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Sample records for ambulatory source factores

  1. Gamma factors of an ambulatory source

    International Nuclear Information System (INIS)

    Some of the procedures for diagnostic or treatment used in the medicine use radioactive materials as the I131. 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*(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 I131 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: ΓKAire = 56 μGy-m2-h-1-GBq-1, and ΓH*(10) = 73 μSv-m2-h-1-GBq-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 ΓKAire and H*(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. 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)

  3. Ambulatory Phlebectomy

    Science.gov (United States)

    ... Stretch Marks Sun-damaged Skin Unwanted Hair Unwanted Tattoos Varicose Veins Vitiligo Wrinkles Treatments and Procedures Ambulatory ... Stretch Marks Sun-damaged Skin Unwanted Hair Unwanted Tattoos Varicose Veins Vitiligo Wrinkles Treatments and Procedures Ambulatory ...

  4. Factors Associated with Hospitalisations for Ambulatory Care-Sensitive Conditions among Persons with an Intellectual Disability--A Publicly Insured Population Perspective

    Science.gov (United States)

    Balogh, R. S.; Ouellette-Kuntz, H.; Brownell, M.; Colantonio, A.

    2013-01-01

    Background: Hospitalisations for ambulatory care-sensitive (ACS) conditions are used as an indicator of access to, and the quality of, primary care. The objective was to identify factors associated with hospitalisations for ACS conditions among adults with an intellectual disability (ID) in the context of a publicly insured healthcare system.…

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

    Directory of Open Access Journals (Sweden)

    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.

  6. 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 | ...

  7. Factors Associated With Unplanned Hospitalizations Among Patients With Nonmetastatic Colorectal Cancers Intended for Treatment in the Ambulatory Setting

    Science.gov (United States)

    Fessele, Kristen L.; Hayat, Matthew J.; Mayer, Deborah K.; Atkins, Robert L.

    2016-01-01

    Background Chemotherapy administration and supportive management for solid tumors is intended to take place in the ambulatory setting, but little is known about why some patients experience treatment-related, adverse events so severe as to require acute inpatient care. Objective Identify predictors of initial and repeated unplanned hospitalizations and potential financial impact among Medicare patients with early-stage (stages I–III) colorectal cancer receiving outpatient chemotherapy. Methods Advanced statistical modeling was used to analyze a cohort of patients (N = 1485) from the Surveillance, Epidemiology and End Results (SEER)–Medicare database diagnosed from 2003–2007 with colorectal cancer as their first primary malignancy. Patients were age 66 and older at diagnosis, had uninterrupted Medicare Parts A and B coverage with no health maintenance organization (HMO) component, and received chemotherapy at least one time. Results Female sex, younger age, multiple comorbidities, rural geography, higher high school completion rates, and lower median income per census tract were significant predictors of the likelihood of initial unplanned hospitalizations. Non-White race, receipt of radiation therapy, rural geography and higher weighted comorbidity scores were factors associated with the number of hospitalizations experienced. The total Medicare charges calculated for these admissions was $38,976,171, with the median charge per admission at $20,412. Discussion Demographic and clinical factors were identified that form the foundation of work towards development of a risk factor profile for unplanned hospitalization. Further work is needed to incorporate additional clinical data to create a clinically applicable model. PMID:26657478

  8. Approximate factorization with source terms

    Science.gov (United States)

    Shih, T. I.-P.; Chyu, W. J.

    1991-01-01

    A comparative evaluation is made of three methodologies with a view to that which offers the best approximate factorization error. While two of these methods are found to lead to more efficient algorithms in cases where factors which do not contain source terms can be diagonalized, the third method used generates the lowest approximate factorization error. This method may be preferred when the norms of source terms are large, and transient solutions are of interest.

  9. [Ambulatory recording of esophageal pH over a 24-hour period in a population of 27 control subjects: analysis of technical and methodological factors influencing results].

    Science.gov (United States)

    Gignoux, C; Bonnet-Eymard, P O; Hostein, J; Fournet, J

    1987-01-01

    Twenty-four hour pH monitoring is used increasingly as a technique for diagnosis of gastro-esophageal reflux (GER). The Synectics recording apparatus (Stockholm, Sweden) was used in 27 ambulatory control subjects in order to: identify the variations of the data-dependent factors (electrodes, buffer solutions, calibration, placement of esophageal electrode). The consequences of these variations were evaluated by studying the measurement deflection after 24 h, baseline variations, and a comparative double pH esophageal recording with reference equipment for 3 h postprandial; to provide normal values for several parameters of GER measurement under the conditions of this study (total number of reflux, number of reflux episodes longer than 5 min, duration of the longest reflux, percentage of time during which pH was less than 4.0). Important interindividual variations were observed. When interpreting the results provided by this type of apparatus, one should take into account these large variations due, first, to the technique used and second, to the conditions of ambulatory recording. PMID:3556956

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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. 

  12. 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...

  13. 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. PMID:15534803

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

    Science.gov (United States)

    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 (PSSI 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. PMID:27121727

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

    Science.gov (United States)

    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. PMID:27382329

  16. Transitioning the RN to Ambulatory Care: An Investment in Orientation.

    Science.gov (United States)

    Allen, Juliet Walshe

    2016-01-01

    Registered nurses (RNs) struggle when transitioning from the inpatient setting to the outpatient clinical environment because it results in a diverse skill-set shift. The RN, considered an outpatient revenue source, experiences a decrease in peer-to-peer relationships, changes in leadership responsibilities, and changes in workgroup dynamics (supervision of unlicensed clinical personnel who function under the direction of the physician, not the RN). Ambulatory organizations find themselves implementing clinical orientation programs that may not delineate the attributes of the RN. This diminishes their value while emphasizing the unlicensed technical skill set. Creating a core RN orientation program template is paramount for the transition of the RN to the ambulatory setting. The literature reveals several areas where improving the value of the RN will ultimately enhance recruitment and retention, patient care outcomes, and leverage the RN role within any organization. Eleven 30-minute in-depth telephone interviews were conducted in addition to 4 nurse observations to explore the lived experience of the RN in ambulatory care. The findings disclosed an overarching theme of nurse isolation and offered insightful underpinnings for the nurse leader as ambulatory growth continues and nurse leaders further endorse the RN presence in the ambulatory setting. PMID:26938183

  17. 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...

  18. 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.

  19. 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

  20. Smoking artifacts: factors of source evaluation.

    Science.gov (United States)

    Powell, L; Hickson, M; Hill, S R; Holt, G; Flick, H

    1978-12-01

    Responses from 323 students in communication indicated that credibility factors associated with nonverbal smoking artifacts are not the same as those associated with verbal stimuli; a character factor was absent for nonverbal stimuli. Verbosity, however, may permit inferences regarding potential verbal behavior. PMID:740490

  1. [Hospital Costs of Ambulatory Care-Sensitive Conditions in Germany].

    Science.gov (United States)

    Fischbach, D

    2016-03-01

    Ambulatory care-sensitive conditions (ACSC) are defined as conditions that lead to a hospital admission of which the onset could have been prevented through a more easily accessible ambulatory sector or one that provides better quality care. They are used by health-care systems as a quality indicator for the ambulatory sector. The definition for ACSC varies internationally. Sets of conditions have been defined and evaluated already in various countries, e. g., USA, England, New Zealand and Canada, but not yet for Germany. Therefore this study aims to evaluate the hospital costs of ACSC in Germany using the National Health Service's set of ACSC. In order to calculate these costs a model has been set up for the time period between 2003 and 2010. It is based on G-DRG browsers issued by the German Institute for the Hospital Remuneration System as required by German law. Within these browsers all relevant DRG-ICD combinations have been extracted. The number of cases per combination was then multiplied by their corresponding cost weights and the average effective base rates. The results were then aggregated into their corresponding ICD groups and then into their respective conditions which lead to the costs per condition and the total costs. The total number of cases and total costs were then compared to another second source. These calculations resulted in 11.7 million cases, of which 10.7% were defined as ambulatory care-sensitive. Within the analysed time period the number of ambulatory care-sensitive cases increased by 6% in total and had a 0.9% CAGR. The corresponding costs amounted to a total of EUR 37.6B and to EUR 3.3B for ACSC. 60% of the costs were caused by three of the 19 ACSC. These results validate that it is worthwhile to further investigate this quality indicator for the ambulatory sector. PMID:25918929

  2. Factors influencing parameters of laser ion sources

    Czech Academy of Sciences Publication Activity Database

    Láska, Leoš; Badziak, J.; Boody, F. D.; Gammino, S.; Jungwirth, Karel; Krása, Josef; Krouský, Eduard; Parys, P.; Pfeifer, Miroslav; Rohlena, Karel; Ryč, L.; Skála, Jiří; Torrisi, L.; Ullschmied, Jiří; Wolowski, J.

    Madrid : ETS, 2006, s. 201. [ECLIM /29./. Madrid (ES), 11.06.2006-16.06.2006] R&D Projects: GA AV ČR IAA1010405 Institutional research plan: CEZ:AV0Z10100523; CEZ:AV0Z20430508 Keywords : laser ion sources * ion characteristics * non-linear processes Subject RIV: BH - Optics, Masers, Lasers

  3. 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

  4. Factors influencing parameters of laser ion sources

    Czech Academy of Sciences Publication Activity Database

    Láska, Leoš; Badziak, J.; Boody, F. P.; Gammino, S.; Jungwirth, Karel; Krása, Josef; Krouský, Eduard; Parys, P.; Pfeifer, Miroslav; Rohlena, Karel; Ryč, L.; Skála, Jiří; Torrisi, L.; Ullschmied, Jiří; Wolowski, J.

    2007-01-01

    Roč. 25, - (2007), s. 199-205. ISSN 0263-0346 R&D Projects: GA AV ČR IAA100100715 Institutional research plan: CEZ:AV0Z10100523; CEZ:AV0Z2043910 Keywords : highly charged ions * laser -produced plasma * self-focusing Subject RIV: BH - Optics, Masers, Laser s Impact factor: 4.696, year: 2007

  5. What Ambulatory Care Managers Need to Know About Examination Room Utilization Measurement and Analysis.

    Science.gov (United States)

    Klarich, Mark J; Rea, Ronald W; Lal, Tarun Mohan; Garcia, Angel L; Steffens, Fay L

    2016-01-01

    Demand for ambulatory care visits is projected to increase 22% between 2008 and 2025. Given this growth, ambulatory care managers need to proactively plan for efficient use of scarce resources (ie, space, equipment, and staff). One important component of ambulatory care space (the number of examination rooms) is dependent on multiple factors, including variation in demand, hours of operation, scheduling, and staff. The authors (1) outline common data collection methods, (2) highlight analysis and reporting considerations for examination room utilization, and (3) provide a strategic framework for short- and long-term decision making for facility design or renovation. PMID:27232683

  6. Ambulatory care training during core internal medicine residency training: the Canadian experience.

    OpenAIRE

    McLeod, P. J.; Meagher, T W

    1993-01-01

    OBJECTIVE: To determine the status of ambulatory care training of core internal medicine residents in Canada. DESIGN: Mail survey. PARTICIPANTS: All 16 program directors of internal medicine residency training programs in Canada. OUTCOME MEASURES: The nature and amount of ambulatory care training experienced by residents, information about the faculty tutors, and the sources and types of patients seen by the residents. As well, the program directors were asked for their opinions on the ideal ...

