatory care. Design Systematic review. Data sources A comprehensive search of PubMed, EMBASE, PROSPERO, CINAHL, the Cochrane Library and SCOPUS was conducted in May 2015, using combinations of keywords and medical subject headings (MeSH) terms. Study selection and data extraction Studies deriving and validating, validating or assessing the impact of a CPR for predicting melanoma diagnosis in ambulatory care were included. Data extraction and methodological quality assessment were guided by the CHARMS checklist. Results From 16 334 studies reviewed, 51 were included, validating the performance of 24 unique CPRs. Three impact analysis studies were identified. Five studies were set in primary care. The most commonly evaluated CPRs were the ABCD, more than one or uneven distribution of Colour, or a large (greater than 6 mm) Diameter (ABCD) dermoscopy rule (at a cut-point of >4.75; 8 studies; pooled sensitivity 0.85, 95% CI 0.73 to 0.93, specificity 0.72, 95% CI 0.65 to 0.78) and the 7-point dermoscopy checklist (at a cut-point of ≥1 recommending ruling in melanoma; 11 studies; pooled sensitivity 0.77, 95% CI 0.61 to 0.88, specificity 0.80, 95% CI 0.59 to 0.92). The methodological quality of studies varied. Conclusions At their recommended cut-points, the ABCD dermoscopy rule is more useful for ruling out melanoma than the 7-point dermoscopy checklist. A focus on impact analysis will help translate melanoma risk prediction rules into useful tools for clinical practice. PMID:28264830

  18. Occupational and leisure time physical activity in contrasting relation to ambulatory blood pressure

    Directory of Open Access Journals (Sweden)

    Clays Els

    2012-11-01

    workers reporting static occupational physical activities, unlike general physically demanding tasks characterized by dynamic movements of large muscle groups, are related to a higher daily systolic BP, while high objective levels of moderate and vigorous leisure time physical activity are related to lower daytime systolic BP. Ambulatory systolic BP may be a physiological explanatory factor for the contrasting effects of occupational and leisure time physical activity.

  19. Preoperative testing and risk assessment: perspectives on patient selection in ambulatory anesthetic procedures

    Directory of Open Access Journals (Sweden)

    Stierer TL

    2015-08-01

    Full Text Available Tracey L Stierer,1,2 Nancy A Collop3,41Department of Anesthesiology, 2Department of Critical Care Medicine, Otolaryngology Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, USA; 3Department of Medicine, 4Department of Neurology, Emory University, Emory Sleep Center, Wesley Woods Center, Atlanta, GA, USAAbstract: With recent advances in surgical and anesthetic technique, there has been a growing emphasis on the delivery of care to patients undergoing ambulatory procedures of increasing complexity. Appropriate patient selection and meticulous preparation are vital to the provision of a safe, quality perioperative experience. It is not unusual for patients with complex medical histories and substantial systemic disease to be scheduled for discharge on the same day as their surgical procedure. The trend to “push the envelope” by triaging progressively sicker patients to ambulatory surgical facilities has resulted in a number of challenges for the anesthesia provider who will assume their care. It is well known that certain patient diseases are associated with increased perioperative risk. It is therefore important to define clinical factors that warrant more extensive testing of the patient and medical conditions that present a prohibitive risk for an adverse outcome. The preoperative assessment is an opportunity for the anesthesia provider to determine the status and stability of the patient’s health, provide preoperative education and instructions, and offer support and reassurance to the patient and the patient’s family members. Communication between the surgeon/proceduralist and the anesthesia provider is critical in achieving optimal outcome. A multifaceted approach is required when considering whether a specific patient will be best served having their procedure on an outpatient basis. Not only should the patient's comorbidities be stable and optimized, but details regarding the planned procedure and the resources available

  20. Educating Asthmatic Children in European Ambulatory Pediatrics: Facts and Insights.

    Science.gov (United States)

    Robberecht, Marie Noëlle; Beghin, Laurent; Deschildre, Antoine; Hue, Valérie; Reali, Laura; Plevnik-Vodušek, Vesna; Moretto, Marilena; Agustsson, Sigurlaug; Tockert, Emile; Jäger-Roman, Elke; Deplanque, Dominique; Najaf-Zadeh, Abolfazl; Martinot, Alain

    2015-01-01

    The aim of this study was to assess the role of European ambulatory pediatricians in caring for asthmatic children, especially in terms of their therapeutic education. We developed a survey that was observational, declarative, retrospective and anonymous in nature. 436 ambulatory pediatricians in Belgium, France, Germany, Italy, Luxembourg and Slovenia were asked to participate in the survey providing information on three children over 6 years old suffering from persistent asthma, who had been followed for at least 6 months. We considered the pediatricians' profile, and their role in the therapeutic education of children. 277 pediatricians (64%) responded: 81% were primary care pediatricians; 46% participated in networks; 4% had specific training in Therapeutic Patient Education; 69% followed more than 5 asthmatic children per month, and over long periods (7 ± 4 years). The profiles of 684 children were assessed. Answers diverged concerning the provision of a Personalized Action Plan (60-88%), training the child to measure and interpret his Peak Expiratory Flow (31-99%), and the prescription of pulmonary function tests during the follow-up programme of consultations (62-97%). Answers converged on pediatricians' perception of their role in teaching children about their condition and its treatment (99%), about inhalation techniques (96%), and in improving the children's ability to take preventive measures when faced with risk situations (97%). This study highlights the role of European pediatricians in caring for asthmatic children, and their lack of training in Therapeutic Patient Education. Programmes and tools are required in order to train ambulatory pediatricians in Therapeutic Patient Education, and such resources should be integrated into primary health care, and harmonized at the European level.

  1. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  2. Investigation of sources of atmospheric aerosol at urban and suburban residential areas in Thailand by positive matrix factorization

    Science.gov (United States)

    Chueinta, Wanna; Hopke, Philip K.; Paatero, Pentti

    Samples of fine and coarse fractions of airborne particulate matter were collected in an urban residential area of metropolitan Bangkok from June 1995 to May 1996 and in a suburban residential area in Pathumthani, Bangkok's boundary province, from September 1993 to August 1994. The samples were analyzed for elemental concentrations by instrumental neutron activation analysis. The data sets were then analyzed by positive matrix factorization followed by rotation to identify the possible sources of atmospheric aerosols in both areas. The best solutions were found to be six factors for elemental compositions of each of the fine and coarse particulate matter fractions at the urban site and five factors each for both fine and coarse fractions at the suburban location. Soil was the major source of airborne particulate matter identified for all data sets. The motor vehicle factor showed much higher concentration for Br in urban than in suburban area. A motorcycle factor with high concentrations of Zn and Mn were found at the urban site. The factor containing highest concentrations of Na and Cl was attributed to sea-salt and was clearly seen in the urban atmosphere. The site was located 35 km to the north from the Gulf of Thailand and was influenced by wind from the south and southwest for most of the year. Charcoal/wood burning and incineration factors were likely to be the local sources. A factor with high concentration of Ca was attributed to a construction near the urban residential site and from two plaster manufacturing factories close to the suburban residential site.

  3. Flexible Capacitive Electrodes for Minimizing Motion Artifacts in Ambulatory Electrocardiograms

    Directory of Open Access Journals (Sweden)

    Jeong Su Lee

    2014-08-01

    Full Text Available This study proposes the use of flexible capacitive electrodes for reducing motion artifacts in a wearable electrocardiogram (ECG device. The capacitive electrodes have conductive foam on their surface, a shield, an optimal input bias resistor, and guarding feedback. The electrodes are integrated in a chest belt, and the acquired signals are transmitted wirelessly for ambulatory heart rate monitoring. We experimentally validated the electrode performance with subjects standing and walking on a treadmill at speeds of up to 7 km/h. The results confirmed the highly accurate heart rate detection capacity of the developed system and its feasibility for daily-life ECG monitoring.

  4. Scheduling of procedures and staff in an ambulatory surgery center.

    Science.gov (United States)

    Pash, Joel; Kadry, Bassam; Bugrara, Suhabe; Macario, Alex

    2014-06-01

    For ambulatory surgical centers (ASC) to succeed financially, it is critical for ASC managers to schedule surgical procedures in a manner that optimizes operating room (OR) efficiency. OR efficiency is maximized by using historical data to accurately predict future OR workload, thereby enabling OR time to be properly allocated to surgeons. Other strategies to maintain a well-functioning ASC include recruiting and retaining the right staff and ensuring patients and surgeons are satisfied with their experience. This article reviews different types of procedure scheduling systems. Characteristics of well-functioning ASCs are also discussed.

  5. 76 FR 65885 - Medicare Program; Changes to the Ambulatory Surgical Centers Patient Rights Conditions for Coverage

    Science.gov (United States)

    2011-10-24

    ... 42 CFR Chapter IV Medicare and Medicaid Programs; Changes to the Ambulatory Surgical Centers Patient... Service 42 CFR Part 416 RlN 0938-AP93 Medicare Program; Changes to the Ambulatory Surgical Centers Patient..., or the patient's surrogate prior to the start of the surgical procedure. In addition, we made...

  6. Estimating qualitative parameters for assessment of body balance and arm function in a simulated ambulatory setting

    NARCIS (Netherlands)

    Meulen, van Fokke B.; Reenalda, Jasper; Veltink, Peter H.

    2013-01-01

    Continuous daily-life monitoring of balance control and arm function of stroke survivors in an ambulatory setting, is essential for optimal guidance of rehabilitation. In a simulated ambulatory setting, balance and arm function of seven stroke subjects is evaluated using on-body measurement systems

  7. 42 CFR 419.31 - Ambulatory payment classification (APC) system and payment weights.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Ambulatory payment classification (APC) system and... Outpatient Services § 419.31 Ambulatory payment classification (APC) system and payment weights. (a) APC... the Federal Food, Drug and Cosmetic Act. (3) The payment rate determined for an APC group...

  8. Increased systolic ambulatory blood pressure and microalbuminuria in treated and non-treated hypertensive smokers

    DEFF Research Database (Denmark)

    Sørensen, Kaspar; Kristensen, Kjeld S; Bang, Lia E;

    2004-01-01

    The primary aim of the present study was to evaluate the impact of smoking status on both clinic and ambulatory blood pressure (BP) and heart rate (HR) by using 24-h ambulatory BP monitoring in treated and non-treated hypertensive smokers and non-smokers. A secondary aim was to evaluate the inter...... the interrelations between BP, smoking status and microalbuminuria....

  9. Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng

    2014-01-01

    Full Text Available Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23 service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P<0.01, those undergoing wide local excision (P<0.01 and those with ductal carcinoma-in situ or early stage breast cancer (P<0.01, were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

  10. Determinants of the ambulatory arterial stiffness index in 7604 subjects from 6 populations

    DEFF Research Database (Denmark)

    Adiyaman, Ahmet; Dechering, Dirk G; Boggia, José

    2008-01-01

    The ambulatory arterial stiffness index (AASI) is derived from 24-hour ambulatory blood pressure recordings. We investigated whether the goodness-of-fit of the AASI regression line in individual subjects (r(2)) impacts on the association of AASI with established determinants of the relation between...

  11. Estimation of blood pressure variability from 24-hour ambulatory finger blood pressure

    NARCIS (Netherlands)

    Omboni, S.; Parati, G.; Castiglioni, P.; Rienzo, M. di; Imholz, B.P.M.; Langewouters, G.J.; Wesseling, K.H.; Mancia, G.

    1998-01-01

    Portapres is a noninvasive, beat-to-beat finger blood pressure (BP) monitor that has been shown to accurately estimate 24-hour intra-arterial BP at normal and high BPs. However, no information is available on the ability of this device to accurately track ambulatory BP variability. In 20 ambulatory

  12. Ambulatory Surgical Facilities, Licensed Ambulatory Sugery Centers, Published in 2007, 1:24000 (1in=2000ft) scale, State of California - Office of the State Chief Information Officer.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:24000 (1in=2000ft) scale, was produced all or in part from Published Reports/Deeds information as of...

  13. Ambulatory Surgical Facilities, Identify the locations of Ambulatory Surgical Centers, Published in 2012, 1:2400 (1in=200ft) scale, Miami-Dade County, Information Technology Department.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Other information as of 2012. It is described as...

  14. Ambulatory recorded ST segment depression on ECG is associated with lower cognitive function in healthy elderly men

    Directory of Open Access Journals (Sweden)

    Sölve Elmståhl

    2009-08-01

    Full Text Available Sölve Elmståhl, Linda FuruängDepartment of Health Sciences, Division of Geriatric Medicine, Lund University, Malmö University Hospital, Malmö, SwedenAbstract: ST segment depression (STDE has been found to be associated with cardiovascular disease in the elderly. Studies of the relation of ambulatory STDE to cognitive function in elderly persons aged 80 years or above is lacking.Objective: To study the association between STDE and cognition.Design and participants: A cross-sectional cohort study of 88 81-year-old men from the population study “Men born in 1914” investigated in an outpatient research clinic. Measurements included ambulatory 24-hour electrocardiogram (ECG monitoring and a cognitive test battery of six tests. Proportion of lower cognitive function was calculated for each test in relation to STDE during the day and at night-time.Results: Fifty-eight percent of the men had STDE and a higher proportion with low visuospatial cognitive function was found among those with STDE compared to the others (84% vs 59%; p = 0.014. A significant trend was noted for subjects without STDE compared to STDE night-time less than 60 minutes and night-time more than 60 minutes for spatial and verbal cognitive functions (p = 0.022. No trends were noted for STDE daytime. Maximal STDE during night showed similar association to spatial function (Benton Visual Retention test, r = -0.26; p = 0.028. Even when seven subjects with a history of stroke were excluded, the occurrence of STDE was associated to lower visuospatial cognitive function compared to those without STDE (87% vs 57%; p = 0.004.Conclusion: ST segment depression on ECG is common among elderly men and might be a vascular risk factor for cognitive deterioration.Keywords: aged 80 and over, ST segment depression, ambulatory long-term ECG, cognition, cohort study, risk factors

  15. Source characterization of highly oxidized multifunctional compounds in a boreal forest environment using positive matrix factorization

    Science.gov (United States)

    Yan, Chao; Nie, Wei; Äijälä, Mikko; Rissanen, Matti P.; Canagaratna, Manjula R.; Massoli, Paola; Junninen, Heikki; Jokinen, Tuija; Sarnela, Nina; Häme, Silja A. K.; Schobesberger, Siegfried; Canonaco, Francesco; Yao, Lei; Prévôt, André S. H.; Petäjä, Tuukka; Kulmala, Markku; Sipilä, Mikko; Worsnop, Douglas R.; Ehn, Mikael

    2016-10-01

    Highly oxidized multifunctional compounds (HOMs) have been demonstrated to be important for atmospheric secondary organic aerosols (SOA) and new-particle formation (NPF), yet it remains unclear which the main atmospheric HOM formation pathways are. In this study, a nitrate-ion-based chemical ionization atmospheric-pressure-interface time-of-flight mass spectrometer (CI-APi-TOF) was deployed to measure HOMs in the boreal forest in Hyytiälä, southern Finland. Positive matrix factorization (PMF) was applied to separate the detected HOM species into several factors, relating these "factors" to plausible formation pathways. PMF was performed with a revised error estimation derived from laboratory data, which agrees well with an estimate based on ambient data. Three factors explained the majority (> 95 %) of the data variation, but the optimal solution found six factors, including two nighttime factors, three daytime factors, and a transport factor. One nighttime factor is almost identical to laboratory spectra generated from monoterpene ozonolysis, while the second likely represents monoterpene oxidation initiated by NO3. The exact chemical processes forming the different daytime factors remain unclear, but they all have clearly distinct diurnal profiles, very likely related to monoterpene oxidation with a strong influence from NO, presumably through its effect on peroxy radical (RO2) chemistry. Apart from these five "local" factors, the sixth factor is interpreted as a transport related factor. These findings improve our understanding of HOM production by confirming current knowledge and inspiring future research directions and provide new perspectives on using factorization methods to understand short-lived atmospheric species.

  16. Extrahepatic sources of factor VIII potentially contribute to the coagulation cascade correcting the bleeding phenotype of mice with hemophilia A.

    Science.gov (United States)

    Zanolini, Diego; Merlin, Simone; Feola, Maria; Ranaldo, Gabriella; Amoruso, Angela; Gaidano, Gianluca; Zaffaroni, Mauro; Ferrero, Alessandro; Brunelleschi, Sandra; Valente, Guido; Gupta, Sanjeev; Prat, Maria; Follenzi, Antonia

    2015-07-01

    A large fraction of factor VIII in blood originates from liver sinusoidal endothelial cells although extrahepatic sources also contribute to plasma factor VIII levels. Identification of cell-types other than endothelial cells with the capacity to synthesize and release factor VIII will be helpful for therapeutic approaches in hemophilia A. Recent cell therapy and bone marrow transplantation studies indicated that Küpffer cells, monocytes and mesenchymal stromal cells could synthesize factor VIII in sufficient amount to ameliorate the bleeding phenotype in hemophilic mice. To further establish the role of blood cells in expressing factor VIII, we studied various types of mouse and human hematopoietic cells. We identified factor VIII in cells isolated from peripheral and cord blood, as well as bone marrow. Co-staining for cell type-specific markers verified that factor VIII was expressed in monocytes, macrophages and megakaryocytes. We additionally verified that factor VIII was expressed in liver sinusoidal endothelial cells and endothelial cells elsewhere, e.g., in the spleen, lungs and kidneys. Factor VIII was well expressed in sinusoidal endothelial cells and Küpffer cells isolated from human liver, whereas by comparison isolated human hepatocytes expressed factor VIII at very low levels. After transplantation of CD34(+) human cord blood cells into NOD/SCIDγNull-hemophilia A mice, fluorescence activated cell sorting of peripheral blood showed >40% donor cells engrafted in the majority of mice. In these animals, plasma factor VIII activity 12 weeks after cell transplantation was up to 5% and nine of 12 mice survived after a tail clip-assay. In conclusion, hematopoietic cells, in addition to endothelial cells, express and secrete factor VIII: this information should offer further opportunities for understanding mechanisms of factor VIII synthesis and replenishment.

  17. Echocardiographic Assessment of Pulmonary Artery Systolic Pressure and Outcomes in Ambulatory Heart Failure Patients

    Science.gov (United States)

    Kalogeropoulos, Andreas P.; Siwamogsatham, Sarawut; Hayek, Salim; Li, Song; Deka, Anjan; Marti, Catherine N.; Georgiopoulou, Vasiliki V.; Butler, Javed

    2014-01-01

    Background Pulmonary hypertension (PH) in patients with heart failure (HF) is associated with worse outcomes and is rapidly being recognized as a therapeutic target. To facilitate pragmatic research efforts, data regarding the prognostic importance of noninvasively assessed pulmonary artery systolic pressure (PASP) in stable ambulatory patients with HF are needed. Methods and Results We examined the association between echocardiographic PASP and outcomes in 417 outpatients with HF (age, 54±13 years; 60.7% men; 50.4% whites; 24.9% with preserved ejection fraction). Median PASP was 36 mm Hg (interquartile range [IQR]: 29, 46). After a median follow‐up of 2.6 years (IQR: 1.7, 3.9) there were 72 major events (57 deaths; 9 urgent heart transplants; and 6 ventricular assist device implantations) and 431 hospitalizations for HF. In models adjusting for clinical risk factors and therapy, a 10‐mm Hg higher PASP was associated with 37% higher risk (95% CI: 18, 59; P<0.001) for major events, and 11% higher risk (95% CI: 1, 23; P=0.039) for major events or HF hospitalization. The threshold that maximized the likelihood ratio for both endpoints was 48 mm Hg; those with PASP ≥48 mm Hg (N=84; 20.1%) had an adjusted hazard ratio of 3.33 (95% CI: 1.96, 5.65; P<0.001) for major events and 1.47 (95% CI: 1.02, 2.11; P=0.037) for major events or HF hospitalization. Reduced right ventricular systolic function had independent prognostic utility over PASP for adverse outcomes. Right atrial pressure and transtricuspid gradient both contributed to risk. Conclusions Elevated PASP, determined by echocardiography, identifies ambulatory patients with HF at increased risk for adverse events. PMID:24492947

  18. Factors associated with sources, transport, and fate of volatile organic compounds and their mixtures in aquifers of the United States

    Science.gov (United States)

    Squillace, P.J.; Moran, M.J.

    2007-01-01

    Factors associated with sources, transport, and fate of volatile organic compounds (VOCs) in groundwater from aquifers throughout the United States were evaluated using statistical methods. Samples were collected from 1631 wells throughout the conterminous United States between 1996 and 2002 as part of the National Water-Quality Assessment (NAWQA) Program of the U.S. Geological Survey. Water samples from wells completed in aquifers used to supply drinking water were analyzed for more than 50 VOCs. Wells were primarily rural domestic water supplies (1184), followed by public water supplies (216); the remaining wells (231) supplied a variety of uses. The median well depth was 50 meters. Age-date information shows that about 60% of the samples had a fraction of water recharged after 1953. Chloroform, toluene, 1,2,4-trimethylbenzene, and perchloroethene were some of the frequently detected VOCs. Concentrations generally were less than 1 ??g/L. Source factors include, in order of importance, general land-use activity, septic/sewer density, and sites where large concentrations of VOCs are potentially released, such as leaking underground storage tanks. About 10% of all samples had VOC mixtures that were associated with concentrated sources; 20% were associated with dispersed sources. Important transport factors included well/screen depth, precipitation/groundwater recharge, air temperature, and various soil characteristics. Dissolved oxygen was strongly associated with VOCs and represents the fate of many VOCs in groundwater. Well type (domestic or public water supply) was also an important explanatory factor. Results of multiple analyses show the importance of (1) accounting for both dispersed and concentrated sources of VOCs, (2) measuring dissolved oxygen when sampling wells to help explain the fate of VOCs, and (3) limiting the type of wells sampled in monitoring networks to avoid unnecessary variance in the data, or controlling for this variance during data analysis.

  19. Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study

    Directory of Open Access Journals (Sweden)

    Fenwick Angela

    2011-02-01

    Full Text Available Abstract Background Patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management. Methods A qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae. Results Participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge; were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house. Conclusions These participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development

  20. Pain Management in Ambulatory Surgery—A Review

    Directory of Open Access Journals (Sweden)

    Jan G. Jakobsson

    2014-07-01

    Full Text Available Day surgery, coming to and leaving the hospital on the same day as surgery as well as ambulatory surgery, leaving hospital within twenty-three hours is increasingly being adopted. There are several potential benefits associated with the avoidance of in-hospital care. Early discharge demands a rapid recovery and low incidence and intensity of surgery and anaesthesia related side-effects; such as pain, nausea and fatigue. Patients must be fit enough and symptom intensity so low that self-care is feasible in order to secure quality of care. Preventive multi-modal analgesia has become the gold standard. Administering paracetamol, NSIADs prior to start of surgery and decreasing the noxious influx by the use of local anaesthetics by peripheral block or infiltration in surgical field prior to incision and at wound closure in combination with intra-operative fast acting opioid analgesics, e.g., remifentanil, have become standard of care. Single preoperative 0.1 mg/kg dose dexamethasone has a combined action, anti-emetic and provides enhanced analgesia. Additional α-2-agonists and/or gabapentin or pregabalin may be used in addition to facilitate the pain management if patients are at risk for more pronounced pain. Paracetamol, NSAIDs and rescue oral opioid is the basic concept for self-care during the first 3–5 days after common day/ambulatory surgical procedures.

  1. Wearable and superhydrophobic hardware for ambulatory biopotential acquisition.

    Science.gov (United States)

    Martinez-Tabares, F J; Delgado-Trejos, E; Castellanos-Dominguez, G

    2013-01-01

    Wearable monitoring devices are a promising trend for ambulatory and real time biosignal processing, because they improve access and coverage by means of comfortable sensors, with real-time communication via mobile networks. In this paper, we present a garment for ambulatory electrocardiogram monitoring, a smart t-shirt with a textile electrode that conducts electricity and has a coating designed to preserve the user's hygiene, allowing long-term mobile measurements. Silicon dioxide nanoparticles were applied on the surface of the textile electrodes to preserve conductivity and impart superhydrophobic properties. A model to explain these results is proposed. The best result of this study is obtained when the contact angles between the fluid and the fabric exceeded 150°, while the electrical resistivity remained below 5 Ω·cm, allowing an acquisition of high quality electrocardiograms in moving patients. Thus, this tool represents an interesting alternative for medium and long-term measurements, preserving the textile feeling of clothing and working under motion conditions.

  2. Iteration Factors in the Line Formation Problem with Frequency Dependent Source Function

    Directory of Open Access Journals (Sweden)

    Kuzmanovska-Barandovska, O.

    2010-06-01

    Full Text Available In this paper some iteration factors families introduced previously to solve the pure line transfer problem are generalized to the case when the background continuum is taken into account.The convergence properties of these factors are discussed when they are applied to the solution of the two-level atom line transfer problem in a constant and variable property media.

  3. Applying spatial regression to evaluate risk factors for microbiological contamination of urban groundwater sources in Juba, South Sudan

    Science.gov (United States)

    Engström, Emma; Mörtberg, Ulla; Karlström, Anders; Mangold, Mikael

    2016-12-01

    This study developed methodology for statistically assessing groundwater contamination mechanisms. It focused on microbial water pollution in low-income regions. Risk factors for faecal contamination of groundwater-fed drinking-water sources were evaluated in a case study in Juba, South Sudan. The study was based on counts of thermotolerant coliforms in water samples from 129 sources, collected by the humanitarian aid organisation Médecins Sans Frontières in 2010. The factors included hydrogeological settings, land use and socio-economic characteristics. The results showed that the residuals of a conventional probit regression model had a significant positive spatial autocorrelation (Moran's I = 3.05, I-stat = 9.28); therefore, a spatial model was developed that had better goodness-of-fit to the observations. The most significant factor in this model (p-value 0.005) was the distance from a water source to the nearest Tukul area, an area with informal settlements that lack sanitation services. It is thus recommended that future remediation and monitoring efforts in the city be concentrated in such low-income regions. The spatial model differed from the conventional approach: in contrast with the latter case, lowland topography was not significant at the 5% level, as the p-value was 0.074 in the spatial model and 0.040 in the traditional model. This study showed that statistical risk-factor assessments of groundwater contamination need to consider spatial interactions when the water sources are located close to each other. Future studies might further investigate the cut-off distance that reflects spatial autocorrelation. Particularly, these results advise research on urban groundwater quality.

  4. Correction Factor for Gaussian Deconvolution of Optically Thick Linewidths in Homogeneous Sources

    Science.gov (United States)

    Kastner, S. O.; Bhatia, A. K.

    1999-01-01

    Profiles of optically thick, non-Gaussian emission line profiles convoluted with Gaussian instrumental profiles are constructed, and are deconvoluted on the usual Gaussian basis to examine the departure from accuracy thereby caused in "measured" linewidths. It is found that "measured" linewidths underestimate the true linewidths of optically thick lines, by a factor which depends on the resolution factor r congruent to Doppler width/instrumental width and on the optical thickness tau(sub 0). An approximating expression is obtained for this factor, applicable in the range of at least 0 tau(sub 0) estimates of the true linewidth and optical thickness.

  5. Factors, origin and sources affecting PM1 concentrations and composition at an urban background site

    Science.gov (United States)

    Squizzato, Stefania; Masiol, Mauro; Agostini, Chiara; Visin, Flavia; Formenton, Gianni; Harrison, Roy M.; Rampazzo, Giancarlo

    2016-11-01

    PM1 is widely believed to provide better information on the anthropogenic fraction of particulate matter pollution than PM2.5. However, data on PM1 are still limited in Europe as well as comprehensive information about its chemical composition and source apportionment and this gap is more evident in the pollution hot-spots still remaining in Europe, such as the Po Valley (Northern Italy). Elemental and organic carbon, 7 water soluble inorganic ions and 17 elements were quantified in 117 PM1 samples collected at an urban background site in Venice-Mestre, a large city located in the eastern Po Valley, during winter (December 2013-February 2014) and summer (May-July 2014) periods. Results show a strong seasonality for PM1 mass concentration (averages ranging from 6 ± 2 in summer to 34 ± 24 μg m- 3 in winter) and for most of the analysed species. Components mainly related to road traffic, residential heating, biomass burning and secondary inorganic aerosol (ammonium nitrate) reached their highest levels in winter, while mineral dust and marine components were elevated in summer. PMF analysis revealed 7 potential sources. Secondary inorganic aerosol (33%) and biomass burning (33%) are the major contributor in winter followed by EC-primary emissions (16%), aged sulphate (6%), road traffic (7%), fossil fuel combustion (%) and marine aerosol (3%). During summer, these sources account for 12%, 14%, 20%, 22%, 8%, 14% and 10%, respectively. Some PM1 sources are located near the sampling site (residential area, traffic road, industrial area) but a major contribution of long range transport is observed when high pollution events occur. The results give useful insights into PM1 composition in an urban area and chemical profiles of sources helpful in the interpretation of receptor model results.

  6. Source apportionment of polycyclic aromatic hydrocarbons in PM2.5 using positive matrix factorization modeling in Shanghai, China.

    Science.gov (United States)

    Wang, Fengwen; Lin, Tian; Feng, Jialiang; Fu, Huaiyu; Guo, Zhigang

    2015-01-01

    Providing quantitative information on the sources of PM2.5-bound polycyclic aromatic hydrocarbons (PAHs) in urban regions is vital to establish effective abatement strategies for air pollution in a megacity. In this study, based on a year data set from October 2011 to August 2012, the sources of PM2.5-bound 16 USEPA priority PAHs (16 PAHs) in Shanghai, a megacity in China, were apportioned by positive matrix factorization (PMF) modeling. The average concentrations (in ng m(-3)) of 16 PAHs in PM2.5 in the fall, winter, spring and summer were 20.5 ± 18.2, 27.2 ± 24.0, 13.7 ± 7.7 and 6.4 ± 8.1, respectively, with an annual average of 16.9 ± 9.0. The source apportionment by PMF indicated that coal burning (30.5%) and gasoline engine emission (29.0%) were the two major sources of PAHs in the PM2.5 in Shanghai, followed by diesel engine emission (17.5%), air-surface exchange (11.9%) and biomass burning (11.1%). The highest source contributor for PAHs in the fall and winter was gasoline engine emission (36.7%) and coal burning (41.9%), respectively; while in the spring and summer, it was diesel engine emission that contributed the most (52.1% and 43.5%, respectively). It was suggested that there was a higher contribution of PAHs from engine emissions in 2011-2012 compared with those in 2002-2003. The major sources apportioned by PMF complemented well with this of using diagnostic ratios, suggesting a convincing identification of sources for the PM2.5-bound 16 PAHs in a megacity.

  7. Factors affecting quality for beta dose rate measurements using ISO 6980 series I reference sources

    Energy Technology Data Exchange (ETDEWEB)

    Burns, R.E. Jr.; O`Brien, J.M. Jr. [Atlan-Tech, Rosewll, GA (United States)

    1993-12-31

    Atlan-Tech, Inc. has performed several calibrations of ISO 6980 Series 1 reference beta sources over the past two to three years. There were many problems encountered in attempting to compare the results of these calibrations with those from other laboratories, indicating the need for more standardization in the methodology employed for the measurement of the absorbed dose rate from ISO 6980 Series 1 reference beta sources. This document describes some of the problems encountered in attempting to intercompare results of beta dose-rate measurements. It proposes some solutions in an attempt to open a dialogue among facilities using reference beta standards for the purpose of promoting better measurement quality assurance through data intercomparison.

  8. Assessment of region, farming system, irrigation source and sampling time as food safety risk factors for tomatoes.

    Science.gov (United States)

    Pagadala, Sivaranjani; Marine, Sasha C; Micallef, Shirley A; Wang, Fei; Pahl, Donna M; Melendez, Meredith V; Kline, Wesley L; Oni, Ruth A; Walsh, Christopher S; Everts, Kathryne L; Buchanan, Robert L

    2015-03-02

    In the mid-Atlantic region of the United States, small- and medium-sized farmers use varied farm management methods and water sources to produce tomatoes. It is unclear whether these practices affect the food safety risk for tomatoes. This study was conducted to determine the prevalence, and assess risk factors for Salmonella enterica, Shiga toxin-producing Escherichia coli (STEC) and bacterial indicators in pre-harvest tomatoes and their production areas. A total of 24 organic and conventional, small- to medium-sized farms were sampled for six weeks in Maryland (MD), Delaware (DE) and New Jersey (NJ) between July and September 2012, and analyzed for indicator bacteria, Salmonella and STEC. A total of 422 samples--tomato fruit, irrigation water, compost, field soil and pond sediment samples--were collected, 259 of which were tomato samples. A low level of Salmonella-specific invA and Shiga toxin genes (stx1 or stx2) were detected, but no Salmonella or STEC isolates were recovered. Of the 422 samples analyzed, 9.5% were positive for generic E. coli, found in 5.4% (n=259) of tomato fruits, 22.5% (n=102) of irrigation water, 8.9% (n=45) of soil, 3/9 of pond sediment and 0/7 of compost samples. For tomato fruit, farming system (organic versus conventional) was not a significant factor for levels of indicator bacteria. However, the total number of organic tomato samples positive for generic E. coli (1.6%; 2/129) was significantly lower than for conventional tomatoes (6.9% (9/130); (χ(2) (1)=4.60, p=0.032)). Region was a significant factor for levels of Total Coliforms (TC) (p=0.046), although differences were marginal, with western MD having the highest TC counts (2.6 log CFU/g) and NJ having the lowest (2.0 log CFU/g). Tomatoes touching the ground or plastic mulch harbored significantly higher levels of TC compared to vine tomatoes, signaling a potential risk factor. Source of irrigation water was a significant factor for all indicator bacteria (p<0.0001), and

  9. Commentary on the required skills for ambulatory cardiac care in the young: is training necessary?

    Science.gov (United States)

    Boris, Jeffrey R

    2015-12-01

    Extensive supplemental training exists for many subspecialty disciplines within fellowship training for paediatric cardiology in the United States of America. These disciplines, or domains, such as echocardiography, cardiac intensive care, interventional cardiology, and electrophysiology, allow for initial exposure and training during the basic 3 years of fellowship, plus mandate a 4th year of advanced training; however, ambulatory cardiology has no in-depth or additional training beyond the basic clinical exposure during fellowship training. Ambulatory cardiology is not included in the recommended scheduling of the various domains of cardiology training. This document reviews the reasons to consider augmenting the depth and breadth of training in ambulatory paediatric cardiology.

  10. Ambulatory Care Visits to Pediatricians in Taiwan: A Nationwide Analysis

    Directory of Open Access Journals (Sweden)

    Ling-Yu Yang

    2015-11-01

    Full Text Available Pediatricians play a key role in the healthy development of children. Nevertheless, the practice patterns of pediatricians have seldom been investigated. The current study analyzed the nationwide profiles of ambulatory visits to pediatricians in Taiwan, using the National Health Insurance Research Database. From a dataset that was randomly sampled one out of every 500 records among a total of 309,880,000 visits in 2012 in the country, 9.8% (n = 60,717 of the visits were found paid to pediatricians. Children and adolescents accounted for only 69.3% of the visits to pediatricians. Male pediatricians provided 80.5% of the services and the main workforces were those aged 40–49 years. The most frequent diagnoses were respiratory tract diseases (64.7% and anti-histamine agents were prescribed in 48.8% of the visits to pediatricians. Our detailed results could contribute to evidence-based discussions on health policymaking.

  11. Bidirectional peritoneal transport of albumin in continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Joffe, P; Henriksen, Jens Henrik Sahl

    1995-01-01

    The present study was undertaken in order to assess bidirectional peritoneal kinetics of albumin after simultaneous i.v. and i.p. injection of radioiodinated albumin tracers (125I-RISA and 131I-RISA) in eight clinically stable uraemic patients undergoing continuous ambulatory peritoneal dialysis...... (CAPD). The plasma volume, intravascular albumin mass (IVM), and overall extravasation rate of albumin were not significantly different from that found in healthy controls. Albumin flux from the plasma into the peritoneal cavity was 3.71 +/- 0.82 (SD) mumol/h, which was only 3% of the overall...... extravasation rate (137 +/- 52 mumol/h). Albumin flux from the peritoneal cavity into the plasma was substantially lower (0.22 +/- 0.07 mumol/h, P peritoneal accumulation of the albumin from plasma over 4 h was 14 +/- 3.2 mumol, which was significantly lower than the intraperitoneal albumin...

  12. Is aerobic workload positively related to ambulatory blood pressure?

    DEFF Research Database (Denmark)

    Korshøj, Mette; Clays, Els; Lidegaard, Mark;

    2016-01-01

    PURPOSE: Cardiovascular disease is prevalent among workers with high levels of occupational physical activity. The increased risk may be due to a high relative aerobic workload, possibly leading to increased blood pressure. However, studies investigating the relation between relative aerobic...... workload and ambulatory blood pressure (ABP) are lacking. The aim was to explore the relationship between objectively measured relative aerobic workload and ABP. METHODS: A total of 116 cleaners aged 18-65 years were included after informed consent was obtained. A portable device (Spacelabs 90217......) was mounted for 24-h measurements of ABP, and an Actiheart was mounted for 24-h heart rate measurements to calculate relative aerobic workload as percentage of relative heart rate reserve. A repeated-measure multi-adjusted mixed model was applied for analysis. RESULTS: A fully adjusted mixed model...

  13. Ambulatory surgery center joint ventures involving tax-exempt entities.

    Science.gov (United States)

    Becker, S; Pristave, R J; McConnell, W

    1999-01-01

    This article provides an overview of the tax-exempt related issues for ambulatory surgery center joint ventures involving tax-exempt entities. The article analyzes the key points of analysis of the guidance released by the IRS, in particular General Counsel Memorandum 39862, Revenue Ruling 98-15, and Redlands Surgical Services v. Commissioner of the Internal Revenue Service. These key points include whether the venture results in private inurement to insiders and whether the venture furthers the charitable purposes of the tax-exempt entity. The article also provides practical guidance to analyze the documents and structure of the joint venture to ensure compliance with the IRS guidance. These practical considerations include, among other things, whether the charitable purposes of the tax-exempt entity are clearly expressed in the documents and whether the tax-exempt entity has sufficient control over the joint venture to ensure the charitable purposes are being adhered to.

  14. Tuberculous peritonitis in a child undergoing continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Tsai, T C; Hsu, J C; Chou, L H; Lee, M L

    1994-01-01

    We present a 13-year-old girl with Arnold-Chiari syndrome and uremia secondary to neurogenic bladder. She had been treated with continuous ambulatory peritoneal dialysis (CAPD) for 13 months prior to the development of peritonitis. The patient demonstrated no improvement with a 3-day therapy of intraperitoneal vancomycin and netilmicin. Meanwhile, smear of centrifuged dialysate revealed acid fast bacilli on two occasions. We, then, started anti-TB therapy with oral isoniazid (INAH), rifampin and ethambutal. The symptoms subsided within three days. In the first week, the patient lost her peritoneal ultrafiltration and needed daytime automatic peritoneal dialysis. At the last follow-up examination, 12 months after treatment, she remained well on standard CAPD.

  15. Eliminating lateral violence in the ambulatory setting: one center's strategies.

    Science.gov (United States)

    Dimarino, Tina J

    2011-05-01

    Lateral violence (eg, disruptive, disparaging, or uncivil behavior inflicted by one peer on another) creates an unpleasant work environment that can have harmful effects on individual nurses, team members, patients, and the bottom line of the health care organization. Educating nurses about the most common forms of lateral violence and strategies for handling inappropriate behavior can be the first step toward eliminating this behavior. Effective nursing leaders develop and maintain a "zero-tolerance" culture that includes clear and concise behavioral expectations and consequences for employees who exhibit unprofessional behavior. Use of a code of conduct, open communication, and quick resolution of issues that arise are strategies that one ambulatory surgery center has used to successfully combat lateral violence in the workplace.

  16. Modifications to the postanesthesia score for use in ambulatory surgery.

    Science.gov (United States)

    Aldrete, J A

    1998-06-01

    The Aldrete Score has withstood the changes in anesthesia and surgical care that have developed in the past three decades. Nevertheless, it is imperative that (1) a modification is made to incorporate the most effective monitor of the respiratory and hemodynamic functions, e.g., pulse oximetry; and (2) the five indices previously used be expanded by incorporating five more indices including dressing, pain, ambulation, fasting/feeding, and urine output to evaluate patients undergoing ambulatory surgery and anesthesia. A patient's recovery from anesthesia and surgery, using 10 indices graded 0, 1, or 2, would provide criteria for street fitness and discharge to home when the patient reaches a postanesthesia recovery score of 18 or higher.

  17. [Approach to the patient in the ambulatory surgery unit].