  7. Priority Setting and Influential Factors on Acceptance of Pharmaceutical Recommendations in Collaborative Medication Reviews in an Ambulatory Care Setting – Analysis of a Cluster Randomized Controlled Trial (WestGem-Study)

    Science.gov (United States)

    Rose, Olaf; Mennemann, Hugo; John, Carina; Lautenschläger, Marcus; Mertens-Keller, Damaris; Richling, Katharina; Waltering, Isabel; Hamacher, Stefanie; Felsch, Moritz; Herich, Lena; Czarnecki, Kathrin; Schaffert, Corinna; Jaehde, Ulrich; Köberlein-Neu, Juliane

    2016-01-01

    Background Medication reviews are recognized services to increase quality of therapy and reduce medication risks. The selection of eligible patients with potential to receive a major benefit is based on assumptions rather than on factual data. Acceptance of interprofessional collaboration is crucial to increase the quality of medication therapy. Objective The research question was to identify and prioritize eligible patients for a medication review and to provide evidence-based criteria for patient selection. Acceptance of the prescribing general practitioner to implement pharmaceutical recommendations was measured and factors influencing physicians’ acceptance were explored to obtain an impression on the extent of collaboration in medication review in an ambulatory care setting. Methods Based on data of a cluster-randomized controlled study (WestGem-study), the correlation between patient parameters and the individual performance in a medication review was calculated in a multiple logistic regression model. Physician’s acceptance of the suggested intervention was assessed using feedback forms. Influential factors were analyzed. Results The number of drugs in use (p = 0.001), discrepancies between prescribed and used medicines (p = 0.014), the baseline Medication Appropriateness Index score (p0.05) and a low kidney function (p>0.05) do not predetermine the outcome. Longitudinal patient care with repeated reviews showed higher interprofessional acceptance and superior patient benefit. A total of 54.9% of the recommendations in a medication review on drug therapy were accepted for implementation. Conclusions The number of drugs in use and medication reconciliation could be a first rational step in patient selection for a medication review. Most elderly, multimorbid patients with polymedication experience a similar chance of receiving a benefit from a medication review. Longitudinal patient care should be preferred over confined medication reviews. The acceptance

  8. Ambulatory ST segment monitoring after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1994-01-01

    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...

  9. Surgical Site Infection Surveillance Following Ambulatory Surgery

    OpenAIRE

    Rhee, Chanu; Huang, Susan S.; Berríos-Torres, Sandra I.; Kaganov, Rebecca; Bruce, Christina; Lankiewicz, Julie; Platt, Richard; Yokoe, Deborah S.

    2015-01-01

    We assessed 4045 ambulatory surgery patients for surgical site infection (SSI) using claims-based triggers for medical chart review. Of 98 patients flagged by codes suggestive of SSI, 35 had confirmed SSIs. SSI rates ranged from 0 to 3.2% for common procedures. Claims may be useful for SSI surveillance following ambulatory surgery.

  10. Analysis of depression in continuous ambulatory peritoneal dialysis patients.

    OpenAIRE

    Kim, Jung Ah; Lee, Yung Kee; Huh, Woo Seong; Kim, Yoon-Goo; Kim, Dae Joong; Oh, Ha-Young; Kang, Soon Ah; Kim Moon, Yang Ha; Kim, Han-Woo; Kim, Ji-Hae

    2002-01-01

    It is well known that depression and sense of hopelessness worsen the quality of life in end-stage renal disease (ESRD) patients receiving dialysis. However, the characteristics of depression in continuous ambulatory peritoneal dialysis (CAPD) patients have not been analyzed in detail. We performed this study to investigate the severity of depression and the factors affecting depression in CAPD patients. With 96 CAPD patients, we evaluated each patient's depressive mood and hopelessness with ...

  11. 48-hour ambulatory electrocardiography in dynamite workers and controls

    OpenAIRE

    Hogstedt, C; Söderholm, B; Bodin, L

    1980-01-01

    ABSTRACT Sudden deaths and chronic cardiovascular diseases have been reported in excess frequency from the explosives industry. Forty-two active dynamite workers and 43 healthy, unexposed workers have been studied by ambulatory electrocardiographic monitoring during two 24-hour periods covering an exposed shift and the “abstinence phase,” 40-64 hours after the last exposure to dynamite. To achieve comparability the non-exposed individuals were screened for risk factors of heart disease in the...

  12. 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.

  13. Separation of synchronous sources through phase locked matrix factorization.

    Science.gov (United States)

    Almeida, Miguel S B; Vigário, Ricardo; Bioucas-Dias, José

    2014-10-01

    In this paper, we study the separation of synchronous sources (SSS) problem, which deals with the separation of sources whose phases are synchronous. This problem cannot be addressed through independent component analysis methods because synchronous sources are statistically dependent. We present a two-step algorithm, called phase locked matrix factorization (PLMF), to perform SSS. We also show that SSS is identifiable under some assumptions and that any global minimum of PLMFs cost function is a desirable solution for SSS. We extensively study the algorithm on simulated data and conclude that it can perform SSS with various numbers of sources and sensors and with various phase lags between the sources, both in the ideal (i.e., perfectly synchronous and nonnoisy) case, and with various levels of additive noise in the observed signals and of phase jitter in the sources. PMID:25291741

  14. Sparse group factor analysis for biclustering of multiple data sources

    OpenAIRE

    Bunte, Kerstin; Leppäaho, Eemeli; Saarinen, Inka; Kaski, Samuel

    2015-01-01

    Motivation: Modelling methods that find structure in data are necessary with the current large volumes of genomic data, and there have been various efforts to find subsets of genes exhibiting consistent patterns over subsets of treatments. These biclustering techniques have focused on one data source, often gene expression data. We present a Bayesian approach for joint biclustering of multiple data sources, extending a recent method Group Factor Analysis (GFA) to have a biclustering interpret...

  15. Identification of sources of Phoenix aerosol by positive matrix factorization

    Energy Technology Data Exchange (ETDEWEB)

    Ramadan, Z.; Song, X.-H.; Hopke, P.K. [Clarkson University, Potsdam, NY (USA). Depts. of Chemical Engineering and Chemistry

    2000-08-01

    Chemical composition data for fine and coarse particles collected in Phoenix, AZ were analyzed using positive matrix factorization (PMF). The objective was to identify the possible aerosol sources at the sampling site. Two sets of fine particle samples were collected by different samplers. Each of the resulting fine particle data sets was analyzed separately. For each fine particle data set, eight factors were obtained, identified as (1) biomass burning characterized by high concentrations of organic carbon (OC) elemental carbon (EC), and K; (2) wood burning with high concentrations of Na, K, OC and EC; (3) motor vehicles with high concentrations of OC and EC; (4) nonferrous smelting process characterized by Cu, Zn, As and Pb; (5) heavy-duty diesel characterized by high EC, OC, and Mn; (6) sea-salt factor dominated by Na and Cl; (7) soil with high values for Al, Si, Ca, Ti and Fe; and (8) secondary aerosol with SO{sub 4}{sup -2} and OC that may represent coal-fired power plant emissions. The major sources for the fine particles were motor vehicles, vegetation burning factors (biomass and wood burning), and coal-fired power plants. These sources contributed most of the fine aerosol mass by emitting carbonaceous particles, and they have higher contributions in winter. For the coarse particles, the major source contributions were soil and construction (high Ca). These sources also peaked in winter. 20 refs., 14 figs., 3 tabs.

  16. 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…

  17. 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...

  18. Ambulatory Medical Care Utilization Estimates for 2007

    Science.gov (United States)

    ... the caveats discussed in the ‘‘Methods’’ section. The relationship between characteristics of the patient’s ZIP Code and the choice of ambulatory care setting is shown in Table 5. For persons ...

  19. Ambulatory and Community-Based Services

    OpenAIRE

    Thomas, Fred

    1999-01-01

    The shift in the site of service delivery from inpatient and institutional to ambulatory and community settings has been prompted by concerns over cost and the prospect for improving the quality of life. In response to these concerns, Medicare has implemented several demonstrations that emphasize ambulatory and community-based services. In this issue, articles are presented on four demonstrations, which focus on the extent to which coordinated care models reduce health care costs, and the cos...

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

    OpenAIRE

    Said Bodur; Selma İnfal

    2015-01-01

    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. Met...

  1. Dark matter conversion as a source of boost factor

    Science.gov (United States)

    Liu, Ze-Peng; Wu, Yue-Liang; Zhou, Yu-Feng

    2012-09-01

    In interacting multi-component dark matter (DM) models, the interactions between the DM components can covert relatively heavy DM components into lighter ones at late times after the thermal decoupling. As a consequence, the relic density of the lightest DM component can be greatly enhanced at late times, which can lead to an alternative source of boost factor required to explain the positron and electron excesses reported by the recent DM indirect search experiments.

  2. 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.

  3. 持续性不卧床腹膜透析相关性腹膜炎的影响因素研究%Risk Factors for Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis

    Institute of Scientific and Technical Information of China (English)

    杨军; 张燕; 许清玉

    2012-01-01

    目的 探讨持续性不卧床腹膜透析(CAPD)相关性腹膜炎(CAPD-related peritonitis,CAPDrp)发生的影响因素.方法 从患者的文化程度、发病季节、基础疾病、1年内复诊次数、营养状况及致病菌种类6个方面,回顾性分析我科近7年来收治的136例次CAPDrp的可能原因.结果 高中和高中以上文化程度者CAPDrp发生的年平均例次明显低于高中以下文化者(P<0.05);每年5~9月发病者CAPDrp发生的年平均例次明显高于其他月份发病者(P<0.05);1年内复诊≥6次的患者CAPDrp发生的年平均例次低于<6次的患者(P<0.05).血红蛋白≤80 g/L者与血红蛋白> 80 g/L比较,清蛋白≤28 g/L者与清蛋白>28 g/L者比较,CAPDrp发生的年平均例次间差异均有统计学意义(P< 0.05).革兰阴性杆菌和真菌的感染率有上升趋势.结论 CAPDrp的发生与患者文化程度、发病季节、基础疾病、1年内复诊次数、营养状况关系密切;与终末期肾病(ESRD)的基础疾病关系不明显.%Objective To investigate the risk factors for continuous ambulatory peritoneal dialysis ( CAPD ) - related peritonitis ( CAPDrp ). Methods The clinical data of 136 patients who suffered from CAPDrp in our center during the past 7 years were retrospectively analyzed in terms of education background, disease - onset season, underlying diseases, visits per year, nutritional status, and pathogen species. Results Patients with a higher education background ( high school or higher ) tended to have lower incidence of CAPDrp ( P 80g/Lvs. ≤80 g/L ) and serum albumin > 28 g/L vs. ≤28 g/L ( bothP <0. 05 ). In addition, it also showed an increasing tendency after tuberculous bacillus and fungus infections. Conclusion CAPDrp is closely related with the patients' education background, disease - onset seasons, underlying diseases, visits per year, and nutritional status; however, it shows no correlation with the underlying diseases of offend - stage ESRD.