    Science.gov (United States)

    Cordero-Ponce, Montserrat; Romero-Sánchez, Isabel María; López-Barea, José; Martínez-Ramos, Pablo

    2008-01-01

    Ambulatory surgery aims to improve the quality of care, provide services in an environment closer to users' normal surroundings, reduce the risk of nosocomial infection and release hospital beds for other uses demanded by the population, thus reducing health costs. Nursing activity in these units should aim to restore health and aid the rapid recovery of patients in their homes. To achieve this, an effective health education program is required. Such programs should be simple and, at the same time, cover the care that these patients will require during the recovery period at home. The unit covers patients in the Virgen de Rocío University Hospital, The Fleming Peripheral Center for Specialties and the Virgen de los Reyes Peripheral Center for Specialties in Seville, Spain and the the specialties included are plastic surgery, otorhinolaryngology, orthopedic surgery, urology, and general surgery. The duration of the education program will be at most 14-17 h.

  18. Ambulatory Blood Pressure Monitoring – Clinical Practice Recommendations

    Directory of Open Access Journals (Sweden)

    Katalin Mako

    2016-09-01

    Full Text Available Ambulatory blood pressure monitoring (ABPM became a subject of considerable scientific interest. Due to the increasing use of the ABPM in everyday clinical practice it is important that all the users have a correct knowledge on the clinical indications, the methodology of using the device including some technical issues and the interpretation of results. In the last years several guidelines and position papers have been published with recommendations for the monitoring process, reference values, for clinical practice and research. This paper represents a summary of the most important aspects related to the use of ABPM in daily practice, being a synthesis of recommendations from the recent published guidelines and position papers. This reference article presents the practical and technical issues of ABPM, the use of this method in special situations, the clinical interpretation of measured values including the presentation of different ABPM patterns, derived parameters, the prognostic significance and the limitations of this method.

  19. Using cadence to study free-living ambulatory behaviour.

    Science.gov (United States)

    Tudor-Locke, Catrine; Rowe, David A

    2012-05-01

    The health benefits of a physically active lifestyle across a person's lifespan have been established. If there is any single physical activity behaviour that we should measure well and promote effectively, it is ambulatory activity and, more specifically, walking. Since public health physical activity guidelines include statements related to intensity of activity, it follows that we need to measure and promote free-living patterns of ambulatory activity that are congruent with this intent. The purpose of this review article is to present and summarize the potential for using cadence (steps/minute) to represent such behavioural patterns of ambulatory activity in free-living. Cadence is one of the spatio-temporal parameters of gait or walking speed. It is typically assessed using short-distance walks in clinical research and practice, but free-living cadence can be captured with a number of commercially available accelerometers that possess time-stamping technology. This presents a unique opportunity to use the same metric to communicate both ambulatory performance (assessed under testing conditions) and behaviour (assessed in the real world). Ranges for normal walking cadence assessed under laboratory conditions are 96-138 steps/minute for women and 81-135 steps/minute for men across their lifespan. The correlation between mean cadence and intensity (assessed with indirect calorimetry and expressed as metabolic equivalents [METs]) based on five treadmill/overground walking studies, is r = 0.93 and 100 steps/minute is considered to be a reasonable heuristic value indicative of walking at least at absolutely-defined moderate intensity (i.e. minimally, 3 METs) in adults. The weighted mean cadence derived from eight studies that have observed pedestrian cadence under natural conditions was 115.2 steps/minute, demonstrating that achieving 100 steps/minute is realistic in specific settings that occur in real life. However, accelerometer data collected in a large

  20. Vapor intrusion attenuation factors relative to subslab and source, reconsidered in light of background data.

    Science.gov (United States)

    Yao, Yijun; Wu, Yun; Suuberg, Eric M; Provoost, Jeroen; Shen, Rui; Ma, Jianqing; Liu, Jing

    2015-04-09

    The basis upon which recommended attenuation factors for vapor intrusion (VI) have been derived are reconsidered. By making a fitting curve to the plot showing the dependence of observed indoor air concentration (c(in)) on subslab concentration (c(ss)) for residences in EPA database, an analytical equation is obtained to identify the relationship among c(in), css and the averaged background level. The new relationship indicates that subslab measurements may serve as a useful guide only if c(ss) is above 500 μg/m(3). Otherwise, c(in) is independent of c(ss), with a distribution in good agreements with other studies of background levels. Therefore, employing this screening value (500 μg/m(3)), new contaminant concentration attenuation factors are proposed for VI, and the values for groundwater-to-indoor and subslab-to-indoor air concentration attenuation factors are 0.004 and 0.02, respectively. The former is applied to examining the reported temporal variations of c(in) obtained during a long-term monitoring study. The results show that using this new groundwater-to-indoor air concentration attenuation factor also provides a reasonably conservative estimate of c(in).

  1. Vapor intrusion attenuation factors relative to subslab and source, reconsidered in light of background data

    Science.gov (United States)

    Yao, Yijun; Wu, Yun; Suuberg, Eric M.; Provoost, Jeroen; shen, Rui; Ma, Jianqing; Liu, Jing

    2016-01-01

    The basis upon which recommended attenuation factors for vapor intrusion (VI) have been derived are reconsidered. By making a fitting curve to the plot showing the dependence of observed indoor air concentration (cin) on subslab concentration (css) for residences in EPA database, an analytical equation is obtained to identify the relationship among cin, css and the averaged background level. The new relationship indicates that subslab measurements may serve as a useful guide only if css is above 500 μg / m3. Otherwise, cin is independent of css, with a distribution in good agreements with other studies of background levels. Therefore, employing this screening value (500 μg / m3), new contaminant concentration attenuation factors are proposed for VI, and the values for groundwater-to-indoor and subslab-to-indoor air concentration attenuation factors are 0.004 and 0.02, respectively. The former is applied to examining the reported temporal variations of cin obtained during a long-term monitoring study. The results show that using this new groundwater-to-indoor air concentration attenuation factor also provides a reasonably conservative estimate of cin. PMID:25618001

  2. A Cyclodissipativity Condition for Power Factor Improvement under Nonsinusoidal Source with Significant Impedance

    NARCIS (Netherlands)

    Puerto-Flores, Dunstano del; Ortega, Romeo; Scherpen, Jacquelien M.A.

    2010-01-01

    The main contribution of this paper is an extension of a recent result that reformulates and solves the power factor compensation for nonlinear loads under nonsinusoidal regime in terms of cyclodissipativity. In the aforementioned result the generator was assumed to be ideal, that is, with negligibl

  3. Vapor intrusion attenuation factors relative to subslab and source, reconsidered in light of background data

    OpenAIRE

    Yao, Yijun; Wu, Yun; Suuberg, Eric M.; Provoost, Jeroen; Shen, Rui; Ma, Jianqing; Jing LIU

    2015-01-01

    The basis upon which recommended attenuation factors for vapor intrusion (VI) have been derived are reconsidered. By making a fitting curve to the plot showing the dependence of observed indoor air concentration (cin) on subslab concentration (css) for residences in EPA database, an analytical equation is obtained to identify the relationship among cin, css and the averaged background level. The new relationship indicates that subslab measurements may serve as a useful guide only if css is ab...

  4. Generic uniqueness of a structured matrix factorization and applications in blind source separation

    OpenAIRE

    Domanov, Ignat; De Lathauwer, Lieven

    2016-01-01

    Algebraic geometry, although little explored in signal processing, provides tools that are very convenient for investigating generic properties in a wide range of applications. Generic properties are properties that hold "almost everywhere". We present a set of conditions that are sufficient for demonstrating the generic uniqueness of a certain structured matrix factorization. This set of conditions may be used as a checklist for generic uniqueness in different settings. We discuss two partic...

  5. Informed Source Separation of Atmospheric and Surface Signal Contributions in Shortwave Hyperspectral Imagery using Non-negative Matrix Factorization

    Science.gov (United States)

    Wright, L.; Coddington, O.; Pilewskie, P.

    2015-12-01

    Current challenges in Earth remote sensing require improved instrument spectral resolution, spectral coverage, and radiometric accuracy. Hyperspectral instruments, deployed on both aircraft and spacecraft, are a growing class of Earth observing sensors designed to meet these challenges. They collect large amounts of spectral data, allowing thorough characterization of both atmospheric and surface properties. The higher accuracy and increased spectral and spatial resolutions of new imagers require new numerical approaches for processing imagery and separating surface and atmospheric signals. One potential approach is source separation, which allows us to determine the underlying physical causes of observed changes. Improved signal separation will allow hyperspectral instruments to better address key science questions relevant to climate change, including land-use changes, trends in clouds and atmospheric water vapor, and aerosol characteristics. In this work, we investigate a Non-negative Matrix Factorization (NMF) method for the separation of atmospheric and land surface signal sources. NMF offers marked benefits over other commonly employed techniques, including non-negativity, which avoids physically impossible results, and adaptability, which allows the method to be tailored to hyperspectral source separation. We adapt our NMF algorithm to distinguish between contributions from different physically distinct sources by introducing constraints on spectral and spatial variability and by using library spectra to inform separation. We evaluate our NMF algorithm with simulated hyperspectral images as well as hyperspectral imagery from several instruments including, the NASA Airborne Visible/Infrared Imaging Spectrometer (AVIRIS), NASA Hyperspectral Imager for the Coastal Ocean (HICO) and National Ecological Observatory Network (NEON) Imaging Spectrometer.

  6. Factors of impact on the evolution of electricity markets from renewable energy sources: a comparison between Romania and Germany

    Directory of Open Access Journals (Sweden)

    Clodnițchi Roxana

    2015-06-01

    Full Text Available When talking about the future of Europe we also think about alternative energy sources. It is up to national governments to decide how to encourage investments in this field in order to contribute to the 20-20-20 EU-objective. Until the network delivery cost for electricity produced from renewable sources will be comparable to the cost for energy from traditional sources ("grid parity", the development of businesses and markets for electricity from renewable sources is going to be driven by support schemes. The state of the grids and the facility of grid-access constitute another two key factors influencing the development of this sector. Last but not least, the question of policy consistency is raised within the business community. Over the past years some support schemes have proved to be more effective than others, and grid conditions have also evolved. Policies supporting the development of renewables also changed at EU-level and at national levels. Based on statistics, scientific literature and the feedback of the business community, this study aims to analyse the development of renewable energy sectors in the European Union by comparing Germany’s and Romania’s experience. Also this study describes the current and expected future market situation in these countries relying on data gained from questionnaires and interviews with specialists in the renewable field.

  7. Factors associated with sources, transport, and fate of chloroform and three other trihalomethanes in untreated groundwater used for drinking water

    Science.gov (United States)

    Carter, Janet M.; Moran, Michael J.; Zogorski, John S.; Price, Curtis V.

    2012-01-01

    Multiple lines of evidence for indicating factors associated with the sources, transport, and fate of chloroform and three other trihalomethanes (THMs) in untreated groundwater were revealed by evaluating low-level analytical results and logistic regression results for THMs. Samples of untreated groundwater from wells used for drinking water were collected from 1996-2007 from 2492 wells across the United States and analyzed for chloroform, bromodichloromethane, dibromochloromethane, and bromoform by a low-level analytical method implemented in April 1996. Using an assessment level of 0.02 μg/L, chloroform was detected in 36.5% of public-well samples and 17.6% of domestic-well samples, with most concentrations less than 1 μg/L. Brominated THMs occurred less frequently than chloroform but more frequently in public-well samples than domestic-well samples. For both public and domestic wells, THMs occurred most frequently in urban areas. Logistic regression analyses showed that the occurrence of THMs was related to nonpoint sources such as urban land use and to point sources like septic systems. The frequent occurrence and concentration distribution pattern of THMs, as well as their frequent co-occurrence with other organic compounds and nitrate, all known to have anthropogenic sources, and the positive associations between THM occurrence and dissolved oxygen and recharge indicate the recycling of water that contains THMs and other anthropogenic contaminants.

  8. Reasons for Journal Impact Factor Changes: Influence of Changing Source Items.

    Science.gov (United States)

    Kiesslich, Tobias; Weineck, Silke B; Koelblinger, Dorothea

    2016-01-01

    Both the concept and the application of the impact factor (IF) have been subject to widespread critique, including concerns over its potential manipulation. This study provides a systematic analysis of significant journal Impact Factor changes, based on the relative contribution of either one or both variables of the IF equation (i.e. citations / articles as the numerator / denominator of the quotient). A cohort of JCR-listed journals which faced the most dramatic absolute IF changes between 2013 and 2014 (ΔIF ≥ 3.0, n = 49) was analyzed for the causes resulting in IF changes that theses journals have experienced in the last five years. Along with the variation by number of articles and citations, this analysis includes the relative change of both variables compared to each other and offers a classification of `valid`and `invalid`scenarios of IF variation in terms of the intended goal of the IF to measure journal quality. The sample cohort features a considerable incidence of IF increases (18%) which are qualified as `invalid`according to this classification because the IF increase is merely based on a favorably changing number of articles (denominator). The results of this analysis point out the potentially delusive effect of IF increases gained through effective shrinkage of publication output. Therefore, careful consideration of the details of the IF equation and possible implementation of control mechanisms versus the volatile factor of number of articles may help to improve the expressiveness of this metric.

  9. Reasons for Journal Impact Factor Changes: Influence of Changing Source Items

    Science.gov (United States)

    2016-01-01

    Both the concept and the application of the impact factor (IF) have been subject to widespread critique, including concerns over its potential manipulation. This study provides a systematic analysis of significant journal Impact Factor changes, based on the relative contribution of either one or both variables of the IF equation (i.e. citations / articles as the numerator / denominator of the quotient). A cohort of JCR-listed journals which faced the most dramatic absolute IF changes between 2013 and 2014 (ΔIF ≥ 3.0, n = 49) was analyzed for the causes resulting in IF changes that theses journals have experienced in the last five years. Along with the variation by number of articles and citations, this analysis includes the relative change of both variables compared to each other and offers a classification of `valid`and `invalid`scenarios of IF variation in terms of the intended goal of the IF to measure journal quality. The sample cohort features a considerable incidence of IF increases (18%) which are qualified as `invalid`according to this classification because the IF increase is merely based on a favorably changing number of articles (denominator). The results of this analysis point out the potentially delusive effect of IF increases gained through effective shrinkage of publication output. Therefore, careful consideration of the details of the IF equation and possible implementation of control mechanisms versus the volatile factor of number of articles may help to improve the expressiveness of this metric. PMID:27105434

  10. Validating hyperbilirubinemia and gut mucosal atrophy with a novel ultramobile ambulatory total parenteral nutrition piglet model

    Science.gov (United States)

    Total parenteral nutrition (TPN) provides all nutrition intravenously. Although TPN therapy has grown enormously, it causes significant complications, including gut and hepatic dysfunction. Current models use animal tethering which is unlike ambulatory human TPN delivery and is cost prohibitive. We ...

  11. A 2-wk reduction of ambulatory activity attenuates peripheral insulin sensitivity

    DEFF Research Database (Denmark)

    Krogh-Madsen, Rikke; Thyfault, John P; Broholm, Christa;

    2010-01-01

    US adults take between approximately 2,000 and approximately 12,000 steps per day, a wide range of ambulatory activity that at the low range could increase risk for developing chronic metabolic diseases. Dramatic reductions in physical activity induce insulin resistance; however, it is uncertain...... possible biological cause for the public health problem of Type 2 diabetes has been identified. Reduced ambulatory activity for 2 wk in healthy, nonexercising young men significantly reduced peripheral insulin sensitivity, cardiovascular fitness, and lean leg mass....... if and how low ambulatory activity would influence peripheral insulin sensitivity. We aimed to explore if healthy, nonexercising subjects who went from a normal to a low level of ambulatory activity for 2 wk would display metabolic alterations including reduced peripheral insulin sensitivity. To do this, ten...

  12. Ambulatory Surgical Facilities, Published in 2010, 1:2400 (1in=200ft) scale, Shawano County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Published Reports/Deeds information as of 2010....

  13. Provider practice models in ambulatory oncology practice: analysis of productivity, revenue, and provider and patient satisfaction.

    Science.gov (United States)

    Buswell, Lori A; Ponte, Patricia Reid; Shulman, Lawrence N

    2009-07-01

    Physicians, nurse practitioners, and physician assistants often work in teams to deliver cancer care in ambulatory oncology practices. This is likely to become more prevalent as the demand for oncology services rises, and the number of providers increases only slightly.

  14. Hospitalization for ambulatory care sensitive conditions and the role of primary care in Italian regions.

    Directory of Open Access Journals (Sweden)

    Aldo Rosano

    2011-03-01

    Full Text Available Abstract
    Background: Hospitalization may often be prevented by timely and effective outpatient care either by preventing the onset of an illness, controlling an acute illness or managing a chronic disease with an appropriate follow-up. The objective of the study is to examine the variability of hospital admissions within Italian regions for Ambulatory Care Sensitive Conditions (ACSCs, and their relationship with primary care supply.
    Methods: Hospital discharge data aggregated at a regional level collected in 2005 were analysed by type of ACS conditions. Main outcome measures were regional hospital admission rates for ACSCs. Negative binomial models were used to analyse the association with individual risk factors (age and gender and regional risk factors (propensity to hospitalisation and prevalence of specific conditions.
    Non-parametric correlation indexes between standardised hospital admission rates and quantitative measures of primary care services were calculated.
    Results: ACSC admissions accounted for 6.6% of total admissions, 35.7% were classified as acute conditions and 64.3% as chronic conditions. Admission rates for ACSCs varied widely across Italian regions with different patterns for chronic and acute conditions. Southern regions showed significantly higher rates for chronic conditions and North-eastern regions for acute conditions. We found a significant negative association between the provision of ambulatory specialist services and standardised hospitalization rates
    (SHR for ACS chronic conditions (r=-0.50; p=0.02 and an inverse correlation among SHR for ACS acute conditions and the rate of GPs per 1,000 residents, although the latter was not statistically significant.
    Conclusions: In Italy, about 480,000 inpatient hospital admissions in 2005 were attributable to ACSCs. Even
    adjusting for potential confounders

  15. Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension.

    Science.gov (United States)

    Kiselev, Anton R; Gridnev, Vladimir I; Shvartz, Vladimir A; Posnenkova, Olga M; Dovgalevsky, Pavel Ya

    2012-01-01

    The use of short message services and mobile phone technology for ambulatory care management is the most accessible and most inexpensive way to transition from traditional ambulatory care management to active ambulatory care management in patients with arterial hypertension (AH). The aim of this study was to compare the clinical efficacy of active ambulatory care management supported by short message services and mobile phone technology with traditional ambulatory care management in AH patients. The study included 97 hypertensive patients under active ambulatory care management and 102 patients under traditional ambulatory care management. Blood pressure levels, body mass, and smoking history of patients were analyzed in the study. The duration of study was 1 year. In the active ambulatory care management group, 36% of patients were withdrawn from the study within a year. At the end of the year, 77% of patients from the active care management group had achieved the goal blood pressure level. That was more than 5 times higher than that in the traditional ambulatory care management group (P mobile phone improves the quality of ambulatory care of hypertensive patients.

  16. Particulate emission factors for mobile fossil fuel and biomass combustion sources.

    Science.gov (United States)

    Watson, John G; Chow, Judith C; Chen, L-W Antony; Lowenthal, Douglas H; Fujita, Eric M; Kuhns, Hampden D; Sodeman, David A; Campbell, David E; Moosmüller, Hans; Zhu, Dongzi; Motallebi, Nehzat

    2011-05-15

    PM emission factors (EFs) for gasoline- and diesel-fueled vehicles and biomass combustion were measured in several recent studies. In the Gas/Diesel Split Study (GD-Split), PM(2.5) EFs for heavy-duty diesel vehicles (HDDV) ranged from 0.2 to ~2 g/mile and increased with vehicle age. EFs for HDDV estimated with the U.S. EPA MOBILE 6.2 and California Air Resources Board (ARB) EMFAC2007 models correlated well with measured values. PM(2.5) EFs measured for gasoline vehicles were ~two orders of magnitude lower than those for HDDV and did not correlate with model estimates. In the Kansas City Study, PM(2.5) EFs for gasoline-powered vehicles (e.g., passenger cars and light trucks) were generally fuel, corresponding to 0.3 and 2 g/mile, respectively. These values are comparable to those of on-road HDDV. EFs for biomass burning measured during the Fire Laboratory at Missoula Experiment (FLAME) were compared with EFs from the ARB Emission Estimation System (EES) model. The highest PM(2.5) EFs (76.8±37.5 g/kg) were measured for wet (>50% moisture content) Ponderosa Pine needles. EFs were generally fuels with low moisture content but underestimated measured EFs for fuel with moisture content >40%. Average EFs for dry chamise, rice straw, and dry grass were within a factor of three of values adopted by ARB in California's San Joaquin Valley (SJV). Discrepancies between measured and modeled emission factors suggest that there may be important uncertainties in current PM(2.5) emission inventories.

  17. Understanding the connection between spiritual well-being and physical health: an examination of ambulatory blood pressure, inflammation, blood lipids and fasting glucose.

    Science.gov (United States)

    Holt-Lunstad, Julianne; Steffen, Patrick R; Sandberg, Jonathan; Jensen, Bryan

    2011-12-01

    Growing research has demonstrated a link between spiritual well-being and better health; however, little is known about possible physiological mechanisms. In a sample of highly religious healthy male and female adults (n = 100) ages 19-59 (m = 28.28) we examined the influence of spiritual well-being, as measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-Ex), on physiological risk factors for heart disease. Specifically we examined 24-h ambulatory blood pressure (BP), inflammation (hs-C-reactive protein), fasting glucose, and blood lipids. Regression analyses reveal that higher levels of spiritual-wellness (total FACIT-Sp-Ex score) was significantly related to lower systolic ambulatory BP (β = -.345; P < .001), diastolic ambulatory BP (β = -.24; P = .02), hs-C-reactive protein (β = -.23; P = .04), fasting glucose (β = -.28; P = .006), and marginally lower triglycerides (β = -.21; P = .09) and VLDL (β = -.21; P = .10) controlling for age, gender, and church attendance. Results remained generally consistent across the Meaning, Peace, Faith and Additional Spiritual Concerns subscales of the FACIT-Sp-Ex. Spiritual well-being may be cardio protective.

  18. Clinical Factors Associated with Lamina Cribrosa Thickness in Patients with Glaucoma, as Measured with Swept Source Optical Coherence Tomography

    OpenAIRE

    Omodaka, Kazuko; Takahashi, Seri; Matsumoto, Akiko; Maekawa, Shigeto; Kikawa, Tsutomu; Himori, Noriko; Takahashi, Hidetoshi; Maruyama, Kazuichi; Kunikata, Hiroshi; Akiba, Masahiro; Nakazawa, Toru

    2016-01-01

    Purpose To investigate the influence of various risk factors on thinning of the lamina cribrosa (LC), as measured with swept-source optical coherence tomography (SS-OCT; Topcon). Methods This retrospective study comprised 150 eyes of 150 patients: 22 normal subjects, 28 preperimetric glaucoma (PPG) patients, and 100 open-angle glaucoma patients. Average LC thickness was determined in a 3 x 3 mm cube scan of the optic disc, over which a 4 x 4 grid of 16 points was superimposed (interpoint dist...

  19. Social class based on occupation is associated with hospitalization for A(H1N1)pdm09 infection. Comparison between hospitalized and ambulatory cases.

    Science.gov (United States)

    Pujol, J; Godoy, P; Soldevila, N; Castilla, J; González-Candelas, F; Mayoral, J M; Astray, J; Garcia, S; Martin, V; Tamames, S; Delgado, M; Domínguez, A

    2016-03-01

    This study aimed to analyse the existence of an association between social class (categorized by type of occupation) and the occurrence of A(H1N1)pmd09 infection and hospitalization for two seasons (2009-2010 and 2010-2011). This multicentre study compared ambulatory A(H1N1)pmd09 confirmed cases with ambulatory controls to measure risk of infection, and with hospitalized A(H1N1)pmd09 confirmed cases to asses hospitalization risk. Study variables were: age, marital status, tobacco and alcohol use, pregnancy, chronic obstructive pulmonary disease, chronic respiratory failure, cardiovascular disease, diabetes, chronic liver disease, body mass index >40, systemic corticosteroid treatment and influenza vaccination status. Occupation was registered literally and coded into manual and non-manual worker occupational social class groups. A conditional logistic regression analysis was performed. There were 720 hospitalized cases, 996 ambulatory cases and 1062 ambulatory controls included in the study. No relationship between occupational social class and A(H1N1)pmd09 infection was found [adjusted odds ratio (aOR) 0·97, 95% confidence interval (CI) 0·74-1·27], but an association (aOR 1·53, 95% CI 1·01-2·31) between occupational class and hospitalization for A(H1N1)pmd09 was observed. Influenza vaccination was a protective factor for A(H1N1)pmd09 infection (aOR 0·41, 95% CI 0·23-0·73) but not for hospitalization. We conclude that manual workers have the highest risk of hospitalization when infected by influenza than other occupations but they do not have a different probability of being infected by influenza.

  20. Patient satisfaction and acceptability: a journey through an ambulatory gynaecology clinic in the West of Ireland

    LENUS (Irish Health Repository)

    Uzochukwu, I

    2016-06-01

    Ambulatory Gynaecology allows a “see-and-treat” approach to managing gynaecological conditions, providing a more streamlined, integrated care pathway than the traditional gynaecology clinic and inpatient care model. This study was designed to assess patient satisfaction and acceptability of Ambulatory Gynaecology services in Mayo University Hospital, Castlebar, Ireland. It also provided for feedback from patients as to how the service might be improved. \\r\

  1. Vascular calcification is not associated with increased ambulatory central aortic systolic pressure in prevalent dialysis patients

    Science.gov (United States)

    Freercks, Robert J; Swanepoel, Charles R; Turest-Swartz, Kristy L; Rayner, Brian L; Carrara, Henri RO; Moosa, Sulaiman EI; Lachman, Anthony S

    2014-01-01

    Summary Introduction Central aortic systolic pressure (CASP) strongly predicts cardiovascular outcomes. We undertook to measure ambulatory CASP in 74 prevalent dialysis patients using the BPro (HealthStats, Singapore) device. We also determined whether coronary or abdominal aortic calcification was associated with changes in CASP and whether interdialytic CASP predicted ambulatory measurement. Methods All patients underwent computed tomography for coronary calcium score, lateral abdominal radiography for aortic calcium score, echocardiography for left ventricular mass index and ambulatory blood pressure measurement using BPro calibrated to brachial blood pressure. HealthStats was able to convert standard BPro SOFT® data into ambulatory CASP. Results Ambulatory CASP was not different in those without and with coronary (137.6 vs 141.8 mmHg, respectively, p = 0.6) or aortic (136.6 vs 145.6 mmHg, respectively, p = 0.2) calcification. Furthermore, when expressed as a percentage of brachial systolic blood pressure to control for peripheral blood pressure, any difference in CASP was abolished: CASP: brachial systolic blood pressure ratio = 0.9 across all categories regardless of the presence of coronary or aortic calcification (p = 0.2 and 0.4, respectively). Supporting this finding, left ventricular mass index was also not different in those with or without vascular calcification (p = 0.7 and 0.8 for coronary and aortic calcification). Inter-dialytic office blood pressure and CASP correlated excellently with ambulatory measurements (r = 0.9 for both). Conclusion Vascular calcification was not associated with changes in ambulatory central aortic systolic pressure in this cohort of prevalent dialysis patients. Inter-dialytic blood pressure and CASP correlated very well with ambulatory measurement. PMID:24626513

  2. Low Lorentz Factor Jets from Compact Stellar Mergers - Candidate Electromagnetic Counterparts to Gravitational Wave Sources

    CERN Document Server

    Lamb, Gavin P

    2016-01-01

    Short gamma-ray bursts (GRBs) are believed to be produced by relativistic jets from mergers of neutron stars (NS) and/or black holes (BH). If the Lorentz factors $\\Gamma$ of jets from compact stellar mergers follow a similar power-law distribution as those observed for other high energy astrophysical phenomena (e.g. blazars, AGN), the population of jets would be dominated by low-$\\Gamma$ outflow. These jets will not produce GRB (i.e. the prompt gamma-rays), but their jet energy will be released as optical and radio transients when they collide into the ambient medium. By using simple Monte Carlo simulations, we study the properties of such transient events. Approximately $78 \\%$ of merger jets within 300 Mpc distance will result in a failed GRB if the jet Lorentz factor follows a power-law distribution of index $-1.75$. Optical transients associated with such failed GRBs will have rather broad distributions of the characteristics: the light curve peaks $t_p \\sim 0.1-10$ days after a merger with a peak flux $m...

  3. Measurement of the low-energy quenching factor in germanium using an 88Y/Be photoneutron source

    Science.gov (United States)

    Scholz, B. J.; Chavarria, A. E.; Collar, J. I.; Privitera, P.; Robinson, A. E.

    2016-12-01

    We employ an 88Y/Be photoneutron source to derive the quenching factor for neutron-induced nuclear recoils in germanium, probing recoil energies from a few hundred eVnr to 8.5 keVnr . A comprehensive Monte Carlo simulation of our setup is compared to experimental data employing a Lindhard model with a free electronic energy loss k and an adiabatic correction for sub -keVnr nuclear recoils. The best fit k =0.179 ±0.001 obtained using a Monte Carlo Markov chain (MCMC) ensemble sampler is in good agreement with previous measurements, confirming the adequacy of the Lindhard model to describe the stopping of few-keV ions in germanium crystals at a temperature of ˜77 K . This value of k corresponds to a quenching factor of 13.7% to 25.3% for nuclear recoil energies between 0.3 and 8.5 keVnr , respectively.

  4. Source and transport factors influencing storm phosphorus losses in agricultural catchments

    Science.gov (United States)

    Shore, Mairead; Jordan, Phil; Mellander, Per-Erik; kelly-quinn, Mary; Wall, David; Murphy, Paul; Melland, Alice

    2014-05-01

    The relative risk of diffuse phosphorus (P) loss from agricultural land was assessed in a well-drained arable catchment and a poorly-drained grassland catchment and in two nested basins within each catchment. This research investigated the relative control of hydrology and soil P on P losses between basins. Quick flow (QF) P losses (defined here as both concentrations and loads), monitored in stream flow during four storm events, were compared with a dynamic metric of transport risk (QF magnitude) and a static metric of critical source area (CSA) risk (extent of highly-connected poorly-drained soils with excess plant-available soil P). The potential for static transport metrics of soil connectivity and soil drainage class, to predict relative QF magnitudes and P losses between basins was also investigated. In basins with similar CSA risk but with contrasting QF magnitudes, mean TRP (total molybdate-reactive P) losses were consistently higher in the basins which had the highest QF magnitudes. This suggests that basin hydrology, rather than hydrology of high-P soils only, determined relative TRP losses between hydrologically contrasting basins. Furthermore, static transport metrics of soil connectivity and soil drainage class reliably discerned relative QF magnitudes and TRP losses between these basins. However, for two of the storm events (both occurring during the hydrologically active season), PP (particulate P) concentrations were frequently higher in basins which had the lowest QF magnitudes and may be attributed to a higher proportion of bare soil in these basins at these times as a result of their predominantly arable nature. In basins with similar hydrology, relative TRP and PP losses did not reflect trends in CSA risk or QF magnitude. The dynamics of TRP and PP losses and QF magnitude between these basins varied across storms, thus could not be predicted using static metrics. Where differences in hydrological dynamics were large, storm TRP losses were well

  5. Increased visceral adipose tissue as a potential risk factor in patients with embolic stroke of undetermined source (ESUS.

    Directory of Open Access Journals (Sweden)

    Antti T Muuronen

    Full Text Available The etiology of an ischemic stroke remains undetermined in 20-35% of cases and many patients do not have any of the conventional risk factors. Increased visceral adipose tissue (VAT is a suggested new risk factor for both carotid artery atherosclerosis (CAA and atrial fibrillation (AF, but its role in the remaining stroke population is unknown. We assessed the amount of VAT in patients with embolic stroke of undetermined source (ESUS after excluding major-risk cardioembolic sources, occlusive atherosclerosis, and lacunar stroke.Altogether 58 patients (mean age 57.7 ± 10.2 years, 44 men with ischemic stroke of unknown etiology but without CAA, known AF or small vessel disease underwent computed tomography angiography and assessment of VAT. For comparison VAT values from three different reference populations were used. Conventional risk factors (smoking, hypertension, diabetes, increased total and LDL-cholesterol, decreased HDL-cholesterol were also registered.Mean VAT area was significantly higher in stroke patients (205 ± 103 cm2 for men and 168 ± 99 cm2 for women compared to all reference populations (P < 0.01. 50% of male and 57% of female patients had an increased VAT area. In male patients, VAT was significantly higher despite similar body mass index (BMI. Increased VAT was more common than any of the conventional risk factors.Increased VAT was found in over half of our patients with ESUS suggesting it may have a role in the pathogenesis of thromboembolism in this selected group of patients.

  6. National Ambulatory Medical Care Survey: tobacco intervention practices in outpatient clinics.

    Science.gov (United States)

    Payne, Thomas J; Chen, Chieh-I; Baker, Christine L; Shah, Sonali N; Pashos, Chris L; Boulanger, Luke

    2012-09-01

    Tobacco use remains the leading cause of preventable death. The outpatient medical clinic represents an important venue for delivering evidence-based interventions to large numbers of tobacco users. Extensive evidence supports the effectiveness of brief interventions. In a retrospective database analysis of 11,827 adult patients captured in the 2005 National Ambulatory Medical Care Survey (of which 2,420 were tobacco users), we examined the degree to which a variety of patient demographic, clinical and physician-related variables predict the delivery of tobacco counseling during a routine outpatient visit in primary care settings. In 2005, 21.7% of identified tobacco users received a tobacco intervention during their visit. The probability of receiving an intervention differed by gender, geographic region and source of payment. Individuals presenting with tobacco-related health conditions were more likely to receive an intervention. Most physicians classified as specialists were less likely to intervene. The provision of tobacco intervention services appears to be increasing at a modest rate, but remains well below desirable levels. It is a priority that brief interventions be routinely implemented to reduce the societal burden of tobacco use.

  7. Parotid gland is the main source of human salivary epidermal growth factor

    Energy Technology Data Exchange (ETDEWEB)

    Thesleff, I.; Viinikka, L.; Saxen, L.; Lehtonen, E.; Perheentupa, J.

    1988-01-01

    To clarify the production of human epidermal growth factor (EGF) by different salivary glands, the authors measured its concentration by radioimmunoassay separately in whole saliva, in parotid gland (PG) saliva and in mixed submandibular (SMG) and sublingual gland (SLG) saliva. Also, they studied the presence of EGF in PG and SMG by immunohistochemistry. The mean concentrations of EDG in PG saliva was higher than in whole saliva, which in turn was higher than in mixed SMG + SLG saliva. No sex difference existed in any salivary gland EGF. Immunohistochemistry revealed EGF in the acinar cells of both PG and SMG, buy only in PG there were prominent EDG deposits in luminal spaces. Their data suggest that EDG is produced by both PG and SMG, but that more of it is secreted from the PG. This result is new and challenges the general view that human salivary EDG is mainly from SMG.

  8. Blind Source Separation of Hemodynamics from Magnetic Resonance Perfusion Brain Images Using Independent Factor Analysis

    Directory of Open Access Journals (Sweden)

    Yen-Chun Chou

    2010-01-01

    Full Text Available Perfusion magnetic resonance brain imaging induces temporal signal changes on brain tissues, manifesting distinct blood-supply patterns for the profound analysis of cerebral hemodynamics. We employed independent factor analysis to blindly separate such dynamic images into different maps, that is, artery, gray matter, white matter, vein and sinus, and choroid plexus, in conjunction with corresponding signal-time curves. The averaged signal-time curve on the segmented arterial area was further used to calculate the relative cerebral blood volume (rCBV, relative cerebral blood flow (rCBF, and mean transit time (MTT. The averaged ratios for rCBV, rCBF, and MTT between gray and white matters for normal subjects were congruent with those in the literature.

  9. Elucidating the factors influencing the biodegradation of cylindrospermopsin in drinking water sources.

    Science.gov (United States)

    Smith, Maree J; Shaw, Glen R; Eaglesham, Geoff K; Ho, Lionel; Brookes, Justin D

    2008-06-01

    The cyanotoxin cylindrospermopsin (CYN) is produced by several species of cyanobacteria and can be persistent in drinking waters supplies, which is of major concern to water authorities because of its potential to severely compromise human health. Consequently, there is a need to fully understand the persistence of CYN in water supplies, in particular, to determine whether this toxin is readily degraded by endemic aquatic organisms. This study provides insights into the environmental factors that can influence the biodegradation of this toxin in Australian drinking water supplies. Biodegradation of CYN was only evident in water supplies that had a history of toxic Cylindrospermopsis raciborskii blooms. In addition, lag periods were evident prior to the onset of biodegradation; however, repeated exposure of the endemic organisms to CYN resulted in substantial decreases in the lag periods. Furthermore, the concentration of CYN was shown to influence biodegradation with a near linear relationship (R(2) of 0.9549) existing between the biodegradation rate and the initial CYN concentration. Temperature was also shown to affect the biodegradation of CYN, which is important since CYN is now being detected in more temperate climates. The presence of copper-based algicides inhibited CYN degradation, which has significant implications since copper-based algicides are commonly used to control cyanobacterial growth in water bodies. The results from this study indicate that the biodegradation of CYN in natural water bodies is a complex process that can be influenced by many environmental factors, some of which include CYN concentration, temperature, and the presence of copper-based algicides.

  10. Factors Affecting Source-Water Quality after Disturbance of Forests by Wildfire

    Science.gov (United States)

    Murphy, S. F.; Martin, D. A.; McCleskey, R. B.; Writer, J. H.

    2015-12-01

    Forests yield high-quality water supplies to communities throughout the world, in part because forest cover reduces flooding and the consequent transport of suspended and dissolved constituents to surface water. Disturbance by wildfire reduces or eliminates forest cover, leaving watersheds susceptible to increased surface runoff during storms and reduced ability to retain contaminants. We assessed water-quality response to hydrologic events for three years after a wildfire in the Fourmile Creek Watershed, near Boulder, Colorado, and found that hydrologic and geochemical responses downstream of a burned area were primarily driven by small, brief convective storms that had relatively high, but not unusual, rainfall intensity. Total suspended sediment, dissolved organic carbon, nitrate, and manganese concentrations were 10-156 times higher downstream of a burned area compared to upstream, and water quality was sufficiently impaired to pose water-treatment concerns. The response in both concentration and yield of water-quality constituents differed depending on source availability and dominant watershed processes controlling the constituent. For example, while all constituent concentrations were highest during storm events, annual sediment yields downstream of the burned area were controlled by storm events and subsequent mobilization, whereas dissolved organic carbon yields were more dependent on spring runoff from upstream areas. The watershed response was affected by a legacy of historical disturbance: the watershed had been recovering from extensive disturbance by mining, railroad and road development, logging, and fires in the late 19th and early 20th centuries, and we observed extensive erosion of mine waste in response to these summer storms. Therefore, both storm characteristics and historical disturbance in a burned watershed must be considered when evaluating the role of wildfire on water quality.

  11. A critical source area phosphorus index with topographic transport factors using high resolution LiDAR digital elevation models

    Science.gov (United States)

    Thomas, Ian; Murphy, Paul; Fenton, Owen; Shine, Oliver; Mellander, Per-Erik; Dunlop, Paul; Jordan, Phil

    2015-04-01

    A new phosphorus index (PI) tool is presented which aims to improve the identification of critical source areas (CSAs) of phosphorus (P) losses from agricultural land to surface waters. In a novel approach, the PI incorporates topographic indices rather than watercourse proximity as proxies for runoff risk, to account for the dominant control of topography on runoff-generating areas and P transport pathways. Runoff propensity and hydrological connectivity are modelled using the Topographic Wetness Index (TWI) and Network Index (NI) respectively, utilising high resolution digital elevation models (DEMs) derived from Light Detection and Ranging (LiDAR) to capture the influence of micro-topographic features on runoff pathways. Additionally, the PI attempts to improve risk estimates of particulate P losses by incorporating an erosion factor that accounts for fine-scale topographic variability within fields. Erosion risk is modelled using the Unit Stream Power Erosion Deposition (USPED) model, which integrates DEM-derived upslope contributing area and Universal Soil Loss Equation (USLE) factors. The PI was developed using field, sub-field and sub-catchment scale datasets of P source, mobilisation and transport factors, for four intensive agricultural catchments in Ireland representing different agri-environmental conditions. Datasets included soil test P concentrations, degree of P saturation, soil attributes, land use, artificial subsurface drainage locations, and 2 m resolution LiDAR DEMs resampled from 0.25 m resolution data. All factor datasets were integrated within a Geographical Information System (GIS) and rasterised to 2 m resolution. For each factor, values were categorised and assigned relative risk scores which ranked P loss potential. Total risk scores were calculated for each grid cell using a component formulation, which summed the products of weighted factor risk scores for runoff and erosion pathways. Results showed that the new PI was able to predict

  12. Risk factors for campylobacteriosis of chicken, ruminant, and environmental origin: a combined case-control and source attribution analysis.

    Directory of Open Access Journals (Sweden)

    Lapo Mughini Gras

    factors for campylobacteriosis are investigated in relation to the attributed reservoirs based on MLST profiles. Combining epidemiological and source attribution data improved campylobacteriosis risk factor identification and characterization, generated hypotheses, and showed that genotype-based source attribution is epidemiologically sensible.

  13. Relationship between width of pulses and Lorentz factor expected from the light curve of fireball sources

    Institute of Scientific and Technical Information of China (English)

    Zhang Fu-Wen; Qin Yi-Ping

    2005-01-01

    Time profiles of many gamma-ray bursts consist of distinct pulses, which provides a possibility of characterizing the temporal structure of these bursts. We employ a simple model of highly symmetric fireballs to analyse the effect of the expansion speed on the light curve arising from different forms of local pulses. The relationship between the ratio r of the FWHM width of the rising phase of the light curve to that of the decaying phase and the Lorentz factor is investigated. The analysis shows that, when the rest frame radiation form is ignored, temporal profiles of the light curve arising from pulses of fireballs will not be affected by the expansion speed (that is, r is almost a constant) as long as the fireball expands relativistically. When the rest frame radiation form is taken into account, there will be a break in the curves of r - log Γ. The location of the break depends mainly on the adopted value of the rest frame peak frequency v0,p. One would reach almost the same result when a jet is considered. In addition, we utilize a sample of 48individual GRB pulses to check the relationship between the ratio r and the expansion speed Γ. We find no significant correlation between them, and this is consistent with the theoretical analysis.

  14. Extraction Factor Of Tungsten Sources From Tungsten Scraps By Zinc Decomposition Process

    Directory of Open Access Journals (Sweden)

    Pee J.-H.

    2015-06-01

    Full Text Available Decomposition promoting factors and extraction process of tungsten carbide and tungstic acid powders in the zinc decomposition process of tungsten scraps which are composed mostly of tungsten carbide and cobalt were evaluated. Zinc volatility was suppressed by the enclosed graphite crucible and zinc volatilization pressure was produced in the reaction graphite crucible inside an electric furnace for ZDP (Zinc Decomposition Process. Decomposition reaction was done for 2hours at 650°, which 100% decomposed the tungsten scraps that were over 30 mm thick. Decomposed scraps were pulverized under 75μm and were composed of tungsten carbide and cobalt identified by the XRD (X-ray Diffraction. To produce the WC(Tungsten Carbide powder directly from decomposed scraps, pulverized powders were reacted with hydrochloric acid to remove the cobalt binder. Also to produce the tungstic acid, pulverized powders were reacted with aqua regia to remove the cobalt binder and oxidize the tungsten carbide. Tungsten carbide and tungstic acid powders were identified by XRD and chemical composition analysis.

  15. Evaluation of model-simulated source contributions to tropospheric ozone with aircraft observations in the factor-projected space

    Directory of Open Access Journals (Sweden)

    Y. Yoshida

    2008-03-01

    Full Text Available Trace gas measurements of TOPSE and TRACE-P experiments and corresponding global GEOS-Chem model simulations are analyzed with the Positive Matrix Factorization (PMF method for model evaluation purposes. Specially, we evaluate the model simulated contributions to O3 variability from stratospheric transport, intercontinental transport, and production from urban/industry and biomass burning/biogenic sources. We select a suite of relatively long-lived tracers, including 7 chemicals (O3, NOy, PAN, CO, C3H8, CH3Cl, and 7Be and 1 dynamic tracer (potential temperature. The largest discrepancy is found in the stratospheric contribution to 7Be. The model underestimates this contribution by a factor of 2–3, corresponding well to a reduction of 7Be source by the same magnitude in the default setup of the standard GEOS-Chem model. In contrast, we find that the simulated O3 contributions from stratospheric transport are in reasonable agreement with those derived from the measurements. However, the springtime increasing trend over North America derived from the measurements are largely underestimated in the model, indicating that the magnitude of simulated stratospheric O3 source is reasonable but the temporal distribution needs improvement. The simulated O3 contributions from long-range transport and production from urban/industry and biomass burning/biogenic emissions are also in reasonable agreement with those derived from the measurements, although significant discrepancies are found for some regions.

  16. Source apportionment of polycyclic aromatic hydrocarbons in surface sediment of mud areas in the East China Sea using diagnostic ratios and factor analysis.

    Science.gov (United States)

    Deng, Wei; Li, Xian Guo; Li, Sheng Yong; Ma, Yan Yan; Zhang, Da Hai

    2013-05-15

    Polycyclic aromatic hydrocarbons (PAHs) and aliphatic hydrocarbons (AHs) have been quantified for surface sediments collected from the East China Sea (ECS). Our results showed that relatively high levels of PAHs and AHs occurred in both the inner and outer mud areas, while their concentrations at the control site were much lower. AHs for all samples were dominated by the unresolved complex mixture (UCM). Results from diagnostic ratios revealed that sedimentary PAHs were mainly originated from mixed combustion residues of biomass, coal, and petroleum. Combustion residues of petroleum and oil were responsible for the presence of high AHs concentrations. We also conducted factor analysis (FA) to further characterize the PAH and AH sources. Four factors were identified based on the loading of components and attributed to coal and wood combustion (Factor 1), traffic-related sources (Factor 2), petrogenic source (Factor 3) and natural gas combustion (Factor 4).

  17. Male longevity in Sardinia, a review of historical sources supporting a causal link with dietary factors.

    Science.gov (United States)

    Pes, G M; Tolu, F; Dore, M P; Sechi, G P; Errigo, A; Canelada, A; Poulain, M

    2015-04-01

    The identification of a hot spot of exceptional longevity, the Longevity Blue Zone (LBZ), in the mountain population of Sardinia has aroused considerable interest toward its traditional food as one of the potential causal factors. This preliminary study on the traditional Sardinian diet has been supported by the literature available, which has been carefully reviewed and compared. Up to a short time ago, the LBZ population depended mostly upon livestock rearing, and consumption of animal-derived foods was relatively higher than in the rest of the island. The nutrition transition (NT) in urbanized and lowland areas began in the mid-1950s, fueled by economic development, whereas in the LBZ it started later owing to prolonged resistance to change by a society organized around a rather efficient pastoral economy. Even nowadays a large proportion of the population in this area still follows the traditional diet based on cereal-derived foods and dairy products. The LBZ cohorts comprising individuals who were of a mature age when NT began may have benefited both from the high-quality, albeit rather monotonous, traditional diet to which they had been exposed most of their life and from the transitional diet, which introduced positive changes such as more variety, increased consumption of fruits and vegetables and moderate meat intake. It could be speculated that these changes may have brought substantial health benefits to this particular aging group, which was in need of nutrient-rich food at this specific time in life, thereby resulting in a decreased mortality risk and, in turn, life-span extension.

  18. Phylogenetic relationships, virulence factors and Rep-PCR epidemiological analysis of E. coli from human sources

    Directory of Open Access Journals (Sweden)

    Simona Caroppo

    2010-06-01

    Full Text Available The potential of Escherichia coli to cause of extra-intestinal infections was studied on a group of 94 clinical isolates. In this work, 32 E. coli isolates from urinary tract infections, 25 from bacteraemia, 12 from low respiratory tract infections, and 25 from the normal commensal flora were characterized for the phylogenetic type, the virulence factors (VFs carriage and the Rep-PCR clonal composition.The B2 phylogenetic type was predominant among the urinary isolates (59%, the B2 and D strains among the haematic isolates (32% and 32%.The A phylogenetic type was predominant among the commensal and the respiratory isolates (52% and 58% respectively.The distribution of the B2 type strains among the urinary isolates and of the D type strains among the faecal isolates was suggesting a urinary-origin for the B2 phylogenetic type isolates found in the blood and a direct faecal derivation for the haematic isolates with D phylogenetic type.Twenty-nine VFs were analyzed.The B2 and D type strains carried a higher burden of VFs than the A and B1 phylogenetic type strains (average of VFs/strain = 8 vs 3. Some of the VFs were homogeneously distributed among the phylogenetic types (fimH, iutA, fyuA, traT. The PAI, papGII, ibeA, KpsMTIII were exclusive of B2 and D phylogenetic type strains, while sfa/foc, focG, cnf1, hlyA and rfc were exclusively observed among the B2 type strains.The clustering analysis by Rep-PCR distinguished two groups of strains, the first including 96.77% of B2 and D type strains, while the second encompassing 91,5% of A and B1 type strains.

  19. Evaluation of Uncertainties in Measuring Particulate Matter Emission Factors from Atmospheric Fugitive Sources Using Optical Remote Sensing

    Science.gov (United States)

    Yuen, W.; Ma, Q.; Du, K.; Koloutsou-Vakakis, S.; Rood, M. J.

    2015-12-01

    Measurements of particulate matter (PM) emissions generated from fugitive sources are of interest in air pollution studies, since such emissions vary widely both spatially and temporally. This research focuses on determining the uncertainties in quantifying fugitive PM emission factors (EFs) generated from mobile vehicles using a vertical scanning micro-pulse lidar (MPL). The goal of this research is to identify the greatest sources of uncertainty of the applied lidar technique in determining fugitive PM EFs, and to recommend methods to reduce the uncertainties in this measurement. The MPL detects the PM plume generated by mobile fugitive sources that are carried downwind to the MPL's vertical scanning plane. Range-resolved MPL signals are measured, corrected, and converted to light extinction coefficients, through inversion of the lidar equation and calculation of the lidar ratio. In this research, both the near-end and far-end lidar equation inversion methods are considered. Range-resolved PM mass concentrations are then determined from the extinction coefficient measurements using the measured mass extinction efficiency (MEE) value, which is an intensive PM property. MEE is determined by collocated PM mass concentration and light extinction measurements, provided respectively by a DustTrak and an open-path laser transmissometer. These PM mass concentrations are then integrated with wind information, duration of plume event, and vehicle distance travelled to obtain fugitive PM EFs. To obtain the uncertainty of PM EFs, uncertainties in MPL signals, lidar ratio, MEE, and wind variation are considered. Error propagation method is applied to each of the above intermediate steps to aggregate uncertainty sources. Results include determination of uncertainties in each intermediate step, and comparison of uncertainties between the use of near-end and far-end lidar equation inversion methods.

  20. Effects of Ramadan fasting on ambulatory blood pressure in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Maryam Alinezhad Namaghi

    2014-02-01

    Full Text Available Background: Previous studies have indicated that Ramadan fasting has beneficial effects on cardiovascular risk factors, specially blood pressure and heart rate (1. In the present study, the effect of Ramadan fasting on 24-hour ambulatory blood pressure and heart rate has been investigated. Materials and Methods: This prospective observational study was conducted on two groups of individuals. Six patients under hypertension treatment were allocated to the case group and 12 healthy individuals were selected as the control group. Twenty-four-hour blood pressure monitoring was carried out during four periods: prior to Ramadan, during the first ten days and the last ten days of Ramadan, and one month after it. All patients continued their medication, which was administered twice per day. Twenty-four-hour mean blood pressure, weight, body mass index (BMI, and waist circumference were compared among the groups. Results: In the case group, there was a significant reduction in subjects’ weight during the third period of the experiment; also, a significant improvement was observed in the heart rate during the second and third periods in the case group (P

  1. Effects of Ramadan Fasting on Ambulatory Blood Pressure in Hypertensive Patients

    Directory of Open Access Journals (Sweden)

    Maryam Alinezhad Namaghi

    2014-03-01

    Full Text Available Background: Previous studies have indicated that Ramadan fasting has beneficial effects on cardiovascular risk factors, specially blood pressure and heart rate (1. In the present study, the effect of Ramadan fasting on 24-hour ambulatory blood pressure and heart rate has been investigated. Materials and Methods: This prospective observational study was conducted on two groups of individuals. Six patients under hypertension treatment were allocated to the case group and 12 healthy individuals were selected as the control group. Twenty-four-hour blood pressure monitoring was carried out during four periods: prior to Ramadan, during the first ten days and the last ten days of Ramadan, and one month after it. All patients continued their medication, which was administered twice per day. Twenty-four-hour mean blood pressure, weight, body mass index (BMI, and waist circumference were compared among the groups. Results: In the case group, there was a significant reduction in subjects’ weight during the third period of the experiment; also, a significant improvement was observed in the heart rate during the second and third periods in the case group (P<0.05, t-test. Conclusion: This study indicated a significant improvement in the subjects’ heart rate over second and third periods of measurements; also, no high-risk variations in blood pressure or heart rate were observed among the subjects.

  2. SY 13-3 DISTRIBUTION OF 24-H AMBULATORY BLOOD PRESSURE IN CHILDREN.

    Science.gov (United States)

    Oh, Jun

    2016-09-01

    Hypertension is a major risk factor for stroke, coronary artery disease and kidney damage in adults and children. There is a paucity of data on the long-term sequelae of persistent hypertension in children, but it is already known that children with hypertension have evidence of end organ damage and are at risk of hypertension into adulthood. The prevalence of hypertension in children is rising, most likely due to a concurrent rise in obesity rates. In children with hypertension, non-pharmacological measures are often recommended as first-line therapy, but a significant proportion of children will eventually require pharmacological treatment to reduce blood pressure, especially those with evidence of end organ damage at presentation or during follow-up. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is an essential tool in the diagnosis and therapeutic monitoring of arterial hypertension in children. In this review I will describe and discuss current methods to evaluate of BP level, the distribution of ABPM, outline available methods for BP assessment and discuss the clinical consequences of BP variability.

  3. Heated blends of phosphate waste: Microstructure characterization, effects of processing factors and use as a phosphorus source for alfalfa growth.

    Science.gov (United States)

    Loutou, M; Hajjaji, M; Mansori, M; Favotto, C; Hakkou, R

    2016-07-15

    Microstructure of expandable lightweight aggregates (LWAs), which was composed of phosphate waste (PW), cement kiln dust (CKD) and raw clay (RC) was investigated, and the effects of processing factors (temperature, waste content, soaking time) on their physical properties were quantified by using response surface methodology (RSM). The potential use of LWAs as a phosphorus source was assessed through the use of seeds of alfalfa. It was found that the main minerals of the waste, namely carbonates and fluorapatite, were involved in the formation of labradorite/anorthite and melt respectively. Stability of mullite- the main constituent of CKD- was sensitive to the melt content. The assemblage of the identified phases was discussed based on the CaO-SiO2-Al2O3 phase diagram. The results of RSM showed that the change of compressive strength, firing shrinkage and water absorption of LWAs versus processing factors was well described with a polynomial model and the weights of the effects of the factors increased in the following order: sintering temperature > waste content (in the case of PW-RC) > soaking time. On the other hand, it was found that due to the release of phosphorus by soil-embedded pellets, the growth of alfalfa plants improved, and the rate enhanced in this order: PW-RC > PW-CKD > PW-CKD-RC. The absorbed quantity of phosphorus (0.12%) was still lower than the common uptake amount.

  4. CT features of peritonitis associated with continuous ambulatory peritoneal dialysis

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Ji Young; Byun, Jae Young; Lee, Sang Hoon; Kwon, Tae Ahn; Kim, Yeon Kil; Kim, Young Ok; Song, Kyung Sup [The Catholic Univ. of Korea College of Medicine, Seoul (Korea, Republic of)

    1999-01-01

    To evaluate the CT findings of peritonitis associated with continuous ambulatory peritoneal dialysis(CAPD). We retrospectively analyzed CT scans of 14 symptomatic patients with peritonitis after CAPD. Diffuse abdominal pain was present in 11, fever in two, and abdominal mass with vomiting in one. The mean duration of CAPD ranged from 10 months to 5 years(mean : 3.9 years). On abdominal CT, we evaluated the presence and location of ascites, bowel wall thickening, cocoon formation, the pattern of enhancement of peritoneal thickening, the presence of calcifications in the peritoneum, and mesenteric and omental change. On enhanced CT, multiloculated ascites was observed in all cases(n=14) ; it was located mainly in the pelvic cavity with small multi-loculated fluid collections in the peritoneal cavity(n=13), including the lesser sac(n=3). In one patient, ascites was located in the space between the greater omentum and anterior peritoneal surface. CT showed ileus in 12 cases, small bowel wall thickening in 11, and cocoon formation in five. Uneven but smooth thickening of the peritoneum, with contrast enhancement, was seen in eight cases, and in five of these, peritoneal thickening was more prominent in the anterior peritoneum. Other findings included reticular opacity in two cases, hematoma of the rectus muscle in one, and umbilical hernia in one. Multiloculated fluid collection, ileus, small bowel wall thickening, uneven but smooth peritoneal thickening, and cocoon formation appear to be CT features of CAPD peritonitis.

  5. Utilization of lean management principles in the ambulatory clinic setting.

    Science.gov (United States)

    Casey, Jessica T; Brinton, Thomas S; Gonzalez, Chris M

    2009-03-01

    The principles of 'lean management' have permeated many sectors of today's business world, secondary to the success of the Toyota Production System. This management method enables workers to eliminate mistakes, reduce delays, lower costs, and improve the overall quality of the product or service they deliver. These lean management principles can be applied to health care. Their implementation within the ambulatory care setting is predicated on the continuous identification and elimination of waste within the process. The key concepts of flow time, inventory and throughput are utilized to improve the flow of patients through the clinic, and to identify points that slow this process -- so-called bottlenecks. Nonessential activities are shifted away from bottlenecks (i.e. the physician), and extra work capacity is generated from existing resources, rather than being added. The additional work capacity facilitates a more efficient response to variability, which in turn results in cost savings, more time for the physician to interact with patients, and faster completion of patient visits. Finally, application of the lean management principle of 'just-in-time' management can eliminate excess clinic inventory, better synchronize office supply with patient demand, and reduce costs.

  6. Dynamics of ambulatory surgery centers and hospitals market entry.

    Science.gov (United States)

    Housman, Michael; Al-Amin, Mona

    2013-08-01

    In this article, we investigate the diversity of healthcare delivery organizations by comparing the market determinants of hospitals entry rates with those of ambulatory surgery centers (ASCs). Unlike hospitals, ASCs is one of the growing populations of specialized healthcare delivery organizations. There are reasons to believe that firm entry patterns differ within growing organizational populations since these markets are characterized by different levels of organizational legitimacy, technological uncertainty, and information asymmetry. We compare the entry patterns of firms in a mature population of hospitals to those of firms within a growing population of ASCs. By using patient-level datasets from the state of Florida, we break down our explanatory variables by facility type (ASC vs. hospital) and utilize negative binomial regression models to evaluate the impact of niche density on ASC and hospital entry. Our results indicate that ASCs entry rates is higher in markets with overlapping ASCs while hospitals entry rates are less in markets with overlapping hospitals and ASCs. These results are consistent with the notion that firms in growing populations tend to seek out crowded markets as they compete to occupy the most desirable market segments while firms in mature populations such as general hospitals avoid direct competition.

  7. Marginal ambulatory teaching cost under varying levels of service utilization.

    Science.gov (United States)

    Panton, D M; Mushlin, A I; Gavett, J W

    1980-06-01

    The ambulatory component of residency training jointly produces two products, namely, training and patient services. In costing educational programs of this type, two approaches are frequently taken. The first considers the total costs of the educational program, including training and patient services. These costs are usually constructed from historical accounting records. The second approach attempts to cost the joint products separately, based upon estimates of future changes in program costs, if the product in question is added to or removed from the program. The second approach relates to typical decisions facing the managers of medical centers and practices used for teaching purposes. This article reports such a study of costs in a primary-care residency training program in a hospital outpatient setting. The costs of the product, i.e., on-the-job training, are evaluated using a replacement-cost concept under different levels of patient services. The results show that the cost of the product, training, is small at full clinical utilization and is sensitive to changes in the volume of services provided.

  8. Mobile Personal Health System for Ambulatory Blood Pressure Monitoring

    Directory of Open Access Journals (Sweden)

    Luis J. Mena

    2013-01-01

    Full Text Available The ARVmobile v1.0 is a multiplatform mobile personal health monitor (PHM application for ambulatory blood pressure (ABP monitoring that has the potential to aid in the acquisition and analysis of detailed profile of ABP and heart rate (HR, improve the early detection and intervention of hypertension, and detect potential abnormal BP and HR levels for timely medical feedback. The PHM system consisted of ABP sensor to detect BP and HR signals and smartphone as receiver to collect the transmitted digital data and process them to provide immediate personalized information to the user. Android and Blackberry platforms were developed to detect and alert of potential abnormal values, offer friendly graphical user interface for elderly people, and provide feedback to professional healthcare providers via e-mail. ABP data were obtained from twenty-one healthy individuals (>51 years to test the utility of the PHM application. The ARVmobile v1.0 was able to reliably receive and process the ABP readings from the volunteers. The preliminary results demonstrate that the ARVmobile 1.0 application could be used to perform a detailed profile of ABP and HR in an ordinary daily life environment, bedsides of estimating potential diagnostic thresholds of abnormal BP variability measured as average real variability.

  9. Endoscope ambulatory nasal polipectomy. Introduction in Sancti Spiritus province.

    Directory of Open Access Journals (Sweden)

    Raquel M. García Alemán

    2010-10-01

    Full Text Available A longitudinal retrospective descriptive study carried out in the Otorrinolaringology Services of the “Camilo Cienfuegos” General Hospital in Sancti Spiritus from september 2007 to september 2009.The population comprised 130 patients diagnosed with Chronic rhinosinusitis and the sample included 48 who showed Bilateral Poliposis grade III-IV who fulfilled the inclusion criteria. The general objective was to determine the results of the endoscopic ambulatory nasal polipectomy; specific objective to evaluate the variables of age and gender clinical manifestations, endoscopic findings, complication histological findings and degree of satisfaction. The statistical analysis included the calculation of frequency stadigraphs expressed in numbers and percentages. Chronic rhinosinusitis which nasal polyposis was more frequent in white men over 40 years-old, the primary symptoms were nasal obstruction and anosmia. The post-surgical medical treatment was carried out depending on the histological study with a predominance of eosinophils. The endoscopy determined the degree of grade III; the classic bilateral anterior tamponing was remplaced by surgical neurolentins made in the room. No patient showed pain during the surgery act, they improved their life quality.

  10. Ibuprofen timing for hand surgery in ambulatory care

    Science.gov (United States)

    Giuliani, Enrico; Bianchi, Anna; Marcuzzi, Augusto; Landi, Antonio; Barbieri, Alberto

    2015-01-01

    OBJECTIVE: To evaluate the effect of pre-operative administration of ibuprofen on post-operative pain control vs. early post-operative administration for hand surgery procedures performed under local anaesthesia in ambulatory care. METHODS: Candidates to trigger finger release by De Quervain tenosynovitis and carpal tunnel operation under local anesthesia were enrolled in the study. Group A received 400 mg ibuprofen before the operation and placebo after the procedure; group B received placebo before the operation and ibuprofen 400 mg at the end of the procedure; both groups received ibuprofen 400 mg every 6h thereafter. Visual analogue scale (VAS) was measured at fixed times before and every 6h after surgery, for a total follow-up of 18h. RESULTS: Groups were similar according to age, gender and type of surgery. Median VAS values did not produce any statistical significance, while there was a statistically significant difference on pre-operative and early post-operative VAS values between groups (A -8.53 mm vs. B 3.36 mm, p=0.0085). CONCLUSION: Average pain levels were well controlled by local anesthesia and post-operative ibuprofen analgesia. Pre-operative ibuprofen administration can contribute to improve early pain management. Level of Evidence II, Therapeutic Studies. PMID:26327799

  11. The content of hope in ambulatory patients with colon cancer.

    Science.gov (United States)

    Beckman, Emily S; Helft, Paul R; Torke, Alexia M

    2013-01-01

    Although hope is a pervasive concept in cancer treatment, we know little about how ambulatory patients with cancer define or experience hope. We explored hope through semistructured interviews with ten patients with advanced (some curable, some incurable) colon cancer at one Midwestern, university-based cancer center. We conducted a thematic analysis to identify key concepts related to patient perceptions of hope. Although we did ask specifically about hope, patients also often revealed their hopes in response to indirect questions or by telling stories about their cancer experience. We identified four major themes related to hope: 1) hope is essential, 2) a change in perspective, 3) the content of hope, and 4) communicating about hope. The third theme, the content of hope, included three subthemes: a) the desire for normalcy, b) future plans, and c) hope for a cure. We conclude that hope is an essential concept for patients undergoing treatment for cancer as it pertains to their psychological well-being and quality of life, and hope for a cure is not and should not be the only consideration. In a clinical context, the exploration of patients' hopes and aspirations in light of their cancer diagnosis is important because it provides a frame for understanding their goals for treatment. Exploration of the content of patients' hope can not only help to illuminate misunderstandings but also clarify how potential treatments may or may not contribute to achieving patients' goals.

  12. Combining risk assessment and epidemiological risk factors to elucidate the sources of human E. coli O157 infection.

    Science.gov (United States)

    Rotariu, O; Ogden, I D; MacRitchie, L; Forbes, K J; Williams, A P; Cross, P; Hunter, C J; Teunis, P F M; Strachan, N J C

    2012-08-01

    E. coli O157 can be transmitted to humans by three primary (foodborne, environmental, waterborne) and one secondary (person-to-person transmission) pathways. A regression model and quantitative microbiological risk assessments (QMRAs) were applied to determine the relative importance of the primary transmission pathways in NE Scotland. Both approaches indicated that waterborne infection was the least important but it was unclear whether food or the environment was the main source of infection. The QMRAs over-predicted the number of cases by a factor of 30 and this could be because all E. coli O157 strains may not be equally infective and/or the level of infectivity in the dose-response model was too high. The efficacy of potential risk mitigation strategies to reduce human exposure to E. coli O157 using QMRAs was simulated. Risk mitigation strategies focusing on food and environment are likely to have the biggest impact on infection figures.

  13. Fungal growth pattern, sources and factors of mould contamination in a dry-cured meat production facility.

    Science.gov (United States)

    Asefa, Dereje T; Kure, Cathrine F; Gjerde, Ragnhild O; Omer, Mohamed K; Langsrud, Solveig; Nesbakken, Truls; Skaar, Ida

    2010-06-15

    The aims of this study were to investigate the patterns of fungal growth on dry-cured meat products, identify the important sources and factors of contamination and recommend intervention measures. The production processes of two smoked dry-cured hams and one unsmoked dry-cured leg of lamb were studied. A longitudinal observational study was performed to collect 642 samples from the meat, production materials, room installations and indoor and outdoor air of the production facility. Standard mycological isolation and identification procedures were followed. Totally, 901 fungal isolates were obtained; of which 57% were moulds while 43% were yeast. Yeasts were dominant on meat surfaces by covering 64% of the isolates. Mould growth was not observed until late in the dry-ripening stage. Yeasts and moulds were isolated from half of the environmental samples, of which moulds contributed by 80%. More than 39 mould species were isolated from the entire production process with a 77% contribution by the species of Penicillium. Penicillium nalgiovense dominated the species composition of moulds isolated from the products and the production environment. A preliminary bioassay analysis on bacterial colonies indicated that most of the P. nalgiovense isolates have the ability to produce penicillin. Such isolates might produce penicillin on the products and can become potential food safety hazards. Improper pressing at the salting process, the air quality in salting, brining and smoking rooms and activities in the sorting room were identified as important factors and sources of fungal contamination. Technical solutions and organized production activities that reduce crack formation, airborne spore concentration and improve air circulation in the facility are recommended as intervention measures.

  14. A straightforward experimental method to evaluate the Lamb–Mössbauer factor of a {sup 57}Co/Rh source

    Energy Technology Data Exchange (ETDEWEB)

    Spina, G., E-mail: gabriele.spina@unifi.it [Dipartimento di Fisica, Università degli Studi di Firenze, Via Sansone 1, 50019 Sesto Fiorentino (Italy); Lantieri, M. [Istituto dei Sistemi Complessi – CNR, Via Madonna del Piano 10, 50019 Sesto Fiorentino (Italy)

    2014-01-01

    In analyzing Mössbauer spectra by means of the integral transmission function, a correct evaluation of the recoilless f{sub s} factor of the source at the position of the sample is needed. A novel method to evaluate f{sub s} for a {sup 57}Co source is proposed. The method uses the standard transmission experimental set up and it does not need further measurements but the ones that are mandatory in order to center the Mössbauer line and to calibrate the Mössbauer transducer. Firstly, the background counts are evaluated by collecting a standard Multi Channel Scaling (MCS) spectrum of a tick metal iron foil absorber and two Pulse Height Analysis (PHA) spectra with the same life-time and setting the maximum velocity of the transducer at the same value of the MCS spectrum. Secondly, f{sub s} is evaluated by fitting the collected MCS spectrum throughout the integral transmission approach. A test of the suitability of the technique is presented, too.

  15. Performance Evaluation and Impact of Weighting Factors on an Energy and Delay Aware Dynamic Source Routing Protocol

    CERN Document Server

    Rekik, Jihen Drira; Ghezala, Henda Ben

    2011-01-01

    Typical applications of the mobile ad-hoc network, MANET, are in disaster recovery operations which have to respect time constraint needs. Since MANET is affected by limited resources such as power constraints, it is a challenge to respect the deadline of a real-time data. This paper proposes the Energy and Delay aware based on Dynamic Source Routing protocol, ED-DSR. ED-DSR efficiently utilizes the network resources such as the intermediate mobile nodes energy and load. It ensures both timeliness and energy efficiency by avoiding low-power and overloaded intermediate mobile nodes. Through simulations, we compare our proposed routing protocol with the basic routing protocol Dynamic Source Routing, DSR. Weighting factors are introduced to improve the route selection. Simulation results, using the NS-2 simulator, show that the proposed protocol prolongs the network lifetime (up to 66%), increases the volume of packets delivered while meeting the data flows real-time constraints and shortens the endto- end delay...

  16. Source Apportionment of Ambient PM10 in the Urban Area of Longyan City, China: a Comparative Study Based on Chemical Mass Balance Model and Factor Analysis Method

    Institute of Scientific and Technical Information of China (English)

    QIU Li-min; LIU Miao; WANG Ju; ZHANG Sheng-nan; FANG Chun-sheng

    2012-01-01

    In order to identify the day and night pollution sources of PM10 in ambient air in Longyan City,the authors analyzed the elemental composition of respirable particulate matters in the day and night ambient air samples and various pollution sources which were collected in January 2010 in Longyan with inductivity coupled plasma-mass spectrometry(ICP-MS).Then chemical mass balance(CMB)model and factor analysis(FA)method were applied to comparatively study the inorganic components in the sources and receptor samples.The results of factor analysis show that the major sources were road dust,waste incineration and mixed sources which contained automobile exhaust,soil dust/secondary dust and coal dust during the daytime in Longyan City,China.There are two major sources of pollution which are soil dust and mixture sources of automobile exhaust and secondary dust during the night in Longyan.The results of CMB show that the major sources are secondary dust,automobile exhaust and road dust during the daytime in Longyan.The major sources are secondary dust,soil dust and automobile exhaust during the night in Longyan.The results of the two methods are similar to each other and the results will guide us to plan to control the PM10 pollution sources in Longyan.

  17. US National Practice Patterns in Ambulatory Operative Management of Lateral Epicondylitis.

    Science.gov (United States)

    Buller, Leonard T; Best, Matthew J; Nigen, David; Ialenti, Marc; Baraga, Michael G

    2015-12-01

    Lateral epicondylitis is a common cause of elbow pain, frequently responsive to nonoperative management. There are multiple operative techniques for persistently symptomatic patients who have exhausted conservative therapies. Little is known regarding US national trends in operative management of lateral epicondylitis. We conducted a study to investigate changes in use of ambulatory procedures for lateral epicondylitis. Cases of lateral epicondylitis were identified using the National Survey of Ambulatory Surgery and were analyzed for trends in demographics and use of ambulatory surgery. Between 1994 and 2006, the population-adjusted rate of ambulatory surgical procedures increased from 7.29 to 10.44 per 100,000 capita. The sex-adjusted rate of surgery for lateral epicondylitis increased by 85% among females and decreased by 31% among males. Most patients were between ages 40 and 49 years, and the largest percentage increase in age-adjusted rates was found among patients older than 50 years (275%) between 1994 and 2006. Use of regional anesthesia increased from 17% in 1994 to 30% in 2006. Private insurance remained the most common payer. Awareness of the increasing use of ambulatory surgery for lateral epicondylitis may lead to changes in health care policies and positively affect patient care.

  18. Perspectives on ambulatory anesthesia: the patient’s point of view

    Directory of Open Access Journals (Sweden)

    Sehmbi H

    2014-12-01

    Full Text Available Herman Sehmbi, Jean Wong, David T WongDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, CanadaAbstract: Recent advances in anesthetic and surgical techniques have led to tremendous growth of ambulatory surgery. With patients with many co-morbid conditions undergoing complex procedures in an ambulatory setting, the challenges in providing ambulatory surgery and anesthesia are immense. In recent years, the paradigm has shifted from a health-care provider focus involving process compliance and clinical outcomes, to a patient-centered strategy that includes patients’ perspectives of desired outcomes. Improving preoperative patient education while reducing unnecessary testing, improving postoperative pain management, and reducing postoperative nausea and vomiting may help enhance patient satisfaction. The functional status of most patients is reduced postoperatively, and thus the pattern of recovery is an area of ongoing research. Standardized and validated psychometric questionnaires such as Quality of Recovery-40 and Postoperative Quality of Recovery Scale are potential tools to assess this. Patient satisfaction has been identified as an important outcome measure and dedicated tools to assess this in various clinical settings are needed. Identification of key aspects of ambulatory surgery deemed important from patients’ perspectives, and implementation of validated outcome questionnaires, are important in improving patient centered care and patient satisfaction.Keywords: ambulatory, patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  19. Outpatient costing and classification: are we any closer toa national standard for ambulatory classification systems?

    Science.gov (United States)

    Cleary, M I; Murray, J M; Michael, R; Piper, K

    1998-10-19

    The Outpatient Costing and Classification Study was commissioned by the Department of Health and Family Services to evaluate the suitability of the Developmental Ambulatory Classification System (DACS). Data on the full range of ambulatory services (outpatient clinics, emergency departments and allied health services) were collected prospectively from a stratified sample of 28 public hospitals. Patient encounters captured in the study represent 1% of the total ambulatory encounters in Australia in one year. Costing per encounter included time spent with the patient, cost of procedures, indirect costs (salaries and consumables), overhead costs and diagnostic costs. The most significant variable explaining cost variation was hospital type, followed by outpatient clinic type. Visit type and presence or absence of a procedure--major splits for the proposed DACS--did not produce splits that were consistent across all hospital strata. The study found that DACS is not an appropriate classification for hospital ambulatory services. A clinic-based structure for outpatients and allied health departments is recommended for classifying and funding ambulatory services in Australia.

  20. Time-dependent stabilization of hypoxia inducible factor-1α by different intracellular sources of reactive oxygen species.

    Directory of Open Access Journals (Sweden)

    Maura Calvani

    Full Text Available Intratumoral hypoxia is a major obstacle in the development of effective cancer chemotherapy, decreasing the efficacy of anti-neoplastic drugs in several solid tumours. The hypoxic environment, through its master regulator hypoxia inducible factor-1 (HIF-1, is able to maintain an anti-apoptotic potential through activation of critical genes associated with drug resistance. Besides affecting metabolism and motility of tumour cells, hypoxia also paradoxically increases production of reactive oxygen species (ROS, which contribute to stabilize HIF-1 through a redox-mediated inhibition of its proteolysis. Here we reported that 1% O(2 hypoxia increases the resistance of human metastatic melanoma cells to conventional chemotherapy with etoposide, and that the increase in chemoresistance strongly depends on ROS delivery due to hypoxia. We reported a biphasic redox-dependent role of HIF-1, involving mitochondrial complex III and NADPH oxidase as oxidants sources, synergising in enhancing survival to chemotherapy. The feed-forward loop engaged by hypoxia involves first an HIF-1-dependent vascular endothelial growth factor-A (VEGF-A autocrine production and, in the later phase, activation of NADPH oxidase from VEGF/VEGFR2 interaction, finally leading to a further redox-dependent long lasting stabilization of HIF-1. We therefore identified a redox-dependent circuitry linking hypoxia-driven ROS to VEGF-A secretion and to enhanced melanoma cell survival to etoposide chemotherapy.

  1. Effect of trans fatty acid isomers from ruminant sources on risk factors of cardiovascular disease: study design and rationale.

    Science.gov (United States)

    Gebauer, Sarah K; Destaillats, Frederic; Mouloungui, Zéphirin; Candy, Laure; Bezelgues, Jean-Baptiste; Dionisi, Fabiola; Baer, David J

    2011-07-01

    Substantial evidence clearly demonstrates the deleterious effects of industrially-produced trans fatty acids (TFA); however, data are lacking from large, well controlled human feeding studies that directly compare the effects of industrially-produced and naturally-occurring TFA. The purpose of the current study is to determine whether consumption of TFA derived from different sources differentially affect risk factors of cardiovascular disease (CVD). The study was a randomized, crossover design, controlled-feeding intervention designed to compare the effects of the following diet treatments on risk factors of CVD: low TFA diet (base diet, 34% energy from fat; 0.1% energy from TFA), base diet with vaccenic acid (3.0% energy), base diet with mixed isomers of TFA from partially hydrogenated vegetable oil (3.0% energy), and base diet with cis-9, trans-11 CLA (1.0% energy). The added energy from TFA replaced energy from stearic acid. Participants were required to be between the ages of 25 and 65 years, have a body mass index between 20 and 38 kg/m(2), total cholesterol affect markers of cardiovascular risk, in the context of a highly controlled feeding study.

  2. Discovering perturbation of modular structure in HIV progression by integrating multiple data sources through non-negative matrix factorization.

    Science.gov (United States)

    Ray, Sumanta; Maulik, Ujjwal

    2016-12-20

    Detecting perturbation in modular structure during HIV-1 disease progression is an important step to understand stage specific infection pattern of HIV-1 virus in human cell. In this article, we proposed a novel methodology on integration of multiple biological information to identify such disruption in human gene module during different stages of HIV-1 infection. We integrate three different biological information: gene expression information, protein-protein interaction information and gene ontology information in single gene meta-module, through non negative matrix factorization (NMF). As the identified metamodules inherit those information so, detecting perturbation of these, reflects the changes in expression pattern, in PPI structure and in functional similarity of genes during the infection progression. To integrate modules of different data sources into strong meta-modules, NMF based clustering is utilized here. Perturbation in meta-modular structure is identified by investigating the topological and intramodular properties and putting rank to those meta-modules using a rank aggregation algorithm. We have also analyzed the preservation structure of significant GO terms in which the human proteins of the meta-modules participate. Moreover, we have performed an analysis to show the change of coregulation pattern of identified transcription factors (TFs) over the HIV progression stages.

  3. A Case of Candida albicans Endophthalmitis with No Predisposing Risk Factors and a Distant Source of Infection

    Directory of Open Access Journals (Sweden)

    Randhir Chavan

    2012-09-01

    Full Text Available Purpose: To report a case of Candida albicans endophthalmitis with no identifiable predisposing risk factors. Case Report: A 57-year-old male presented with a 3-day history of worsening floaters and reduced visual acuity. Fundoscopy and optical coherence tomography showed presence of fluffy white preretinal and intraretinal infiltrates. With no past medical history or evidence of immunosuppression but having travelled abroad and suffered from diarrhoea, fungal aetiology was thought to be unlikely and as a result, treatment was commenced for toxoplasma. Despite treatment, his vision did not improve. Initial investigations including inflammatory markers, serology for toxoplasmosis, blood culture, chest radiograph and aqueous sampling could not identify a source of infection. However, polymerase chain reaction results from vitreous sampling revealed C. albicans. As a result, the patient was treated with intravenous voriconazole and intravitreal amphotericin B. As initial clinical improvement was limited, a vitrectomy was performed with further intravitreal amphotericin B. Clinical improvement was rapid following vitrectomy. After repeated Gram staining and culture of infected toenails, Gram-positive yeast cells were isolated. Conclusion: Although C. albicans is a frequent cause of endogenous endophthalmitis, patients often have one or more predisposing systemic condition assisting the diagnosis. The present case illustrates that (1 even in the absence of any predisposing risk factors, C.albicans should be considered as a possible differential diagnosis in recalcitrant uveitis, and (2 endogenous candida endophthalmitis can be a result of fungal infections from distant sites such as the toenails.

  4. Measurement of the low-energy quenching factor in germanium using an $^{88}$Y/Be photoneutron source

    CERN Document Server

    Scholz, B J; Collar, J I; Privitera, P; Robinson, A E

    2016-01-01

    We employ an $^{88}$Y/Be photoneutron source to derive the quenching factor for neutron-induced nuclear recoils in germanium, probing recoil energies from a few hundred eV$_{nr}$ to 8.5keV$_{nr}$. A comprehensive Monte Carlo simulation of our setup is compared to experimental data employing a Lindhard model with a free electronic energy loss $k$ and an adiabatic correction for sub-keV$_{nr}$ nuclear recoils. The best fit $k=0.179\\pm 0.001$ obtained using a Monte Carlo Markov Chain (MCMC) ensemble sampler is in good agreement with previous measurements, confirming the adequacy of the Lindhard model to describe the stopping of few-keV ions in germanium crystals at a temperature of $\\sim$77 K. This value of $k$ corresponds to a quenching factor of 13.7 % to 25.3 % for nuclear recoil energies between 0.3 keV$_{nr}$ and 8.5 keV$_{nr}$, respectively.