  4. Source Apportionment of Atmospheric Mercury Using Positive Matrix Factorization

    Science.gov (United States)

    Richards, L. M.; Perry, K. D.; Abbott, M. L.

    2008-12-01

    A growing problem in the western United States is the widespread contamination of remote lakes by the atmospheric transport and deposition of mercury. Because methylmercury is known to bioaccumulate within the food chain, even small amounts of mercury introduced into an aquatic ecosystem can result in fish that are unsuitable for human consumption. The problem is complex because many natural and anthropogenic sources of mercury exist within the western United States (e.g., coal combustion, cement production, wildfires, mining activities, and emissions from naturally enriched soils and geothermal areas). Mercury can also be transported intercontinental distances (e.g., Asian coal combustion) under appropriate meteorological conditions. Thus, any mercury source apportionment study must be able to distinguish between these disparate source types. In this study, we measured gaseous elemental mercury (GEM), reactive gaseous mercury (RGM), and particulate mercury (HgP) with a Tekran system near Salmon Falls Creek Reservoir in south-central Idaho. These measurements were made during a series of one-month-long, intensive operation periods (IOPs) in the winter, spring, and summer of 2008. In each IOP, we also made coincident size- and time-resolved aerosol elemental composition measurements using an 8-stage rotating drum impactor and synchrotron X-ray fluorescence (SXRF) analysis. The SXRF analysis provided aerosol elemental concentration measurements with 3-hour time resolution. The Positive Matrix Factorization (PMF) receptor model was applied to the high-resolution, aerosol elemental composition data from each IOP to determine the temporal variability of the contributing source types based on the calculated source profiles. A multiple linear regression (MLR) technique was then used to apportion the measured mercury concentrations to the source types identified by the PMF analysis.

  5. Efficiency factor of a chemical nuclear reactor with gamma sources

    International Nuclear Information System (INIS)

    A chemonuclear reactor is simulated in order to calculate the efficiency factor of molecular species in chemical reactions induced by gamma radiation, with the purpose to obtain information for its design and consider the electromagnetic energy as a possible solution to the present problem of energy. The research is based on a mathematical model of succesive Compton processes applied to spherical and cylindrical geometry and corroborated through the absorbed dose and the experimental date of the increase factor, for the radioisotopic sources Co-60 and Cs-137 relating the quantity of energy deposited into various cylinders with the G value, the relation radius/height of the reactor is optimized according to the molecular production. This is illustrated with the radiolysis of a solution of CH3OH/H2O which forms H2 and with the obtainment of C2H5Br that represents and industrial process induced radioactively. The results show a greater energy deposition with Cs-137 but a larger production of H2/hr with Co-60, and besides we can find high production values of C2H5Br. The cylinder with more advantages is that whose relation R/H is of 0.5. It can be concluded that the final selection of the reactor should be made after a more intense study of the used isotope and the source activity. The efficiency factor of H2 can be increased selecting the appropriate type and concentration of solute of the irradiated aqueous solutions

  6. 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...

  7. 76 FR 19524 - Publication of Inflation Adjustment Factor, Nonconventional Source Fuel Credit, and Reference...

    Science.gov (United States)

    2011-04-07

    ... Internal Revenue Service Publication of Inflation Adjustment Factor, Nonconventional Source Fuel Credit...: Notice. SUMMARY: Publication of the inflation adjustment factor, nonconventional source fuel credit, and.... 45K). The inflation adjustment factor and reference price are used to determine the credit...

  8. 78 FR 21008 - Publication of Inflation Adjustment Factor, Nonconventional Source Fuel Credit, and Reference...

    Science.gov (United States)

    2013-04-08

    ... Internal Revenue Service Publication of Inflation Adjustment Factor, Nonconventional Source Fuel Credit...: Notice. SUMMARY: Publication of the inflation adjustment factor, nonconventional source fuel credit, and.... 45K). The inflation adjustment factor and reference price are used to determine the credit...

  9. Electronic word of mouth and the impact of source factors

    OpenAIRE

    Knudsen, Jan Andreas; Kjølen, Lars

    2011-01-01

    This study has evaluated the aspects of source factors and their influence on perceived credibility in the context of word-of-mouth (WOM) and compared it with the literature on electronic-word-of-mouth (eWOM). Through this comparison, holes in the literature regarding how the receiver of eWOM evaluates credibility when the information about the sender is scarce or missing are revealed and a two-part study is conducted. The main findings indicate that a larger amount of infor...

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

    NARCIS (Netherlands)

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

    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

  11. Diagnostic Errors in Ambulatory Care: Dimensions and Preventive Strategies

    Science.gov (United States)

    Singh, Hardeep; Weingart, Saul N.

    2009-01-01

    Despite an increasing focus on patient safety in ambulatory care, progress in understanding and reducing diagnostic errors in this setting lag behind many other safety concerns such as medication errors. To explore the extent and nature of diagnostic errors in ambulatory care, we identified five dimensions of ambulatory care from which errors may…

  12. Source to sink transport and regulation by environmental factors

    Directory of Open Access Journals (Sweden)

    Remi eLemoine

    2013-07-01

    Full Text Available Source-to-sink transport of sugar is one of the major determinants of plant growth and relies on the efficient and controlled distribution of sucrose (and some other sugars such as raffinose and polyols across plant organs through the phloem. However, sugar transport through the phloem can be affected by many environmental factors that alter source/sink relationships. In this paper, we summarize current knowledge about the phloem transport mechanisms and review the effects of several abiotic (water and salt stress, mineral deficiency, CO2, light, temperature, air and soil pollutants and biotic (mutualistic and pathogenic microbes, viruses, aphids and parasitic plants factors. Concerning abiotic constraints, alteration of the distribution of sugar among sinks is often reported, with some sinks as roots favoured in case of mineral deficiency. Many of these constraints impair the transport function of the phloem but the exact mechanisms are far from being completely known. Phloem integrity can be disrupted (e.g. by callose deposition and under certain conditions, phloem transport is affected, earlier than photosynthesis. Photosynthesis inhibition could result from the increase in sugar concentration due to phloem transport decrease. Biotic interactions (aphids, fungi, viruses… also affect crop plant productivity. Recent breakthroughs have identified some of the sugar transporters involved in these interactions on the host and pathogen sides. The different data are discussed in relation to the phloem transport pathways. When possible, the link with current knowledge on the pathways at the molecular level will be highlighted.

  13. Augmentation index's change and its influencing factor in patients on continuous ambulatory peritoneal dialysis%持续性非卧床腹膜透析患者增强指数的变化及影响因素

    Institute of Scientific and Technical Information of China (English)

    孙特; 林洪丽; 张瑜; 于长青; 孙红艳

    2010-01-01

    目的 应用增强指数(AI)检测持续性非卧床腹膜透析(CAPD)患者的动脉弹性,分析影响AI的因素,评估CAPD患者的动脉弹性功能状况.方法 测量46例CAPD患者(CAPD组)及42例健康者(对照组)的身高、体重、血压,检测血液指标,应用桡动脉压力波形分析仪测定AI,分析影响AI的因素.结果 CAPD组患者的收缩压、舒张压、脉压、中心动脉压和心率换算成75次/min的AI值(AIP75)明显高于对照组.CAPD患者女性的AIP75明显高于男性[(96.67±8.95)%比(89.89±6.46)%,P=0.022].简单相关分析显示,CAPD患者的AI与性别、年龄、收缩压、舒张压、脉压、中心动脉压呈正相关,与身高、体重、体重指数呈负相关,与各项血液指标及透析龄无相关性.多元线性回归分析显示,CAPD患者的AI与性别、年龄、身高、舒张压及中心动脉压存在线性回归关系.结论 CAPD患者动脉弹性降低,动脉硬度增加,其AI与年龄、身高、舒张压及中心动脉压密切相关,是部分反映动脉弹性的一个无创指标.中心动脉压与动脉弹性、僵硬度密切相关,临床测定中心动脉压对于预防心血管事件具有重要意义.%Objective To analyze the factors influencing augmentation index (AI) by examining the AI changes in patients who received continuous ambulatory peritoneal dialysis (CAPD) therapy, and evaluate the artery elastic function situation. Methods The height, weight, blood pressure, blood indicators were detected in 46 CAPD patients (CAPD group) and 42 controls (control group). AI was managed by OMRON HEM-90OOAI, and the influencing factor was analyzed. Results Systolic blood pressure(SBP),diastolic blood pressure(DBP), pulse pressure, central aortic pressure and AIp75 (AI value, when pulse was 75 beats/min) in CAPD group were significantly higher than those in control group. Within CAPD patients,the AIp75, in female was significantly higher than that in nude [(96.67±8.95 )% vs (89.89±6

  14. 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

  15. 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.

  16. 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.

  17. Ambulatory Measurement of Ground Reaction Forces

    NARCIS (Netherlands)

    Veltink, Peter H.; Liedtke, Christian; Droog, Ed

    2004-01-01

    The measurement of ground reaction forces is important in the biomechanical analysis of gait and other motor activities. It is the purpose of this study to show the feasibility of ambulatory measurement of ground reaction forces using two six degrees of freedom sensors mounted under the shoe. One se

  18. 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

  19. 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. PMID:14961226

  20. 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

  1. Evaluation of Ambulatory Care Information Systems

    OpenAIRE

    Simborg, Donald W.; Whiting-O'Keefe, Quinn E.

    1980-01-01

    The central purpose of an ambulatory care information system is to communicate information to the practitioner to facilitate clinical decision making. The clinical decision can be considered the dependent output variable in a process having the information system, the patient, clinician characteristics, and the environment as the independent input variables. Evaluation approaches using patient outcomes are problematic because of the indirect relationship between the information system and pat...

  2. Comprehensive Ambulatory Medicine Training for Categorical Internal Medicine Residents

    OpenAIRE

    Bharel, Monica; Jain, Sharad; Hollander, Harry

    2003-01-01

    It is challenging to create an educational and satisfying experience in the outpatient setting. We developed a 3-year ambulatory curriculum that addresses the special needs of our categorical medicine residents with distinct learning objectives for each year of training and clinical experiences and didactic sessions to meet these goals. All PGY1 residents spend 1 month on a general medicine ambulatory care rotation. PGY2 residents spend 3 months on an ambulatory block focusing on 8 core medic...