  5. Ambulatory assessed implicit affect is associated with salivary cortisol

    Directory of Open Access Journals (Sweden)

    Joram eMossink

    2015-02-01

    Full Text Available One of the presumed pathways linking negative emotions to adverse somatic health is an overactive HPA-axis, usually indicated by elevated cortisol levels. Traditionally, research has focused on consciously reported negative emotions. Yet, given that the majority of information processing occurs without conscious awareness, stress physiology might also be influenced by affective processes that people are not aware of. In a 24-hour ambulatory study we examined whether cortisol levels were associated with two implicit measures. Implicit affect was assessed using the Implicit Positive and Negative Affect Test, and implicit negative memory bias was assessed with the word fragment completion tasks. In 55 healthy participants, we measured subjective stress levels, worries, implicit and explicit affect each hour during waking hours. Also, saliva samples were collected at three fixed times during the day, as well as upon waking and 30 minutes thereafter (cortisol awakening response. Multilevel analyses of the daytime cortisol levels revealed that the presence of an implicit negative memory bias was associated with increased cortisol levels. Additionally, implicit PA and, unexpectedly, implicit NA were negatively associated with cortisol levels. Finally, participants demonstrating higher levels of implicit sadness during the first measurement day, had a stronger cortisol rise upon awakening at the next day. Contrary to previous research, no associations between explicit affect and cortisol were apparent. The current study was the first to examine the concurrent relation between implicit measures and stress physiology in daily life. The results suggest that the traditional focus on consciously reported feelings and emotions is limited, and that implicit measures can add to our understanding of how stress and emotions contribute to daily physiological activity and, in the long term, health problems.

  6. Psychometric properties of the Persian version of the Ambulatory Care Learning Educational Environment Measure (ACLEEM questionnaire, Shiraz, Iran

    Directory of Open Access Journals (Sweden)

    Parvizi MM

    2016-09-01

    Full Text Available Mohammad Mahdi Parvizi,1,2 Mitra Amini,2 Mohammad Reza Dehghani,2 Peyman Jafari,3 Zahra Parvizi,1 1Health Policy Research Center, 2Quality Improvement in Clinical Education Research Center, 3Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Fars, Iran Purpose: Evaluation is the main component in design and implementation of educational activities and rapid growth of educational institution programs. Outpatient medical education and clinical training environment is one of the most important parts of training of medical residents. This study aimed to determine the validity and reliability of the Persian version of Ambulatory Care Learning Educational Environment Measure (ACLEEM questionnaire, as an instrument for assessment of educational environments in residency medical clinics. Materials and methods: This study was performed on 180 residents in Shiraz University of Medical Sciences, Shiraz, Iran, in 2014–2015. The questionnaire designers’ electronic permission (by email and the residents’ verbal consent were obtained before distributing the questionnaires. The study data were gathered using ACLEEM questionnaire developed by Arnoldo Riquelme in 2013. The data were analyzed using the SPSS statistical software, version 14, and MedCalc® software. Then, the construct validity, including convergent and discriminant validities, of the Persian version of ACLEEM questionnaire was assessed. Its internal consistency was also checked by Cronbach’s alpha coefficient. Results: Five team members who were experts in medical education were consulted to test the cultural adaptation, linguistic equivalency, and content validity of the Persian version of the questionnaire. Content validity indexes were >0.9 in all items. In factor analysis of the instrument, the ­Kaiser–Meyer–Olkin index was 0.928 and Barlett’s sphericity test yielded the following results: X 2=6,717.551, df =1,225, and P ≤0.001. Besides, Cronbach

  7. Antibioticoterapia ambulatorial como fator de indução da resistência bacteriana: uma abordagem racional para as infecções de vias aéreas Outpatient antibiotic therapy as a predisposing factor for bacterial resistance: a rational approach to airway infections

    Directory of Open Access Journals (Sweden)

    Cristiana M. Nascimento-Carvalho

    2006-11-01

    Full Text Available OBJETIVOS: Apresentar as recomendações baseadas em evidência para uso de antibióticos no tratamento das infecções respiratórias agudas (IRA mais freqüentes e as informações disponíveis sobre a importância desse tipo de conduta. FONTES DOS DADOS: Bases de dados MEDLINE, LILACS, publicações técnicas de organizações internacionais, diretrizes nacionais e internacionais. Foram utilizados os unitermos acute respiratory infection, otitis, sinusitis, tonsillitis, pneumonia, antibiotic, guidelines, bacterial resistance. Artigos citados pelos artigos incluídos foram analisados quanto à apresentação de informação de interesse. SÍNTESE DOS DADOS: A resistência bacteriana tem crescido, sendo atualmente reconhecida como problema mundial de saúde pública. As IRA são a causa mais freqüente para uso de antibiótico na comunidade; grande parte desses casos, tanto nas vias aéreas superiores (otite, sinusite, faringoamidalite como nas inferiores (pneumonia, são decorrente de infecção viral. As recomendações para racionalizar o uso de antibióticos nos pacientes com IRA têm como objetivo comum minimizar o uso desnecessário de antibióticos, visto que a "pressão antibiótica" é um dos fatores desencadeantes da resistência bacteriana. CONCLUSÕES: É de grande importância a distinção, entre os pacientes com IRA, daqueles que podem se beneficiar do uso de antibióticos. O uso das recomendações para a prescrição de antibióticos é uma estratégia para minimizar a freqüência de resistência bacteriana.OBJECTIVES: To present evidence-based recommendations for the use of antibiotics for the treatment of the most common acute respiratory infections (ARI and the available information on the importance of this type of management. SOURCES: MEDLINE and LILACS databases, technical publications by international organizations, national and international directives. The search terms acute respiratory infection, otitis, sinusitis

  8. Solute clearance measurement in the assessment of dialysis adequacy among African continuous ambulatory peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Aliyu Abdu

    2015-01-01

    Full Text Available Solute clearance measurement is an objective means of quantifying the dose of peritoneal dialysis (PD. Despite continued debate on the interpretation and precise prognostic value of small solute clearance in PD patients, guidelines based on solute clearance values are common in clinical practice. There is limited information on the solute clearance indices and PD adequacy parameters among this predominantly low socioeconomic status PD population. We investigated the solute clearance among continuous ambulatory peritoneal dialysis (CAPD patients at the Charlotte Maxeke Johannesburg Academic Hospital and its relationship with other parameters of PD adequacy. Seventy patients on CAPD were studied in this cross-sectional study. Solute clearance was assessed using urea clearance (Kt/V. Linear regression analysis was used to determine factors associated with solute clearance, while analysis of variance was used to test the influence of weekly Kt/V on blood pressure (BP, hemoglobin (Hb and other biochemical parameters. The mean age of the study population was 37.9 ± 12.4 years, 43% were females and 86% were black Africans. The mean duration on CAPD was 19.7 ± 20.8 months. Mean systolic and diastolic BP were 144 ± 28 and 92 ± 17 mm Hg, respectively. The mean Hb was 11.1 ± 2.2 g/dL and the mean weekly Kt/V was 1.7 ± 0.3. Factors like systolic BP, Hb level, serum levels of cholesterol, calcium, phosphate, parathyroid hormone and albumin were not significantly associated with the weekly Kt/V. We conclude that the dose of PD received by the majority of our patients in terms of the weekly Kt/V is within the recommended values and that this finding is significant considering the low socioeconomic background of our patients. There is no significant association between Kt/V and other indices of dialysis adequacy.

  9. Age-specific differences between conventional and ambulatory daytime blood pressure values

    DEFF Research Database (Denmark)

    Conen, David; Aeschbacher, Stefanie; Thijs, Lutgarde;

    2014-01-01

    Mean daytime ambulatory blood pressure (BP) values are considered to be lower than conventional BP values, but data on this relation among younger individuals individuals not taking antihypertensive treatment from 13...... population-based cohorts. We compared individual differences between daytime ambulatory and conventional BP according to 10-year age categories. Age-specific prevalences of white coat and masked hypertension were calculated. Among individuals aged 18 to 30, 30 to 40, and 40 to 50 years, mean daytime BP...... was significantly higher than the corresponding conventional BP (6.0, 5.2, and 4.7 mm Hg for systolic; 2.5, 2.7, and 1.7 mm Hg for diastolic BP; all Pindividuals aged 60 to 70 and ≥70 years, conventional BP was significantly higher than daytime ambulatory BP (5.0 and 13.0 mm Hg for systolic; 2.0 and 4...

  10. Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration.

    Science.gov (United States)

    Pracht, Etienne E; Bass, Elizabeth

    2011-01-01

    This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable.

  11. Office, ambulatory and home blood pressure measurement in children and adolescents.

    Science.gov (United States)

    Karpettas, Nikos; Kollias, Anastasios; Vazeou, Andriani; Stergiou, George S

    2010-11-01

    There is an increasing interest in pediatric hypertension, the prevalence of which is rising in parallel with the obesity epidemic. Traditionally the assessment of hypertension in children has relied on office blood pressure (BP) measurements by the physician. However, as in adults, office BP might be misleading in children mainly due to the white coat and masked hypertension phenomena. Thus, out-of-office BP assessment, using ambulatory or home monitoring, has gained ground for the accurate diagnosis of hypertension and decision-making. Ambulatory monitoring is regarded as indispensable for the evaluation of pediatric hypertension. Preliminary data support the usefulness of home monitoring, yet more evidence is needed. Office, ambulatory and home BP normalcy tables providing thresholds for diagnosis have been published and should be used for the assessment of elevated BP in children.

  12. Ambulatory electroencephalogram in children: A prospective clinical audit of 100 cases

    Directory of Open Access Journals (Sweden)

    Nahin Hussain

    2013-01-01

    Full Text Available Ambulatory electroencephalogram has been used for differentiating epileptic from nonepileptic events, recording seizure frequency and classification of seizure type. We studied 100 consecutive children prospectively aged 11 days to 16 years that were referred for an ambulatory electroencephalogram to a regional children′s hospital. Ambulatory electroencephalogram was clinically useful in contributing to a clinical diagnosis in 71% of children who were referred with a range of clinical questions. A diagnosis of epileptic disorder was confirmed by obtaining an ictal record in 26% and this included 11 children that had previously normal awake and or sleep electroencephalogram. We recommend making a telephone check of the current target event frequency and prioritising those with typical events on most days in order to improve the frequency of recording a typical attack.

  13. Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome

    DEFF Research Database (Denmark)

    Stolarz-Skrzypek, Katarzyna; Thijs, Lutgarde; Richart, Tom

    2010-01-01

    Ambulatory blood pressure (BP) monitoring provides information not only on the BP level but also on the diurnal changes in BP. In the present review, we summarized the main findings of the International Database on Ambulatory BP in relation to Cardiovascular Outcome (IDACO) with regard to risk...

  14. Knee Muscle Strength at Varying Angular Velocities and Associations with Gross Motor Function in Ambulatory Children with Cerebral Palsy

    Science.gov (United States)

    Hong, Wei-Hsien; Chen, Hseih-Ching; Shen, I-Hsuan; Chen, Chung-Yao; Chen, Chia-Ling; Chung, Chia-Ying

    2012-01-01

    The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n =…

  15. Early detection and treatment of myocardial ischaemia after operation using continual ambulatory arterial pressure monitoring and ECG ST segment analysis.

    Science.gov (United States)

    Edwards, N D; Troy, G; Yeo, W; Jackson, P; Reilly, C S

    1995-10-01

    We report a case in which the use of continual ambulatory arterial pressure monitoring and ECG ST-segment analysis allowed early detection and treatment of myocardial ischaemia in the postoperative period. We believe that this case illustrates the potential value of ambulatory monitoring in the early postoperative period in high-risk patients.

  16. Strategies for classifying patients based on office, home, and ambulatory blood pressure measurement.

    Science.gov (United States)

    Zhang, Lu; Li, Yan; Wei, Fang-Fei; Thijs, Lutgarde; Kang, Yuan-Yuan; Wang, Shuai; Xu, Ting-Yan; Wang, Ji-Guang; Staessen, Jan A

    2015-06-01

    Hypertension guidelines propose home or ambulatory blood pressure monitoring as indispensable after office measurement. However, whether preference should be given to home or ambulatory monitoring remains undetermined. In 831 untreated outpatients (mean age, 50.6 years; 49.8% women), we measured office (3 visits), home (7 days), and 24-h ambulatory blood pressures. We applied hypertension guidelines for cross-classification of patients into normotension or white-coat, masked, or sustained hypertension. Based on office and home blood pressures, the prevalence of white-coat, masked, and sustained hypertension was 61 (10.3%), 166 (20.0%), and 162 (19.5%), respectively. Using daytime (from 8 am to 6 pm) instead of home blood pressure confirmed the cross-classification in 575 patients (69.2%), downgraded risk from masked hypertension to normotension (n=24) or from sustained to white-coat hypertension (n=9) in 33 (4.0%), but upgraded risk from normotension to masked hypertension (n=179) or from white-coat to sustained hypertension (n=44) in 223 (26.8%). Analyses based on 24-h ambulatory blood pressure were confirmatory. In adjusted analyses, both the urinary albumin-to-creatinine ratio (+20.6%; confidence interval, 4.4-39.3) and aortic pulse wave velocity (+0.30 m/s; confidence interval, 0.09-0.51) were higher in patients who moved up to a higher risk category. Both indexes of target organ damage and central augmentation index were positively associated (P≤0.048) with the odds of being reclassified. In conclusion, for reliably diagnosing hypertension and starting treatment, office measurement should be followed by ambulatory blood pressure monitoring. Using home instead of ambulatory monitoring misses the high-risk diagnoses of masked or sustained hypertension in over 25% of patients.

  17. Source apportionment of particle-bound polycyclic aromatic hydrocarbons in Lumbini, Nepal by using the positive matrix factorization receptor model

    Science.gov (United States)

    Chen, Pengfei; Li, Chaoliu; Kang, Shichang; Yan, Fangping; Zhang, Qianggong; Ji, Zhengming; Tripathee, Lekhendra; Rupakheti, Dipesh; Rupakheti, Maheswar; Qu, Bin; Sillanpää, Mika

    2016-12-01

    Indo-Gangetic Plain (IGP) is one of the most polluted regions in the world. Despite numbers of studies conducted at urban site, few data are available at rural area. In this study, characteristics of 15 particle-bound priority polycyclic aromatic hydrocarbons (PAHs) of total suspended particles (TSPs) collected at a typical rural area (Lumbini) of IGP from April 2013 to March 2014 were reported. The results showed that annual average TSP and PAH concentrations were 209 ± 123 μg/m3 and 94.8 ± 54.6 ng/m3, respectively, which were similar to those of large cities such as Agra and Delhi in the upwind adjacent regions. Clear seasonal variation of TSP and PAH concentrations was observed, with the highest average concentration occurring in winter followed by the pre-monsoon, post-monsoon, and monsoon seasons, reflecting combined influence of source strength and monsoon circulation on PAH concentrations of Lumbini. Positive matrix factorization analysis showed that biomass combustion (50.6%) and vehicular emissions (30.4%) were first two sources of PAHs, followed by coal combustion (11.6%) and air-soil exchange (7.4%), in line with that of diagnostic molecular ratios results. Because of extensive agro-residue burning, intensive forest fires, and conducive weather conditions, contribution of biomass burning during non-monsoon season (55.7%) was higher than that of monsoon season (42.1%). The total BaP equivalent concentration (BaPeq) of particulate PAHs ranged between 2.51 and 47.3 ng/m3, was 2-40 times higher than the WHO guideline (1 ng/m3), implying local residents were at risk for adverse health effects.

  18. Different sources of soil CO2 respiration from a drained spruce forest and their dependence on environmental factors

    Science.gov (United States)

    Nousratpour, A.

    2011-12-01

    The annual CO2 emission from soils corresponds to a large portion of the global carbon cycle and equals 10 percent of the total atmospheric carbon pool. The total forest soil CO2 loss equals the sum of contribution from autotrophic and heterotrophic organisms. The autotrophic respiration is derived from recent photosynthates from the forest canopy and exudates via the roots. The heterotrophic respiration is less directly dependent on root presence and recently assimilated photosynthates, which points to the possibility of separate mechanisms governing the CO2 emissions. The variation of the CO2 flux from these some-what overlapping sources in the soil i.e. rhizospheric and non-rhizosperically is still not fully understood. Soil temperature and water availability in particular have often been used to explain the variation of soil CO2 efflux by using regression methods. In this experiment around 1000 hours of soil CO2-emission rates from a drained spruce forest was collected from 6 plots, among which 3 were previously root excluded. The emission rates were collected during 5 campaigns throughout the growing season along with continuous above ground and below ground temperature and water properties such as precipitation and VPD (vapor pressure deficit). The resulting matrix was analyzed using multivariate statistical model PLSr (Partial Least Squares regression). This operation reduces the dimensionality of large datasets with probable multicollinearity and helps clarify the dependence of a response factor on x- variables. In addition a time series analysis is applied to the dataset to address the time lag between below ground temperature and water properties to the above ground weather conditions such as VPD and air temperature. Mean carbon emission from the control plots (428 mg Carbon m-2 hr-1) was significantly larger than that from the root excluded plots (136 mg Carbon m-2 hr-1). During the growing season more than 2/3 of the total CO2 release was estimated to

  19. [Present and future ambulatory nursing care in Switzerland: what general practitioners should know].

    Science.gov (United States)

    Weber-Yaskevich, Olga; Reber, Alexandra; Gillabert, Cédric

    2011-09-28

    In response to the ambulatorization of medical care, the panel of ambulatory nursing medical care is operating important changes. Since 2011, "acute and transitional medical care" is being prescribed by hospital practitioners, implying a new definition of the nurse's profession. The consequence is more complex and more autonomous nursing care: an academic formation has been created for nurses (bachelor and master) and their assistants (healthcare and community assistants). The futur will probably be made of ambulatory case management by nurses (advanced nurse practictioner). General practictioners will not only collaborate with the nurses but also assign them with tasks handled until then by themselves, prescribing, among other things, domiciliary "long-term" medical care.

  20. The Anxiolytic Effect of Aromatherapy on Patients Awaiting Ambulatory Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Cheng-Hua Ni

    2013-01-01

    Full Text Available The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil and control (water vapor conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromatherapy showed a greater reduction in preoperative anxiety than those in the control groups. Aromatherapy may be a useful part of a holistic approach to reducing preoperative anxiety before ambulatory surgery.

  1. Transient myocardial ischaemia during ambulatory monitoring out of hospital in patients with chronic stable angina pectoris

    DEFF Research Database (Denmark)

    Egstrup, K

    1988-01-01

    Transient myocardial ischaemia during daily life, detected by ambulatory electrocardiographic monitoring, was investigated in 42 patients with chronic stable angina and documented coronary artery disease. Ambulatory monitoring was initiated for 36 hours after all prophylactic antianginal medication...... had been withdrawn for 5 days. There were 196 episodes of ST-segment depression, 145 (74%) of which were not accompanied by angina. As well, a tendency to more prolonged and greater ST-segment change with symptomatic ischaemic episodes was noted. A diurnal variation in transient ischaemia both...

  2. MOTIVATIONS OF RENAL PATIENT TO CHOOSE THE CONTINUUM AMBULATORIAL PERITONEAL DIALISE

    Directory of Open Access Journals (Sweden)

    Maria Josefina da Silva

    2003-06-01

    Full Text Available The renal disease imposes to its porter a new conception due. Nowadays, modern techniques, makepossible more freedom to the client, being one of them, continuum Dialise peritoneal ambulatorial. Our objective isto study the election by the method and the feelings related to this chose by the client. We conclude that thermethod, despite its advantages, is not the first option yet, the patient, in some cases are not well trained withintercorrences, but most of them are satisfied with the chose. The nursing still participates just a bit of this processbut it has important role in the ambulatorial and domiciliar attendance of this client, needing more specificformation.

  3. Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding.

    Science.gov (United States)

    Cooper, Natalie A M; Robinson, Lynne L L; Clark, T Justin

    2015-10-01

    Hysteroscopy is now an ambulatory procedure, having moved from a conventional day-case operating theatre environment to the outpatient clinic setting. Outpatient hysteroscopy can be used as a diagnostic test and as a therapeutic modality for women presenting with abnormal uterine bleeding. In many cases women can be diagnosed and treated efficiently during a single hospital appointment. This article reviews the development of ambulatory hysteroscopy and how it should optimally be performed and implemented. The contemporary role of this technology for investigating and treating women with abnormal uterine bleeding is then discussed.

  4. Psychometric properties of the Persian version of the Ambulatory Care Learning Educational Environment Measure (ACLEEM) questionnaire, Shiraz, Iran

    Science.gov (United States)

    Parvizi, Mohammad Mahdi; Amini, Mitra; Dehghani, Mohammad Reza; Jafari, Peyman; Parvizi, Zahra

    2016-01-01

    Purpose Evaluation is the main component in design and implementation of educational activities and rapid growth of educational institution programs. Outpatient medical education and clinical training environment is one of the most important parts of training of medical residents. This study aimed to determine the validity and reliability of the Persian version of Ambulatory Care Learning Educational Environment Measure (ACLEEM) questionnaire, as an instrument for assessment of educational environments in residency medical clinics. Materials and methods This study was performed on 180 residents in Shiraz University of Medical Sciences, Shiraz, Iran, in 2014–2015. The questionnaire designers’ electronic permission (by email) and the residents’ verbal consent were obtained before distributing the questionnaires. The study data were gathered using ACLEEM questionnaire developed by Arnoldo Riquelme in 2013. The data were analyzed using the SPSS statistical software, version 14, and MedCalc® software. Then, the construct validity, including convergent and discriminant validities, of the Persian version of ACLEEM questionnaire was assessed. Its internal consistency was also checked by Cronbach’s alpha coefficient. Results Five team members who were experts in medical education were consulted to test the cultural adaptation, linguistic equivalency, and content validity of the Persian version of the questionnaire. Content validity indexes were >0.9 in all items. In factor analysis of the instrument, the Kaiser–Meyer–Olkin index was 0.928 and Barlett’s sphericity test yielded the following results: X2=6,717.551, df =1,225, and P≤0.001. Besides, Cronbach’s alpha coefficient of ACLEEM questionnaire was 0.964. Cronbach’s alpha coefficients were also >0.80 in all the three domains of the questionnaire. Overall, the Persian version of ACLEEM showed excellent convergent validity and acceptable discriminant validity, except for the clinical training domain

  5. Bacteriemia por Chryseobacterium indologenes em diabético em hemodiálise ambulatorial Bacteremia by Chryseobacterium indologenes in a diabetic patient undergoing ambulatory hemodialysis

    Directory of Open Access Journals (Sweden)

    Marcus Machado Ramos Souza de Souza

    2012-02-01

    Full Text Available Chryseobacterium indologenes é uma bactéria de baixa virulência, encontrada no meio ambiente, raramente associada às infecções não hospitalares. A maioria das infecções causadas por ela associa-se ao uso de dispositivos invasivos durante a permanência em hospital. O presente relato trata de paciente renal crônico, diabético, apresentando episódios de bacteriemia durante sessões de hemodiálise ambulatorial por meio de cateter permcath.Chryseobacterium indologenes is a low-virulent bacterium found in the environment, which is rarely associated with non-nosocomial infections. Most infections caused by this pathogen are associated with the use of invasive devices in hospitalized patients. This study reports the case of a diabetic patient with chronic renal disease presenting episodes of bacteremia undergoing ambulatory hemodialysis with permcath catheter.

  6. Role of medical and social factors in the development of tuberculosis in sources of m. tuberculosis infection

    Directory of Open Access Journals (Sweden)

    Larisa Kastykpaeva

    2011-04-01

    Full Text Available The paper describes results of study of social characteristics of patients in foci of drug-sensitive M. tuberculosis excretion (Group I and multidrug resistant tuberculosis (MDR TB (Group II. Main risk factors of TB disease in sources of M. infection are revealed. 58.1% of patients with MDR TB were jobless, and 43.1% of newly detected drug-sensitive TB patients did not have work as well. 35.0% of Group II patients didn’t have a home or lodged the hostels, while homeless made only 2.0% in Group I patients. 36.6% Group II patients had lower living income per month (up to 5000 KZT than patients in Group I (16.7%. Level of education in patients of Group I was reliably higher that of those of Group II (P<0.05. More than a half of patients in Group II (55.6% and 26.9% in Group I had the harm habits: smoking and alcohol abusing. 9.7% of patients with MDR TB were drug abusers.

  7. Impact factors on the long-term sustainability of Borehole Heat Exchanger coupled Ground Source Heat Pump System

    Science.gov (United States)

    Shao, Haibing; Hein, Philipp; Görke, Uwe-Jens; Bucher, Anke; Kolditz, Olaf

    2016-04-01

    In recent years, Ground Source Heat Pump System (GSHPS) has been recognized as an efficient technology to utilize shallow geothermal energy. Along with its wide application, some GSHPS are experiencing a gradual decrease in Borehole Heat Exchanger (BHE) outflow temperatures and thus have to be turned off after couple of years' operation. A comprehensive numerical investigation was then performed to model the flow and heat transport processes in and around the BHE, together with the dynamic change of heat pump efficiency. The model parameters were based on the soil temperature and surface weather condition in the Leipzig area. Different scenarios were modelled for a service life of 30 years, to reveal the evolution of BHE outflow and surrounding soil temperatures. It is found that lateral groundwater flow and using BHE for cooling will be beneficial to the energy recovery, along with the efficiency improvement of the heat pump. In comparison to other factors, the soil heat capacity and thermal conductivity are considered to have minor impact on the long-term sustainability of the system. Furthermore, the application of thermally enhanced grout material will improve the sustainability and efficiency. In contrast, it is very likely that undersized systems and improper grouting are the causes of strong system degradation.

  8. Household trends in access to improved water sources and sanitation facilities in Vietnam and associated factors: findings from the Multiple Indicator Cluster Surveys, 2000–2011

    OpenAIRE

    Tuyet-Hanh, Tran Thi; Lee, Jong-Koo; Oh, Juhwan; Van Minh, Hoang; Lee, Chul Ou; Hoan, Le Thi; Nam, You-Seon; Long, Tran Khanh

    2016-01-01

    Background: Despite progress made by the Millennium Development Goal (MDG) number 7.C, Vietnam still faces challenges with regard to the provision of access to safe drinking water and basic sanitation.Objective: This paper describes household trends in access to improved water sources and sanitation facilities separately, and analyses factors associated with access to improved water sources and sanitation facilities in combination.Design: Secondary data from the Vietnam Multiple Indicator Clu...

  9. Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

    Science.gov (United States)

    Wearne, Nicola; Kilonzo, Kajiru; Effa, Emmanuel; Davidson, Bianca; Nourse, Peter; Ekrikpo, Udeme; Okpechi, Ikechi G

    2017-01-01

    Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT) despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or regionally) in LMICs to improve uptake of patients treated with CAPD. Workforce training and retraining will be necessary to ensure that there is coordination of CAPD programs and increase the use of protocols designed to improve CAPD outcomes such as insertion of catheters, treatment of peritonitis, and treatment of complications associated with CAPD. Training of nephrology workforce in CAPD will increase workforce experience and make CAPD a more acceptable RRT modality with improved outcomes. PMID:28115864

  10. Submicron aerosol source apportionment of wintertime pollution in Paris, France by Double Positive Matrix Factorization (PMF2 using Aerosol Chemical Speciation Monitor (ACSM and multi-wavelength Aethalometer

    Directory of Open Access Journals (Sweden)

    J.-E. Petit

    2014-06-01

    Full Text Available Online non-refractory submicron Aerosol Mass Spectrometer (AMS measurements in urban areas have successfully allowed the apportionment of specific sources and/or physical and chemical properties of the organic fraction. However, in order to be fully representative of PM pollution, a comprehensive source apportionment analysis is needed by taking into account all major components of submicron aerosols, creating strengthened bonds between the organic components and pollution sources. We present here a novel two-step methodology to perform such an analysis, by taking advantage of high time resolution of monitoring instruments: the Aerosol Chemical Speciation Monitor (ACSM and the multi-wavelength absorption measurements (Aethalometer AE31 in Paris, France. As a first step, organic aerosols (OA were deconvoluted to hydrocarbon-like OA (HOA, Biomass Burning OA (BBOA and Oxygenated OA (OOA with Positive Matrix Factorization, and black carbon was deconvolved into its wood burning and fossil fuel combustion fractions. A second PMF analysis was then carried out with organic factors, BC fractions and inorganic species (nitrate, sulfate, ammonium, chloride, leading to a~four-factor solution allowing real-time characterization of the major sources of PM1. Outputs of this PMF2 include two dominant combustion sources (wood burning and traffic as well as semi-volatile and low-volatile secondary aerosols. While HOA is found to be emitted by both wood burning and traffic, the latter sources occurred to significantly contribute also to OOA.

  11. Source apportionment of polycyclic aromatic hydrocarbons (PAHs) in surface sediments of the Rizhao coastal area (China) using diagnostic ratios and factor analysis with nonnegative constraints.

    Science.gov (United States)

    Chen, Hai-yang; Teng, Yan-guo; Wang, Jin-sheng

    2012-01-01

    In this study, sources of polycyclic aromatic hydrocarbons (PAHs) found in surface sediments of the Rizhao coastal area (China) were apportioned using diagnostic ratios and factor analysis with nonnegative constraints (FA-NNC). Bivariate plots of selected diagnostic ratios showed that the sources of PAHs identified in surface sediments seemed to be mixed sources dominated by petroleum-related. Literature PAH source profiles were modified based on the first-order degradation reaction in the atmosphere and sediments, and were considered as comparison for source identification. Five significant factors were determined with the diagnostic tools including coefficient of determination, cumulative percent variance and Exner function. By visually comparing PAH patterns and from the sum of squares of differences between modeled and modified literature PAH profiles, the potential sources were apportioned with the FA-NNC. The main contribution sources of PAHs originated from diesel engine (27.22%), followed by traffic emission (25.03%), gasoline engine (18.95%), coal power plant (14.77%) and coal residential (14.03%). Energy consumption was the predominant reason for PAH pollution in that region.

  12. Network motif-based identification of transcription factor-target gene relationships by integrating multi-source biological data

    Directory of Open Access Journals (Sweden)

    de los Reyes Benildo G

    2008-04-01

    Full Text Available Abstract Background Integrating data from multiple global assays and curated databases is essential to understand the spatio-temporal interactions within cells. Different experiments measure cellular processes at various widths and depths, while databases contain biological information based on established facts or published data. Integrating these complementary datasets helps infer a mutually consistent transcriptional regulatory network (TRN with strong similarity to the structure of the underlying genetic regulatory modules. Decomposing the TRN into a small set of recurring regulatory patterns, called network motifs (NM, facilitates the inference. Identifying NMs defined by specific transcription factors (TF establishes the framework structure of a TRN and allows the inference of TF-target gene relationship. This paper introduces a computational framework for utilizing data from multiple sources to infer TF-target gene relationships on the basis of NMs. The data include time course gene expression profiles, genome-wide location analysis data, binding sequence data, and gene ontology (GO information. Results The proposed computational framework was tested using gene expression data associated with cell cycle progression in yeast. Among 800 cell cycle related genes, 85 were identified as candidate TFs and classified into four previously defined NMs. The NMs for a subset of TFs are obtained from literature. Support vector machine (SVM classifiers were used to estimate NMs for the remaining TFs. The potential downstream target genes for the TFs were clustered into 34 biologically significant groups. The relationships between TFs and potential target gene clusters were examined by training recurrent neural networks whose topologies mimic the NMs to which the TFs are classified. The identified relationships between TFs and gene clusters were evaluated using the following biological validation and statistical analyses: (1 Gene set enrichment

  13. Adesão de pacientes HIV positivos à dietoterapia ambulatorial Adherence of positive HIV patients to ambulatory diet therapy

    Directory of Open Access Journals (Sweden)

    Késia Diego Quintaes

    1999-08-01

    Full Text Available É conhecida a importância do estado nutricional para a evolução clínica de pacientes HIV positivos. Entretanto, é desconhecida a expectativa do paciente com relação à dietoterapia. Por um período de 30 semanas foram acompanhados 50,0% dos pacientes HIV positivo (grupos II e IV atendidos pelo ambulatório de Doenças Sexualmente Transmissíveis do Hospital e Maternidade Celso Pierro. Neste período foram realizadas duas entrevistas, sendo o intervalo entre elas de 10 semanas. Na primeira foram colhidos dados socioeconômicos, antropométricos, verificadas as modificações voluntárias feitas na alimentação e também a expectativa do paciente quanto a este tipo de tratamento. Na segunda foram colhidos indicadores diretos e indiretos de adesão ao tratamento. A adesão foi maior entre os pacientes do grupo IV (64,7% do que entre os do grupo II (35,3%. No entanto, 81,3% dos pacientes do grupo II, após tomarem conhecimento da sorologia positiva para HIV, modificaram voluntariamente sua alimentação, demostrando ser este um importante período para sensibilização do paciente para o tratamento.It's well known the importance of nutritional status to the clinical evolution of positive HIV patients. However, the patient expectation in relation to diet therapy is unknown. During 30 weeks, 50.0% of the patients HIV positive (groups II and IV attended by the ambulatory of Sexually Transmitted Diseases of Hospital and Maternity Celso Pierro, were interviewed. In this period two interviews with an interval of ten weeks were carried out. At the first one socioeconomic and anthropometric data were collected voluntary feeding modifications and also the patient expectation about such treatment were verified. At the second one, direct and indirect indicators of the adherence to treatment were colleded. The adherence was greater in pacients of group IV (64.7% than in group II (35.3%. However, 81.3% of the patients from group II, after being aware

  14. Estimating qualitative parameters for assessment of body balance in a simulated ambulatory setting

    NARCIS (Netherlands)

    Meulen, van Fokke B.; Reenalda, Jasper; Veltink, Peter H.

    2013-01-01

    Continuous daily-life monitoring of balance control of stroke survivors in an ambulatory setting, is essential for optimal guidance of rehabilitation. The purpose of this study is to demonstrate the relation between qualitative parameters of body balance while measuring in stroke patients in a simul

  15. Treatment goals for ambulatory blood pressure and plasma lipids after stroke are often not reached

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Kofoed, Klaus

    2013-01-01

    In Danish health care, secondary prevention after stroke is currently handled mainly by general practitioners using office blood pressure (OBP) assessment of hypertension. The aim of this study was to compare the OBP approach to 24-hour assessment by ambulatory blood pressure (ABP) monitoring....... Furthermore, we aimed to record the degree of adherence to recommended therapy goals for blood pressure and plasma lipids....

  16. Effects of an isocaloric healthy Nordic diet on ambulatory blood pressure in metabolic syndrome

    DEFF Research Database (Denmark)

    Brader, L; Uusitupa, M; Dragsted, Lars Ove

    2013-01-01

    beneficial effects on ambulatory BP in subjects with metabolic syndrome (MetS).Subjects/methods:In total, 37 subjects were randomized to either a healthy Nordic diet or a control diet. A healthy Nordic diet embraced whole grains, rapeseed oil, berries, fruits, vegetables, fish, nuts and low-fat dairy...

  17. Evaluation of a Professional Practice Model in the Ambulatory Care Setting

    Science.gov (United States)

    2014-03-10

    patient satisfaction , nurse -sensitive indicators of quality care as measured by...Project Number: N10-C04 Aim one Evaluate levels of nursing and patient satisfaction in ambulatory care clinics following implementation of a...Clarke, S.P., Sloane, D., Lake, E.T., Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing

  18. Temporal changes in clinic and ambulatory blood pressure during cyclic post-menopausal hormone replacement therapy

    DEFF Research Database (Denmark)

    Sørensen, M B; Rasmussen, Verner; Jensen, Gorm Boje

    2000-01-01

    cyclic norethisterone acetate (NETA) or placebo in two 12-week periods separated by a 3-month washout Clinic blood pressure was measured sitting by the same observer with a mercury manometer at four visits in each period. Twenty-four hour ambulatory blood pressure was measured at baseline...

  19. Association between endothelial dysfunction and arterial stiffness in continuous ambulatory peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)

    顾玥

    2014-01-01

    Objective To investigate the association between endothelial dysfunction and arterial stiffness in continuous ambulatory peritoneal dialysis(CAPD)patients.Methods Ninety-four stable CAPD patients from a single center were enrolled in this cross-sectional study.Ultrasound evaluation was conducted on brachial artery to estimate endothelial-dependent

  20. Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region

    Directory of Open Access Journals (Sweden)

    Kelly Holanda Prezotto

    2015-02-01

    Full Text Available OBJECTIVE to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Paraná, Brazil by condition type, age group and health region. METHOD a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. RESULTS there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. CONCLUSION the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.

  1. The comparison of two analgesic regimes after ambulatory surgery: an observational study

    NARCIS (Netherlands)

    Worp, F. van der; Stapel, J.T.; Lako, S.J.; Hendriks, J.C.M.; Vissers, K.C.P.; Steegers, M.A.H.

    2014-01-01

    INTRODUCTION: Over the past 15 years, the number of ambulatory surgical procedures worldwide has increased continuously. Studies show that 30% to 40% of the patients experience moderate-to-severe pain in the first 48 hours. The objective of this observational study is to compare the percentage of mo

  2. Perceived Racism and Ambulatory Blood Pressure in African American College Students

    Science.gov (United States)

    Hill, LaBarron K.; Kobayashi, Ihori; Hughes, Joel W.

    2007-01-01

    Experiences with racial discrimination may contribute to stress-induced blood pressure (BP) elevations among African Americans. It was reported that perceived racism was associated with ambulatory BP (ABP) during waking hours. This study examined perceived racism and ABP among 40 African American college students, who completed an ABP assessment…

  3. A 15-year longitudinal study on ambulatory blood pressure tracking from childhood to early adulthood

    NARCIS (Netherlands)

    Li, Zhibin; Snieder, Harold; Harshfield, Gregory A.; Treiber, Frank A.; Wang, Xiaoling

    2009-01-01

    This study evaluates the tracking stability of office blood pressure (BP), ambulatory BP (ABP), BP variability (BPV) and nocturnal BP drops (dipping) from childhood to early adulthood, and their dependence on ethnicity, gender and family history (FH) of essential hypertension (EH). Generalized estim

  4. RELATIONSHIP BETWEEN BLOOD-PRESSURE DURING HEMODIALYSIS AND AMBULATORY BLOOD-PRESSURE IN BETWEEN DIALYSES

    NARCIS (Netherlands)

    HUISMAN, RM; DEBRUIN, C; KLONT, D; SMIT, AJ

    1995-01-01

    Background. Ambulatory blood pressure measurements in haemodialysis patients are relevant in view of the high cardiovascular morbidity and mortality in chronic haemodialysis patients. Methods. Twelve normotensive patients were studied from the beginning of one dialysis until the end of the next (mea

  5. Staphylococcus Aureus Nasal Carriage and Infection in Patients on Continuous Ambulatory Peritoneal Dialysis

    NARCIS (Netherlands)

    M.A. Luzar; G.A. Coles; B. Faller; A. Slingeneyer; G. Dah Dah; C. Briat; C. Wone; Y. Knefati; M. Kessler; F. Peluso

    1990-01-01

    textabstractWe studied 140 consecutive patients beginning continuous ambulatory peritoneal dialysis (CAPD) at one of seven hospitals to assess the relation of the nasal carriage of Staphylococcus aureus to subsequent catheter-exit-site infection or peritonitis. Shortly before the implantation of the

  6. Raoultella planticola peritonitis in a patient on continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Kim, Sun Woo; Kim, Ji Eun; Hong, Yu Ah; Ko, Gang Jee; Pyo, Heui Jung; Kwon, Young Joo

    2015-12-01

    A 65-year-old man on continuous ambulatory peritoneal dialysis was admitted with peritonitis. Empirical antibiotic therapy was initiated, and Raoultella planticola was identified in the peritoneal fluid culture. We treated the patient with intraperitoneally administered ciprofloxacin and ceftazidime according to the antibiotic susceptibility. His condition improved, and he was well treated with a 2-week antibiotic course.

  7. Treatment goals for ambulatory blood pressure and plasma lipids after stroke are often not reached

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Kofoed, Klaus

    2013-01-01

    In Danish health care, secondary prevention after stroke is currently handled mainly by general practitioners using office blood pressure (OBP) assessment of hypertension. The aim of this study was to compare the OBP approach to 24-hour assessment by ambulatory blood pressure (ABP) monitoring. Fu....... Furthermore, we aimed to record the degree of adherence to recommended therapy goals for blood pressure and plasma lipids....