  3. Factors Affecting the Sustainability of Groundwater-Source Cooling

    Science.gov (United States)

    Ferguson, G. A.; Woodbury, A. D.

    2004-12-01

    The use of groundwater in thermal applications has grown in popularity due to increases in environmental awareness and rising energy costs. While this source of energy is generally seen as beneficial to the environment, changes in subsurface temperatures resulting from thermal development and other factors may make this practice unsustainable. An example of such changes in subsurface temperatures has been observed in Winnipeg, Manitoba, where groundwater is extensively used for cooling applications. Temperatures in a regional aquifer beneath the city were found to be as much as ten degrees Celsius greater than those measured in surrounding rural areas. Numerical modeling indicates increases in temperature of up to 5 degrees Celsius can be attributed to downward heat flow originating in buildings in many cases. Areas where increases in temperature were found to be greater corresponded to areas where water is being injected into the aquifer. This water is being produced in the process of using groundwater for cooling applications, such as air conditioning and industrial cooling, and is being injected back into the aquifer to maintain hydraulic head and reduce the demand on Winnipeg's sewer system. In most cases, the heat introduced by injecting this water is significantly affecting temperatures at the production well of the same system and numerical modeling indicates that this is inevitable with the current method of development. The combination of heat loss from buildings and injection of heated water is largely responsible for a reduction in the efficiency of groundwater as a coolant and may eventually make the use of groundwater in cooling applications unsustainable.

  4. 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

  5. 77 FR 22067 - Publication of Inflation Adjustment Factor, Nonconventional Source Fuel Credit, and Reference...

    Science.gov (United States)

    2012-04-12

    ... Internal Revenue Service Publication of Inflation Adjustment Factor, Nonconventional Source Fuel Credit...: Notice. SUMMARY: Publication of the inflation adjustment factor, nonconventional source fuel credit, and.... section 45K). The inflation adjustment factor is used to determine the credit allowable under section...

  6. 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.

  7. 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.

  8. 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.

  9. Cross-sectional study and influencing factors of self-management ability in patients undergoing continuous ambulatory peritoneal dialysis%腹膜透析患者自我管理能力的横断面研究及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    庞建红; 汪小华; 王菲; 陈月琴; 鞠阳; 许义; 马珊珊

    2014-01-01

    Objective To investigate the status quo and influencing factors of self-management ability in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).Methods Totally 339 CAPD patients with clinical follow-up regularly were investigated for the situation of self-management with general information questionnaire and Self-management Scale for CAPD.Results The total score of patients' self-management ability was (66.03±15.57).Multiple linear regression analysis showed that education level,marital status,occupation and duration of dialysis were influencing factors of patients' self-management ability.Conclusions Patients undergoing CAPD have certain degree of self-management ability.Nurses should promote their self-management ability according to different education level,marital status,occupation and duration of dialysis.%目的 了解持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者自我管理能力现状,并探讨其影响因素.方法 采用一般资料调查表和CAPD患者自我管理量表,对339例常规门诊随访的CAPD患者进行调查,并对调查结果进行分析.结果 本组患者自我管理总分为(66.03±15.57)分,多元线性回归分析显示,影响患者自我管理能力的主要因素有文化程度、婚姻状况、工作状态和透析龄.结论 本次受调查的患者具有一定的自我管理能力,临床护理人员可针对不同文化程度、婚姻状况、工作状态及透析龄的患者采取差异性的健康教育方式,促进患者自我管理能力的提高.

  10. Degree of Ambulatory Disability: Effects on Rural Siblings' Social Development.

    Science.gov (United States)

    Chamberlain, Theresa Nowak; Ross-Reynolds, Jane

    1993-01-01

    Interviews with 22 mothers of children with ambulatory disability and 33 nondisabled siblings showed no differences in sibling's child care responsibilities, general home responsibilities, or independence related to severity of the ambulatory disability. A difference in the amount of social activity, reported by mothers, was not confirmed by…

  11. Home and ambulatory blood pressure monitoring: when? who?

    Science.gov (United States)

    Kantarci, Gülçin

    2013-12-01

    Blood pressure measurement in the diagnosis and management of hypertension, including the technique required for ambulatory blood pressure monitoring and home blood pressure monitoring, will be reviewed in this article. Home and ambulatory measurements are widely used, both to confirm the diagnosis and to improve adherence to therapy. The major advantage of out-of-office blood pressure monitoring is that it provides a large number of blood pressure measurements away from the medical environment, which represents a more reliable assessment of actual blood pressure than office blood pressure. The advantage of ambulatory blood pressure monitoring is its unique ability to measure nocturnal blood pressure. Although not fully validated in large-scale clinical trials, ambulatory blood pressure monitoring appears to correlate best with prognosis. Ambulatory blood pressure monitoring and home blood pressure monitoring provide somewhat different information on the subject's blood pressure status, and the two methods should thus be regarded as complementary, rather than competitive or alternative. PMID:25019016

  12. 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,…

  13. Factors affecting the repeatability of gamma camera calibration for quantitative imaging applications using a sealed source

    International Nuclear Information System (INIS)

    Several applications in nuclear medicine require absolute activity quantification of single photon emission computed tomography images. Obtaining a repeatable calibration factor that converts voxel values to activity units is essential for these applications. Because source preparation and measurement of the source activity using a radionuclide activity meter are potential sources of variability, this work investigated instrumentation and acquisition factors affecting repeatability using planar acquisition of sealed sources. The calibration factor was calculated for different acquisition and geometry conditions to evaluate the effect of the source size, lateral position of the source in the camera field-of-view (FOV), source-to-camera distance (SCD), and variability over time using sealed Ba-133 sources. A small region of interest (ROI) based on the source dimensions and collimator resolution was investigated to decrease the background effect. A statistical analysis with a mixed-effects model was used to evaluate quantitatively the effect of each variable on the global calibration factor variability. A variation of 1 cm in the measurement of the SCD from the assumed distance of 17 cm led to a variation of 1–2% in the calibration factor measurement using a small disc source (0.4 cm diameter) and less than 1% with a larger rod source (2.9 cm diameter). The lateral position of the source in the FOV and the variability over time had small impacts on calibration factor variability. The residual error component was well estimated by Poisson noise. Repeatability of better than 1% in a calibration factor measurement using a planar acquisition of a sealed source can be reasonably achieved. The best reproducibility was obtained with the largest source with a count rate much higher than the average background in the ROI, and when the SCD was positioned within 5 mm of the desired position. In this case, calibration source variability was limited by the quantum

  14. Ambulatory Blood Pressure Monitoring in Diabetes and Obesity—A Review

    OpenAIRE

    Kazuo Eguchi

    2011-01-01

    Diabetes mellitus and obesity are both related to the risk of cardiovascular disease and sudden death. In hypertensive guidelines, diabetes and obesity, especially abdominal obesity, are regarded as high-risk factors. Ambulatory blood pressure monitoring (ABPM) is an established method for the management of hypertension. However, ABPM is not a standard tool for the management of hypertension in diabetes and obesity. In this paper, recent data on the use of ABPM in diabetes and obesity will be...

  15. Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care-sensitive Conditions

    DEFF Research Database (Denmark)

    Prior, Anders; Vestergaard, Mogens; Davydow, Dimitry S;

    2016-01-01

    BACKGROUND: Psychiatric disorders are associated with an increased risk for ambulatory care-sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population. OBJECTIVES.......67) after fully adjusting for multimorbidity and socioeconomic factors. Individuals with above reference stress levels experienced 1703 excess ACSC-related hospitalizations (18% of all). A dose-response relationship was observed between perceived stress and the ACSC-related hospitalization rate regardless...

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

    Science.gov (United States)

    2011-02-07

    ... provision that permits veal calves that are tired or cold to be set aside and treated (74 FR 11465... Slaughter'' (72 FR 38700)). The Agency had prohibited the slaughter of non-ambulatory disabled cattle for...-Ambulatory Disabled Following Ante-Mortem Inspection'' (74 FR 11464)). In that rulemaking the Agency...

  17. CONSUMER BIOTECHNOLOGY FOOD AND NUTRITION INFORMATION SOURCES: THE TRUST FACTOR

    OpenAIRE

    Ekanem, Enefiok P.; Muhammad, Safdar; Tegegne, Fisseha; Singh, Surendra P.

    2004-01-01

    Although much has been written on consumer attitudes toward genetically modified foods, not much is known about how or where consumers get the information for the decisions they make about genetically modified foods. This paper reports on the media used by consumers in acquiring information about biotech food and nutrition issues, and examines how much trust consumers put in selected information sources. The paper also discusses how socio-economic variables affect level of trust in selected s...

  18. Probabilistic Inference of Transcription Factor Binding from Multiple Data Sources

    OpenAIRE

    Lähdesmäki, Harri; Rust, Alistair G.; Shmulevich, Ilya

    2008-01-01

    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 ...

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

    Science.gov (United States)

    Lähdesmäki, Harri; Rust, Alistair G; Shmulevich, Ilya

    2008-01-01

    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 data sources

  20. College choice of natural science students: The factors and sources that influence enrollment decisions

    Science.gov (United States)

    Kim, Samuel

    This dissertation studied how institutional factors and sources of influence affected the enrollment decisions of natural science students admitted to a selective, private research institution. In terms of institutional factors, participants were asked to rate both the importance of factors and how satisfied they were with these factors at the survey institution. Institutional factors were divided into four sub-categories: cost-related factors, campus-related factors, academic opportunities and extra-curricular opportunities. Participants were also asked to rate the importance of sources of information/influence on their final enrollment decision; these sources were divided into three categories: student's network, institutional sources and reputation. Results were also disaggregated by enrollment decision and demographic variables (gender, ethnicity, SES, mother's educational level and father's educational level) to determine if differences existed between groups. An online survey was used to collect data and these results were based on quantitative analysis using both descriptive and inferential statistics. Factors that were considered important to natural science students in their college choice were campus, major availability, research opportunities, faculty contact, student activities and total cost. The factors that students were satisfied with at the survey institution were major availability and campus. The sources that were most important to students in making their college choice were the university's reputation and major reputation. Significant differences were found between groups based on demographic and enrollment variables in their ratings of factor importance, factor satisfaction and importance of sources of information/influence.