  8. Acceptance and side effects of ambulatory blood pressure monitoring: evaluation of a new technology.

    Science.gov (United States)

    Beltman, F W; Heesen, W F; Smit, A J; May, J F; Lie, K I; Meyboom-de Jong, B

    1996-09-01

    Ambulatory blood pressure (BP) monitoring is probably becoming a clinically useful procedure for the evaluation of hypertensive patients. Previous reports have shown that the devices are safe and serious side effects are rare. Discomfort and inconveniences associated with its use are more frequent. In this study, patient acceptance of ambulatory blood pressure monitoring (ABPM) was compared with acceptance of other diagnostic procedures and their side effects were assessed. Patients were asked to fill in a form and 129 of 166 patients responded. The acceptance was measured with a visual analogue scale which ranged from 'very annoying' on the left to 'not annoying at all' on the right. All forms were collected anonymously. Mean distance (cm) of the visual likert scale was 8.6 to 9.4 for the diagnostic procedures frequently used in routine patient care. Ambulatory BP measurement (ABPM) scored 6.1 cm. Reported side effects (in 27% of patients) were: plan (9%), skin irritation (8%), noisy device (8%), inconvenience with work (3%), haematoma (2%) and other (4%). Reports from the patients on sleep quality were: 23% normal, 61% minor disturbance, 14% had sleep, and 2% did not sleep at all. It can be concluded that ambulatory BP monitoring was the diagnostic procedure with the lowest patient acceptance. Side effects of this new technology were reported by 27% of patients. However, risks are relatively minor. Sleep disturbances were very frequent and was a serious problem for 16% of patients.

  9. Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010

    Directory of Open Access Journals (Sweden)

    Rita Maria Rodrigues-Bastos

    2014-12-01

    Full Text Available OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD = 10.42 in 2000 to 14.92/thousand inhabitants (SD = 10.04 in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

  10. Improving patient experience in a pediatric ambulatory clinic : a mixed method appraisal of service delivery

    NARCIS (Netherlands)

    Soeteman, Marijn; Peters, Vera; Busari, Jamiu O

    2015-01-01

    OBJECTIVE: In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infr

  11. Self-Selected Walking Speed is Predictive of Daily Ambulatory Activity in Older Adults.

    Science.gov (United States)

    Middleton, Addie; Fulk, George D; Beets, Michael W; Herter, Troy M; Fritz, Stacy L

    2016-04-01

    Daily ambulatory activity is associated with health and functional status in older adults; however, assessment requires multiple days of activity monitoring. The objective of this study was to determine the relative capabilities of self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) to provide insight into daily ambulatory activity (steps per day) in community-dwelling older adults. Sixty-seven older adults completed testing and activity monitoring (age 80.39 [6.73] years). SSWS (R2 = .51), MWS (R2 = .35), and WSR calculated as a ratio (R2 = .06) were significant predictors of daily ambulatory activity in unadjusted linear regression. Cutpoints for participants achieving < 8,000 steps/day were identified for SSWS (≤ 0.97 m/s, 44.2% sensitivity, 95.7% specificity, 10.28 +LR, 0.58 -LR) and MWS (≤ 1.39 m/s, 60.5% sensitivity, 78.3% specificity, 2.79 +LR, 0.50 -LR). SSWS may be a feasible proxy for assessing and monitoring daily ambulatory activity in older adults.

  12. 75 FR 14606 - Medicare Program; Request for Nominations to the Advisory Panel on Ambulatory Payment...

    Science.gov (United States)

    2010-03-26

    ...; Center for Medicare Management, Hospital & Ambulatory Policy Group, Division of Outpatient Care; 7500... components of the Medicare hospital Outpatient Prospective Payment System (OPPS). The Charter requires that... consist of a chair and up to 15 members who are full- time employees of hospitals, hospital systems,...

  13. Peritonitis Due to Roseomonas fauriae in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

    OpenAIRE

    Bibashi, Evangelia; Sofianou, Danai; Kontopoulou, Konstantina; Mitsopoulos, Efstathios; Kokolina, Elisabeth

    2000-01-01

    Roseomonas is a newly described genus of pink-pigmented, nonfermentative, gram-negative bacteria that have been recognized as a cause of human infections. Roseomonas fauriae is a species rarely isolated from clinical specimens. We report the first known case of peritonitis caused by R. fauriae in a patient receiving continuous ambulatory peritoneal dialysis.

  14. Peritonitis due to Roseomonas fauriae in a patient undergoing continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Bibashi, E; Sofianou, D; Kontopoulou, K; Mitsopoulos, E; Kokolina, E

    2000-01-01

    Roseomonas is a newly described genus of pink-pigmented, nonfermentative, gram-negative bacteria that have been recognized as a cause of human infections. Roseomonas fauriae is a species rarely isolated from clinical specimens. We report the first known case of peritonitis caused by R. fauriae in a patient receiving continuous ambulatory peritoneal dialysis.

  15. Prognostic value of ambulatory heart rate revisited in 6928 subjects from 6 populations

    DEFF Research Database (Denmark)

    Hansen, Tine Willum; Thijs, Lutgarde; Staessen, Jan A.;

    2008-01-01

    The evidence relating mortality and morbidity to heart rate remains inconsistent. We performed 24-hour ambulatory blood pressure monitoring in 6928 subjects (not on beta-blockers; mean age: 56.2 years; 46.5% women) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uru...

  16. Ciprofloxacin treatment of bacterial peritonitis associated with chronic ambulatory peritoneal dialysis caused by Neisseria cinerea.

    Science.gov (United States)

    Taegtmeyer, M; Saxena, R; Corkill, J E; Anijeet, H; Parry, C M

    2006-08-01

    Bacterial peritonitis is a well-recognized complication of chronic ambulatory peritoneal dialysis (CAPD) in patients with end-stage renal failure. We present a case of peritonitis due to an unusual pathogen, Neisseria cinerea, unresponsive to the standard intraperitoneal (i.p.) vancomycin and gentamicin, which responded rapidly to oral ciprofloxacin.

  17. Ambulatory human motion tracking by fusion of inertial and magnetic sensing with adaptive actuation

    NARCIS (Netherlands)

    Schepers, H. Martin; Roetenberg, Daniel; Veltink, Peter H.

    2010-01-01

    Over the last years, inertial sensing has proven to be a suitable ambulatory alternative to traditional human motion tracking based on optical position measurement systems, which are generally restricted to a laboratory environment. Besides many advantages, a major drawback is the inherent drift cau

  18. The Prognostic Value of Ambulatory Heart Rate Revisited in 6928 Subjects from 6 Populations

    DEFF Research Database (Denmark)

    Hansen, Tine Willum; Thijs, Lutgarde; Staessen, Jan A.;

    2008-01-01

    The evidence relating mortality and morbidity to heart rate remains inconsistent. We performed 24-hour ambulatory blood pressure monitoring in 6928 subjects (not on β-blockers; mean age: 56.2 years; 46.5% women) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay...

  19. Ambulatory diffuse optical tomography and multimodality physiological monitoring system for muscle and exercise applications

    Science.gov (United States)

    Hu, Gang; Zhang, Quan; Ivkovic, Vladimir; Strangman, Gary E.

    2016-09-01

    Ambulatory diffuse optical tomography (aDOT) is based on near-infrared spectroscopy (NIRS) and enables three-dimensional imaging of regional hemodynamics and oxygen consumption during a person's normal activities. Although NIRS has been previously used for muscle assessment, it has been notably limited in terms of the number of channels measured, the extent to which subjects can be ambulatory, and/or the ability to simultaneously acquire synchronized auxiliary data such as electromyography (EMG) or electrocardiography (ECG). We describe the development of a prototype aDOT system, called NINscan-M, capable of ambulatory tomographic imaging as well as simultaneous auxiliary multimodal physiological monitoring. Powered by four AA size batteries and weighing 577 g, the NINscan-M prototype can synchronously record 64-channel NIRS imaging data, eight channels of EMG, ECG, or other analog signals, plus force, acceleration, rotation, and temperature for 24+ h at up to 250 Hz. We describe the system's design, characterization, and performance characteristics. We also describe examples of isometric, cycle ergometer, and free-running ambulatory exercise to demonstrate tomographic imaging at 25 Hz. NINscan-M represents a multiuse tool for muscle physiology studies as well as clinical muscle assessment.

  20. Predictive value of ambulatory blood pressure shortly after withdrawal of antihypertensive drugs in primary care patients

    NARCIS (Netherlands)

    Beltman, FW; Heesen, WF; Smit, AJ; May, JF; deGraeff, PA; Havinga, TK; Schuurman, FH; vanderVeur, E; Lie, KI; MeyboomdeJong, B

    1996-01-01

    Objective-To determine whether ambulatory blood pressure eight weeks after withdrawal of antihypertensive medication is a more sensitive measure than seated blood pressure to predict blood pressure in the long term. Design-Patients with previously untreated diastolic hypertension were treated with a

  1. Ambulatory surgery center market share and rates of outpatient surgery in the elderly.

    Science.gov (United States)

    Hollenbeck, Brent K; Hollingsworth, John M; Dunn, Rodney L; Zaojun Ye; Birkmeyer, John D

    2010-12-01

    Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P < .01). For all 4 procedures, adjusted rates of procedures were significantly higher in HSAs with the highest ASC market share. The greatest difference, both in relative and absolute terms, was observed for patients undergoing cystoscopy. In areas of high ASC market share, the age-adjusted rate of cystoscopy was nearly 3-fold higher than in areas with low ASC market share (34.5 vs 11.9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

  2. Impact of natalizumab on ambulatory improvement in secondary progressive and disabled relapsing-remitting multiple sclerosis.

    Directory of Open Access Journals (Sweden)

    Diego Cadavid

    Full Text Available BACKGROUND: There is an unmet need for disease-modifying therapies to improve ambulatory function in disabled subjects with multiple sclerosis. OBJECTIVES: Assess the effects of natalizumab on ambulatory function in disabled subjects with relapsing-remitting multiple sclerosis (RRMS or secondary progressive multiple sclerosis (SPMS. METHODS: We retrospectively reviewed ambulatory function as measured by timed 25-foot walk (T25FW in clinical trial subjects with an Expanded Disability Status Scale score ≥3.5, including RRMS subjects from the phase 3 AFFIRM and SENTINEL trials, relapsing SPMS subjects from the phase 2 MS231 study, and nonrelapsing SPMS subjects from the phase 1b DELIVER study. For comparison, SPMS subjects from the intramuscular interferon beta-1a (IM IFNβ-1a IMPACT study were also analyzed. Improvement in ambulation was measured using T25FW responder status; response was defined as faster walking times over shorter (6-9-month or longer (24-30-month treatment periods relative to subjects' best predose walking times. RESULTS: There were two to four times more T25FW responders among disabled MS subjects in the natalizumab arms than in the placebo or IM IFNβ-1a arms. Responders walked 25 feet an average of 24%-45% faster than nonresponders. CONCLUSION: Natalizumab improves ambulatory function in disabled RRMS subjects and may have efficacy in disabled SPMS subjects. Confirmation of the latter finding in a prospective SPMS study is warranted.

  3. Accelerometry: A Feasible Method to Quantify Physical Activity in Ambulatory and Nonambulatory Adolescents with Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Jan Willem Gorter

    2012-01-01

    Full Text Available Objective. To determine the feasibility of physical activity monitoring in adolescents with cerebral palsy (CP. Methods. A convenience sample of ambulatory and non-ambulatory adolescents (N=23; 17 males, 6 females; mean age 13.5 y, SD 2.6 y; Gross Motor Function Classification System (GMFCS distribution: n=9 Level I, n=5 Level II, n=5 Level III, n=4 Level IV was recruited. Physical activity (PA was objectively assessed using the ActiGraph GT1M activity monitor. Discomfort or adverse effects of wearing the accelerometers were recorded by participants. Levels of physical activity were determined as total PA, light PA (LPA, moderate PA (MPA, moderate-to-vigorous (MVPA, and vigorous PA (VPA using cut-points recently validated for CP. Results. Most participants showed little reluctance. Mean daily MVPA for all participants was 30.7 minutes (SD 30.3, which corresponded to 2.7 (SD 2.4 minutes of MVPA per hour or 4.5% (SD 3.9 of the total monitoring time. Total PA and MVPA were greatest in ambulatory youth (GMFCS levels I and II compared with youth who use a walking aid or wheelchair (GMFCS levels III and IV (P<0.05. Conclusion(s. The results support the use of the accelerometer as a feasible and useful measure of activity in ambulatory and nonambulatory adolescents with CP.

  4. Ambulatory Activity of Children with Cerebral Palsy: Which Characteristics Are Important?

    Science.gov (United States)

    van Wely, Leontien; Becher, Jules G.; Balemans, Astrid C. J.; Dallmeijer, Annet J.

    2012-01-01

    Aim: To assess ambulatory activity of children with cerebral palsy (CP), aged 7 to 13 years, and identify associated characteristics. Method: Sixty-two children with spastic CP (39 males, 23 females; mean age 10y 1mo, SD 1y 8mo; age range 7-13y), classified as Gross Motor Function Classification System (GMFCS) levels I to III, participated.…

  5. 76 FR 74121 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Science.gov (United States)

    2011-11-30

    .... Background b. Packaging Issues (1) CMS Presentation of Findings Regarding Expanded Packaging at the February... CONTACT: Marjorie Baldo, (410) 786-4617, Hospital outpatient prospective payment issues. Char Thompson, (410) 786-2300, Ambulatory surgical center issues. Michele Franklin, (410) 786-4533, and Jana...

  6. Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification

    DEFF Research Database (Denmark)

    Li, Yan; Thijs, Lutgarde; Boggia, José

    2014-01-01

    Experts proposed blood pressure (BP) load derived from 24-hour ambulatory BP recordings as a more accurate predictor of outcome than level, in particular in normotensive people. We analyzed 8711 subjects (mean age, 54.8 years; 47.0% women) randomly recruited from 10 populations. We expressed BP...

  7. Institutional and familial cost of patients in continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Enrique Villarreal-Ríos

    2014-07-01

    Full Text Available Objective: to determine the cost of institutional and familial care for patients with chronic kidney disease replacement therapy with continuous ambulatory peritoneal dialysis. Methods: a study of the cost of care for patients with chronic kidney disease treated with continuous ambulatory peritoneal dialysis was undertaken. The sample size (151 was calculated with the formula of the averages for an infinite population. The institutional cost included the cost of outpatient consultation, emergencies, hospitalization, ambulance, pharmacy, medication, laboratory, x-rays and application of erythropoietin. The family cost included transportation cost for services, cost of food during care, as well as the cost of medication and treatment materials acquired by the family for home care. The analysis included averages, percentages and confidence intervals. Results: the average annual institutional cost is US$ 11,004.3. The average annual family cost is US$ 2,831.04. The average annual cost of patient care in continuous ambulatory peritoneal dialysis including institutional and family cost is US$ 13,835.35. Conclusion: the cost of chronic kidney disease requires a large amount of economic resources, and is becoming a serious problem for health services and families. It's also true that the form of patient management in continuous ambulatory peritoneal dialysis is the most efficient in the use of institutional resources and family.

  8. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring

    NARCIS (Netherlands)

    Parati, Gianfranco; Stergiou, George; O'Brien, Eoin; Asmar, Roland; Beilin, Lawrence; Bilo, Grzegorz; Clement, Denis; de la Sierra, Alejandro; de Leeuw, Peter; Dolan, Eamon; Fagard, Robert; Graves, John; Head, Geoffrey A; Imai, Yutaka; Kario, Kazuomi; Lurbe, Empar; Mallion, Jean-Michel; Mancia, Giuseppe; Mengden, Thomas; Myers, Martin; Ogedegbe, Gbenga; Ohkubo, Takayoshi; Omboni, Stefano; Palatini, Paolo; Redon, Josep; Ruilope, Luis M; Shennan, Andrew; Staessen, Jan A; vanMontfrans, Gert; Verdecchia, Paolo; Waeber, Bernard; Wang, Jiguang; Zanchetti, Alberto; Zhang, Yuqing

    2014-01-01

    Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published

  9. High Prevalence of Obesity in Ambulatory Children and Adolescents with Intellectual Disability

    Science.gov (United States)

    Stewart, L.; Van de Ven, L.; Katsarou, V.; Rentziou, E.; Doran, M.; Jackson, P.; Reilly, J. J.; Wilson, D.

    2009-01-01

    Background: Obesity prevalence is unusually high among adults with intellectual disability (ID). There is limited and conflicting evidence on obesity prevalence among ambulatory children and adolescents with ID. The present study aimed to estimate obesity prevalence in this group and to compare with population prevalence. Methods: Survey of nine…

  10. Is There Any Infl uence of the Ambulatory Status of Children with Myelomeningocele on Their Clinical and Renal Outcomes?

    Directory of Open Access Journals (Sweden)

    Meryem BENZER

    2012-09-01

    Full Text Available OBJECTIVE: The aim of this study is to evaluate the infl uence of the ambulatory status of children with MMC on renal functions, clinical and radiological fi ndings. MATERIAL and METHODS: The records of 83 children with MMC between 2005-2010 were reviewed retrospectively. The ambulatory status of the patients was classifi ed as independent walkers (walks without assistive appliances, assisted walkers (requires walking aid, and non-ambulatory (wheelchair bound and the patient characteristics were evaluated according to the ambulatory status. RESULTS: The mean age was 7.1±0.61 years and median follow-up was 58 (32-97 months. Thirtyseven patients (44.6% had been operated in the fi rst three days of life. The patients with earlier initiation of follow-up earlier had less hydronephrosis and trabeculated bladder. Sixty-one children (73.5% were non-ambulatory, 14 (16.9% were assisted walkers and eight (9.6% were independent walkers. GFR was less than 80 ml/minute/1.73m² in six patients. There were no relation between ambulatory status and patients' renal functions, radiological and clinical fi ndings. CONCLUSION: Ambulatory status does not infl uence renal functions, clinical and radiological fi ndings of children with MMC. Beginning follow-up earlier may lead to fewer complications such as hydronephrosis and deformed and trabeculated bladder. Besides, patients operated in the fi rst three days of life were more compliant with regular follow-ups.

  11. A New Source Apportionment Method of Maxed Dust Source Based on Cluster Analysis and Factor Analysis%基于聚类分析和因子分析的混合尘源解析新方法

    Institute of Scientific and Technical Information of China (English)

    郑雪峰; 邹长武; 印红玲

    2011-01-01

    The cluster analysis and factor analysis methods were successfully used to solve the problem of multicollinearity in CMB ( chemical mass balance)model. First the cluster analysis was used to analyse the colinearity among the emission sources, then the main factors of the emission sources with strong colinearity were selected by principal component analysis. Bring them and other single sources into the CMB to calculate.Finally returned the main factors contribution to single source of mixed dust sources, the contribution of each emission sources could be acquired.Compared with the other methods,the results showed that the analytical results were realistic and the method was feasible.%运用聚类分析扣因子分析来解决大气颗粒物源解析CMB模型(化学质量平衡模型)在解析混合尘源中遇到的共线性问题.即通过聚类分析对排放源进行共线性强弱分类,根据分析结果对其中共线性较强的一类(扬尘类源)提取主因子,并和其他独立尘源共同带入CMB模型进行计算.最后将主因子贡献量返回,得到各个源贡献值.通过和其他方法的效果进行比较,结果表明,该方法解析结果符合实际,具有可行性.

  12. Ambulatory blood pressure and echocardiographic left ventricular dimensions in elderly hypertensive subjects.

    Science.gov (United States)

    Rizzo, V; Piccirillo, G; Cicconetti, P; Bianchi, A; Capponi, L; Salza, M C; Cacciafesta, M; Marigliano, V

    1996-10-01

    In a consecutive series of 62 hypertensive elderly subjects, the authors studied the relation of blood pressure circadian variations with echocardiographic parameters of left ventricular (LV) hypertrophy. All the subjects were submitted to an ambulatory blood pressure monitoring (ABPM) and to B- and M-mode echocardiography. In the elderly hypertensive group, LV mass index (LVMI) was more strongly related to twenty-four-hour, daytime and nighttime systolic ambulatory blood pressure (r = 0.52, r = 0.37, r = 0.51) than diastolic ambulatory blood pressures were (r = 0.32, r = 0.18, r = 0.33). Casual systolic and diastolic blood pressure (CBP) was found more weakly related to LVMI than ambulatory blood pressures were (r = 0.35, r = 0.26). Elderly hypertensive subjects were divided into two subgroups in relation to the presence (group 1) or absence (group 2) of blood pressure nocturnal decline. No differences were found between these two subgroups in regard to: casual blood pressure values, ambulatory blood pressures in the diurnal period, sex, body surface area, height, weight, and age. LVMIs were computed in all three groups and showed the following results: 89.32 +/- 19.76 in elderly normotensives, 91.21 +/- 31.32 in group 1, and 99.80 +/- 18.21 in group 2. Echocardiographic parameters of LV dimensions and LVMIs were different in group 1 and 2. An inverse correlation, statistically significant, was observed between LVMIs and the nocturnal blood pressure reduction (systolic: r = -0.36, P < 0.05; diastolic: r = -0.29, P < 0.05). These results suggest an association between a smaller LV mass and nocturnal blood pressure decline in elderly hypertensive patients.

  13. [Ambulatory blood pressure profiles of patients with permanent or occasional hypertension. Correlation with clinical data].

    Science.gov (United States)

    Herpin, D; Amiel, A; Boutaud, P; Ciber, M A; Demange, J

    1987-06-01

    Ambulatory blood pressure (BP) recording was performed in 57 untreated hypertensive patients by means of the "Spacelabs" non-invasive apparatus. Patients were divided into two groups according to BP measurements previously made during medical consultation. Group I comprised 25 "permanently hypertensive" patients (diastolic BP always above 95 mmHg) and group II, 32 "occasionally hypertensive" patients (diastolic BP sometimes normal, sometimes above 95 mmHg). The same circadian rhythm was observed in both groups. The mean ambulatory BP level was significantly higher (p less than 0.001) in group I patients than in group II patients, either over the whole of the 24-hour period (142.0/88.0 versus 122.7/75.3 mmHg), or in day time (149.0/92.5 versus 128.2/78.9 mmHg) or at night (128.0/80.1 versus 111.5/68.0 mmHg). In contrast, there did not seem to be any significant difference between the two groups in relative long-term variability of BP, expressed as the standard deviation/mean BP values ratio. Comparison with clinical data showed that BP values measured during consultation (160/103 mmHg in group I, 143/94 mmHg in group II) were higher than ambulatory values and, chiefly, that there was very poor correlation between the two measurement methods, precluding any extrapolation. Automatic ambulatory BP recording provides for more accurate evaluation of hypertensive patients, enabling emotional "artefacts" to be excluded and patients "reactivity" to their socio-professional environment to be assessed. However, in the absence of sufficient epidemiological data, doctors should not feel authorized to base their therapeutic decisions on the sole data supplied by ambulatory BP recordings.

  14. Diagnostic thresholds for ambulatory blood pressure moving lower: a review based on a meta-analysis-clinical implications

    DEFF Research Database (Denmark)

    Hansen, T.W.; Kikuya, M.; Thijs, L.;

    2008-01-01

    Upper limits of normal ambulatory blood pressure (ABP) have been a matter of debate in recent years. Current diagnostic thresholds for ABP rely mainly on statistical parameters derived from reference populations. Recent findings from the International Database of Ambulatory Blood Pressure....../75 mm Hg, 130/85 mm Hg, and 110/70 mm Hg, respectively, and those for ambulatory hypertension were 130/80 mm Hg, 140/85 mm Hg, and 120/70 mm Hg. However, in clinical practice, any diagnostic threshold for blood pressure needs to be assessed in the context of the patient's overall risk profile. The IDACO...

  15. Source apportionment of methane and nitrous oxide in California's San Joaquin Valley at CalNex 2010 via positive matrix factorization

    Directory of Open Access Journals (Sweden)

    A. Guha

    2015-03-01

    Full Text Available Sources of methane (CH4 and nitrous oxide (N2O were investigated using measurements from a site in southeast Bakersfield as part of the CalNex (California at the Nexus of Air Quality and Climate Change experiment from 15 May to 30 June 2010. Typical daily minimum mixing ratios of CH4 and N2O were higher than daily averages that were simultaneously observed at a similar latitude background station (NOAA, Mauna Loa by approximately 70 and 0.5 ppb, respectively. Substantial enhancements of CH4 and N2O (hourly averages > 500 ppb and > 7 ppb, respectively were routinely observed suggesting the presence of large regional sources. Collocated measurements of carbon monoxide (CO and a range of volatile organic compounds (VOCs (e.g. straight-chain and branched alkanes, cycloalkanes, chlorinated alkanes, aromatics, alcohols, isoprene, terpenes and ketones were used with a Positive Matrix Factorization (PMF source apportionment method to estimate the contribution of regional sources to observed enhancements of CH4 and N2O. The PMF technique provided a "top-down" deconstruction of ambient gas-phase observations into broad source categories, yielding a 7-factor solution. We identified these source factors as emissions from evaporative and fugitive; motor vehicles; livestock and dairy; agricultural and soil management; daytime light and temperature driven; non-vehicular urban; and nighttime terpene biogenics and anthropogenics. The dairy and livestock factor accounted for a majority of the CH4 (70–90% enhancements during the duration of the experiments. Propagation of uncertainties in the PMF-derived factor profiles and time series from bootstrapping analysis resulted in a 29% uncertainty in the CH4 apportionment to this factor. The dairy and livestock factor was also a principal contributor to the daily enhancements of N2O (60–70% with an uncertainty of 33%. Agriculture and soil management accounted for ~20–25% of N2O enhancements over the course of a

  16. Source apportionment of methane and nitrous oxide in California's San Joaquin Valley at CalNex 2010 via positive matrix factorization

    Science.gov (United States)

    Guha, A.; Gentner, D. R.; Weber, R. J.; Provencal, R.; Goldstein, A. H.

    2015-03-01

    Sources of methane (CH4) and nitrous oxide (N2O) were investigated using measurements from a site in southeast Bakersfield as part of the CalNex (California at the Nexus of Air Quality and Climate Change) experiment from 15 May to 30 June 2010. Typical daily minimum mixing ratios of CH4 and N2O were higher than daily averages that were simultaneously observed at a similar latitude background station (NOAA, Mauna Loa) by approximately 70 and 0.5 ppb, respectively. Substantial enhancements of CH4 and N2O (hourly averages > 500 ppb and > 7 ppb, respectively) were routinely observed suggesting the presence of large regional sources. Collocated measurements of carbon monoxide (CO) and a range of volatile organic compounds (VOCs) (e.g. straight-chain and branched alkanes, cycloalkanes, chlorinated alkanes, aromatics, alcohols, isoprene, terpenes and ketones) were used with a Positive Matrix Factorization (PMF) source apportionment method to estimate the contribution of regional sources to observed enhancements of CH4 and N2O. The PMF technique provided a "top-down" deconstruction of ambient gas-phase observations into broad source categories, yielding a 7-factor solution. We identified these source factors as emissions from evaporative and fugitive; motor vehicles; livestock and dairy; agricultural and soil management; daytime light and temperature driven; non-vehicular urban; and nighttime terpene biogenics and anthropogenics. The dairy and livestock factor accounted for a majority of the CH4 (70-90%) enhancements during the duration of the experiments. Propagation of uncertainties in the PMF-derived factor profiles and time series from bootstrapping analysis resulted in a 29% uncertainty in the CH4 apportionment to this factor. The dairy and livestock factor was also a principal contributor to the daily enhancements of N2O (60-70%) with an uncertainty of 33%. Agriculture and soil management accounted for ~20-25% of N2O enhancements over the course of a day, not

  17. The development and validation of a five factor model of sources of self-efficacy in clinical nursing education

    NARCIS (Netherlands)

    Gloudemans, Henk; Schalk, Rene; Reynaert, Wouter; Braeken, Johan

    2012-01-01

    Background: The aim of this study is to validate a newly developed nurses' self-efficacy sources inventory. We test the validity of a five-dimensional model of sources of self-efficacy, which we contrast with the traditional four-dimensional model based on Bandura's theoretical concepts. Methods: Co

  18. Source apportionment of the ambient PM2.5 across St. Louis using constrained positive matrix factorization

    NARCIS (Netherlands)

    Amato, F.; Hopke, P.K.

    2012-01-01

    In most cases, receptor models are applied to data from a single monitoring site even if there are multiple sampling locations in a given urban area. When it can be reasonably expected that the sites are affected by the same set of sources, it is possible to use the spatial variability of the source

  19. Data Sources for the Model-based Small Area Estimates of Cancer Risk Factors and Screening Behaviors - Small Area Estimates

    Science.gov (United States)

    The model-based estimates of important cancer risk factors and screening behaviors are obtained by combining the responses to the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS).

  20. Hypotension based on office and ambulatory monitoring blood pressure. Prevalence and clinical profile among a cohort of 70,997 treated hypertensives.

    Science.gov (United States)

    Divisón-Garrote, Juan A; Banegas, José R; De la Cruz, Juan J; Escobar-Cervantes, Carlos; De la Sierra, Alejandro; Gorostidi, Manuel; Vinyoles, Ernest; Abellán-Aleman, José; Segura, Julián; Ruilope, Luis M

    2016-09-01

    We aimed to determine the prevalence of hypotension and factors associated with the presence of this condition in treated hypertensive patients undergoing ambulatory blood pressure monitoring (ABPM). Data were taken from the Spanish ABPM Registry. Office blood pressure (BP) and ABPM were determined using validated devices under standardized conditions. Based on previous studies, hypotension was defined as office systolic/diastolic BP office BP, 12.2% with daytime ABPM, 3.9% with nighttime ABPM, and 6.8% with 24-hour ABPM. Low diastolic BP values were responsible for the majority of cases of hypotension. Some 68% of the hypotension cases detected by daytime ABPM did not correspond to hypotension according to office BP. The variables independently and consistently associated with higher likelihood of office, daytime, and 24 hour-based hypotension were age, female gender, history of ischemic heart disease, and body mass index office BP. ABPM could be especially helpful for identifying ambulatory hypotension, in particular in patients who are older, women, or with previous ischemic heart disease where antihypertensive treatment should be especially individualized and cautious.

  1. 持续非卧床腹膜透析腹膜功能减退影响因素和干预策略%Influencing factors and interventions for the deterioration of peritoneal function in continuous ambulatory peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)

    丁小强; 吉俊

    2013-01-01

    In patients on peritoneal dialysis,the peritoneal function deteriorated with the prolonged dialysis time,characterized by the acceleration in solute transportation,decrease in fluid ultra-filtration and progeression into ultra-filtration failure in the end stage.The ultra-filtration failure is the direct cause of the failure of peritoneal dialysis.The influencing factors include peritonitis,bio-incompatible peritoneal dialysis solutions,residual renal function and long time of dialysis.Peritoneal equilibration test is commonly used in evaluation of the peritoneal function,of which the results should be interpreted with the clinical conditions.Standardized prevention and treatment of peritonitis,proper dialysis prescriptions,reservation of residual renal function,application of novel dialysate may be effective strategies in protecting peritoneal function.%随着腹膜透析龄的不断延长,患者腹膜功能将逐渐减退,表现为对溶质转运加快,水分超滤逐渐减少,直至发生超滤衰竭;一旦发生超滤衰竭,将直接导致腹膜透析失败.腹膜炎、生物不相容透析液、残余肾功能、长透析龄是腹膜功能减退的影响因素.腹膜平衡试验是目前评价腹膜功能最常用的方法,但应结合临床动态分析.规范防治腹膜炎、制定合理的透析处方、保护残余肾功能、应用新型透析液等是保护腹膜功能切实有效的干预策略.

  2. Tratamento ambulatorial da endocardite bacteriana estreptocócica Tratamiento clínico de la endocarditis bacteriana estreptocócica Ambulatory treatment of streptococcal bacterial endocarditis

    Directory of Open Access Journals (Sweden)

    Sirio Hassem Sobrinho

    2010-04-01

    Full Text Available A endocardite bacteriana é uma grave doença infecciosa cujo tratamento é tradicionalmente feito com o paciente internado. recebendo medicação intravenosa. A possibilidade de tratamento domiciliar ou ambulatorial. em casos estritamente selecionados. é atraente tanto do ponto de vista social quanto do econômico. Apresentamos o relato de 6 pacientes com diagnóstico de endocardite bacteriana por Streptococcus. tratados parcial ou integralmente em regime ambulatorial. Todos evoluíram sem complicações e com resolução completa do quadro infeccioso.La endocarditis bacteriana es una severa enfermedad infecciosa cuyo tratamiento se hace tradicionalmente con el paciente internado, recibiendo medicación intravenosa. La posibilidad de tratamiento domiciliar o clínico, en casos estrictamente seleccionados, es atractivo desde el punto de vista social como del económico. Presentamos el caso clínico de 6 pacientes con diagnóstico de endocarditis bacteriana por streptococcus, tratados parcial o integralmente en régimen ambulatorio. Todos evolucionaron sin complicaciones y con resolución completa del cuadro infeccioso.Bacterial endocarditis is a severe infectious disease. of which treatment is traditionally carried out in hospitalized patients through intravenous medication. The possibility of at-home or ambulatory treatment. for stringently selected cases. is attractive from the social as well as from the economic point of view. We report 6 patients with a diagnosis of bacterial endocarditis caused by Streptococcus. treated partially or completely on an outpatient basis. All of them evolved without complications and presented complete resolution of the infection.

  3. Left or right? Sources of political orientation: the roles of genetic factors, cultural transmission, assortative mating, and personality.

    Science.gov (United States)

    Kandler, Christian; Bleidorn, Wiebke; Riemann, Rainer

    2012-03-01

    In this study, we used an extended twin family design to investigate the influences of genetic and cultural transmission as well as different sources of nonrandom mating on 2 core aspects of political orientation: acceptance of inequality and rejecting system change. In addition, we studied the sources of phenotypic links between Big Five personality traits and political beliefs using self- and other reports. Data of 1,992 individuals (224 monozygotic and 166 dizygotic twin pairs, 92 unmatched twins, 530 spouses of twins, 268 fathers, and 322 mothers) were analyzed. Genetically informative analyses showed that political attitudes are genetically but not environmentally transmitted from parents to offspring and that a substantial proportion of this genetic variance can be accounted for by genetic variance in personality traits. Beyond genetic effects and genotypic assortative mating, generation-specific environmental sources act to increase twins' and spouses' resemblance in political beliefs. The results suggest multiple sources of political orientations in a modern democracy.

  4. Duty factor variation possibility from 1% to 100% with PKU microwave driven Cs-free volume H{sup −} sources

    Energy Technology Data Exchange (ETDEWEB)

    Peng, S. X., E-mail: sxpeng@pku.edu.cn; Zhang, T.; Ren, H. T.; Xu, Y.; Zhang, J. F.; Guo, Z. Y. [State Key Laboratory of Nuclear Physics and Technology and Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871 (China); Zhang, A. L. [University of Chinese Academy of Sciences, Beijing 100049 (China); Chen, J. E. [State Key Laboratory of Nuclear Physics and Technology and Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871 (China); University of Chinese Academy of Sciences, Beijing 100049 (China)

    2016-02-15

    Microwave driven cesium-free volume H{sup −} sources, that have the ability to deliver tens of mA H{sup −} at 35 keV both in CW and 10% duty factor (100 Hz/1 ms), were developed at Peking University (PKU) [S. X. Peng et al., in Proceeding of IPAC 2015, WEPWA027, Richmond, Virginia, USA, 3–8 May 2015]. Recently, special efforts were paid on the investigation of duty factor variation possibility from 1% to 100% with them. Most of the experiments were carried out with a pulsed length (τ) of 1 ms and different intervals of 99 ms, 49 ms, 39 ms, 29 ms, 19 ms, 9 ms, 4 ms, 2 ms, 1 ms, 0.5 ms, and 0 ms, respectively. Other experiments were focused on CW operation and fixed duty factor of 1%. Experimental results prove that PKU H{sup −} sources can deliver tens of mA H{sup −} at duty factor from 1% to 100%. The RF power efficiency increases steadily with the increasing of duty factor from 1% to CW at a fixed pulsed length. Under a given duty factor and pulsed length, RF power efficiency keeps constant and the H{sup −} current increases with RF power linearly. Details will be presented in the paper.

  5. Ambulatory Surgical Facilities, cruical infrastructures, Published in 2007, 1:100000 (1in=8333ft) scale, Marion County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:100000 (1in=8333ft) scale, was produced all or in part from Field Survey/GPS information as of 2007. It...

  6. Ear Acupuncture for Post-Operative Pain Associated with Ambulatory Arthroscopic Knee Surgery: A Randomized Controlled Trial

    Science.gov (United States)

    2014-01-14

    E7(/(3+21(180%(5 ,QFOXGHDUHDFRGH 14 Jan 2014 Final Report Ear acupuncture for post-operative pain associated with ambulatory arthroscopic...DISTRIBUTION A. Approved for public release: distribution unlimited. The purpose of this study is to compare ear acupuncture plus standard therapy versus...3298 Ear Acupuncture for Post-operative Pa111 Assoc1ated With Ambulatory Arthroscopic Knee Surgery A Randomized Controlled Trial ’• V ’’ ’-’ I

  7. Are published characteristics of the ambulatory blood pressure generalizable to rural Chinese? The JingNing population study

    OpenAIRE

    2005-01-01

    OBJECTIVE: We investigated the ambulatory blood pressure (BP) in rural Chinese and compared its characteristics with those reported in other population-based studies. METHODS: We enrolled inhabitants from six villages of the JingNing County, China. We recorded the ambulatory BP using 90207 SpaceLabs monitors. Trained physicians measured the conventional BP at the participants' homes. Hypertension was defined as a conventional BP of >/=140/>/=90 mmHg or a condition requiring the intake of anti...

  8. Fatores associados ao abandono de acompanhamento ambulatorial em um serviço de assistência especializada em HIV/aids na cidade do Rio de Janeiro, RJ Factors associated with HIV/AIDS treatment dropouts in a special care unit in the City of Rio de Janeiro, RJ, Brazil

    Directory of Open Access Journals (Sweden)

    Louise Bastos Schilkowsky

    2011-06-01

    Full Text Available OBJETIVO: Este estudo visou a identificar fatores associados ao abandono do serviço de saúde por pacientes com HIV/aids. MÉTODOS: O estudo foi desenvolvido no Serviço de Assistência Especializada de um hospital universitário do Rio de Janeiro, considerando uma amostra estratificada de pacientes adultos, incluindo todos os casos de abandono (155 e 44,0% dos 790 casos em acompanhamento regular. Análises bivariadas visaram a identificar associações entre o abandono do serviço de saúde e variáveis demográficas, socioeconômicas e clínicas. Um modelo de regressão logística e um modelo de Cox foram utilizados para a identificação dos efeitos independentes das variáveis explicativas sobre o risco de abandono, no segundo caso incorporando a informação sobre a ocorrência do desfecho no decorrer do tempo. RESULTADOS: Os pacientes tinham em média 35 anos, sendo predominantemente do sexo masculino (66,4% e de nível socioeconômico baixo (45%. Em ambos os modelos, mostraram-se consistentemente associados ao risco de abandono estar desempregado ou possuir vínculo instável, usar drogas ilícitas e ter antecedentes psiquiátricos - associação positiva; e idade, ter o diagnóstico de aids e ter usado vários esquemas antirretrovirais - associação negativa. Na regressão logística, mostrou-se também positivamente associado à ocorrência de abandono o tempo entre o diagnóstico e a primeira consulta, enquanto no modelo Cox, o hazard de ocorrência de abandono mostrou-se positivamente associado a ser solteiro e negativamente associado a ter nível de escolaridade mais elevado. CONCLUSÕES: Os resultados deste trabalho permitem a identificação de pacientes com HIV/aids mais vulneráveis ao abandono do serviço de saúde.OBJECTIVE: This study aimed to identify factors associated with the health care of patients with HIV/AIDS who drop out. METHODS: The study was developed in a specialized health care unit of a University hospital in

  9. The Effects of Ambulatory Accelerations on the Stability of a Magnetically Suspended Impeller for an Implantable Blood Pump.

    Science.gov (United States)

    Paul, Gordon; Rezaienia, Mohammed Amin; Rahideh, Akbar; Munjiza, Ante; Korakianitis, Theodosios

    2016-09-01

    This article describes the effects of ambulatory accelerations on the stability of a magnetically suspended impeller for use in implantable blood pumps. A magnetic suspension system is developed to control the radial position of a magnetic impeller using coils in the pump casing. The magnitude and periodicity of ambulatory accelerations at the torso are measured. A test rig is then designed to apply appropriate accelerations to the suspension system. Accelerations from 0 to 1 g are applied to the suspended impeller with ambulatory periodicity while the radial position of the impeller and power consumption of the suspension system are monitored. The test is carried out with the impeller suspended in air, water, and a glycerol solution to simulate the viscosity of blood. A model is developed to investigate the effects of the radial magnetic suspension system and fluid damping during ambulatory accelerations. The suspension system reduces the average displacement of the impeller suspended in aqueous solutions within its casing to 100 µm with a power consumption of below 2 W during higher magnitude ambulatory accelerations (RMS magnitude 0.3 g). The damping effect of the fluid is also examined and it is shown that buoyancy, rather than drag, is the primary cause of the damping at the low displacement oscillations that occur during the application of ambulatory accelerations to such a suspension system.

  10. Prevalência de complicações micro e macrovasculares e de seus fatores de risco em pacientes com diabetes melito do tipo 2 em atendimento ambulatorial Prevalence of micro and macroangiopatic chronic complications and their risk factors in the care of out patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Rafael Selbach Scheffel

    2004-09-01

    eram fumantes atuais e 21% ex-tabagistas. CONCLUSÃO: As complicações crônicas do DM do tipo 2 têm uma alta prevalência nos pacientes ambulatoriais de hospitais gerais. Praticamente todos os pacientes apresentavam pelo menos um fator de risco para doença cardiovascular, o que justifica o seu rastreamento e controle.BACKGROUND: Type 2 diabetes (DM2 has been related to the development of macroangiopatic [coronary heart disease (CHD, peripheral vascular disease (PVD and stroke] and microangiopatic [retinopathy, nephropathy, and distal sensory neuropathy (DSN] complications. The aims of this study were to analyze prevalence of complications in DM2 patients and to estimate their associated risk factors. METHODS: Cross-sectional study, including 927 out patients with DM2 from three medical centers in Rio Grande do Sul: Hospital de Clínicas de Porto Alegre (n = 475, Grupo Hospitalar Conceição (n = 229 and Hospital São Vicente de Paula (n = 223. Of the patients 42% were male, mean age was 59 ± 10 years and the median known duration of DM2 was 11 (5 - 43 years. Retinopathy was identified by direct fundoscopy; CHD by WHO questionnaire and/or abnormal ECG and/or perfusion abnormalities on myocardial scintigraphy; DSN by compatible symptoms and absent sensation on 10 g monofilament and/or tune fork; PVD by the presence of claudication and absent foot pulses; stroke by presence of sequels and history; and nephropathy by the urinary albumin excretion rate (>20 µg/min. Hypertension was defined by blood pressure (>140/90 mmHg and/or use of antihypertensive drugs. Body mass index (BMI, kg/m² and waist-to-hip ratio (WHR were calculated. RESULTS: CHD was present in 36% and PVD in 33% of the patients. Among the microvascular, 37% had nephropathy (12% with macroalbuminuria; 48% retinopathy (15% proliferative retinopathy. DSN was present in 36%. Seventy three percent of the patients presented arterial hypertension. Cholesterol levels were >200 mg/dl in 64% and BMI > 30 kg

  11. Changing sources and environmental factors reduce the rates of decline of organochlorine pesticides in the Arctic atmosphere

    Directory of Open Access Journals (Sweden)

    S. Becker

    2012-05-01

    Full Text Available An extensive database of organochlorine (OC pesticide concentrations measured at the Norwegian Arctic monitoring station at Ny-Ålesund, Svalbard, was analysed to assess longer-term trends in the Arctic atmosphere. Dynamic Harmonic Regression (DHR is employed to investigate the seasonal and cyclical behaviour of chlordanes, DDTs and hexachlorobenzene (HCB, and to isolate underlying inter-annual trends. Although a simple comparison of annual mean concentrations (1994–2005 suggest a decline for all of the OCs investigated, the longer-term trends identified by DHR only show a significant decline for p,p'-DDT. Indeed, HCB shows an increase from 2003–2005. This is thought to be due to changes in source types and the presence of impurities in current use pesticides, together with retreating sea ice affecting air-water exchange. Changes in source types were revealed by using isomeric ratios for the chlordanes and DDTs. Declining trends in ratios of trans-chlordane/cis-chlordane (TC/CC indicate a shift from primary sources, to more "weathered" secondary sources, whereas an increasing trend in o,p'-DDT/p,p'-DDT ratios indicate a shift from use of technical DDT to dicofol. Continued monitoring of these OC pesticides is required to fully understand the influence of a changing climate on the behaviour and environmental cycling of these chemicals in the Arctic as well as possible impacts from "new" sources.

  12. Curvularia lunata, a rare fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD); a rare case report

    Science.gov (United States)

    Subramanyam, Haritha; Elumalai, Ramprasad; Kindo, Anupma Jyoti; Periasamy, Soundararajan

    2016-01-01

    Peritonitis is an inflammation of the peritoneum that occurs in patients with end-stage renal disease (ESRD) treated by peritoneal dialysis. Fungal peritonitis is a dreaded complication of peritoneal dialysis. Curvularia lunata is known to cause extra renal disease like endocarditis, secondary allergic bronchopulmonary aspergillosis and endophthalmitis. This case report presents a case of continuous ambulatory peritoneal dialysis peritonitis with this disease and its management. This case is of a 45-year-old man, presented with ESRD, secondary to diabetic nephropathy. After 3 months of hemodialysis the patient was put on continuous ambulatory peritoneal dialysis (CAPD). Local Examination at catheter site showed skin excoriation and purulent discharge. Further peritoneal dialysis (PD) fluid analysis showed neutrophilic leukocytosis and diagnosis of Curvularia lunata PD peritonitis.

  13. Effects of Baroreflex Activation Therapy on Ambulatory Blood Pressure in Patients With Resistant Hypertension.

    Science.gov (United States)

    Wallbach, Manuel; Lehnig, Luca-Yves; Schroer, Charlotte; Lüders, Stephan; Böhning, Enrico; Müller, Gerhard A; Wachter, Rolf; Koziolek, Michael J

    2016-04-01

    Baroreflex activation therapy (BAT) has been demonstrated to decrease office blood pressure (BP) in the randomized, double-blind Rheos trial. There are limited data on 24-hour BP changes measured by ambulatory BP measurements (ABPMs) using the first generation rheos BAT system suggesting a significant reduction but there are no information about the effect of the currently used, unilateral BAT neo device on ABPM. Patients treated with the BAT neo device for uncontrolled resistant hypertension were prospectively included into this study. ABPM was performed before BAT implantation and 6 months after initiation of BAT. A total of 51 patients were included into this study, 7 dropped out from analysis because of missing or insufficient follow-up. After 6 months, 24-hour ambulatory systolic (from 148 ± 17 mm Hg to 140 ± 23 mm Hg, Phypertension. Randomized controlled trials are needed to evaluate BAT effects on ABPM in patients with resistant hypertension accurately.

  14. Curvularia lunata, a rare fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD; a rare case report

    Directory of Open Access Journals (Sweden)

    Subramanyam Haritha

    2016-01-01

    Full Text Available Peritonitis is an inflammation of the peritoneum that occurs in patients with end-stage renal disease (ESRD treated by peritoneal dialysis. Fungal peritonitis is a dreaded complication of peritoneal dialysis. Curvularia lunata is known to cause extra renal disease like endocarditis, secondary allergic bronchopulmonary aspergillosis and endophthalmitis. This case report presents a case of continuous ambulatory peritoneal dialysis peritonitis with this disease and its management. This case is of a 45-year-old man, presented with ESRD, secondary to diabetic nephropathy. After 3 months of hemodialysis the patient was put on continuous ambulatory peritoneal dialysis (CAPD. Local Examination at catheter site showed skin excoriation and purulent discharge. Further peritoneal dialysis (PD fluid analysis showed neutrophilic leukocytosis and diagnosis of Curvularia lunata PD peritonitis.

  15. Treatable renal failure found in non-ambulatory Duchenne muscular dystrophy patients.

    Science.gov (United States)

    Motoki, Takahiro; Shimizu-Motohashi, Yuko; Komaki, Hirofumi; Mori-Yoshimura, Madoka; Oya, Yasushi; Takeshita, Eri; Ishiyama, Akihiko; Saito, Takashi; Nakagawa, Eiji; Sugai, Kenji; Murata, Miho; Sasaki, Masayuki

    2015-10-01

    Duchenne muscular dystrophy (DMD) is a progressive muscular disorder in which respiratory and heart failures are the main causes of death. Intensive intervention in respiratory and cardiac function has dramatically improved the prognosis; however, dysfunction in other multiple organs may emerge in the later stages of the disease. We report the case of four non-ambulatory DMD patients who presented with renal failure. Common findings included decreased fluid intake, use of diuretics, and presence of chronic heart failure. The levels of serum cystatin C (CysC), a marker of kidney function unaffected by reduced muscle mass, were elevated in all four patients. In two patients, renal failure improved by increasing fluid intake, and discontinuing or reducing the dose of diuretics. The findings suggest that non-ambulatory DMD patients are at a risk of reduced kidney perfusion, which potentially leads to prerenal failure. Therefore, in DMD patients, dehydration signs and CysC levels should be monitored.

  16. Process visibility analysis in ambulatory care: a simulation study with RFID data.

    Science.gov (United States)

    Lin, Yi-Chin; Padman, Rema

    2013-01-01

    Healthcare is primarily delivered in the ambulatory care setting worldwide. The high variability in service delivery encountered in this environment negatively impacts process efficiency and patient satisfaction. In this study, we analyze care delivery process in ambulatory care using time and location stamped data collected via Radio Frequency Identification (RFID)-enabled badges worn by patients, clinicians, and staff as they complete each clinic visit. With the objective of improving process visibility and minimizing patient waiting time, we examine this data to delineate the major components of waiting time and use simulation modeling to evaluate the impact of possible interventions. Results indicate that as a prevalent strategy, different appointment scheduling rules can only reduce patient waiting time in the waiting room. Surprisingly, waiting time in the exam room is unchanged, requiring new approaches to improve care coordination that address this delay. The results also highlight the value of RFID technology and the challenges in deploying them to improve service delivery.

  17. Channel Selection and Feature Projection for Cognitive Load Estimation Using Ambulatory EEG

    Directory of Open Access Journals (Sweden)

    Tian Lan

    2007-01-01

    Full Text Available We present an ambulatory cognitive state classification system to assess the subject's mental load based on EEG measurements. The ambulatory cognitive state estimator is utilized in the context of a real-time augmented cognition (AugCog system that aims to enhance the cognitive performance of a human user through computer-mediated assistance based on assessments of cognitive states using physiological signals including, but not limited to, EEG. This paper focuses particularly on the offline channel selection and feature projection phases of the design and aims to present mutual-information-based techniques that use a simple sample estimator for this quantity. Analyses conducted on data collected from 3 subjects performing 2 tasks (n-back/Larson at 2 difficulty levels (low/high demonstrate that the proposed mutual-information-based dimensionality reduction scheme can achieve up to 94% cognitive load estimation accuracy.

  18. Exposure to Racial Discrimination and Ambulatory Blood Pressure in Women with Type 2 Diabetes.

    Science.gov (United States)

    Wagner, Julie; Tennen, Howard; Finan, Patrick; Feinn, Richard; Burg, Matthew M; Seawell, Asani; White, William B

    2016-10-01

    Diabetes is the only disorder in which women's risk for heart disease exceeds men's. Elevated blood pressure (BP) increases cardiovascular risk in people with type 2 diabetes. Racial discrimination and neuroticism are both associated with BP levels but have not been examined in concert. This study investigated self-reported racial discrimination, neuroticism and ambulatory BP in women with type 2 diabetes. Thirty-nine Black and 38 White women completed a race-neutral version of the Schedule of Racist Events; BP was evaluated using ambulatory monitoring devices. Actigraphy and diaries were used to document times of sleep and wakefulness. Racial discrimination interacted with neuroticism to predict systolic and diastolic BP both while awake and during sleep, after adjustment for covariates. For each, the influence of racist events was stronger at lower levels of neuroticism. Racial discrimination is associated with higher levels of 24-h BP in diabetic women who are low in neuroticism. Copyright © 2015 John Wiley & Sons, Ltd.

  19. Volume of Cataract Surgery and Surgeon Gender: The Florida Ambulatory Surgery Center Experience 2005 Through 2012.

    Science.gov (United States)

    French, Dustin D; Margo, Curtis E; Campbell, Robert R; Greenberg, Paul B

    2016-01-01

    Cataract is the most common surgically reversible cause of vision loss and the most common major surgical procedure performed in the United States. To understand how gender composition might affect differences in health services, we examined the surgeon gender-specific rates of routine cataract surgery performed in ambulatory surgical centers in Florida. Routine cataract surgeries were identified through the Florida Agency for Health Care Administration (AHCA) ambulatory surgery center dataset. The background of individual surgeons was determined by linking license numbers in the dataset to physician profiles publicly available from AHCA. From 2005 through 2012, women ophthalmologists in Florida performed roughly half the annual rate of cataract surgery as their male counterparts. This difference is not explained by greater time in clinical practice for men. Further investigation into the causes of this gender-volume disparity is warranted to determine what roles choice and barriers may play.

  20. A two-week reduction of ambulatory activity attenuates peripheral insulin sensitivity

    DEFF Research Database (Denmark)

    Krogh-Madsen, Rikke; Thyfault, John P; Broholm, Christa

    2009-01-01

    possible biological cause for the public health problem of type 2 diabetes has been identified. Reduced ambulatory activity for two weeks in healthy, non-exercising young men significantly reduced peripheral insulin sensitivity, cardiovascular fitness, and lean leg mass. Key words: Inactivity, Insulin...... activity would influence peripheral insulin sensitivity. We aimed to explore if healthy, non-exercising subjects who went from a normal to a low level of ambulatory activity for two weeks would display metabolic alterations including reduced peripheral insulin sensitivity. -To do this, ten healthy young...... after step reduction, with a post hoc analysis revealing the most pronounced effect after 4 h of insulin infusion. In addition, the two-week period induced a 7% decline in VO2max (ml/min; cardiovascular fitness). Lean mass of legs, but not arms and truck, decreased concurrently. Taken together, one...

  1. Mood-congruent memory in daily life: evidence from interactive ambulatory monitoring.

    Science.gov (United States)

    Loeffler, Simone N; Myrtek, Michael; Peper, Martin

    2013-05-01

    Evidence from the psychological laboratory indicates that emotional states tend to facilitate the encoding and retrieval of stimuli of the same emotional valence. To explore mood-congruent memory and the role of arousal in daily life, we applied a new interactive ambulatory technique. Psychophysiological arousal as indexed by non-metabolic heart rate, self-reported emotions and situational information were assessed during 24-h recordings in 70 healthy participants. The emotional state was used to trigger word list presentations on a minicomputer. Our results show that psychophysiological arousal at the time of encoding enhanced the recall of negative words in negative emotional conditions, whereas low psychophysiological arousal facilitated recall of positive words. In positive contexts, mood congruency was more prominent when arousal was low. These results demonstrate how automated experimentation with an ambulatory technique may help to assess emotional memory in real-world contexts, thus providing new methods for diverse fields of application.

  2. Preoperative ambulatory inspiratory muscle training in patients undergoing esophagectomy. A pilot study.

    Science.gov (United States)

    Agrelli, Taciana Freitas; de Carvalho Ramos, Marisa; Guglielminetti, Rachel; Silva, Alex Augusto; Crema, Eduardo

    2012-01-01

    A major decline in pulmonary function is observed on the first day after upper abdominal surgery. This decline can reduce vital and inspiratory capacity and can culminate in restrictive lung diseases that cause atelectasis, reduced diaphragm movement, and respiratory insufficiency. The objective of this study was to evaluate the efficacy of preoperative ambulatory respiratory muscle training in patients undergoing esophagectomy. The sample consisted of 20 adult patients (14 men [70%] and 6 women [30%]) with a diagnosis of advanced chagasic megaesophagus. A significant increase in maximum inspiratory pressure was observed after inspiratory muscle training when compared with baseline values (from -55.059 ± 18.359 to -76.286 ± 16.786). Preoperative ambulatory inspiratory muscle training was effective in increasing respiratory muscle strength in patients undergoing esophagectomy and contributed to the prevention of postoperative complications.

  3. Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

    Directory of Open Access Journals (Sweden)

    Wearne N

    2017-01-01

    Full Text Available Nicola Wearne,1 Kajiru Kilonzo,2 Emmanuel Effa,3 Bianca Davidson,1 Peter Nourse,4 Udeme Ekrikpo,1,5 Ikechi G Okpechi1 1Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; 2Department of Medicine, Kilimanjaro Christian Medical College, Moshi, Tanzania; 3Department of Medicine, University of Calabar, Calabar, Nigeria; 4Division of Paediatric Nephrology, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; 5Department of Internal Medicine, University of Uyo, Uyo, Nigeria Abstract: Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs. There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or

  4. Relationship between serum albumin and pulse wave velocity in patients on continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Li-Tao Cheng

    2008-08-01

    Full Text Available Li-Tao Cheng1, Li-Jun Tang1,2, Hui-Min Chen1,3, Wen Tang1, Tao Wang11Division of Nephrology, Peking University Third Hospital, Beijing, China; 2Division of Nephrology, Qilu Hospital of Shandong University, Ji’nan, China; 3Division of Cardiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, ChinaBackground: Hypoalbuminemia is a risk factor for cardiovascular events and mortality in dialysis patients, but the underlying mechanism remains unclear. Meanwhile, increased pulse wave velocity (PWV, the marker of arterial stiffness, has been proved to be an independent predictor of cardiovascular disease. The relationship between serum albumin and PWV in continuous ambulatory peritoneal dialysis patients (CAPD was studied.Methods: Sixty-two CAPD patients were studied. The average age was 63 ± 12 years and dialysis duration was 23 ± 22 months. Serum albumin, C-reactive protein (CRP, and carotid-femoral PWV were measured.Results: Among these patients, 43.5% were men. The mean serum albumin concentration was 37 ± 4 g/L and PWV was 11.9 ± 2.3 m/s. PWV positively correlated with age (r = 0.35, P < 0.01, diabetes (yes = 1, no = 0; r = 0.292, P < 0.05, systolic blood pressure (SBP; r = 0.493, P < 0.001 and CRP (r = 0.295, P < 0.05, but negatively correlated with serum albumin (r = −0.357, P < 0.01. In multiple regression analysis, SBP (β = 0.615, P < 0.001, age (β = 0.414, P < 0.01, albumin (β = −0.315, P < 0.05 and total cholesterol (β = 0.275, P < 0.05 were independent determinants of PWV. In a non-inflamed subgroup (CRP < 3 mg/L, n = 30, albumin still negatively correlated with PWV (r = −0.66, P < 0.001.Conclusion: Serum albumin inversely correlated with increased PWV in CAPD patients, suggesting that increased arterial stiffness might be the link between hypoalbuminemia and increased cardiovascular mortality in dialysis patients.Keywords: hypoalbuminemia, cardiovascular events, pulse wave velocity, arterial

  5. Continuous Ambulatory Peritoneal Dialysis in Limpopo Province, South Africa: Predictors of Patient and Technique Survival

    Science.gov (United States)

    Isla, Ramon A. Tamayo; Mapiye, Darlington; Swanepoel, Charles R.; Rozumyk, Nadiya; Hubahib, Jerome E.; Okpechi, Ikechi G.

    2014-01-01

    ♦ Introduction and aim: Continuous ambulatory peritoneal dialysis (CAPD) is not a frequently used modality of dialysis in many parts of Africa due to several socio-economic factors. Available studies from Africa have shown a strong association between outcome and socio-demographic variables. We sought to assess the outcome of patients treated with CAPD in Limpopo, South Africa. ♦ Methods: This was a retrospective study of 152 patients treated with CAPD at the Polokwane Kidney and Dialysis Centre (PKDC) from 2007 to 2012. We collected relevant demographic and biochemical data for all patients included in the study. A composite outcome of death while still on peritoneal dialysis (PD) or CAPD technique failure from any cause requiring a change of modality to hemodialysis (HD) was selected. The peritonitis rate and causes of peritonitis were assessed from 2008 when all related data could be obtained. ♦ Results: There were 52% males in the study and the average age of the patients was 36.8 ± 11.4 years. Unemployment rate was high (71.1%), 41.1% had tap water at home, the average distance travelled to the dialysis center was 122.9 ± 78.2 kilometres and half the patients had a total income less than USD ($)180 per month. Level of education, having electricity at home, having tap water at home, body mass index (BMI), serum albumin and hemoglobin were significantly different between those reaching the composite outcome and those not reaching it (p < 0.05). The overall peritonitis rate was 0.82/year with 1-year, 2-year and 5-year survival found to be 86.7%, 78.7% and 65.3% (patient survival) and 83.3%, 71.7% and 62.1% (technique survival). Predictors of the composite outcome were BMI (p = 0.011), serum albumin (p = 0.030), hemoglobin (p = 0.002) and more than 1 episode of peritonitis (p = 0.038). ♦ Conclusion: Treatment of anemia and malnutrition as well as training and re-training of CAPD patients and staff to prevent recurrence of peritonitis can have positive

  6. Risk factors for human salmonellosis originating from pigs, cattle, broiler chickens and egg laying hens: a combined case-control and source attribution analysis.

    Directory of Open Access Journals (Sweden)

    Lapo Mughini-Gras

    Full Text Available Several case-control studies have investigated risk factors for human salmonellosis while others have used Salmonella subtyping to attribute human infections to different food and animal reservoirs. This study combined case-control and source attribution data into a single analysis to explore risk factors at the point of exposure for human salmonellosis originating from four putative food-producing animal reservoirs (pigs, cattle, broilers and layers/eggs in the Netherlands. We confirmed that most human cases (∼ 90% were attributable to layers/eggs and pigs. Layers/eggs and broilers were the most likely reservoirs of salmonellosis in adults, in urban areas, and in spring/summer, whereas pigs and cattle were the most likely reservoirs of salmonellosis in children, in rural areas, and in autumn/winter. Several reservoir-specific risk factors were identified. Not using a chopping board for raw meat only and consuming raw/undercooked meat were risk factors for infection with salmonellas originating from pigs, cattle and broilers. Consuming raw/undercooked eggs and by-products were risk factors for layer/egg-associated salmonellosis. Using antibiotics was a risk factor for pig- and cattle-associated salmonellosis and using proton-pump inhibitors for salmonellosis attributable to any reservoir. Pig- and cattle-associated infections were also linked to direct contact with animals and environmental exposure (e.g. playing in sandboxes. Eating fish, meat in pastry, and several non-meat foods (fruit, vegetables and pasteurized dairy products were protective factors. Consuming pork and occupational exposure to animals and/or raw meats were protective against layer/egg-associated salmonellosis. We concluded that individuals acquiring salmonellosis from different reservoirs have different associated risk factors, suggesting that salmonellas may infect humans through various transmission pathways depending on their original reservoirs. The outcome of

  7. Risk factors for human salmonellosis originating from pigs, cattle, broiler chickens and egg laying hens: a combined case-control and source attribution analysis.

    Science.gov (United States)

    Mughini-Gras, Lapo; Enserink, Remko; Friesema, Ingrid; Heck, Max; van Duynhoven, Yvonne; van Pelt, Wilfrid

    2014-01-01

    Several case-control studies have investigated risk factors for human salmonellosis while others have used Salmonella subtyping to attribute human infections to different food and animal reservoirs. This study combined case-control and source attribution data into a single analysis to explore risk factors at the point of exposure for human salmonellosis originating from four putative food-producing animal reservoirs (pigs, cattle, broilers and layers/eggs) in the Netherlands. We confirmed that most human cases (∼ 90%) were attributable to layers/eggs and pigs. Layers/eggs and broilers were the most likely reservoirs of salmonellosis in adults, in urban areas, and in spring/summer, whereas pigs and cattle were the most likely reservoirs of salmonellosis in children, in rural areas, and in autumn/winter. Several reservoir-specific risk factors were identified. Not using a chopping board for raw meat only and consuming raw/undercooked meat were risk factors for infection with salmonellas originating from pigs, cattle and broilers. Consuming raw/undercooked eggs and by-products were risk factors for layer/egg-associated salmonellosis. Using antibiotics was a risk factor for pig- and cattle-associated salmonellosis and using proton-pump inhibitors for salmonellosis attributable to any reservoir. Pig- and cattle-associated infections were also linked to direct contact with animals and environmental exposure (e.g. playing in sandboxes). Eating fish, meat in pastry, and several non-meat foods (fruit, vegetables and pasteurized dairy products) were protective factors. Consuming pork and occupational exposure to animals and/or raw meats were protective against layer/egg-associated salmonellosis. We concluded that individuals acquiring salmonellosis from different reservoirs have different associated risk factors, suggesting that salmonellas may infect humans through various transmission pathways depending on their original reservoirs. The outcome of classical case

  8. Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy

    DEFF Research Database (Denmark)

    Brix, Lone Dragnes; Thillemann, Theis Muncholm; Nikolajsen, Lone

    2016-01-01

    anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING: Data from 144 patients were available for analysis (LA + S...... was shorter (P anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy....

  9. Aspergillus niger peritonitis in a patient on continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Usha Kalawat

    2013-07-01

    Full Text Available Fungal peritonitis is an uncommon condition which is associated with high morbidity and mortality in patients on continuous ambulatory peritoneal dialysis (CAPD. It is associated with several complications and many of the patients who develop this condition are unable to resume CAPD treatment and have to shift to haemodialysis. Here we report the rare occurrence of fungal peritonitis due to Aspergillus niger in a patient on CAPD.

  10. Imaging features of encapsulating peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients.

    LENUS (Irish Health Repository)

    Ti, Joanna P

    2010-07-01

    OBJECTIVE: The purpose of this article is to present the spectrum of radiologic findings of encapsulating peritoneal sclerosis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). CONCLUSION: Although a rare diagnosis, encapsulating peritoneal sclerosis in patients undergoing CAPD has a high morbidity and mortality. Diagnosis is often delayed because clinical features are insidious and nonspecific. Radiologic imaging may be helpful in the early diagnosis of encapsulating peritoneal sclerosis and in facilitating timely intervention for CAPD patients with encapsulating peritoneal sclerosis.

  11. 45. Ezetimibe and statins yields on silent holter ambulatory myocardial ischemia

    Directory of Open Access Journals (Sweden)

    W. Kadro

    2016-07-01

    Full Text Available Further cholestrol lowering may affect silent ischemia detected on holter monitoring. Cholesterol lowering is associated with a reduction in cardiovascular morbidity and mortality. Statins are the main drugs for cholesterol lowering. Ezetimibe when added to statins gives further reduction in cholesterol but its long-term effect on cardiovascular morbidity and mortality and ischemic events is not known. This study sought to determine whether further cholesterol lowering with ezitimibe will also results in a reduction of myocardial ischemia during daily life. We enrolled 50 patients with proven stable coronary artery disease (CAD and at least one episode of ST-segment depression on ambulatory ECG monitoring. All of them were receiving optimal therapy for CAD including statin therapy for cholesterol reduction. 25 patients were randomized to continue their statin therapy (Statin only group and 25 to recieve statin plus ezitimibe 10 mg/day (ezitimibe group. Serum cholesterol and LDL cholesterol levels and ambulatory monitoring were repeated after 4–6 months of therapy. The two groups were comparable with respect to baseline characteristics, number of episodes of ST-segment depression, and baseline serum cholesterol levels. The ezitimibe group had lower mean total and LDL cholesterol levels at study end and experienced a significant reduction in the number of episodes of ST-segment depression compared with the statin only group. ST-segment depression was completely resolved in 13 of 25 patients (52% in the ezitimibe group versus 3 of 25 (12% in the statin only group. The ezitimibe group exhibited a highly significant reduction in ambulatory ischemia (P < .001. By logistic regression, treatment with ezitimibe was an independent predictor of ischemia resolution. Further cholesterol lowering with ezitimibe can result in reduction or resolution of myocardial ischemia recorded as episodes of ST-segment depression in ambulatory monitoring of the ECG.

  12. Medication-related problem type and appearance rate in ambulatory hemodialysis patients

    OpenAIRE

    Drayer Debra K; Manley Harold J; Muther Richard S

    2003-01-01

    Abstract Background Hemodialysis (HD) patients are at risk for medication-related problems (MRP). The MRP number, type, and appearance rate over time in ambulatory HD patients has not been investigated. Methods Randomly selected HD patients were enrolled to receive monthly pharmaceutical care visits. At each visit, MRP were identified through review of the patient chart, electronic medical record, patient interview, and communications with other healthcare disciplines. All MRP were categorize...

  13. Facial nerve palsy: incidence of different ethiologies in a tertiary ambulatory

    OpenAIRE

    Atolini Junior, Nédio; Jorge Junior, José Jarjura; Gignon, Vinícius de Faria; Kitice, Adriano Tomio; Prado, Letícia Suriano de Almeida; Santos, Vânia Gracia Wolff

    2009-01-01

    Introduction: The ethiologic diferencial diagnostic for facial nerve paralisis is still a challenge and the literature has shown conflictive results concerning its epidemiology. Objective: To outline the incidence of the different ethiologies and the profile of peripheral facial nerve paralysis patients in the otolaryngology ambulatory of the Faculdade de Ciencias Medicas e Biologicas da PUC-SP - campus Sorocaba. Method: The records of 54 patients with facial nerve paralysis seen during the y...

  14. Severe “sweet” pleural effusion in a continuous ambulatory peritoneal dialysis patient

    OpenAIRE

    2014-01-01

    Introduction: Hydrothorax is a rare complication of continuous ambulatory peritoneal dialysis (CAPD) which can progress quickly to cause acute respiratory distress. Case presentation: We present a 76 year-old female with a past medical history significant for end-stage renal disease (ESRD) on daily home peritoneal dialysis for 2 years presented to the hospital from home with shortness of breath at rest and cough for 2 days prior to admission. She developed severe respiratory distress and h...

  15. Controlled-Release Oxycodone Versus Naproxen at Home After Ambulatory Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Björn Stessel, MD

    2014-12-01

    Conclusions: Paracetamol/CR oxycodone and paracetamol/naproxen are equally effective in treatment of acute postoperative pain at home after ambulatory surgery with comparable patient satisfaction level. We suggest paracetamol/CR oxycodone to be a valuable alternative for the current paracetamol/naproxen gold standard, particularly in patients with a contraindication for nonsteroidal anti-inflammatory drugs. ClinicalTrials.gov identifier: NCT02152592.

  16. Recurrent bacterial peritonitis caused by Neisseria cinerea in a chronic ambulatory peritoneal dialysis (CAPD) patient.

    Science.gov (United States)

    George, M J; DeBin, J A; Preston, K E; Chiu, C; Haqqie, S S

    1996-10-01

    We present an unusual case of recurrent (chronic ambulatory peritoneal dialysis) CAPD-associated peritonitis caused by Neisseria cinerea. Using DNA restriction fragment length polymorphism (RFLP) analysis, we determined that the recurrent infection was caused by reinfection with a different N. cinerea strain rather than relapse with the index strain and that the probable origin of the reinfecting organism was the patient's upper respiratory tract.

  17. Muscle Strength Enhancement Following Home-Based Virtual Cycling Training in Ambulatory Children with Cerebral Palsy

    Science.gov (United States)

    Chen, Chia-Ling; Hong, Wei-Hsien; Cheng, Hsin-Yi Kathy; Liaw, Mei-Yun; Chung, Chia-Ying; Chen, Chung-Yao

    2012-01-01

    This study is the first well-designed randomized controlled trial to assess the effects of a novel home-based virtual cycling training (hVCT) program for improving muscle strength in children with spastic cerebral palsy (CP). Twenty-eight ambulatory children with spastic CP aged 6-12 years were randomly assigned to an hVCT group (n = 13) or a…

  18. Improving the quality of palliative care for ambulatory patients with lung cancer

    DEFF Research Database (Denmark)

    von Plessen, Christian; Aslaksen, Aslak

    2005-01-01

    PROBLEM: Most patients with advanced lung cancer currently receive much of their health care, including chemotherapy, as outpatients. Patients have to deal with the complex and time consuming logistics of ambulatory cancer care. At the same time, members of staff often waste considerable time......; satisfaction among patients. STRATEGIES FOR CHANGE: Rescheduled patients' appointments, automated retrieval of blood test results, systematic reporting in patients' files, design of an information leaflet, and refurnishing of the waiting area at the clinic. EFFECTS OF CHANGE: Interventions resulted...

  19. A novel ambulatory closed circuit breathing system for use during exercise.

    LENUS (Irish Health Repository)

    McMorrow, R C N

    2011-05-01

    We describe a unique ambulatory closed circuit for delivering high fractions of inspired oxygen to an exercising user who does not require isolation from their environment. We describe the major components and their function and suggest potential applications for such a circuit. This circuit may benefit patients who are chronically dependant on oxygen, are unable to exercise due to hypoxia, or require oxygen supplementation at high altitude.

  20. Ambulatory hernia surgery under local anesthesia is feasible and safe in obese patients.

    Science.gov (United States)

    Acevedo, A; León, J

    2010-02-01

    Ambulatory hernia surgery under local anesthesia is becoming more widely used worldwide. Although many reports include obese patients, there are no studies that report specifically on the feasibility and safety of ambulatory hernia surgery in this category of patients. This paper documents our experience in this respect. The present investigation is an observational study performed at the CRS Hernia Center, Santiago, Chile, on 510 obese and 1,521 non-obese patients with all kinds of hernias susceptible to ambulatory hernia repair under local anesthesia. Both tissue and mesh repairs were performed. Obesity was defined as a body mass index (BMI) greater than 30. Patients with a BMI greater than 45 were excluded from this study. Operative time and pain experienced during the intervention were recorded. During the controls performed by a staff member at the 7th postoperative day, a questionnaire was answered by each patient regarding satisfaction, complaints, and postoperative pain. A second questionnaire was completed on the 30th postoperative day. Satisfaction and pain were both measured by means of a 10-point visual analog scale (VAS). The mean age was similar in both groups (51 years for non-obese and 52 years for obese patients). Obesity was present in 38.3% of women and in 17.5% of men (P ambulatory abdominal wall hernia repair under local anesthesia is feasible in obese patients. Because of the increased length of surgery in these patients, monitored sedation and prophylactic antibiotic cover should be used. The slight decrease in patient satisfaction is balanced by the lower risks and higher costs associated with full general anesthetic.

  1. Ambulatory Blood Pressure Monitoring Profile as a Useful Prognostic Tool in Patients with Primary Hypertension

    OpenAIRE

    Mohamed, A. L.; Katiman, E; Hassan, J Abu

    2003-01-01

    Ambulatory blood pressure monitoring (ABPM) devices are increasingly being used in the assessment of hypertension. The purpose of the study was to investigate patient’s diurnal BP variation and to further determine the differences of BP readings between male and female patients and the effects of age in patients who attended the clinic with essential hypertension. In addition, evidence of relationship between the parameters recorded by 24-hour ABPM was also investigated. This study was conduc...

  2. Long-term therapy for heart failure with continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    McKinnie, J J; Bourgeois, R J; Husserl, F E

    1985-06-01

    This article reports the treatment with continuous ambulatory peritoneal dialysis of a patient with intractable congestive heart failure secondary to an ischemic cardiomyopathy. Although the use of peritoneal dialysis to treat refractory heart failure is not new, the advent of an effective continuous peritoneal dialysis system has allowed its use over prolonged periods of time. The two-year treatment interval described herein represents the longest reported application of this technique, to the best of our knowledge.

  3. Translating caring theory across the continuum from inpatient to ambulatory care.

    Science.gov (United States)

    Tonges, Mary; McCann, Meghan; Strickler, Jeff

    2014-06-01

    While theory-based practice is a Magnet® characteristic, translating theories to practice remains challenging. As a result, theory-guided practice remains an ideal rather than a realized goal in many organizations. This article provides an overview of a research-derived caring theory, a translational model for theory-driven practice, implementation of a delivery model designed to translate theory across the acute and ambulatory care continuum, and resulting outcomes in oncology clinics and the emergency department.

  4. Outcome tools used for ambulatory children with cerebral palsy: responsiveness and minimum clinically important differences

    OpenAIRE

    Oeffinger, D; Bagley, A; Rogers, S.; Gorton, G; Kryscio, R; Abel, M.; Damiano, D; Barnes, D.; Tylkowski, C

    2008-01-01

    This prospective longitudinal multicenter study of ambulatory children with cerebral palsy (CP) examined changes in outcome tool score over time, tool responsiveness, and used a systematic method for defining minimum clinically important differences (MCIDs). Three hundred and eighty-one participants with CP (Gross Motor Function Classification System [GMFCS] Levels I–III; age range 4–18y, mean age 11y [SD 4y 4mo]; 265 diplegia, 116 hemiplegia; 230 males, 151 females). At baseline and follow-u...

  5. Digital Dermatitis in Dairy Cows: A Review of Risk Factors and Potential Sources of Between-Animal Variation in Susceptibility

    Directory of Open Access Journals (Sweden)

    Maeve A. Palmer

    2015-07-01

    Full Text Available Digital dermatitis (DD is a bacterial disease that primarily affects the skin on the heels of cattle. It is a major cause of lameness in dairy cows and a significant problem for the dairy industry in many countries, causing reduced animal welfare and economic loss. A wide range of infection levels has been found on infected farms, prompting investigations into both farm level and animal level risk factors for DD occurrence. There also appears to be individual variation between animals in susceptibility to the disease. The identification of factors affecting individual variation in susceptibility to DD might allow changes in breeding policies or herd management which could be used to reduce DD prevalence. Factors mentioned in the literature as possibly influencing individual variation in susceptibility to DD include physical factors such as hoof conformation and properties of the skin, physiological factors such as the efficacy of the immune response, and behavioural factors such as standing half in cubicles. Further work is required to determine the influence of these factors, identify the genetic basis of variation, clarify the level of heritability of DD susceptibility and to determine how this is correlated with production and health traits currently used in breeding programmes.

  6. [Influence of treatment with olmesartan on ambulatory blood pressure monitoring parameters in patients with arterial hypertension].

    Science.gov (United States)

    Bregvadze, T R; Tseluĭko, V I; Mishchuk, N E

    2013-12-01

    Hypertension is the most common disease of the cardiovascular system. Active treatment of hypertension with adequate control of blood pressure (BP) can prevent complications, improve life quality and increase life expectancy. One of the interesting new antihypertensive agents, from the group of angiotensin receptor blockers is olmesartan. The obvious advantages of ambulatory blood pressure monitoring to traditional one-time measurements of BP make this method perspective for quality control of anti-hypertensive therapy. The aim of this study was to evaluate the influence of treatment with olmesartan on ambulatory blood pressure monitoring parameters in patients with hypertension. 38 out-patients with hypertension at the age of 25-84 years (mean 55,3±10,6) were studied. Patients received olmesartan 20 mg daily as monotherapy (20 patients (52,6%)) or in combination with other antihypertensive agents (18 patients (47,4%)). Treatment continued for 6 months. The complex examination included: measurement of office brachial BP, electrocardiography, echocardiography and ambulatory blood pressure monitoring (ABPM). As a result of treatment, office BP and diurnal BP, according to ABPM, significantly decreased; the favorable circadian BP profile dynamics were found: significantly less frequently observed lack of reduction in BP during night (daily index - non-dipper) - 18% vs. 64% (p treatment of hypertensive patients with olmesartan provides significant decline not only in office BP, but also in diurnal BP, normalizes BP of active and passive periods, also - daily index and reduces BP variability.

  7. Influence of major pulmonary resection on postoperative daily ambulatory activity of the patients.

    Science.gov (United States)

    Novoa, Nuria; Varela, Gonzalo; Jiménez, Marcelo F; Aranda, Jose Luis

    2009-12-01

    To describe and compare the daily ambulatory activity of the patients before and one month after major lung resection. Daily activity was measured using a pedometer (OMROM Walking Style PRO) given preoperatively in a prospective way to a series of 21 consecutive cases scheduled for lobectomy or pneumonectomy. Analyzed variables were age, pulmonary function, mean number of total and aerobic steps per day, walked distance and mean daily time of aerobic activity. Activity variables were analyzed individually and as a new differential variable DELTA. Wilcoxon and Mann-Whitney nonparametric tests were used for comparison between groups. General series data: 19 male. Age: 63+/-10.9 years. FEV(1)%: 88.4+/-22.7. DLCO: 86.2+/-21.6. Eleven cases had COPD criteria. Type of surgery: 3 pneumonectomy/18 lobectomy. Activity data: all patients showed a global decrease of their activity one month after surgery but, patients in the pneumonectomy group are unable to keep aerobic activity meanwhile patients that undergone lobectomy showed only a 25% reduction in the measured variables. Major pulmonary resection decreases the time and the quality of the daily ambulatory activity of the patients during the first postoperative month. Despite limitations, the chosen pedometer OMRON Walking Style Pro is an efficient tool to evaluate the perioperative daily ambulatory activity of patients.

  8. The Unified Parkinson's Disease Rating Scale as a predictor of peak aerobic capacity and ambulatory function.

    Science.gov (United States)

    Ivey, Frederick M; Katzel, Leslie I; Sorkin, John D; Macko, Richard F; Shulman, Lisa M

    2012-01-01

    The Unified Parkinson's Disease Rating Scale (UPDRS) is a widely applied index of disease severity. Our objective was to assess the utility of UPDRS for predicting peak aerobic capacity (VO2 peak) and ambulatory function. Participants (n = 70) underwent evaluation for UPDRS (Total and Motor ratings), VO2 peak, 6-minute walk distance (6MW), and 30-foot self-selected walking speed (SSWS). Using regression, we determined the extent to which the Total and Motor UPDRS scores predicted each functional capacity measure after adjusting for age and sex. We also tested whether adding the Hoehn and Yahr scale (H-Y) to the model changed predictive power of the UPDRS. Adjusted for age and sex, both the Total UPDRS and Motor UPDRS subscale failed to predict VO2 peak. The Total UPDRS did weakly predict 6MW and SSWS (both p UPDRS subscale did not predict these ambulatory function tests. After adding H-Y to the model, Total UPDRS was no longer an independent predictor of 6MW but remained a predictor of SSWS. We conclude that Total and Motor UPDRS rating scales do not predict VO2 peak, but that a weak relationship exists between Total UPDRS and measures of ambulatory function.