  1. Risk factors influence in renewable energy sources implementation in the country's electricity production

    International Nuclear Information System (INIS)

    The extension of the share of renewable energy sources in the gross electricity production is determined in significant extent by the influence of the risk factors classified as technological, political and market risks. The risk factors influence analyses concerning future electricity production from renewable energy sources as well as market expectations are presented

  2. Factors Influencing the Selection of Precision Farming Information Sources by Cotton Producers

    OpenAIRE

    Jenkins, Amanda; Velandia, Margarita M.; Lambert, Dayton M.; Roberts, Roland K.; Larson, James A.; Burton C. English; Martin, Steven W

    2011-01-01

    Precision farming information demanded by cotton producers is provided by various suppliers, including consultants, farm input dealerships, University Extension systems, and media sources. Factors associated with the decisions to select among information sources to search for precision farming information are analyzed using a multivariate probit regression accounting for correlation among the different selection decisions. Factors influencing these decisions are age, education, and income. Th...

  3. 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.

  4. 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.

  5. Growing ambulatory care nurse leaders in a multigenerational workforce.

    Science.gov (United States)

    Moye, Janet P; Swan, Beth Ann

    2009-01-01

    Ambulatory care faces challenges in sustaining a nursing workforce in the future as newly licensed nurses are heavily recruited to inpatient settings and retirements will impact ambulatory care sooner than other areas. Building a diverse team by recruiting nurses of different ages (generations) and skills may result in a more successful and robust organization. Knowledge about generational characteristics and preferences will aid nurse leaders and recruiters in attracting high-quality, talented nurses. Nurses of Generations X and Y can increase their likelihood of success in ambulatory care by better understanding intergenerational issues. PMID:20050492

  6. [Ambulatory treatment of deep venous thrombosis].

    Science.gov (United States)

    Metz, D; Hezard, N; Brasselet, C

    2001-11-01

    Conventional treatment of deep venous thrombosis (DVT) has been based, until recently, on non-fractionated heparin by continuous intravenous infusion in hospital until effective anticoagulation could be obtained by oral anticoagulants introduced early. Low molecular weight heparin (LMWH) seems to be as effective and has a better bio-availability, which means that there are fewer adverse effects. This usage has logically led to the increase in the possibilities of treatment of DVT at home. However, certain precautions are necessary, especially the evaluation of the individual patient's risk with this strategy. This requires multidisciplinary collaboration and the respect of strict rules (precise diagnostic objective, hospital admission at the slightest doubt of pulmonary embolism) to demonstrate the value of ambulatory LMWH therapy which would improve patient comfort and allow early mobilisation. PMID:11794978

  7. Surgical complications of continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Sanderson, M C; Swartzendruber, D J; Fenoglio, M E; Moore, J T; Haun, W E

    1990-12-01

    Surgical experience with 260 consecutive patients with chronic renal failure receiving continuous ambulatory peritoneal dialysis (CAPD) at one medical center from 1980 to 1989 is reviewed. Patients received CAPD for a mean of 24.2 months (range: 3 days to 91 months). Catheter longevity consistently improved in all but 1 year from 1984 to 1989, as did exit-site and tunnel infections. Of 311 catheters inserted, 151 (49%) required removal, of which 111 (74%) were attributed to peritonitis. Cumulative patient survival was 80%, 60%, and 53% at 1, 2, and 3 years, respectively. Diabetic patients had statistically significant lower survival rates. Additional complications including catheter leakage, catheter malposition, catheter obstruction, and abdominal wall hernias were negligible. Although CAPD is not free from serious complications, our data show remarkable improvement since 1980 in catheter longevity, hospital stay, and infection rates. PMID:2252113

  8. [Ambulatory surgery. Patients and patient education].

    Science.gov (United States)

    Bredland, T; Duesund, R

    1996-02-20

    This article reviews the concept of day surgery and shows how the treatment can be organized pre-, per- and post-operatively. It can be established in a hospital-integrated unit, a unit separate from the hospital, but connected with it, or a satellite ambulatory facility. Because the patient spends only a short time in hospital it is necessary to have structured preparations before admission, for the benefit of both patient and staff. It should be easy to identify patients suitable for day surgery from the waiting lists, and preparations should be directed at treatment by day surgery right from the start. Rules must be worked out for selecting patients, as well as guidelines for information to patients. It is also necessary to plan the operation programme, and to agree how nurses and doctors should take care of the patient during the different steps of treatment. PMID:8658453

  9. Comparing Ambulatory Preceptors’ and Students’ Perceptions of Educational Planning

    OpenAIRE

    Qualters, Donna M.; Regan, Mary Beth; O’Brien, Mary Callery; Stone, Sarah L

    1999-01-01

    To compare ambulatory preceptors’ and students’ perceptions of the use of educational planning (setting goals, assessing needs, formulating objectives, choosing methods, and providing feedback and evaluation) in the office setting, we mailed a survey, which was returned by 127 longitudinal ambulatory preceptors and 168 first-year and second-year medical students. Faculty perceptions did not match student perceptions of what occurred in the longitudinal preceptor program teaching sessions in e...

  10. 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.......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....

  11. Management of comorbidities in ambulatory anesthesia: a review

    OpenAIRE

    Dabu-Bondoc S; Shelley KH

    2015-01-01

    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 pa...

  12. Management of comorbidities in ambulatory anesthesia: a review

    OpenAIRE

    Shelley, Kirk

    2015-01-01

    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 ...

  13. 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. PMID:18061764

  14. Anxiety and Postoperative Recovery in Ambulatory Surgery Patients

    OpenAIRE

    Parris, Winston C.V.; Matt, Denise; Jamison, Robert N.; Maxson, Wayne

    1988-01-01

    There has been a growing trend toward one-day ambulatory surgery. Unfortunately, there has been little research evaluating how patients recover at home after one-day surgery. This study examined the relationship between preoperative anxiety and postoperative recovery in ambulatory surgery patients. Fifty women who were scheduled for a laparascopy completed a series of questionnaires on the day before surgery and on each of three days after surgery. One month after surgery, the patients were t...

  15. Home and ambulatory blood pressure monitoring: when? who?

    OpenAIRE

    Gülçin KANTARCI

    2013-01-01

    Blood pressure measurement in the diagnosis and management of hypertension, including the technique required for ambulatory blood pressure monitoring and home blood pressure monitoring, will be reviewed in this article. Home and ambulatory measurements are widely used, both to confirm the diagnosis and to improve adherence to therapy. The major advantage of out-of-office blood pressure monitoring is that it provides a large number of blood pressure measurements away from the medical environme...

  16. Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua G.; Tulpule, Mandar

    2011-01-01

    Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

  17. 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.

  18. A Complex Matrix Factorization approach to Joint Modeling of Magnitude and Phase for Source Separation

    OpenAIRE

    Ahuja, Chaitanya; Nathwani, Karan; Rajesh M. Hegde

    2014-01-01

    Conventional NMF methods for source separation factorize the matrix of spectral magnitudes. Spectral Phase is not included in the decomposition process of these methods. However, phase of the speech mixture is generally used in reconstructing the target speech signal. This results in undesired traces of interfering sources in the target signal. In this paper the spectral phase is incorporated in the decomposition process itself. Additionally, the complex matrix factorization problem is reduce...

  19. Patient sources of information and decision factors in selecting cosmetic surgeons.

    Science.gov (United States)

    Nowak, L I; Washburn, J H

    1998-01-01

    This paper presents the results of an exploratory study designed to examine influential information sources and decision factors in the selection of plastic surgeons for cosmetic versus medical procedures. Physician referrals were found to be the most influential sources of information for both groups. Word-of-mouth and magazine and newspaper articles were also important information sources for cosmetic patients. Primary selection factors were significantly different between groups, with board certification the most influential for cosmetic patients and recommendation by physician most influential for medical patients. PMID:10185452

  20. 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. PMID:25759064

  1. 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

    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......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...... 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...

  2. Development on Monte Carlo methodology with scatter correction factor of afterloading 192 Ir source

    International Nuclear Information System (INIS)

    Objective: To facilitate activity measurement by using the thimble ionization chamber in hospitals, to obtain air kerma scatter correction factor of medical afterloading of 192Ir source by developing an available and convenient calculation method. Methods: According to International Atomic Energy Agency (IAEA) 1079 Report to calculate the scatter correction factor of 192Ir source, to measure air kerma of 192Ir source with and without lead shield using thimble ionization chamber. Simulation measurement conditions were used to calculate scatter correction factor of 192Ir source and comparison was made between experimental results and literature records. At the same time, the different ionization chamber models were simulated at different room sizes to obtain scattering correction factor of 192 Ir source. Results: Comparison was made between the simulation scatter correction factors of 192Ir source and experiment by the shadow shield, and the relative deviation was 0.8%. The deviation of the 192Ir activity calculated according to the simulated scatter correction factor and measured by well type ionization chamber was 2.4%. By comparison between the calculated results by using two kinds of spherical ionization chamber and those ones deduced by IAEA 1079 Report,the relative deviations ranged within 0.3%-0.4%. Five different types of thimble ionization chamber and different room sizes were simulated and calculated by MC simulation, with the relative deviation within 3%. Conclusions: Monte Carlo simulation method for calculating afterloading 192Ir source's scatter correction factor is feasible, and this method is convenient for use in the thimble chamber for brachytherapy QA work in the hospital. (authors)

  3. 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

  4. Colecistectomia videolaparoscópica ambulatorial Laparoscopic cholecystectomy in an ambulatory care setting

    Directory of Open Access Journals (Sweden)

    Alexandre Cruz Henriques

    2001-02-01

    Full Text Available OBJETIVO: Os autores apresentam sua experiência com 50 pacientes operados de colecistectomia videolaparoscópica em regime ambulatorial, no Hospital de Ensino da Faculdade de Medicina do ABC. MÉTODO: Quarenta e dois pacientes (84% eram do sexo feminino e oito (16% do masculino, a idade variou de 23 a 60 anos, com média de 41,5 anos. Foram submetidos ao procedimento pacientes com diagnóstico de colecistite crônica calculosa, que obedeciam aos seguintes critérios: inexistência de colecistite aguda, idade máxima de 60 anos, ausência de suspeita de coledocolitíase, avaliação clínica pré-operatória ASA I ou II, aprovação do paciente quanto ao método e período de internação empregados e presença de acompanhante. O posicionamento da equipe e a técnica utilizada foram os preconizados pela escola americana. RESULTADOS: O tempo cirúrgico variou de 50 minutos a 2 horas, com média de 1 hora e 25 minutos. A colangiografia intra-operatória foi realizada em 35 pacientes (70%, demonstrando coledocolitíase em um caso (2%, que necessitou conversão para cirurgia aberta. As complicações mais freqüentes no período pós-operatório imediato foram náuseas e vômitos em três casos (6%, seguidas de dor abdominal intensa em dois casos (4%. Foram tratados com antieméticos e analgésicos e tiveram a alta hospitalar adiada para o dia seguinte à operação. Quarenta e quatro pacientes (88% tiveram condições de alta no mesmo dia. O período de permanência hospitalar foi entre nove e 12 horas. O retorno ambulatorial era programado para o sétimo e trigésimo dias pós-operatório, não havendo necessidade de reinternação em nenhum caso. CONCLUSÕES: A colecistectomia videolaparoscópica ambulatorial é um procedimento seguro.BACKGROUND: The authors present their experience with 50 patients undergoing videolaparoscopic cholecystectomy in an ambulatory care setting at University Hospital, ABC Medical School. METHODS:Forty-two patients (84