  9. Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure.

    Science.gov (United States)

    Lang, C C; Chomsky, D B; Rayos, G; Yeoh, T K; Wilson, J R

    1997-01-01

    The purpose of this study was to determine whether skeletal muscle atrophy limits the maximal exercise capacity of stable ambulatory patients with heart failure. Body composition and maximal exercise capacity were measured in 100 stable ambulatory patients with heart failure. Body composition was assessed by using dual-energy X-ray absorption. Peak exercise oxygen consumption (VO2peak) and the anaerobic threshold were measured by using a Naughton treadmill protocol and a Medical Graphics CardioO2 System. VO2peak averaged 13.4 +/- 3.3 ml.min-1.kg-1 or 43 +/- 12% of normal. Lean body mass averaged 52.9 +/- 10.5 kg and leg lean mass 16.5 +/- 3.6 kg. Leg lean mass correlated linearly with VO2peak (r = 0.68, P < 0.01), suggesting that exercise performance is influences by skeletal muscle mass. However, lean body mass was comparable to levels noted in 1,584 normal control subjects, suggesting no decrease in muscle mass. Leg muscle mass was comparable to levels noted in 34 normal control subjects, further supporting this conclusion. These findings suggest that exercise intolerance in stable ambulatory patients with heart failure is not due to skeletal muscle atrophy.

  10. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses.

    Science.gov (United States)

    Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy

    2015-01-01

    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research.

  11. Associations of ambulatory blood pressure with urinary caffeine and caffeine metabolite excretions.

    Science.gov (United States)

    Guessous, Idris; Pruijm, Menno; Ponte, Belén; Ackermann, Daniel; Ehret, Georg; Ansermot, Nicolas; Vuistiner, Philippe; Staessen, Jan; Gu, Yumei; Paccaud, Fred; Mohaupt, Markus; Vogt, Bruno; Pechère-Bertschi, Antoinette; Pechère-Berstchi, Antoinette; Martin, Pierre-Yves; Burnier, Michel; Eap, Chin B; Bochud, Murielle

    2015-03-01

    Intake of caffeinated beverages might be associated with reduced cardiovascular mortality possibly via the lowering of blood pressure. We estimated the association of ambulatory blood pressure with urinary caffeine and caffeine metabolites in a population-based sample. Families were randomly selected from the general population of Swiss cities. Ambulatory blood pressure monitoring was conducted using validated devices. Urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured in 24 hours urine using ultrahigh performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of urinary excretions with blood pressure although adjusting for major confounders. The 836 participants (48.9% men) included in this analysis had mean age of 47.8 and mean 24-hour systolic and diastolic blood pressure of 120.1 and 78.0 mm Hg. For each doubling of caffeine excretion, 24-hour and night-time systolic blood pressure decreased by 0.642 and 1.107 mm Hg (both P values theobromine excretion was not associated with blood pressure. Anti-hypertensive therapy, diabetes mellitus, and alcohol consumption modify the association of caffeine urinary excretion with systolic blood pressure. Ambulatory systolic blood pressure was inversely associated with urinary excretions of caffeine and other caffeine metabolites. Our results are compatible with a potential protective effect of caffeine on blood pressure.

  12. Characteristic of Ambulatory Blood Pressure in Normotensive Subjects With Type 2 Diabetes Mellitus

    Institute of Scientific and Technical Information of China (English)

    Chen Xiaochao; Xu Mingtong; Kong Minyi; Xue Shengneng

    2005-01-01

    Objectives To observe the characteristic of ambulatory blood pressure monitoring in normotensive diabetic subjects with normoalbuminuria or microalbuminuria. Methods Fifty-two normotensive patients with type 2 diabetes received ambulatory blood pressure monitoring were divided into normoalbuminuric and microalbuminuric groups according to their albumin excretion rate, the other 28 normotensive subjects without diabetes were contributed as control group. Ambulatory blood pressure monitoring was performed on a working day and measurement of blood pressure circadian rhythm was analyzed. Results Normotensive microalbuminuric diabetic patients had higher night-time systolic blood pressure and more blood pressure burden than normotensive normoalbuminuric diabetic patients. Additionally, the microalbuminuric patients had a higher frequency of non-dippers than normoalbuminuric ones, although they were all normotensive. Compared to the normotensive non-diabetic control subjects, the nighttime systolic blood pressure and frequency of nondippers of the normoalbuminuric diabetic patients were significantly higher. Conclusions Intensive attention should be paid in control of blood pressure in diabetic patients to prevent and limit damage of target organ including kidney, even in those normotensive subjects.

  13. Compensatory movements during functional activities in ambulatory children with Duchenne muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Joyce Martini

    2014-01-01

    Full Text Available Objective: During the transitional phase (ambulatory to non-ambulatory, synergies characterize the evolution of Duchenne muscular dystrophy (DMD. This study was performed to describe and quantify compensatory movements while sitting down on/rising from the floor and climbing up/down steps. Method: Eighty videos (5 children × 4 assessments × 4 tasks were recorded quarterly in the year prior to gait loss. Compensatory movements from the videos were registered based on the Functional Evaluation Scale for DMD. Results: The most frequently observed compensatory movements were upper limb support on lower limbs/floor/handrail during all the tasks and lumbar hyperlordosis, trunk support on handrail, equinus foot, increased base of support, non-alternated descent, and pauses while climbing up/down steps. Conclusion: Climbing up/down steps showed a higher number of compensatory movements than sitting down on/rising from the floor, which seemed to be lost before climbing up/down steps in ambulatory children with DMD.

  14. Artificial neural network-based classification of body movements in ambulatory ECG signal.

    Science.gov (United States)

    Darji, Sachin T; Kher, Rahul K

    2013-11-01

    Abstract Ambulatory ECG monitoring provides electrical activity of the heart when a person is involved in doing normal routine activities. Thus, the recorded ECG signal consists of cardiac signal along with motion artifacts introduced due to a person's body movements during routine activities. Detection of motion artifacts due to different physical activities might help in further cardiac diagnosis. Ambulatory ECG signal analysis for detection of various motion artifacts using adaptive filtering approach is addressed in this paper. We have used BIOPAC MP 36 system for acquiring ECG signal. The ECG signals of five healthy subjects (aged between 22-30 years) were recorded while the person performed various body movements like up and down movement of the left hand, up and down movement of the right hand, waist twisting movement while standing and change from sitting down on a chair to standing up movement in lead I configuration. An adaptive filter-based approach has been used to extract the motion artifact component from the ambulatory ECG signal. The features of motion artifact signal, extracted using Gabor transform, have been used to train the artificial neural network (ANN) for classifying body movements.

  15. An application of the theory of planned behaviour to study the influencing factors of participation in source separation of food waste.

    Science.gov (United States)

    Karim Ghani, Wan Azlina Wan Ab; Rusli, Iffah Farizan; Biak, Dayang Radiah Awang; Idris, Azni

    2013-05-01

    Tremendous increases in biodegradable (food waste) generation significantly impact the local authorities, who are responsible to manage, treat and dispose of this waste. The process of separation of food waste at its generation source is identified as effective means in reducing the amount food waste sent to landfill and can be reused as feedstock to downstream treatment processes namely composting or anaerobic digestion. However, these efforts will only succeed with positive attitudes and highly participations rate by the public towards the scheme. Thus, the social survey (using questionnaires) to analyse public's view and influencing factors towards participation in source separation of food waste in households based on the theory of planned behaviour technique (TPB) was performed in June and July 2011 among selected staff in Universiti Putra Malaysia, Serdang, Selangor. The survey demonstrates that the public has positive intention in participating provided the opportunities, facilities and knowledge on waste separation at source are adequately prepared by the respective local authorities. Furthermore, good moral values and situational factors such as storage convenience and collection times are also encouraged public's involvement and consequently, the participations rate. The findings from this study may provide useful indicator to the waste management authorities in Malaysia in identifying mechanisms for future development and implementation of food waste source separation activities in household programmes and communication campaign which advocate the use of these programmes.

  16. Using Confirmatory Factor Analysis to Understand Executive Control in Preschool Children: Sources of Variation in Emergent Mathematic Achievement

    Science.gov (United States)

    Bull, Rebecca; Espy, Kimberly Andrews; Wiebe, Sandra A.; Sheffield, Tiffany D.; Nelson, Jennifer Mize

    2011-01-01

    Latent variable modeling methods have demonstrated utility for understanding the structure of executive control (EC) across development. These methods are utilized to better characterize the relation between EC and mathematics achievement in the preschool period, and to understand contributing sources of individual variation. Using the sample and…

  17. Concentrations of polycyclic aromatic hydrocarbons in New York City community garden soils: Potential sources and influential factors.

    Science.gov (United States)

    Marquez-Bravo, Lydia G; Briggs, Dean; Shayler, Hannah; McBride, Murray; Lopp, Donna; Stone, Edie; Ferenz, Gretchen; Bogdan, Kenneth G; Mitchell, Rebecca G; Spliethoff, Henry M

    2016-02-01

    A total of 69 soil samples from 20 community gardens in New York City (New York, USA) were collected and analyzed for 23 polycyclic aromatic hydrocarbons (PAHs) and black carbon. For each garden, samples were collected from nongrowing areas (non-bed) and from vegetable-growing beds, including beds with and without visible sources of PAHs. The sum of the US Environmental Protection Agency's 16 priority PAHs ranged up to 150 mg/kg, and the median (5.4 mg/kg) and mean (14.2 mg/kg) were similar to those previously reported for urban areas in the northeast United States. Isomer ratios indicated that the main sources of PAHs were petroleum, coal, and wood combustion. The PAH concentrations were significantly and positively associated with black carbon and with modeled air PAH concentrations, suggesting a consistent relationship between historical deposition of atmospheric carbon-adsorbed PAHs and current PAH soil concentrations. Median PAH soil concentration from non-bed areas was higher (7.4 mg/kg) than median concentration from beds in the same garden (4.0 mg/kg), and significantly higher than the median from beds without visible sources of PAHs (3.5 mg/kg). Median PAH concentration in beds from gardens with records of soil amendments was 58% lower compared with beds from gardens without those records. These results suggest that gardening practices in garden beds without visible sources of PAHs contribute to reduce PAH soil concentrations.

  18. Long-term variation (1960-2003) and causal factors of non-point-source nitrogen and phosphorus in the upper reach of the Yangtze River.

    Science.gov (United States)

    Shen, Zhenyao; Chen, Lei; Ding, Xiaowen; Hong, Qian; Liu, Ruimin

    2013-05-15

    The knowledge of long-term variation and causal factors of non-point source (NPS) pollution in large-scale watersheds is helpful in the development of water quality control programs. In this study, the Improved Export Coefficient Model and the Revised Universal Soil Loss Equation were combined to estimate the temporal and spatial variations (1960-2003) of NPS pollution in the upper reach of the Yangtze River (URYR). Two change points for NPS pollution were successfully detected. In the URYR, the dissolved nitrogen (DN) and dissolved phosphorus (DP) increased before 2000 and decreased after 2000, whereas the inflection points from increase to decline were around 1980 for the adsorbed N (AN) and adsorbed P (AP). The results also indicated that the dissolved pollutants were mainly contributed by the anthropogenic factors, while the adsorbed pollutants were primarily exported by the natural factors. By comparing the load intensities from each source, it revealed that for the dissolved pollutants, the major source of the high load intensity transferred from urban land to dry land after 1980. Simultaneously, the high load intensity areas of the adsorbed pollutants transferred from forest to orchard around 1980, which was mainly attributed to the increasing fertilizer application. These results may be useful for planning and management of the URYR and other large-scale watersheds.

  19. Olmesartan medoxomil-based antihypertensive therapy evaluated by ambulatory blood pressure monitoring: efficacy in high-risk patient subgroups.

    Science.gov (United States)

    Chrysant, Steven G; Germino, F Wilford; Neutel, Joel M

    2012-12-01

    Hypertension affects approximately 26% of the world's adult population and is a recognized major risk factor for morbidity and mortality associated with cardiovascular, cerebrovascular, and renal diseases. However, despite the availability of a range of effective antihypertensive agents and a growing awareness of the consequences of high blood pressure (BP), the treatment and control of hypertension remains suboptimal. A number of patient subgroups are categorized as 'high risk' and may have hypertension that is more difficult to treat, including obese individuals, patients with stage 2 hypertension, those with type 2 diabetes mellitus (T2DM), patients with coronary artery disease or a history of stroke, and Black patients. As the benefits of lowering BP in patients with hypertension are unequivocal, particularly in high-risk patients, treating high-risk patients with hypertension to BP goals and maintaining 24-hour BP control is important to help reduce cardiovascular risk and improve outcomes. Although the BP goals recommended in current consensus guidelines for the management of patients with hypertension are based on cuff BP measurements, ambulatory BP monitoring (ABPM) provides a valuable diagnostic tool and allows a more accurate assessment of BP levels throughout the 24-hour dosing period. ABPM is a better predictor of prognosis than office BP measurement and is also useful for assessing whether antihypertensive therapy remains effective in the critical last few hours of the dosing period, which usually coincides with the morning BP surge associated with arousal and arising. ABPM has been adopted by new evidence-based guidelines in the United Kingdom to confirm a suspected diagnosis of hypertension, which is an indication of the growing importance of ABPM in the management of hypertension. This review provides an overview of the efficacy and safety of antihypertensive therapy based on olmesartan medoxomil ± hydrochlorothiazide and amlodipine

  20. Source apportionment of methane and nitrous oxide in California's San Joaquin Valley at CalNex 2010 via positive matrix factorization

    Science.gov (United States)

    Guha, A.; Gentner, D. R.; Weber, R. J.; Provencal, R.; Goldstein, A. H.

    2015-10-01

    Sources of methane (CH4) and nitrous oxide (N2O) were investigated using measurements from a site in southeast Bakersfield as part of the CalNex (California at the Nexus of Air Quality and Climate Change) experiment from mid-May to the end of June 2010. Typical daily minimum mixing ratios of CH4 and N2O were higher than daily minima that were simultaneously observed at a mid-oceanic background station (NOAA, Mauna Loa) by approximately 70 ppb and 0.5 ppb, respectively. Substantial enhancements of CH4 and N2O (hourly averages > 500 and > 7 ppb, respectively) were routinely observed, suggesting the presence of large regional sources. Collocated measurements of carbon monoxide (CO) and a range of volatile organic compounds (VOCs) (e.g., straight-chain and branched alkanes, cycloalkanes, chlorinated alkanes, aromatics, alcohols, isoprene, terpenes and ketones) were used with a positive matrix factorization (PMF) source apportionment method to estimate the contribution of regional sources to observed enhancements of CH4 and N2O. The PMF technique provided a "top-down" deconstruction of ambient gas-phase observations into broad source categories, yielding a seven-factor solution. We identified these emission source factors as follows: evaporative and fugitive; motor vehicles; livestock and dairy; agricultural and soil management; daytime light and temperature driven; non-vehicular urban; and nighttime terpene biogenics and anthropogenics. The dairy and livestock factor accounted for the majority of the CH4 (70-90 %) enhancements during the duration of experiments. The dairy and livestock factor was also a principal contributor to the daily enhancements of N2O (60-70 %). Agriculture and soil management accounted for ~ 20-25 % of N2O enhancements over a 24 h cycle, which is not surprising given that organic and synthetic fertilizers are known to be a major source of N2O. The N2O attribution to the agriculture and soil management factor had a high uncertainty in the

  1. A modeling study on the controlling factors of seismic source distribution and their strength index——Practical analyses of the seismic environmental factors of the Honghe fault

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    A model, in which various seismic environmental factors areinvolved, has been developed in the paper on the bases of relevant data. The environmental factors include the crust structure, lithological conditions, fault plan attitude, the crust stress state, pore-fluid pressure and geothermal conditions, etc. The effect of each of the factors on the tectonic movement energy index has been analyzed. The model calculation results indicate that shear fractu-re energy of a fault generally increases with depth; it reached a peak value at a certain depth, then turns gradually attenuated. Of all the factors, the effects of pore-fluid pressure and geothermal conditions on the energy index are of prominence. High pore-fluid pressure and high temperature circumstance may result in decline of the peak value of the shear fracture energy curve, making the depths of the peak value and of the bell-waist value deepened. Such effects restrict strong seismic events, but suitable for micro-seismic activity and/or fault creep. The lower limit of focal depth under such an environment is relatively deep. Contrarily, low pore-fluid pressure and low geothermal temperature circumstance result in increase of the peak value of the shear fracture energy curve, and the curve becoming steep. The later circumstance is favorable to the formation of locked segment where possesses high strength and high-energy accumulation. If these two kind of segments are arranged interactively along a fault zone, such arrangement would boost the energy transition among the segments, forming mechanical circumstance of energy highly accumulated in one segment with adjacent segment(s) less-locked. Such contrast of the strength and energy would provide conditions for strong earthquakes with high stress drop. An analysis of the northwest seg-ment of the Honghe fault has provided some evidence for the modeling results.

  2. Evaluation of Peritonitis Incidence, Etiology, Associated Factors and Prognosis of Continuous Ambulatory Peritoneal Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Nefise ÖZBALCI

    2013-05-01

    Full Text Available OBJECTIVE: Peritonitis is the most important complication of peritoneal dialysis (PD. We evaluated the incidence of peritonitis, active microorganisms and their susceptibility profile and determine prognosis. MATERIAL and METHODS: One hundred fifty three PD patients were evaluated for aetiology, drug usage, accompanying disease, type, duration and personal preference for PD, care-giver, protein catabolic rate (PCR, residual urine volume, ultrafiltration volume, type of peritoneal membrane transport and baseline laboratory values. RESULTS: The incidence of peritonitis was 0,284 attack/patient/year. The most common organisms were coagulase negative staphylococci (18.3% followed by S. aureus (14.8% and gram-negative bacillus (13.1%. Peritonitis was more common in elderly, those with longer PD duration, low residual urine volume, patients with low PCR and hepatitis C. However, patients using erythropoietin and automated PD had low incidence of peritonitis compared to others. Mortality rate was higher in gram-negative and fungal peritonitis and prognosis was worse in gramnegative peritonitis CONCLUSION: Peritonitis incidence and aetiology were compatible with literature. One must be careful to protect residual renal function (RRF as peritonitis incidence was significantly reduced in patients with RRF. PCR values were significantly lower in peritonitis. Adequate protein intake and nutritional support may be important in this respect.

  3. Drinking water from alternative water sources: differences in beliefs, social norms and factors of perceived behavioural control across eight Australian locations.

    Science.gov (United States)

    Dolnicar, S; Hurlimann, A

    2009-01-01

    Australia is facing serious challenges in the management of water in various urban and regional locations. Two popular responses to these challenges are increasing supply through alternative water sources such as recycled and desalinated water. However, significant gaps exist in our knowledge of community attitudes to these alternative sources of water, particularly for potable use. This paper reports results from an Australian study of community attitudes to alternative water sources. Sixty six qualitative interviews were held at eight locations with distinctly different water situations. This paper explores all three antecedents to the behaviour of drinking recycled water and desalinated water as postulated by the Theory of Planned Behaviour: attitudes, social norms and factors of perceived behavioural control. Key results indicate that while people hold both positive and negative beliefs (mostly cost, health and environmental concerns) about water from alternative sources, nearly all of them are willing to drink it if the water crisis were to deteriorate further. People also feel they lack knowledge and state that information from scientists would influence their decision to drink recycled and desalinated water most. Friends and relatives are most influential in preventing people from drinking recycled water. The findings reported in this paper have major implications for water policy, and will be of particular interest to water engineers. The paper raises a provocative question: Is it better to avoid public consultation in introducing water from alternative sources?

  4. Post-event processing in social anxiety disorder after real-life social situations - An ambulatory assessment study.

    Science.gov (United States)

    Helbig-Lang, Sylvia; von Auer, Maxie; Neubauer, Karolin; Murray, Eileen; Gerlach, Alexander L

    2016-09-01

    Excessive post-mortem processing after social situations, a core symptom of social anxiety disorder (SAD), is thought to contribute to the perpetuation of social anxiety by consolidating negative self-schemata. Empirical findings on actual mechanisms underlying this so-called Post-Event Processing (PEP) are still scarce. The present study sought to identify variables associated with the experience of PEP after real-life social situations in a sample of 49 individuals diagnosed with SAD. Using an ambulatory assessment approach, individuals were asked to report on each distressing social event experienced during one week. A total of 192 events were captured. Hierarchical linear modeling indicated that next to trait social anxiety, the type of social situation (performance vs. interaction situations), self-focused attention, safety behavior use, and negative affect predicted levels of PEP after social situations. These findings add to the growing literature that emphasizes the importance of situational factors for the experience of PEP, and highlight potential venues to prevent it.

  5. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency's ambulatory care unit through simulation.

    Science.gov (United States)

    Santibáñez, Pablo; Chow, Vincent S; French, John; Puterman, Martin L; Tyldesley, Scott

    2009-12-01

    We consider an ambulatory care unit (ACU) in a large cancer centre, where operational and resource utilization challenges led to overcrowding, excessive delays, and concerns regarding safety of critical patient care duties. We use simulation to analyze the simultaneous impact of operations, scheduling, and resource allocation on patient wait time, clinic overtime, and resource utilization. The impact of these factors has been studied before, but usually in isolation. Further, our model considers multiple clinics operating concurrently, and includes the extra burden of training residents and medical students during patient consults. Through scenario analyses we found that the best outcomes were obtained when not one but multiple changes were implemented simultaneously. We developed configurations that achieve a reduction of up to 70% in patient wait times and 25% in physical space requirements, with the same appointment volume. The key findings of the study are the importance of on time clinic start, the need for improved patient scheduling; and the potential improvements from allocating examination rooms flexibly and dynamically among individual clinics within each of the oncology programs. These findings are currently being evaluated for implementation by senior management.

  6. The influence of domestic overload on the association between job strain and ambulatory blood pressure among female nursing workers.

    Science.gov (United States)

    Portela, Luciana Fernandes; Rotenberg, Lucia; Almeida, Ana Luiza Pereira; Landsbergis, Paul; Griep, Rosane Harter

    2013-11-27

    Evidence suggests that the workplace plays an important etiologic role in blood pressure (BP) alterations. Associations in female samples are controversial, and the domestic environment is hypothesized to be an important factor in this relationship. This study assessed the association between job strain and BP within a sample of female nursing workers, considering the potential role of domestic overload. A cross-sectional study was conducted in a group of 175 daytime workers who wore an ambulatory BP monitor for 24 h during a working day. Mean systolic and diastolic BP were calculated. Job strain was evaluated using the Demand-Control Model. Domestic overload was based on the level of responsibility in relation to four household tasks and on the number of beneficiaries. After adjustments no significant association between high job strain and BP was detected. Stratified analyses revealed that women exposed to both domestic overload and high job strain had higher systolic BP at home. These results indicate a possible interaction between domestic overload and job strain on BP levels and revealed the importance of domestic work, which is rarely considered in studies of female workers.

  7. Continuous ambulatory peritoneal dialysis: Nurses′ experiences of teaching patients

    Directory of Open Access Journals (Sweden)

    Amnah Shubayra

    2015-01-01

    In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching.

  8. Semi-quantitative and simulation analyses of effects of {gamma} rays on determination of calibration factors of PET scanners with point-like {sup 22}Na sources

    Energy Technology Data Exchange (ETDEWEB)

    Hasegawa, Tomoyuki [School of Allied Health Sciences, Kitasato University, 1-15-1, Kitasato, Minamiku, Sagamihara, Kanagawa, 252-0373 (Japan); Sato, Yasushi [National Institute of Advanced Industrial Science and Technology, 1-1-1, Umezono, Tsukuba, Ibaraki, 305-8568 (Japan); Oda, Keiichi [Tokyo Metropolitan Institute of Gerontology, 1-1, Nakamachi, Itabashi, Tokyo, 173-0022 (Japan); Wada, Yasuhiro [RIKEN Center for Molecular Imaging Science, 6-7-3, Minamimachi, Minatoshima, Chuo, Kobe, Hyogo, 650-0047 (Japan); Murayama, Hideo [National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage, Chiba, 263-8555 (Japan); Yamada, Takahiro, E-mail: hasegawa@kitasato-u.ac.jp [Japan Radioisotope Association, 2-28-45, Komagome, Bunkyo-ku, Tokyo, 113-8941 (Japan)

    2011-09-21

    The uncertainty of radioactivity concentrations measured with positron emission tomography (PET) scanners ultimately depends on the uncertainty of the calibration factors. A new practical calibration scheme using point-like {sup 22}Na radioactive sources has been developed. The purpose of this study is to theoretically investigate the effects of the associated 1.275 MeV {gamma} rays on the calibration factors. The physical processes affecting the coincidence data were categorized in order to derive approximate semi-quantitative formulae. Assuming the design parameters of some typical commercial PET scanners, the effects of the {gamma} rays as relative deviations in the calibration factors were evaluated by semi-quantitative formulae and a Monte Carlo simulation. The relative deviations in the calibration factors were less than 4%, depending on the details of the PET scanners. The event losses due to rejecting multiple coincidence events of scattered {gamma} rays had the strongest effect. The results from the semi-quantitative formulae and the Monte Carlo simulation were consistent and were useful in understanding the underlying mechanisms. The deviations are considered small enough to correct on the basis of precise Monte Carlo simulation. This study thus offers an important theoretical basis for the validity of the calibration method using point-like {sup 22}Na radioactive sources.

  9. Examining the Clinical Correlates of Autism Spectrum Disorder in Youth by Ascertainment Source

    Science.gov (United States)

    Joshi, Gagan; Faraone, Stephen V.; Wozniak, Janet; Petty, Carter; Fried, Ronna; Galdo, Maribel; Furtak, Stephannie L.; McDermott, Katie; Epstien, Cecily; Walker, Rosemary; Caron, Ashley; Feinberg, Leah; Biederman, Joseph

    2014-01-01

    To examine whether presentation of autism spectrum disorder (ASD) and associated patterns of psychiatric comorbidity and dysfunction vary by referral source. ASD youth referred to a specialized ambulatory program for ASD (N = 143) were compared to ASD youth referred to a general child psychiatry clinic (N = 217). More ASD clinic youth met criteria…

  10. Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City

    Directory of Open Access Journals (Sweden)

    Torres-Arreola Laura del Pilar

    2007-09-01

    Full Text Available Abstract Background In Mexico, inappropriate prescription of drugs with potential interactions causing serious risks to patient health has been little studied. Work in this area has focused mainly on hospitalized patients, with only specific drug combinations analyzed; moreover, the studies have not produced conclusive results. In the present study, we determined the frequency of potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age, who used Mexican Institute of Social Security (IMSS family medicine clinics. In addition, we aimed to identify the associated factors for these interactions. Methods We collected information on general patient characteristics, medical histories, and medication (complete data. The study included 624 ambulatory patients over 50 years of age, with non-malignant pain syndrome, who made ambulatory visits to two IMSS family medicine clinics in Mexico City. The patients received 7-day prescriptions for non-opioid analgesics. The potential interactions were identified by using the Thompson Micromedex program. Data were analyzed using descriptive, bivariate and multiple logistic regression analyses. Results The average number of prescribed drugs was 5.9 ± 2.5. About 80.0% of patients had prescriptions implying one or more potential drug-drug interactions and 3.8% of patients were prescribed drug combinations with interactions that should be avoided. Also, 64.0% of patients had prescriptions implying one or more potential drug disease interactions. The factors significantly associated with having one or more potential interactions included: taking 5 or more medicines (adjusted Odds Ratio (OR: 4.34, 95%CI: 2.76–6.83, patient age 60 years or older (adjusted OR: 1.66, 95% CI: 1.01–2.74 and suffering from cardiovascular diseases (adjusted OR: 7.26, 95% CI: 4.61–11.44. Conclusion The high frequency of prescription of drugs with potential drug interactions showed in

  11. Scopus’s Source Normalized Impact per Paper (SNIP) versus a Journal Impact Factor based on Fractional Counting of Citations

    NARCIS (Netherlands)

    Leydesdorff, L.; Opthof, T.

    2010-01-01

    Impact factors (and similar measures such as the Scimago Journal Rankings) suffer from two problems: (a) citation behavior varies among fields of science and, therefore, leads to systematic differences, and (b) there are no statistics to inform us whether differences are significant. The recently in

  12. The effect of source herd and abattoir factors on pig carcass Salmonella contamination evaluated by multilevel modelling

    DEFF Research Database (Denmark)

    Baptista, Filipa Matos; Dahl, Jan; Nielsen, Liza Rosenbaum

    2010-01-01

    In Denmark, a Surveillance-and-Control Programme for Salmonella in pigs has been in place for several years. This study investigated factors associated with Salmonella pig carcass contamination, namely estimated daily number of Salmonella seropositive pigs delivered to slaughter, average Salmonel...

  13. Model-free data analysis for source separation based on Non-Negative Matrix Factorization and k-means clustering (NMFk)

    Science.gov (United States)

    Vesselinov, V. V.; Alexandrov, B.

    2014-12-01

    The identification of the physical sources causing spatial and temporal fluctuations of state variables such as river stage levels and aquifer hydraulic heads is challenging. The fluctuations can be caused by variations in natural and anthropogenic sources such as precipitation events, infiltration, groundwater pumping, barometric pressures, etc. The source identification and separation can be crucial for conceptualization of the hydrological conditions and characterization of system properties. If the original signals that cause the observed state-variable transients can be successfully "unmixed", decoupled physics models may then be applied to analyze the propagation of each signal independently. We propose a new model-free inverse analysis of transient data based on Non-negative Matrix Factorization (NMF) method for Blind Source Separation (BSS) coupled with k-means clustering algorithm, which we call NMFk. NMFk is capable of identifying a set of unique sources from a set of experimentally measured mixed signals, without any information about the sources, their transients, and the physical mechanisms and properties controlling the signal propagation through the system. A classical BSS conundrum is the so-called "cocktail-party" problem where several microphones are recording the sounds in a ballroom (music, conversations, noise, etc.). Each of the microphones is recording a mixture of the sounds. The goal of BSS is to "unmix'" and reconstruct the original sounds from the microphone records. Similarly to the "cocktail-party" problem, our model-freee analysis only requires information about state-variable transients at a number of observation points, m, where m > r, and r is the number of unknown unique sources causing the observed fluctuations. We apply the analysis on a dataset from the Los Alamos National Laboratory (LANL) site. We identify and estimate the impact and sources are barometric pressure and water-supply pumping effects. We also estimate the

  14. Scopus's Source Normalized Impact per Paper (SNIP) versus a Journal Impact Factor based on Fractional Counting of Citations

    CERN Document Server

    Leydesdorff, Loet

    2010-01-01

    Impact factors (and similar measures such as the Scimago Journal Rankings) suffer from two problems: (i) citation behavior varies among fields of science and therefore leads to systematic differences, and (ii) there are no statistics to inform us whether differences are significant. The recently introduced SNIP indicator of Scopus tries to remedy the first of these two problems, but a number of normalization decisions are involved which makes it impossible to test for significance. Using fractional counting of citations-based on the assumption that impact is proportionate to the number of references in the citing documents-citations can be contextualized at the paper level and aggregated impacts of sets can be tested for their significance. It can be shown that the weighted impact of Annals of Mathematics (0.247) is not so much lower than that of Molecular Cell (0.386) despite a five-fold difference between their impact factors (2.793 and 13.156, respectively).

  15. Nonattendance in pediatric pulmonary clinics: an ambulatory survey

    Directory of Open Access Journals (Sweden)

    Dreiher Jacob

    2009-04-01

    Full Text Available Abstract Background Nonattendance for scheduled appointments disturbs the effective management of pediatric pulmonary clinics. We hypothesized that the reasons for non-attendance and the necessary solutions might be different in pediatric pulmonary medicine than in other pediatric fields. We therefore investigated the factors associated with nonattendance this field in order to devise a corrective strategy. Methods The effect of age, gender, ethnic origin, waiting time for an appointment and the timing of appointments during the day on nonattendance proportion were assessed. Chi-square tests were used to analyze statistically significant differences of categorical variables. Logistic regression models were used for multivariate analysis. Results A total of 1190 pediatric pulmonology clinic visits in a 21 month period were included in the study. The overall proportion of nonattendance was 30.6%. Nonattendance was 23.8% when there was a short waiting time for an appointment (1–7 days and 36.3% when there was a long waiting time (8 days and above (p-value Conclusion The factors associated with nonattendance in pediatric pulmonary clinics include the length of waiting time for an appointment, the hour of the appointment within the day and the origin of the patient.

  16. Determination of effective atomic numbers, effective electrons numbers, total atomic cross-sections and buildup factor of some compounds for different radiation sources

    Science.gov (United States)

    Levet, A.; Özdemir, Y.

    2017-01-01

    The photon interaction parameters such as mass attenuation coefficient, effective atomic number, effective electron density, buildup factor have been measured for Fe(NO3)3, V4O2, NaCO3·H2O, C6H5FeO7·H2O and CuCI compounds using 137Ba, 157Gd and 241Am γ-rays sources in stable geometry. The mass attenuation coefficients have been determined experimentally via Energy Dispersive X-ray Fluorescence Spectroscopy (EDXRF) system and theoretically by using WinXCom computer program. Then, effective atomic numbers, Zeff, and electron densities, Neff, have been calculated by using the mass attenuation coefficients. The obtained values of effective atomic numbers have been compared with the ones calculated according to a different approach proposed by Hine and the calculated ones from theory. Also, photon buildup factors were obtained by changing collimator diameters in the different photon energies. We observed that the buildup factor increased as the collimator diameter increased for all sources used.

  17. Quality of Ambulatory Education from the Viewpoint of the Clinical Medical Students at Kermanshah University of Medical Sciences in 2013

    Directory of Open Access Journals (Sweden)

    Elham Niroumand

    2014-09-01

    Full Text Available Introduction: Ambulatory education is an integral part of medical education. The present study was carried out to evaluate the quality of ambulatory education from the viewpoint of clinical medical students at Kermanshah University of Medical Sciences. Methods: In this descriptive cross-sectional study, the study sample included medical externs externs and interns of Kermanshah University of Medical Sciences that were selected through census sampling technique in the academic year 2012-2013. The instrument for data collection was a researcher-made questionnaire with acceptable validity and reliability. The obtained data were analyzed by SPSS-16 software using descriptive statistics. Results: 65 (50% externs and 75 (65% interns participated in the study and 1588 questionnaires were completed via self-administered technique. The mean of the teachers’ quality of ambulatory education at Kermanshah University of Medical Sciences was 22.6±5.2 and the mean for the clinics’ quality of physical environment was 19±5.13, indicating favorable and semi-favorable status, respectively. Qualitative evaluation of ambulatory education from the viewpoint of externs and interns showed a significant difference with more satisfaction from the part of the interns (p<0.001. Conclusion: The findings revealed that the teachers’ quality of ambulatory education at Kermanshah University of Medical Sciences was favorable, but the physical condition of the clinics indicated a semi-favorable status.

  18. A dynamic data source selection system for smartwatch platform.

    Science.gov (United States)

    Nemati, Ebrahim; Sideris, Konstantinos; Kalantarian, Haik; Sarrafzadeh, Majid

    2016-08-01

    A novel data source selection algorithm is proposed for ambulatory activity tracking of elderly people. The algorithm introduces the concept of dynamic switching between the data collection modules (a smartwatch and a smartphone) to improve accuracy and battery life using contextual information. We show that by making offloading decisions as a function of activity, the proposed algorithm improves power consumption and accuracy of the previous work by 7 hours and 5% respectively compared to the baseline.

  19. Raquianestesia posterior para cirurgias anorretais em regime ambulatorial: estudo piloto Raquianestesia posterior para cirugías anorrectales en régimen ambulatorial: estudio piloto Restricted dorsal spinal anesthesia for ambulatory anorectal surgery: a pilot study

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2004-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O aumento do número de cirurgias ambulatoriais exige o emprego de métodos anestésicos que permitam a liberação do paciente após a cirurgia. Freqüentemente, as cirurgias anorretais são realizadas com os pacientes hospitalizados. Este estudo examina a possibilidade de esses procedimentos serem realizados em regime ambulatorial com baixas doses de bupivacaína hipobárica. MÉTODO: Trinta pacientes, estado físico ASA I e II, foram submetidos à raquianestesia com solução hipobárica de bupivacaína a 0,15% através de agulha 27G Quincke para cirurgias anorretais. A punção subaracnóidea foi realizada com o paciente em decúbito ventral com auxílio de coxim em seu abdômen para corrigir a lordose lombar e o espaço intervertebral. RESULTADOS: O bloqueio sensitivo foi obtido em todos os pacientes. A sua dispersão variou de T10 a L2 com moda em T12. Apenas três pacientes apresentaram algum grau de bloqueio motor. A duração do bloqueio foi de 122,17 ± 15,35 minutos. Estabilidade hemodinâmica foi observada em todos os pacientes. Nenhum paciente desenvolveu cefaléia pós-punção da dura-máter. CONCLUSÕES: Seis miligramas de bupivacaína a 0,15% em solução hipobárica proporcionaram um bloqueio predominantemente sensitivo, quando injetados em decúbito ventral. As principais vantagens são rápida recuperação, estabilidade hemodinâmica e satisfação do paciente, sendo uma boa indicação para anestesia ambulatorial.JUSTIFICATIVA Y OBJETIVOS: El aumento del número de cirugías ambulatoriales exige el empleo de métodos anestésicos que permitan la liberación del paciente después de la cirugía. Frecuentemente, las cirugías anorrectales son realizadas con los pacientes hospitalizados. Este estudio examina la posibilidad de que esos procedimientos puedan ser realizados en régimen ambulatorial con bajas dosis de bupivacaína hipobárica. MÉTODO: Treinta pacientes, estado físico ASA I y II, fueron

  20. House dust mites: a risk factor to be considered for occupational safety or source of work-related allergens.

    Science.gov (United States)

    Saleh, Ahmed Megahed Ahmed; Ali, Hisham Abd El-Raouf; Ahmed, Salwa Abdalla Mohamed; Mohammad, Naema Mahmoud; Morsy, Tosson A

    2013-12-01

    House dust mites (HDM) can be found worldwide where human beings live independent from the climate and are a major source of multiple allergens. Mite allergens sensitize and induce perennial rhinitis, asthma, or atopic dermatitis in a large portion of patients with allergic disease particularly children. There is convincing evidence that avoidance of mite allergen can effectively reduce allergic symptoms. This study examined dust from a military hospital and the private home of some nursing staff. A total of seven species of mites belonging to six genera were recovered. The commonest species was Dermatophagoides farinae followed by D. pteronyssinus and the lowest Laelaps nuttalli. Besides, the 7th mite or Parasitus consanguineous live free on dust as a bio-control agent of mites. The presence of mites in and out doors in a hospital and dwellings of medical personnel pave the way to consider HDM as occupational or nosocomial Allergens.

  1. Using confirmatory factor analysis to understand executive control in preschool children: sources of variation in emergent mathematic achievement.

    Science.gov (United States)

    Bull, Rebecca; Espy, Kimberly Andrews; Wiebe, Sandra A; Sheffield, Tiffany D; Nelson, Jennifer Mize

    2011-07-01

    Latent variable modeling methods have demonstrated utility for understanding the structure of executive control (EC) across development. These methods are utilized to better characterize the relation between EC and mathematics achievement in the preschool period, and to understand contributing sources of individual variation. Using the sample and battery of laboratory tasks described in Wiebe, Espy and Charak (2008), latent EC was related strongly to emergent mathematics achievement in preschool, and was robust after controlling for crystallized intellectual skills. The relation between crystallized skills and emergent mathematics differed between girls and boys, although the predictive association between EC and mathematics did not. Two dimensions of the child 's social environment contributed to mathematics achievement: social network support through its relation to EC and environmental stressors through its relation with crystallized skills. These findings underscore the need to examine the dimensions, mechanisms, and individual pathways that influence the development of early competence in basic cognitive processes that underpin early academic achievement.