  5. 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

  6. Ambulatory laparoscopic cholecystectomy: Is it safe and cost effective?

    Directory of Open Access Journals (Sweden)

    Ali Athar

    2009-01-01

    Full Text Available Background : Laparoscopic cholecystectomy (LC is the most commonly performed minimal invasive surgery. However, practice of its use as an ambulatory surgery in our hospital settings is uncommon. Objective : To evaluate safety and cost effectiveness of LC as an ambulatory day care surgery. Study Design : Quasiexperimental. Setting : Department of surgery, Aga Khan University Hospital, Karachi, Pakistan. Materials and Methods : Patients with uncomplicated symptomatic gallstones were selected for Ambulatory LC. They were admitted electively on the same day and operated on in the morning hours and discharged after a check by the surgeon 6-8 hrs later. Results : Of fifty (n = 50 patients selected for ambulatory LC, 92% were discharged successfully after 6-8 hrs observation. No significant perioperative complications were noted. Unplanned admission and readmission rate was 8 and 2%, respectively. Cost saving for the daycare surgery was Rs. 6,200, Rs. 13,300, and Rs.22,800 per patient as compared to in patient general, semiprivate, and private ward package, respectively. Conclusion : Practice ambulatory LC is safe and cost-effective in selected patients with uncomplicated symptomatic gallstones.

  7. Data library of gamma-ray buildup factors for point isotropic source

    International Nuclear Information System (INIS)

    Gamma-ray buildup factors for a point isotropic source have been calculated as a function of atomic number of heavy elements and source energies over an energy range from 0.015 MeV to 15 MeV, for penetration depths up to 40 mfp, bu the PALLAS-PL,SP-Br code. These data include the contribution of bremsstrahlung, annihilation radiation and fluorescence X-ray. The calculated absorbed-dose, exposure and dose-equivalent buildup factors are tabulated for molybdenum, tin, tungsten, lead and uranium, which are practical interest shield materials, lanthanum and gadolinium which are important materials for obtaining buildup factors by interpolation with the atomic number. In the case of high atomic number materials, inclusion of brems-strahlung source has great influence on the buildup factors for high source energies and that of fluorescence X-ray gives spectracular effects on those for low energies close to the K edge of attenuation cross section. Furthermore, the geometrical-progression (G-P) parameters have been determined for these buildup factors in order to obtain the values of buildup factors at arbitrary distances and energies. (author)

  8. [Ambulatory invasive and noninvasive blood pressure monitoring].

    Science.gov (United States)

    Bachmann, K; Wortmann, A; Engels, G

    1989-08-01

    Indirect arterial blood pressure measurement has not changed substantially since its introduction by Riva-Rocci in 1986, Korotkoff in 1905 and Recklinghausen in 1906. Random measurements in the clinic or practice reflect only incompletely the dynamic nature of the blood pressure. Blood pressure recordings by patients themselves have provided more information through better temporal resolution, however, exact characterization of the pressure response throughout the entire day and, in particular, during physical exertion are not enabled; the latter are especially important with regard to diagnosis and treatment of hypertension. In 1966, therefore, radiotelemetric transmission of direct, continuously-measured arterial blood pressure was developed which enabled beat-to-beat registration of blood pressure, outside the laboratory, during normal daily life and sport activities. The initial results showed a marked variability of the blood pressure during the course of the day (Figure 1). Excessive blood pressure increases were observed during exposure to cold, static and dynamic exercise and to a lesser degree during automobile driving and exposure to heat (Figure 3). Recording of the pressure curves via transmission by radiotelemetry shows a high degree of accuracy and temporal resolution, spatial and situational freedom but is invasive and costly in terms of personnel. The same holds true for direct continuous blood pressure registration and storage on a portable tape recorder. Portable, automatic blood pressure measuring units for ambulatory monitoring employ indirect auscultatory or oscillometric recording with a cuff. As compared with the radiotelemetric direct continuous blood pressure measuring method, the indirect method has subordinate temporal resolution, that is, the measurements are only intermittent.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2676813

  9. Genospecies and virulence factors of Aeromonas species in different sources in a North African country

    OpenAIRE

    Ahmed, Salwa F.; Cappuccinelli, Piero; Klena, John D.; Ghenghesh, Khalifa Sifaw

    2014-01-01

    Introduction: Aeromonads of medical importance have been reported from numerous clinical, food, and water sources, but identification of genospecies and virulence factors of Aeromonas species from countries in North Africa and the Middle East are few.Methods: In total 99 Aeromonas species isolates from different sources (diarrheal children [n=23], non-diarrheal children [n=16], untreated drinking water from wells [n=32], and chicken carcasses [n=28]) in Tripoli, Libya, were included in the pr...

  10. Design of bright, fiber-coupled and fully factorable photon pair sources

    International Nuclear Information System (INIS)

    From quantum computation to quantum key distribution, many quantum-enhanced applications rely on the ability to generate pure single photons. Even though the process of spontaneous parametric downconversion (SPDC) is widely used as the basis for photon-pair sources, the conditions for pure heralded single-photon generation, taking into account both spectral and spatial degrees of freedom, have not been fully described. We present an analysis of the spatio-temporal correlations present in photon pairs produced by type-I, non-collinear SPDC. We derive a set of conditions for full factorability in all degrees of freedom-required for the heralding of pure single photons-between the signal and idler modes. In this paper, we consider several possible approaches for the design of bright, fiber-coupled and factorable photon-pair sources. We show through numerical simulations of the exact equations that sources based on: (i) the suppression of spatio-temporal entanglement according to our derived conditions and (ii) a tightly focused pump beam together with optimized fiber-collection modes and spectral filtering of the signal and idler photon pairs, lead to a source brightness of the same order of magnitude. Likewise, we find that both of these sources lead to a drastically higher factorable photon-pair flux, compared to an unengineered source.

  11. Comparing ambulatory preceptors' and students' perceptions of educational planning.

    Science.gov (United States)

    Qualters, D M; Regan, M B; O'Brien, M C; Stone, S L

    1999-03-01

    To compare ambulatory preceptors' and students' perceptions of the use of educational planning (setting goals, assessing needs, formulating objectives, choosing methods, and providing feedback and evaluation) in the office setting, we mailed a survey, which was returned by 127 longitudinal ambulatory preceptors and 168 first-year and second-year medical students. Faculty perceptions did not match student perceptions of what occurred in the longitudinal preceptor program teaching sessions in educational planning areas. Students perceived these activities were occurring with much less frequency than faculty perceived. Medical education needs to move beyond the usual faculty development workshop paradigm to a more comprehensive educational development model that includes training both faculty and students in core educational skills. This will enable the ambulatory setting to reach its full educational potential in training future physicians. PMID:10203628

  12. Novel Data Fusion Method and Exploration of Multiple Information Sources for Transcription Factor Target Gene Prediction

    Directory of Open Access Journals (Sweden)

    Dai Xiaofeng

    2010-01-01

    Full Text Available Background. Revealing protein-DNA interactions is a key problem in understanding transcriptional regulation at mechanistic level. Computational methods have an important role in predicting transcription factor target gene genomewide. Multiple data fusion provides a natural way to improve transcription factor target gene predictions because sequence specificities alone are not sufficient to accurately predict transcription factor binding sites. Methods. Here we develop a new data fusion method to combine multiple genome-level data sources and study the extent to which DNA duplex stability and nucleosome positioning information, either alone or in combination with other data sources, can improve the prediction of transcription factor target gene. Results. Results on a carefully constructed test set of verified binding sites in mouse genome demonstrate that our new multiple data fusion method can reduce false positive rates, and that DNA duplex stability and nucleosome occupation data can improve the accuracy of transcription factor target gene predictions, especially when combined with other genome-level data sources. Cross-validation and other randomization tests confirm the predictive performance of our method. Our results also show that nonredundant data sources provide the most efficient data fusion.

  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. Identifying non-point source critical source areas based on multi-factors at a basin scale with SWAT

    Science.gov (United States)

    Liu, Ruimin; Xu, Fei; Zhang, Peipei; Yu, Wenwen; Men, Cong

    2016-02-01

    The identification of critical source areas (CSAs) is a precondition for non-point source (NPS) pollution control at a basin scale, especially in areas with limited resources. Based on the Soil and Water Assessment Tool (SWAT), nutrient loads coupled with population density and water quality requirements are regarded as multi-factors for CSAs identification in Xiangxi river watershed, the first tributary of the Yangtze River. The results based on the calibrated model found that the subbasins heavily and seriously polluted by nutrient loads were different from the subbasins identified as CSAs, demonstrating integrating socio-economic factors like population density and water quality requirements to identify CSAs is of much necessity. The CSAs occupied 19.7% of the total subbasins, and accounted for 53% total nitrogen loads, 54% total phosphorus loads and 36% of the total population. Considering the model calibration and validation will take a long time as well as data deficiency in some subbasins, the influence of uncalibrated SWAT on CSAs identifications was discussed. The comparative results between CSAs identification with calibrated and uncalibrated SWAT model revealed that model calibration had little effect on nutrients distribution and CSAs locations in the study area. Uncalibrated SWAT model may be applied when the research objective is less related to model calibration. The results will be greatly effective for CSAs identification and NPS pollution control at a basin scale.

  15. [Ambulatory surgery in France: practical and medicolegal considerations].

    Science.gov (United States)

    Wodey, E; de la Brière, F

    2013-12-01

    In France, ambulatory anaesthesia and surgery seem to be well codified. Many recommendations have been published by the Health Authority and the professional associations: they are summarized in this review. However, numerous practical problems persist: for example, two situations specific to paediatric practice are problematic parental comprehension and application of the information provided and poor access to strong analgesics outside the hospital. Despite this, the paediatric population is an ideal target for ambulatory care because of its usual good health and quicker recovery after minor injury as proven by the small percentage of failure and readmission. PMID:24209990

  16. Source apportionment of ambient particle number concentrations in central Los Angeles using positive matrix factorization (PMF)

    Science.gov (United States)

    Sowlat, Mohammad Hossein; Hasheminassab, Sina; Sioutas, Constantinos

    2016-04-01

    In this study, the positive matrix factorization (PMF) receptor model (version 5.0) was used to identify and quantify major sources contributing to particulate matter (PM) number concentrations, using PM number size distributions in the range of 13 nm to 10 µm combined with several auxiliary variables, including black carbon (BC), elemental and organic carbon (EC/OC), PM mass concentrations, gaseous pollutants, meteorological, and traffic counts data, collected for about 9 months between August 2014 and 2015 in central Los Angeles, CA. Several parameters, including particle number and volume size distribution profiles, profiles of auxiliary variables, contributions of different factors in different seasons to the total number concentrations, diurnal variations of each of the resolved factors in the cold and warm phases, weekday/weekend analysis for each of the resolved factors, and correlation between auxiliary variables and the relative contribution of each of the resolved factors, were used to identify PM sources. A six-factor solution was identified as the optimum for the aforementioned input data. The resolved factors comprised nucleation, traffic 1, traffic 2 (with a larger mode diameter than traffic 1 factor), urban background aerosol, secondary aerosol, and soil/road dust. Traffic sources (1 and 2) were the major contributor to PM number concentrations, collectively making up to above 60 % (60.8-68.4 %) of the total number concentrations during the study period. Their contribution was also significantly higher in the cold phase compared to the warm phase. Nucleation was another major factor significantly contributing to the total number concentrations (an overall contribution of 17 %, ranging from 11.7 to 24 %), with a larger contribution during the warm phase than in the cold phase. The other identified factors were urban background aerosol, secondary aerosol, and soil/road dust, with relative contributions of approximately 12 % (7.4-17.1), 2.1 % (1

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

    DEFF Research Database (Denmark)

    Schmidt, Mikkel Nørgaard

    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....

  18. The Factor Structure of Source Credibility Scales for Immediate Superiors in the Organizational Context.

    Science.gov (United States)

    Falcione, Raymond L.

    This study reports on two investigations designed to determine the generalizability of source credibility scales for immediate superiors across organizational contexts. Semantic differential-type scales that have been found to load on factors of course credibility in previous studies were combined to provide an item pool for this investigation. In…

  19. Heralded single-photon source utilizing highly nondegenerate, spectrally factorable spontaneous parametric downconversion.

    Science.gov (United States)

    Kaneda, Fumihiro; Garay-Palmett, Karina; U'Ren, Alfred B; Kwiat, Paul G

    2016-05-16

    We report on the generation of an indistinguishable heralded single-photon state, using highly nondegenerate spontaneous parametric downconversion (SPDC). Spectrally factorable photon pairs can be generated by incorporating a broadband pump pulse and a group-velocity matching (GVM) condition in a periodically-poled potassium titanyl phosphate (PPKTP) crystal. The heralding photon is in the near IR, close to the peak detection efficiency of off-the-shelf Si single-photon detectors; meanwhile, the heralded photon is in the telecom L-band where fiber losses are at a minimum. We observe spectral factorability of the SPDC source and consequently high purity (90%) of the produced heralded single photons by several different techniques. Because this source can also realize a high heralding efficiency (> 90%), it would be suitable for time-multiplexing techniques, enabling a pseudo-deterministic single-photon source, a critical resource for optical quantum information and communication technology. PMID:27409894

  20. Success Factors and Measures for Public Sector IS/IT Co-Sourcing Contracts

    Directory of Open Access Journals (Sweden)

    Erhan Edguer

    2004-05-01

    Full Text Available The main objective of this research was to explore the effectiveness of contract negotiations between buyers and suppliers in small government organizations, which collectively outsource their IS/IT activities to a single outsourcing vendor, usually referred to as ‘co-sourcing’. A major finding of this study was that organizations could have a successful co-sourcing arrangement by determining and putting into practice certain critical success factors. This research was the first study of government co-sourcing arrangements in Australia that aimed to identify the success of a contract and the critical factors that affected it. In this regard, it can contribute to the existing body of knowledge in co-sourcing activities that have been growing rapidly in government departments as well as in the private sector.

  1. 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.

  2. Adesão medicamentosa em idosos em seguimento ambulatorial Medicine adeshion in eldery people in an ambulatorial attendance

    OpenAIRE

    Fernanda Aparecida Cintra; Maria Elena Guariento; Lilian Akemi Miyasaki

    2010-01-01

    Este estudo objetivou avaliar a adesão ao tratamento medicamentoso em idosos em seguimento ambulatorial e identificar os fatores relacionados a esta adesão. Foram entrevistados 165 idosos em seguimento ambulatorial no Hospital das Clínicas da Universidade Estadual de Campinas (Unicamp), São Paulo. Utilizou-se instrumento próprio, com informações relativas à identificação dos sujeitos, dados de saúde autorreferidos e relativos à terapêutica medicamentosa. Os dados foram submetidos às análises ...

  3. Risk of postoperative hypoxemia in ambulatory orthopedic surgery patients with diagnosis of obstructive sleep apnea: a retrospective observational study

    Directory of Open Access Journals (Sweden)

    Ma Yan

    2010-06-01

    Full Text Available Abstract Background It is unclear when it is safe to discharge patients with a diagnosis of Obstructive Sleep Apnea (OSA after ambulatory surgical procedures due to concern for postoperative respiratory compromise and hypoxemia. Our OSA patients undergoing ambulatory-type orthopedic procedures are monitored overnight in the PACU, thus we reviewed patient records to determine incidence of complications. Methods Two hundred and six charts of patients with preoperative diagnosis of OSA based on ICD-9 codes were reviewed for outcomes including episodes of hypoxemia. Univariate analysis followed by logistic regression and propensity analysis was performed to determine independent risk factors for hypoxemia and association with adverse outcomes. Results The majority of patients had regional anesthesia (95%. Thirty four percent of patients had hypoxemia in the PACU. Initial risk factors for hypoxemia identified by univariate analysis were BMI ≥ 35, increased age, history of COPD, upper extremity procedure, and use of peripheral nerve block. Independent risk factors identified by logistic regression were history of COPD (OR 3.64 with 95% CI 1.03-12.88 and upper extremity procedure (2.53, 1.36-4.68. After adjustment with propensity scores, adverse events were rare, and unplanned hospital admission after PACU stay was not increased with hypoxemia (11% vs 16% Conclusions Episodes of postoperative hypoxemia in OSA patients undergoing ambulatory surgery with regional anesthesia are not associated with increased adverse outcomes or unplanned hospital admission.

  4. T-wave Alternans Analysis In Ambulatory ECG Monitoring

    OpenAIRE

    Ch?apinski, Jakub; Kaminski, Marek; Sakowicz, Bartosz; Kotas, Rafa?

    2010-01-01

    The aim of the research presented in this paper was to test and evaluate the possibility of T-wave alternans (TWA) detection with the use of standard ambulatory ECG monitors. In development work there is proposal of author's advanced method allowing to remove from signal any distortion and disturbances making impossible further analysis.

  5. Extensive peritoneal calcifications associated with continuous ambulatory peritoneal dialysis

    International Nuclear Information System (INIS)

    Peritoneal calcification, which can lead to intestinal obstruction and potentially lethal hemoperitoneum, is a rare complication of continuous ambulatory peritoneal dialysis. We describe a case in which extensive peritoneal calcification had arisen for this reason. Although the patient was asymptomatic, extensive calcification was present on the parietal and visceral peritoneum, including the hepatic and splenic surface. (author)

  6. Computerized ambulatory monitoring in mood disorders: feasibility, compliance, and reactivity.

    Science.gov (United States)

    Husky, Mathilde M; Gindre, Claire; Mazure, Carolyn M; Brebant, Catherine; Nolen-Hoeksema, Susan; Sanacora, Gerard; Swendsen, Joel

    2010-07-30

    Patients with depression (n=20) or bipolar disorder (n=21) completed computerized ambulatory monitoring for three consecutive days. Results indicate satisfactory rates of acceptance and compliance, with no salient fatigue effects. However, some evidence for reactive effects was found. The findings provide support for this approach in the study of mood disorders. PMID:20488558

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

    Science.gov (United States)

    Viera, Anthony J.; Shimbo, Daichi

    2016-01-01

    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 can be segmented into time windows of particular interest, e.g., mean daytime and nighttime values. During sleep, blood pressure typically decreases, or dips, such that mean sleep blood pressure is lower than mean awake blood pressure. A non-dipping pattern and nocturnal hypertension are strongly associated with increased cardiovascular morbidity and mortality. Approximately 70% of individuals dip ≥10% at night, while 30% have non-dipping patterns, when blood pressure remains similar to daytime average, or occasionally rises above daytime average. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure since they increase accuracy for diagnosis and the prediction of cardiovascular risk. PMID:25107387

  8. 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...... mass at the end of the dialysis (54 +/- 19 mumol, P

  9. 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. PMID:21714372

  10. Calculation of anisotropy factors for 241Am-Be neutron sources

    International Nuclear Information System (INIS)

    The authors calculated anisotropy factors for 241Am-Be neutron sources used for calibration of neutron-measuring devices for radiation protection purpose. In this calculation, we created a calculation model composed of following three steps: (1) calculation of α-particle spectrum at the surface of spherical cluster of AmO2, (2) calculation of neutron yield in a thick beryllium target and of neutron spectrum produced by 8Be (α,n) reactions; and (3) calculation of angular fluence distribution of neutrons emerging from two different encapsulation types of 241Am-Be neutron sources. This computation was made by combining an in-house code using the 9Be(α,n) cross section data library (JENDL/AN-2005) and the Monte Carlo code MCNP-4C. As a result, anisotropy factors in the direction perpendicular to the source capsule axis were evaluated to be 1.030 and 1.039 for 241Am-Be in a standard Amersham X3 capsule and X4 capsule, respectively. These values are in reasonable close agreement with the published experimental data. If the support structures are included in the simulation, the anisotropy factors for these neutron sources increase by about 10%. (author)

  11. Functional assessment: bridge between family and rehabilitation medicine within an ambulatory practice.

    Science.gov (United States)

    Seltzer, G B; Granger, C V; Wineberg, D E

    1982-10-01

    This study describes development of a functional assessment instrument used to screen ambulatory care patients who have difficulty performing daily activities. Sample selection occurred in 2 stages. In the first stage, an interdisciplinary team used clinical selection criteria in order to screen patients into 2 groups: group 1, those likely to have functional limitations; and group 2, those not likely to have functional limitations. Using clinical selection criteria for a 3-week period in an ambulatory primary care setting, it was found that 20% of the outpatients seen fell into group 1. In the second stage, a randomly selected subsample of 194 persons was used, with 97 in group 1, and 97 in group 2. The Functional Assessment Screening Questionnaire (FASQ) was tested using this second sample. The FASQ was found to discriminate between the 2 groups, with those in group 1 having a significantly greater number of functional difficulties than those in group 2. An analysis was conducted to investigate which diagnostic problems were more likely to be associated with patients reporting functional limitations. Fourteen diagnostic patient problems found to be significantly more limiting than for the total sample were identified. The factor structure of the FASQ was examined and a format for clinically integrating the FASQ factors was offered. PMID:6215908