  2. An application of the theory of planned behaviour to study the influencing factors of participation in source separation of food waste

    Energy Technology Data Exchange (ETDEWEB)

    Karim Ghani, Wan Azlina Wan Ab., E-mail: wanaz@eng.upm.edu.my [Department of Chemical and Environmental Engineering, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan (Malaysia); Rusli, Iffah Farizan, E-mail: iffahrusli@yahoo.com [Department of Chemical and Environmental Engineering, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan (Malaysia); Biak, Dayang Radiah Awang, E-mail: dayang@eng.upm.edu.my [Department of Chemical and Environmental Engineering, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan (Malaysia); Idris, Azni, E-mail: azni@eng.upm.edu.my [Department of Chemical and Environmental Engineering, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan (Malaysia)

    2013-05-15

    Highlights: ► Theory of planned behaviour (TPB) has been conducted to identify the influencing factors for participation in source separation of food waste using self administered questionnaires. ► The findings suggested several implications for the development and implementation of waste separation at home programme. ► The analysis indicates that the attitude towards waste separation is determined as the main predictors where this in turn could be a significant predictor of the repondent’s actual food waste separation behaviour. ► To date, none of similar have been reported elsewhere and this finding will be beneficial to local Authorities as indicator in designing campaigns to promote the use of waste separation programmes to reinforce the positive attitudes. - Abstract: Tremendous increases in biodegradable (food waste) generation significantly impact the local authorities, who are responsible to manage, treat and dispose of this waste. The process of separation of food waste at its generation source is identified as effective means in reducing the amount food waste sent to landfill and can be reused as feedstock to downstream treatment processes namely composting or anaerobic digestion. However, these efforts will only succeed with positive attitudes and highly participations rate by the public towards the scheme. Thus, the social survey (using questionnaires) to analyse public’s view and influencing factors towards participation in source separation of food waste in households based on the theory of planned behaviour technique (TPB) was performed in June and July 2011 among selected staff in Universiti Putra Malaysia, Serdang, Selangor. The survey demonstrates that the public has positive intention in participating provided the opportunities, facilities and knowledge on waste separation at source are adequately prepared by the respective local authorities. Furthermore, good moral values and situational factors such as storage convenience and

  3. Household trends in access to improved water sources and sanitation facilities in Vietnam and associated factors: findings from the Multiple Indicator Cluster Surveys, 2000–2011

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    Tran Thi Tuyet-Hanh

    2016-02-01

    Full Text Available Background: Despite progress made by the Millennium Development Goal (MDG number 7.C, Vietnam still faces challenges with regard to the provision of access to safe drinking water and basic sanitation. Objective: This paper describes household trends in access to improved water sources and sanitation facilities separately, and analyses factors associated with access to improved water sources and sanitation facilities in combination. Design: Secondary data from the Vietnam Multiple Indicator Cluster Survey in 2000, 2006, and 2011 were analyzed. Descriptive statistics and tests of significance describe trends over time in access to water and sanitation by location, demographic and socio-economic factors. Binary logistic regressions (2000, 2006, and 2011 describe associations between access to water and sanitation, and geographic, demographic, and socio-economic factors. Results: There have been some outstanding developments in access to improved water sources and sanitation facilities from 2000 to 2011. In 2011, the proportion of households with access to improved water sources and sanitation facilities reached 90% and 77%, respectively, meeting the 2015 MDG targets for safe drinking water and basic sanitation set at 88% and 75%, respectively. However, despite these achievements, in 2011, only 74% of households overall had access to combined improved drinking water and sanitation facilities. There were also stark differences between regions. In 2011, only 47% of households had access to both improved water and sanitation facilities in the Mekong River Delta compared with 94% in the Red River Delta. In 2011, households in urban compared to rural areas were more than twice as likely (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.9–2.5 to have access to improved water and sanitation facilities in combination, and households in the highest compared with the lowest wealth quintile were over 40 times more likely (OR: 42.3; 95% CI: 29.8–60

  4. Experience with noninvasive ambulatory 24-hour blood pressure recording in a community hospital.

    Science.gov (United States)

    van de Weijgert, E J; Braun, J J

    1992-04-01

    In 40 subjects (23 treated with antihypertensive medication), 24-h ambulatory blood pressure was measured with an oscillometric blood pressure monitor (Spacelabs model 90202). We studied applicability in the out-patient department with regard to patient tolerance, correlation with mercury manometer measurements, 24-h blood pressure variability and the use in detecting "white-coat" hypertension. The measurements were tolerated quite well except for complaints of sleep disturbance and local irritation from the cuff. The average percentage of missed measuring points was 9.2%. Correlation between blood pressure with the mercury manometer and the Spacelabs monitor (averages of three consecutive readings) was: systolic 0.87 and diastolic 0.73 (P less than 0.001). No evidence for systematic error between the two methods was found. Diurnal blood pressure variation was significant with an average night-time drop of 12 +/- 15 mmHg systolic and 12 +/- 11 mmHg diastolic. "Office" blood pressure measured with the Spacelabs monitor was in the hypertensive range for 28 patients (systolic greater than or equal to 160 and/or diastolic greater than or equal to 95 mmHg). Only 15 of these subjects still met the hypertension criteria on the basis of mean daytime ambulatory blood pressure values. When ambulatory blood pressures during arbitrary 3-h periods of the daytime were studied, the number of patients with established hypertension did not change. The patients with this "office" or "white-coat" hypertensive response could not be distinguished on the basis of variability in daytime blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory.

    Science.gov (United States)

    Hehl, Jennifer; McDonald, Deborah Dillon

    2014-06-01

    The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner.

  6. Improving ambulatory saliva-sampling compliance in pregnant women: a randomized controlled study.

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    Julian Moeller

    Full Text Available OBJECTIVE: Noncompliance with scheduled ambulatory saliva sampling is common and has been associated with biased cortisol estimates in nonpregnant subjects. This study is the first to investigate in pregnant women strategies to improve ambulatory saliva-sampling compliance, and the association between sampling noncompliance and saliva cortisol estimates. METHODS: We instructed 64 pregnant women to collect eight scheduled saliva samples on two consecutive days each. Objective compliance with scheduled sampling times was assessed with a Medication Event Monitoring System and self-reported compliance with a paper-and-pencil diary. In a randomized controlled study, we estimated whether a disclosure intervention (informing women about objective compliance monitoring and a reminder intervention (use of acoustical reminders improved compliance. A mixed model analysis was used to estimate associations between women's objective compliance and their diurnal cortisol profiles, and between deviation from scheduled sampling and the cortisol concentration measured in the related sample. RESULTS: Self-reported compliance with a saliva-sampling protocol was 91%, and objective compliance was 70%. The disclosure intervention was associated with improved objective compliance (informed: 81%, noninformed: 60%, F(1,60  = 17.64, p<0.001, but not the reminder intervention (reminders: 68%, without reminders: 72%, F(1,60 = 0.78, p = 0.379. Furthermore, a woman's increased objective compliance was associated with a higher diurnal cortisol profile, F(2,64  = 8.22, p<0.001. Altered cortisol levels were observed in less objective compliant samples, F(1,705  = 7.38, p = 0.007, with delayed sampling associated with lower cortisol levels. CONCLUSIONS: The results suggest that in pregnant women, objective noncompliance with scheduled ambulatory saliva sampling is common and is associated with biased cortisol estimates. To improve sampling compliance, results suggest

  7. Application of positive matrix factorization to on-road measurements for source apportionment of diesel- and gasoline-powered vehicle emissions in Mexico City

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    D. A. Thornhill

    2009-12-01

    Full Text Available The goal of this research is to quantify diesel- and gasoline-powered motor vehicle emissions within the Mexico City Metropolitan Area (MCMA using on-road measurements captured by a mobile laboratory combined with positive matrix factorization (PMF receptor modeling. During the MCMA-2006 ground-based component of the MILAGRO field campaign, the Aerodyne Mobile Laboratory (AML measured many gaseous and particulate pollutants, including carbon dioxide, carbon monoxide (CO, nitrogen oxides (NOx, benzene, toluene, alkylated aromatics, formaldehyde, acetaldehyde, acetone, ammonia, particle number, fine particulate mass (PM2.5, and black carbon (BC. These serve as inputs to the receptor model, which is able to resolve three factors corresponding to gasoline engine exhaust, diesel engine exhaust, and the urban background. Using the source profiles, we calculate fuel-based emission factors for each type of exhaust. The MCMA's gasoline-powered vehicles are considerably dirtier, on average, than those in the US with respect to CO and aldehydes. Its diesel-powered vehicles have similar emission factors of NOx and higher emission factors of aldehydes, particle number, and BC. In the fleet sampled during AML driving, gasoline-powered vehicles are responsible for 97% of mobile source emissions of CO, 22% of NOx, 95–97% of aromatics, 72–85% of carbonyls, 74% of ammonia, negligible amounts of particle number, 26% of PM2.5, and 2% of BC; diesel-powered vehicles account for the balance. Because the mobile lab spent 17% of its time waiting at stoplights, the results may overemphasize idling conditions, possibly resulting in an underestimate of NOx and overestimate of CO emissions. On the other hand, estimates of the inventory that do not correctly account for emissions during idling are likely to produce bias in the opposite direction. Nevertheless, the fuel-based inventory suggests that mobile

  8. Quantification of vehicle fleet PM10 particulate matter emission factors from exhaust and non-exhaust sources using tunnel measurement techniques.

    Science.gov (United States)

    Lawrence, Samantha; Sokhi, Ranjeet; Ravindra, Khaiwal

    2016-03-01

    Road tunnels act like large laboratories; they provide an excellent environment to quantify atmospheric particles emission factors from exhaust and non-exhaust sources due to their known boundary conditions. Current work compares the High Volume, Dichotomous Stacked Filter Unit and Partisol Air Sampler for coarse, PM10 and PM2.5 particle concentration measurement and found that they do not differ significantly (p = 95%). PM2.5 fraction contributes 66% of PM10 proportions and significantly influenced by traffic (turbulence) and meteorological conditions. Mass emission factors for PM10 varies from 21.3 ± 1.9 to 28.8 ± 3.4 mg/vkm and composed of Motorcycle (0.0003-0.001 mg/vkm), Cars (26.1-33.4 mg/vkm), LDVs (2.4-3.0 mg/vkm), HDVs (2.2-2.8 mg/vkm) and Buses (0.1 mg/vkm). Based on Lawrence et al. (2013), source apportionment modelling, the PM10 emission of brake wear (3.8-4.4 mg/vkm), petrol exhaust (3.9-4.5 mg/vkm), diesel exhaust (7.2-8.3 mg/vkm), re-suspension (9-10.4 mg/vkm), road surface wear (3.9-4.5 mg/vkm), and unexplained (7.2 mg/vkm) were also calculated. The current study determined that the combined non-exhaust fleet PM10 emission factor (16.7-19.3 mg/vkm) are higher than the combined exhaust emission factor (11.1-12.8 mg/vkm). Thus, highlight the significance of non-exhaust emissions and the need for legislation and abatement strategies to reduce their contributions to ambient PM concentrations.

  9. Circadian variation of blood pressure in patients with chronic renal failure on continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Clausen, P; Feldt-Rasmussen, B; Ladefoged, Jens

    1995-01-01

    The circadian pattern of blood pressure variation was investigated in 10 patients with advanced chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) and in an age-matched group of controls without renal disease with similar office blood pressure level. Monitoring was done using....... In patients with chronic renal failure undergoing CAPD, an otherwise unnoticed 24-h hypertension and nocturnal blood pressure elevation can be discovered by use of 24-h blood pressure monitoring and this may indicate a need of earlier start of antihypertensive treatment in CAPD patients with borderline...

  10. [Analysis of the market and future trends of the instrumentation for ambulatory electrocardiography].

    Science.gov (United States)

    Varanini, M; Taddei, A; Marchesi, C

    1987-12-01

    An inquiry has been made among most manufacturers of ambulatory ECG instrumentation. Both playback and real time systems have been considered. The inquiry, based on a questionnaire, was mainly aimed at identifying possible standard technical solutions emerging from the analysis of various implementations, and at verifying whether techniques for performance evaluation are in common use. Main conclusions of this study include: playback systems are still in competition with real time systems; automatic analysis has not yet reached adequate accuracy; analysis of ST-T interval, while performed by most systems, is not evaluated because common standard of quality is lacking.

  11. [The social hygienic assessment of significance of diseases under organization of ambulatory polyclinic care].

    Science.gov (United States)

    Babenko, A I; Murakhovskiy, A G; Tomtchuk, A A; Bravve, Yu I

    2013-01-01

    The article presents the results of analysis of appealability of adult population of Omsk to municipal polyclinic on the subject of diseases. The coefficients of relative importance of different classes of diseases to determine the groups af their significance were calculated on the basis of integrated evaluation of common and primary morbidity and diseases of patients under dispensarization monitoring. The established character of formation of flows of appealabiliy of population on the subject of diseases is a basic one to determine demand in medical technologies and planning of activities of ambulatory polyclinic section of health care.

  12. Manager's leadership is the main skill for ambulatory health care plan success.

    Science.gov (United States)

    Marin, Gustavo Horacio; Silberman, Martin; Colombo, Maria Virginia; Ozaeta, Belen; Henen, Jaime

    2015-01-01

    To demonstrate effectiveness of ambulatory health care plan implementation among institutions and variables associated with the differences observed. Randomized selection of primary health care (PHC) centers was done. Leadership ability of the plan manager was explored. Univariate/bivariate analyses were performed to observe correlation between variables. Two groups of PHC centers were established according to the efficacy of plan implementation: high and low performance. Differences between groups were observed (592%-1023% more efficacy in controls and practices; P < .001). Leadership was responsible for the main differences observed. Leadership of manager for implementation of the health care plan was the major important variable to reach the best efficacy standards.

  13. A Fourier series approach for comparing groups of subjects on ambulatory blood pressure patterns.

    Science.gov (United States)

    Somes, G W; Harshfield, G A; Arheart, K L; Miller, S T

    1994-06-30

    We develop an approach to the statistical analysis of 24-hour ambulatory blood pressure monitoring where we represent each subject's profile by a different mathematical model. We first smooth the data and then use a Fourier series approach to determine the best model for each subject. We then estimate summary variables based on each subject's model to compare distinct groups of subjects. In comparing 15 adult black male hypertensives to eight adult black male normotensives we found that the two groups differ on the shift away from the mesor for both the systolic and the diastolic blood pressure profile.

  14. Strengthening the Effectiveness of State-Level Community Health Worker Initiatives Through Ambulatory Care Partnerships

    Science.gov (United States)

    Allen, Caitlin; Nell Brownstein, J.; Jayapaul-Philip, Bina; Matos, Sergio; Mirambeau, Alberta

    2017-01-01

    The transformation of the US health care system and the recognition of the effectiveness of community health workers (CHWs) have accelerated national, state, and local efforts to engage CHWs in the support of vulnerable populations. Much can be learned about how to successfully integrate CHWs into health care teams, how to maximize their impact on chronic disease self-management, and how to strengthen their role as emissaries between clinical services and community resources; we share examples of effective strategies. Ambulatory care staff members are key partners in statewide initiatives to build and sustain the CHW workforce and reduce health disparities. PMID:26049655

  15. Morganella Morganii - A Rare Cause of Continuous Ambulatory Peritoneal Dialysis Peritonitis

    Directory of Open Access Journals (Sweden)

    Savaş SİPAHİ

    2014-05-01

    Full Text Available Nephrology professionals have selected continuous ambulatory peritoneal dialysis (CAPD as the best initial therapy for patients who have chronic renal failure. Among complications, peritonitis continues to be one of the most important complications of CAPD. The typical spectrum of organisms causing peritonitis include Gram-positives (67%, Gram-negative rods (28%, fungi (2.5%, and anaerobics (2.5 %. Among Gram-negative bacterial species, Escherichia coli, Acinetobacter species, and Enterobacter are the most seen pathogens. In this report, we present a case of CAPD peritonitis due to Morganella morganii. To our knowledge, this presentation is the second report of CAPD peritonitis due to M. morganii.

  16. Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations

    DEFF Research Database (Denmark)

    Gu, Yu-Mei; Thijs, Lutgarde; Li, Yan

    2014-01-01

    Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (... years) and using average risk as reference, we computed multivariable-adjusted hazard ratios (HRs) to assess risk by tenths of the PP distribution or risk associated with stepwise increasing (+1 mm Hg) PP levels. All adjustments included mean arterial pressure. Among 6028 younger participants (68 853...

  17. Social interactions between veterinary medical students and their teachers in an ambulatory clinic setting in Finland.

    Science.gov (United States)

    Koskinen, Heli I

    2010-01-01

    In this study, the social interactions between students and their teachers in an ambulatory clinic setting were investigated using Bales's interaction process analysis framework. Observational data were collected during five small-group sessions. The observations were quantified, and the behaviors of students and teachers were compared statistically. This study demonstrated that the interaction between students and their teachers was for the most part equal and could be characterized as "positively task oriented." The study has implications for veterinary educators wishing to use social psychology frameworks to assess the quality of learning in small-group clinical setting.

  18. Teachers' Voice Use in Teaching Environments: A Field Study Using Ambulatory Phonation Monitor

    DEFF Research Database (Denmark)

    Lyberg Åhlander, Viveka; Pelegrin Garcia, David; Whitling, Susanna

    2014-01-01

    ' activity and ambient noise) was recorded with a sound level meter; the room temperature and air quality were measured simultaneously. The acoustic properties of the empty classrooms were measured. Results: Teachers with VP behaved vocally different from their VH peers, in particular during teaching...... examined in laryngeal, vocal, hearing, and psychosocial aspects. The fundamental frequency, SPL, and phonation time were recorded with an Ambulatory Phonation Monitor during one representative workday. The teachers reported their activities in a structured diary. The SPL (including teachers' and students...

  19. Factors Affecting the Presence and the Diversity of Bryophytes in the Petrifying Sources Habitat (7220 in Wallonia and the Brussels-Capital Region, Belgium

    Directory of Open Access Journals (Sweden)

    J.-M. Couvreur

    2016-01-01

    Full Text Available Bryological composition, water chemistry, and environmental factors were characterized on 67 Belgian travertines. We explore the relationship between these environmental factors and the community composition, species richness, or presence of individual species using Redundancy Analysis with Hellinger’s transformation (tb-RDA or Generalized Linear Models (GLMs. The best variables explaining the community composition are slope, NO3, NH4, and PO4. The species richness is negatively related to canopy cover and PO4. Palustriella commutata tends to be more frequent when the slope is steeper and to a lesser degree when the canopy cover is lower. Eucladium verticillatum tends to be slightly more frequent when canopy cover and NH4 concentrations are lower. Cratoneuron filicinum is more frequent at higher Mg concentrations and Pellia endiviifolia is more frequent at lower PO4 concentrations and higher NO3 concentrations. Brachythecium rivulare showed wide ecological amplitude and almost none of the tested environmental factors seem to be related to its presence. The study identifies eutrophication as the main factor responsible for habitat deterioration. Practical indications on the best ways to maintain or to enhance the quality of these petrifying sources are given.

  20. Endometrial glands as a source of nutrients, growth factors and cytokines during the first trimester of human pregnancy: A morphological and immunohistochemical study

    Directory of Open Access Journals (Sweden)

    Jauniaux Eric

    2004-07-01

    Full Text Available Abstract Background The maternal circulation to the human placenta is not fully established until 10–12 weeks of pregnancy. During the first trimester the intervillous space is filled by a clear fluid, in part derived from secretions from the endometrial glands via openings in the basal plate. The aim was to determine the activity of the glands throughout the first trimester, and to identify components of the secretions. Methods Samples of human decidua basalis from 5–14 weeks gestational age were examined by transmission electron microscopy and immunohistochemically. An archival collection of placenta-in-situ samples was also reviewed. Results The thickness of the endometrium beneath the implantation site reduced from approximately 5 mm at 6 weeks to 1 mm at 14 weeks of gestation. The glandular epithelium also transformed from tall columnar cells, packed with secretory organelles, to a low cuboidal layer over this period. The lumens of the glands were always filled with precipitated secretions, and communications with the intervillous space could be traced until at least 10 weeks. The glandular epithelium reacted strongly for leukaemia inhibitory factor, vascular endothelial growth factor, epidermal growth factor, transforming growth factor beta, alpha tocopherol transfer protein, MUC-1 and glycodelin, and weakly for lactoferrin. As gestation advanced uterine natural killer cells became closely approximated to the basal surface of the epithelium. These cells were also immunopositive for epidermal growth factor. Conclusions Morphologically the endometrial glands are best developed and most active during early human pregnancy. The glands gradually regress over the first trimester, but still communicate with the intervillous space until at least 10 weeks. Hence, they could provide an important source of nutrients, growth factors and cytokines for the feto-placental unit. The endometrium may therefore play a greater role in regulating placental

  1. Spatial variation of chemical composition and sources of submicron aerosol in Zurich: factor analysis of mobile aerosol mass spectrometer data

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    C. Mohr

    2011-04-01

    Full Text Available Mobile measurements of PM1 (PM with an aerodynamic diameter D<1 μm chemical composition using a quadrupole aerosol mass spectrometer and a multi-angle absorption photometer were performed using the PSI mobile laboratory during winter 2007/2008 and December 2008 in the metropolitan area of Zurich, Switzerland. Positive matrix factorization (PMF applied to the organic fraction of PM1 yielded 3 factors: Hydrocarbon-like organic aerosol (HOA related to traffic emissions; organic aerosol from wood burning for domestic heating purposes (WBOA; and oxygenated organic aerosol (OOA, assigned to secondary organic aerosol formed by oxidation of volatile precursors. The spatial variation of the chemical composition of PM1 shows a uniform distribution throughout the city: for primary emissions, road traffic is important along major roads (varying between 7 and 14% of PM1 for different sites within the city, but overall, domestic wood burning is more important for the organic aerosol concentrations in Zurich during winter time (varying between 8–15% of PM1 for different sites within the city. OOA makes up the largest fraction of organic aerosol (44% on average. A new method, based on simultaneous on-road mobile and stationary background measurements and using the ratio of on-road sulfate to stationary sulfate to correct for small-scale dynamic effects, allows for the separation of PM1 emitted or produced locally and the PM1 from the regional background. It could be shown that especially during thermal inversions over the Swiss plateau, regional background concentrations contribute substantially to particulate number concentrations (60% on average as well as to the concentrations of PM1 components (on average 60% for black carbon and HOA, over 97% for WBOA and OOA, and more than 94% for the measured inorganic components in downtown Zurich. The results emphasize, on

  2. Crises hipertensivas em portadores de hipertensão arterial em tratamento ambulatorial Crisis hipertensivas en portadores de hipertensión arterial en tratamiento ambulatorio Hypertensive crises in bearers of arterial hypertension in ambulatorial treatment

    Directory of Open Access Journals (Sweden)

    Nirla Gomes Guedes

    2005-06-01

    presión arterial a factores emocionales.This study assessed the socio-demographic characteristics and the characteristics of therapeutic adhesion of 27 bearers of arterial hypertension undergoing ambulatorial treatment who had hypertensive urgencies crises or emergencies in the city of Fortaleza in the period between October of 2002 and May of 2003. The majority were women, between 50 and 60-years old, with little formal education, treatment time shorter than 5 years and time of diagnosis varying from 5 to 10 years. The use of medicine was the treatment that was most mentioned, followed by the reduction of the consumption of salt and attendance to medical appointments. However, attending the appointments and receiving orientation did not seem to change their behavior, since most of the patients that were interviewed practiced no physical exercises and demonstrated little knowledge of the illness, for they attributed the rise of the arterial pressure to emotional factors.

  3. Campylobacteriosis in urban versus rural areas: a case-case study integrated with molecular typing to validate risk factors and to attribute sources of infection.

    Directory of Open Access Journals (Sweden)

    Simon Lévesque

    Full Text Available Campylobacter infection is a leading cause of bacterial gastroenteritis worldwide, and most clinical cases appear as isolated, sporadic infections for which the source is rarely apparent. From July 2005 to December 2007 we conducted a prospective case-case study of sporadic, domestically-acquired Campylobacter enteritis in rural versus urban areas and a prevalence study of Campylobacter in animal and environmental sources in the Eastern Townships, Quebec. Isolates were typed using Multilocus Sequence Typing (MLST to reinforce the case-case findings and to assign a source probability estimate for each human isolate. The risk of human campylobacteriosis was 1.89-fold higher in rural than urban areas. Unconditional multivariate logistic regression analysis identified two independent risk factors associated with human Campylobacter infections acquired in rural area: occupational exposure to animals (OR = 10.6, 95% CI: 1.2-91, p = 0.032, and household water coming from a private well (OR = 8.3, 95% CI: 3.4-20.4, p<0.0001. A total of 851 C. jejuni isolates (178 human, 257 chicken, 87 bovine, 266 water, 63 wild bird were typed using MLST. Among human isolates, the incidence rates of clonal complexes (CC CC-21, CC-45, and CC-61 were higher in rural than urban areas. MLST-based source attribution analysis indicated that 64.5% of human C. jejuni isolates were attributable to chicken, followed by cattle (25.8%, water (7.4%, and wild birds (2.3%. Chicken was the attributable source for the majority of cases, independent of residential area, sex and age. The increased incidence in rural compared to urban areas was associated with occupational exposure to animals, particularly cattle among those aged 15-34 years, and with consumption of private well water. Both bovine and water exposure appeared to contribute to the seasonal variation in campylobacteriosis. These results provide a basis for developing public education and preventive programs targeting the

  4. Female genital mutilation management in the ambulatory clinic setting: a case study and review of the literature.

    Science.gov (United States)

    Craven, Spencer; Kavanagh, Alex; Khavari, Rose

    2016-01-01

    A 31-year-old patient with obstructive voiding symptoms and apareunia in the setting of Type III female genital mutilation/cutting (FGM/C) is presented. The patient underwent ambulatory clinic defibulation to relieve her symptoms. FGM has been shown to have serious immediate complications and many chronic complications that greatly impact patients' lives. Several case series have been published describing center-specific experience with defibulation procedures for Type III FGM/C. Here, we present the treatment of a patient with Type III FGM/C in an ambulatory urology clinic in the United States.

  5. Female genital mutilation management in the ambulatory clinic setting: a case study and review of the literature

    Science.gov (United States)

    Craven, Spencer; Kavanagh, Alex; Khavari, Rose

    2016-01-01

    A 31-year-old patient with obstructive voiding symptoms and apareunia in the setting of Type III female genital mutilation/cutting (FGM/C) is presented. The patient underwent ambulatory clinic defibulation to relieve her symptoms. FGM has been shown to have serious immediate complications and many chronic complications that greatly impact patients’ lives. Several case series have been published describing center-specific experience with defibulation procedures for Type III FGM/C. Here, we present the treatment of a patient with Type III FGM/C in an ambulatory urology clinic in the United States. PMID:27333917

  6. Assessment of pedometer-determined physical activity in Danish adults: the importance of non-ambulatory activities

    DEFF Research Database (Denmark)

    Rothausen, Berit Worm; Gille, Maj-Britt; Biltoft-Jensen, Anja Pia;

    and Physical Activity 2007-08, wore a pedometer (Yamax SW-200 Tokyo, Japan) and recorded daily steps and non-ambulatory activities for seven consecutive days. Time spent on non-ambulatory activities was converted to step equivalents using 1) a simple conversion method (SCM) adding 200 step equivalents....../min, and 2) a more complex conversion method (CCM) adding activity-specific step equivalents/min (assuming that 3 METS equals 100 steps/min). Very similar conversion methods have been suggested by Miller et al. 20061. Moreover, data from a Danish pilot study (n=28) were used to adjust for double...

  7. Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome

    DEFF Research Database (Denmark)

    Stolarz-Skrzypek, Katarzyna; Thijs, Lutgarde; Richart, Tom;

    2010-01-01

    Ambulatory blood pressure (BP) monitoring provides information not only on the BP level but also on the diurnal changes in BP. In the present review, we summarized the main findings of the International Database on Ambulatory BP in relation to Cardiovascular Outcome (IDACO) with regard to risk...... variability as captured by the average of the daytime and nighttime s.d. weighted for the duration of the daytime and nighttime interval (s.d.(dn)) and the average real variability (ARV(24)) predicted the outcome, but improved the prediction of the composite of all cardiovascular events by only 0...

  8. Sources and atmospheric processing of organic aerosol in the Mediterranean: insights from aerosol mass spectrometer factor analysis

    Directory of Open Access Journals (Sweden)

    L. Hildebrandt

    2011-12-01

    Full Text Available Atmospheric particles were measured in the late winter (25 February–26 March 2009 at a remote coastal site on the island of Crete, Greece during the Finokalia Aerosol Measurement Experiment-2009. A quadrupole aerosol mass spectrometer (Q-AMS was employed to quantify the size-resolved chemical composition of non-refractory submicron aerosol, and a thermodenuder was used to analyze the organic aerosol (OA volatility. Complementary measurements included particle size distributions from a scanning mobility particle sizer, inorganic and organic particle composition from filter analysis, air ion concentrations, O3, NOx and NOy concentrations, and meteorological measurements. Factor analysis was performed on the OA mass spectra, and the variability in OA composition could best be explained with three OA components. The oxygenated organic aerosol (OOA was similar in composition and volatility to the summertime OA previously measured at this site and may represent an effective endpoint in particle-phase oxidation of organics. The two other OA components, one associated with amines (Amine-OA and the other probably associated with the burning of olive branches (OB-OA, had very low volatility but were less oxygenated. Hydrocarbon-like organic aerosol (HOA was not detected. The absence of OB-OA and Amine-OA in the summer data may be due to lower emissions and/or photochemical conversion of these components to OOA.

  9. Sources and atmospheric processing of organic aerosol in the Mediterranean: insights from aerosol mass spectrometer factor analysis

    Directory of Open Access Journals (Sweden)

    L. Hildebrandt

    2011-07-01

    Full Text Available Atmospheric particles were measured in the winter at a remote coastal site on the island of Crete, Greece during the Finokalia Aerosol Measurement Experiment-2009. A Quadrupole aerosol mass spectrometer (Q-AMS was employed to quantify the size-resolved chemical composition of non-refractory submicron aerosol, and a thermodenuder was used to analyze the organic aerosol (OA volatility. Complementary measurements included particle size distributions from a scanning mobility particle sizer, inorganic and organic particle composition from filter analysis, concentrations of O3, NOx and NOy, and meteorological measurements. Factor analysis was performed on the OA mass spectra, and the variability in OA composition could best be explained with three OA components. The oxygenated organic aerosol (OOA was similar in composition and volatility to the summertime OA previously measured at this site and appears to represent an effective endpoint in particle-phase oxidation of organics. The two other OA components, one associated with amines (Amine-OA and the other probably associated with the burning of olive branches (OB-OA, had lower volatility but were less oxygenated. Hydrocarbon-like organic aerosol (HOA was not detected. The absence of OB-OA and Amine-OA in the summer data may be due to lower emissions and/or photochemical conversion of these components to OOA.

  10. Association between maternal and fetal factors and quality of cord blood as a source of stem cells

    Directory of Open Access Journals (Sweden)

    Rodrigo Dias Nunes

    2015-02-01

    Full Text Available Objectives: To comparatively analyze maternal and fetal factors and quality markers of blood samples in a public umbilical cord blood bank. Method: This is a cross-sectional descriptive study that revisited 458 records of donations from September 2009 to March 2013 at the Hemocentro de Santa Catarina. The means of markers were used to define cutoff points for the quality of cord blood. Results: Most donations came from women with ages between 18 and 29 years (62.8%, gestational age ≥ 40 weeks (55.2%, vaginal delivery (51.3%, primiparous (41.4%, and with male newborns (54.4% weighing between 3000 and 3499 g (41.8%. The volume of the dona- tions ranged from 71.6 to 275.2 mL, the total nucleated cell count ranged from 4.77 × 108 to 31.0 × 108 cells and CD34+ cells ranged from 0.05 to 1.23%. There were statistically significant differences in the volume with respect to gestation age > 38 weeks (p-value = 0.001, cesarean section (p-value 3500 g (p-value 3500 g (p-value < 0.001. There was no statistically significant difference between the variables and the percentage of CD34+ cells. Conclusions: Delivery route and birth weight influence the volume of cord blood and the total nucleated cell count. Gestational age influences only the volume of cord blood.

  11. Depressive Symptoms and 24-Hour Ambulatory Blood Pressure in Africans: The SABPA Study

    Directory of Open Access Journals (Sweden)

    Mark Hamer

    2012-01-01

    Full Text Available Disturbances in circadian rhythm might play a central role in the neurobiology of depression. We examined the association between depressive symptoms and 24-hour ambulatory BP in a sample of 405 (197 black and 208 Caucasian urbanized African teachers aged 25 to 60 yrs (mean 44.6 ± 9.6 yrs. Depressive symptoms were assessed using the self-administered 9-item Patient Health Questionnaire (PHQ-9. After adjusting for age, sex, and ethnicity, participants with severe depressive symptoms (PHQ-9 ≥ 15 had higher odds of hypertension defined from ambulatory BP and/or use of antihypertensive medication (odds ratio = 2.19, 95% CI, 1.00–4.90 in comparison to participants with no symptoms. Compared to Caucasians with no depressive symptoms, those with severe symptoms had blunted nocturnal systolic BP drop of 4.7 mmHg (95% CI, −0.5 to 10.0, P=0.07. In summary, depressive symptoms were associated with the circadian BP profile in black and Caucasian Africans.

  12. Accuracy of patient's turnover time prediction using RFID technology in an academic ambulatory surgery center.

    Science.gov (United States)

    Marchand-Maillet, Florence; Debes, Claire; Garnier, Fanny; Dufeu, Nicolas; Sciard, Didier; Beaussier, Marc

    2015-02-01

    Patients flow in outpatient surgical unit is a major issue with regards to resource utilization, overall case load and patient satisfaction. An electronic Radio Frequency Identification Device (RFID) was used to document the overall time spent by the patients between their admission and discharge from the unit. The objective of this study was to evaluate how a RFID-based data collection system could provide an accurate prediction of the actual time for the patient to be discharged from the ambulatory surgical unit after surgery. This is an observational prospective evaluation carried out in an academic ambulatory surgery center (ASC). Data on length of stay at each step of the patient care, from admission to discharge, were recorded by a RFID device and analyzed according to the type of surgical procedure, the surgeon and the anesthetic technique. Based on these initial data (n = 1520), patients were scheduled in a sequential manner according to the expected duration of the previous case. The primary endpoint was the difference between actual and predicted time of discharge from the unit. A total of 414 consecutive patients were prospectively evaluated. One hundred seventy four patients (42%) were discharged at the predicted time ± 30 min. Only 24% were discharged behind predicted schedule. Using an automatic record of patient's length of stay would allow an accurate prediction of the discharge time according to the type of surgery, the surgeon and the anesthetic procedure.

  13. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings

    Directory of Open Access Journals (Sweden)

    Sen S

    2014-06-01

    Full Text Available Objective: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC models in the inpatient, ambulatory, and community practice settings. Methods: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results: Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications. Additionally, a checklist has been created to assist other pharmacists in developing the pharmacist’s TOC roles in a practice environment or incorporating more TOC elements in their practice setting. Conclusion: Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care.

  14. The efficacy of ginger added to ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Pragnadyuti Mandal

    2014-01-01

    Full Text Available Background: Post-operative nausea and vomiting (PONV frequently hampers implementation of ambulatory surgery in spite of so many costly antiemetic drugs and regimens. Objective: The study was carried out to compare the efficacy of ginger (Zingiber officinale added to Ondansetron in preventing PONV after ambulatory surgery. Materials and Methods: It was a prospective, double blinded, and randomized controlled study. From March 2008 to July 2010, 100 adult patients of either sex, aged 20-45, of ASA physical status I and II, scheduled for day care surgery, were randomly allocated into Group A[(n = 50 receiving (IV Ondansetron (4 mg and two capsules of placebo] and Group B[(n = 50 receiving IV Ondansetron (4 mg and two capsules of ginger] simultaneously one hour prior to induction of general anaesthesia (GA in a double-blind manner. One ginger capsule contains 0.5 gm of ginger powder. Episodes of PONV were noted at 0.5h, 1h, 2h, 4h, 6h, 12h and 18h post- operatively. Statistical Analysis and Results: Statistically significant difference between groups A and B (P < 0.05, was found showing that ginger ondansetron combination was superior to plain Ondansetron as antiemetic regimen for both regarding frequency and severity. Conclusion: Prophylactic administration of ginger and ondansetron significantly reduced the incidence of postoperative nausea and vomiting compared to ondansetron alone in patients undergoing day care surgery under general anaesthesia.

  15. Use of a non-traditional university ambulatory practice to teach large animal medicine.

    Science.gov (United States)

    Masterson, Margaret A; Welker, Bimbo; Midla, Lowell T; Meiring, Richard W; Hoblet, Kent H

    2004-01-01

    While many other veterinary schools have moved away from a traditional university-based ambulatory practice, the Ohio State University's Large Animal Practice has continued to provide a cost-effective and valuable method of preparing students for today's careers in veterinary medicine. The practice provides a full array of services to production, equine, and camelid clients, including herd health, individual animal medicine and surgery, and emergency services. Acquiring established practices from alumni has formed the client base. Four full-time veterinarians operate the clinic. While these same clinicians do some classroom teaching, their primary responsibility is devoted to the five to six fourth-year veterinary students who rotate through the clinic every two weeks. Teaching methods and objectives for these students include case discussions, homework, truck quiz books, and practice management issues. Financially, the clinic runs as a private practice, with minimal support from the college (201,000 US dollars per fiscal year) and a gross income of 676,000 US dollars per year. Thus, in a cost-effective manner, this required core ambulatory rotation provides students with a scientific learning experience that exposes them to all aspects of large animal production medicine in a real-world setting.

  16. Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study

    Directory of Open Access Journals (Sweden)

    Ann Scheck McAlearney

    2013-01-01

    Full Text Available Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR system implementation and to synthesize the key informants' perspectives about successful implementation practices. Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system. Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success.

  17. Improved survival with an ambulatory model of non-invasive ventilation implementation in motor neuron disease.

    Science.gov (United States)

    Sheers, Nicole; Berlowitz, David J; Rautela, Linda; Batchelder, Ian; Hopkinson, Kim; Howard, Mark E

    2014-06-01

    Non-invasive ventilation (NIV) increases survival and quality of life in motor neuron disease (MND). NIV implementation historically occurred during a multi-day inpatient admission at this institution; however, increased demand led to prolonged waiting times. The aim of this study was to evaluate the introduction of an ambulatory model of NIV implementation. A prospective cohort study was performed. Inclusion criteria were referral for NIV implementation six months pre- or post-commencement of the Day Admission model. This model involved a 4-h stay to commence ventilation with follow-up in-laboratory polysomnography titration and outpatient attendance. Outcome measures included waiting time, hospital length of stay, adverse events and polysomnography data. Results indicated that after changing to the Day Admission model the median waiting time fell from 30 to 13.5 days (p Survival was also prolonged (median (IQR) 278 (51-512) days pre- vs 580 (306-1355) days post-introduction of the Day Admission model; hazard ratio 0.41, p = 0.04). Daytime PaCO2 was no different. In conclusion, reduced waiting time to commence ventilation and improved survival were observed following introduction of an ambulatory model of NIV implementation in people with MND, with no change in the effectiveness of ventilation.

  18. Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem

    2013-09-01

    Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

  19. Is there an overprescription of proton pump inhibitors in oncohematologic patients undergoing ambulatory oncospecific treatment?

    Directory of Open Access Journals (Sweden)

    Meritxell Pujal Herranz

    2016-09-01

    Full Text Available Objective: The aim of this study is to evaluate the prevalence of proton pump inhibitors (PPIs prescription, and the level of adequacy of the indication of these drugs in oncohematologic patients under ambulatory oncoespecific treatment. Method: An observational descriptive study in oncohematologic patients under ambulatory oncoespecific treatment. A protocol for the rational use of PPI targeted to oncohematologic patients based on the PPI protocol of our hospital was designed. Patients under active treatment with PPIs were quantified and the appropriateness of their indications evaluated. Results: 111 patients (71 oncologic and 40 hematologic were included. 56% of all oncologic patients and 63% of all hematologic patients were under active treatment with PPIs. After reviewing the indications for PPI in all patients, 72% of oncologic and 12% of hematologic patients did not present evidence justifying treatment with these drugs. Conclusion: It is important the pharmacist to detect unappropriated prescriptions of PPIs, especially among oncologic patients, and to promote a deprescription of these drugs

  20. Evaluation of sedentary women’s ambulatory blood pressure and its relation to muscle strength

    Directory of Open Access Journals (Sweden)

    Ramires Alsamir Tibana

    2012-09-01

    Full Text Available Objective: To compare the ambulatory blood pressure in women with different values of relative muscle strength. Methods: Data from 21 (aged 33.8±8.0 years sedentary women from Vila Telebrasília was collected during the period of November 2010 to July 2011. The volunteers were submitted to the evaluation of the handgrip strength and ambulatory monitoring of blood pressure (AMBP for a 72-hour period. Following the evaluation of handgrip strength to determine the absolute muscle strength, an adjustment in the body mass was made, in order to determine the relative muscle strength. Based on the relative value of muscular strength, the sample was divided into tertiles to compare systolic, diastolic and mean blood pressure during the periods of 24 hours, daytime and night-time, by using an one-way ANOVA, followed by Bonferroni test when appropriate, with a significance level of p<0.05. Results: Significant differences were found for systolic blood pressure between tertile 1 (99.3±12.2 and tertile 3 (106.8±11.1 in the night-time (P<0.05. Values of mean blood pressure were also significantly different between tertile 1 (70.2±6.3 and tertile 3 (80.3 ± 8.8 in the night-time (p<0,05. Conclusion: Women with higher relative muscle strength present lower values of blood pressure during night-time