  12. An overview of anesthetic procedures, tools, and techniques in ambulatory care

    Directory of Open Access Journals (Sweden)

    Messieha Z

    2015-01-01

    Full Text Available Zakaria Messieha Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA Abstract: Ambulatory surgical and anesthesia care (ASAC, also known as Same Day Surgery or Day Care in some countries, is the fastest growing segment of ambulatory surgical and anesthesia care. Over 50 million ambulatory surgical procedures are conducted annually comprising over 60% of all anesthesia care with an impressive track record of safety and efficiency. Advances in ambulatory anesthesia care have been due to newer generation of inhalation and intravenous anesthetics as well as airway management technology and techniques. Successful ambulatory anesthesia care relies on patient selection, adequate facilities, highly trained personnel and quality improvement policies and procedures. Favoring one anesthetic technique over the other should be patient and procedure-specific. Effective management of post-operative pain as well as nausea and vomiting are the final pieces in assuring success in ambulatory anesthesia care. Keywords: ambulatory anesthesia, out-patient anesthesia, Day-Care anesthesia

  13. 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

  14. Ambulatory pressure monitoring in the assessment of antihypertensive therapy.

    Science.gov (United States)

    Coats, A J; Conway, J; Somers, V K; Isea, J E; Sleight, P

    1989-06-01

    A low-cost, ambulatory blood-pressure monitor has been calibrated and validated against a random zero sphygmomanometer. The repeatability of ambulatory pressure recordings after a placebo month in 44 mild to moderate untreated hypertensives was assessed. Systolic blood pressure showed a mean difference over 1 month of 2.0 mmHg, with a standard deviation of differences of 9.3 mmHg. The diastolic blood pressure mean difference was 0.1 mmHg (SD = 6.3 mmHg). This variability was much less than for clinic readings (SD = 17.3 mmHg) or for single home pressure readings (SD = 19.7 mmHg). Using ambulatory monitoring to detect a drop in pressure of 8/5 mmHg with a power of 0.9, the number of subjects needed in a parallel group trial is reduced from 360 to 68, and in a crossover study from 88 to 16 subjects. The usefulness of ambulatory pressure monitoring is demonstrated in a placebo-controlled comparison of atenolol, nifedipine retard, or their combination in random order. Eleven subjects, 21-60 years, with initial average blood pressures of 166.5/104.7 mmHg, showed a reduction in pressure with atenolol 50 mg a day of 15.1/10.0 mmHg, with nifedipine retard 20 mg b.i.d. of 21.0/11.6 mmHg, and with atenolol 50 mg and nifedipine retard 20 mg once a day of 26.2/16.8 mmHg. Ambulatory monitoring of pressure improved the accuracy of the trial and demonstrated a reduction in the alerting response with atenolol. PMID:2487802

  15. 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

  16. Constrained positive matrix factorization: Elemental ratios, spatial distinction, and chemical transport model source contributions

    Science.gov (United States)

    Sturtz, Timothy M.

    Source apportionment models attempt to untangle the relationship between pollution sources and the impacts at downwind receptors. Two frameworks of source apportionment models exist: source-oriented and receptor-oriented. Source based apportionment models use presumed emissions and atmospheric processes to estimate the downwind source contributions. Conversely, receptor based models leverage speciated concentration data from downwind receptors and apply statistical methods to predict source contributions. Integration of both source-oriented and receptor-oriented models could lead to a better understanding of the implications sources have on the environment and society. The research presented here investigated three different types of constraints applied to the Positive Matrix Factorization (PMF) receptor model within the framework of the Multilinear Engine (ME-2): element ratio constraints, spatial separation constraints, and chemical transport model (CTM) source attribution constraints. PM10-2.5 mass and trace element concentrations were measured in Winston-Salem, Chicago, and St. Paul at up to 60 sites per city during two different seasons in 2010. PMF was used to explore the underlying sources of variability. Information on previously reported PM10-2.5 tire and brake wear profiles were used to constrain these features in PMF by prior specification of selected species ratios. We also modified PMF to allow for combining the measurements from all three cities into a single model while preserving city-specific soil features. Relatively minor differences were observed between model predictions with and without the prior ratio constraints, increasing confidence in our ability to identify separate brake wear and tire wear features. Using separate data, source contributions to total fine particle carbon predicted by a CTM were incorporated into the PMF receptor model to form a receptor-oriented hybrid model. The level of influence of the CTM versus traditional PMF was

  17. 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.

  18. Thromboprophylaxis Guidelines in Cancer with a Primary Focus on Ambulatory Patients Receiving Chemotherapy: A Review from the Southern Network on Adverse Reactions (SONAR)

    Science.gov (United States)

    Maxwell, Whitney D.; Bennett, Charles L.

    2014-01-01

    Patients with cancer are at increased risk for venous thromboembolism (VTE). Factors related to cancer type, site, stage, duration, and extent of disease contribute to the oncology patient’s risk of VTE. Patient-specific factors such as history of prior VTE and comorbidity are also contributory. The role of treatment-related factors, including chemotherapy regimen, has been a focus of recent investigation because most cases of VTE in the oncology setting occur in ambulatory patients. Thus, an emerging area of clinical research is primary VTE prophylaxis in the ambulatory cancer setting. Clinical guidelines currently recommend primary thromboprophylaxis in cancer patients who are undergoing surgery, who are hospitalized, and who are in a specific subset of high-risk ambulatory cancer patients. Validated risk stratification tools are essential for identification of patients who are at high risk of thrombosis. Emerging data from recently published clinical trials, as well as ongoing studies, are likely to advance our understanding of the potential utility of antithrombotic agents for primary prophylaxis in ambulatory patients with cancer and may influence future clinical guideline recommendations. PMID:23111863

  19. Continuous 24 hour ambulatory monitoring of intragastric pH in man.

    Science.gov (United States)

    Kapur, B K; Howlett, P J; Kenyon, N G; Lunt, M J; Mills, J G; Smallwood, R H; Wilson, A J; Bardhan, K D

    1987-05-01

    A system has been developed which permits continuous 24 hour ambulatory recording of intragastric pH under near-physiological conditions. The system utilises a Cecar combination pH electrode connected through a pre-amplifier to an Oxford Medical Systems Medilog 4-24 cassette recorder, and the pH recorded continuously on to tape. The data is replayed at high speed, digitised and then analysed. Sources of error included system drift, system noise and the effect of changes in electrode environment due to saliva, food, loss of fluid contact, temperature variations and electrode time constant. These were found to be small. In contrast, the major changes in pH detected reflect real changes at the electrode tip. These changes can be recorded by the system. Developments in electronics and improvements in both the size and quality of pH electrodes, over the past few decades, has enabled intragastric pH recordings to be made with greater ease. However, a large number of investigators still assess gastric acidity by infrequent, intermittent sampling of gastric secretion through a naso-gastric tube. This new ambulatory system is a significant improvement and its versatility allows studies in acid secretion physiology, pharmacology and pathophysiology. PMID:3595080

  20. Source apportionment of PM10 at a small industrial area using Positive Matrix Factorization

    Science.gov (United States)

    Lim, Jong-Myoung; Lee, Jin-Hong; Moon, Jong-Hwa; Chung, Yong-Sam; Kim, Ki-Hyun

    2010-01-01

    In this study, PM10-bound concentrations of 28 trace metals and 3 ionic components were measured from samples collected at Daejeon Industrial Complexes I and II, Korea from April 2000 to December 2002. Positive matrix factorization (PMF) and conditional probability function (CPF) were applied to these PM data sets to identify the diverse sources in the industrial area. A total of nine source types were identified to be important which include: secondary aerosol, cement/construction, soil dust, road dust, vehicle exhaust, incineration/Pb-related industry, metal smelting, fossil fuel combustion, and field burning. Results of our study suggest that there are competing relationships between anthropogenic and natural source processes in this industrial area.

  1. Size-resolved source apportionment of ambient particles by positive matrix factorization

    Science.gov (United States)

    Han, J. S.; Moon, K. J.; Lee, S. J.; Kim, Y. J.; Ryu, S. Y.; Cliff, S. S.; Yi, S. M.

    2005-07-01

    Size- and time-resolved aerosol samples were collected using an eight-stage DRUM sampler from 29 March to 29 May in 2002 at Gosan, Jeju Island, Korea, which is one of the representative background sites in East Asia. These samples were analyzed using synchrotron X-ray fluorescence for 3-h average concentrations of 19 elements consisting of S, Si, Al, Fe, Ca, Cl, Cu, Zn, Ti, K, Mn, Pb, Ni, V, Se, As, Rb, Cr, Br. The size-resolved data sets were then analyzed using the positive matrix factorization (PMF) technique in order to identify possible sources and estimate their contribution to particulate matter mass. PMF analysis uses the uncertainty of the measured data to provide an optimal weighting. Fifteen sources were resolved in eight size ranges (0.07-12 µm) and included Chinese aerosol, soil dust, sea salt, biomass burning, coal combustion, oil heating furnace, residual oil-fired boiler, municipal incineration, nonferrous metal source, ferrous metal source, gasoline vehicle, diesel vehicle, copper smelter, and volcano emission. PMF analysis of size-resolved source contributions showed that natural sources represented by soil dust, sea salt and Chinese aerosol contributed about 79% to the predicted primary PM mass in the coarse size range (1.15-12 µm). On the other hand, anthropogenic sources such as coal combustion and biomass burning contributed about 60% in the fine size range (0.56-2.5 µm). The diesel vehicle source contributed the most in the ultra-fine size range (0.07-0.56 µm) and was responsible for about 52% of the primary PM mass.

  2. Sources, factors, mechanisms and possible solutions to pollutants in marine ecosystems

    International Nuclear Information System (INIS)

    Algal toxins or red-tide toxins produced during algal blooms are naturally-derived toxic emerging contaminants (ECs) that may kill organisms, including humans, through contaminated fish or seafood. Other ECs produced either naturally or anthropogenically ultimately flow into marine waters. Pharmaceuticals are also an important pollution source, mostly due to overproduction and incorrect disposal. Ship breaking and recycle industries (SBRIs) can also release various pollutants and substantially deteriorate habitats and marine biodiversity. Overfishing is significantly increasing due to the global food crisis, caused by an increasing world population. Organic matter (OM) pollution and global warming (GW) are key factors that exacerbate these challenges (e.g. algal blooms), to which acidification in marine waters should be added as well. Sources, factors, mechanisms and possible remedial measures of these challenges to marine ecosystems are discussed, including their eventual impact on all forms of life including humans. -- Review of sources, factors, mechanisms and possible remedial measures of key pollutants (contaminants, toxins, ship breaking, overfishing) in marine ecosystems

  3. Thromboprophylaxis Guidelines in Cancer with a Primary Focus on Ambulatory Patients Receiving Chemotherapy: A Review from the Southern Network on Adverse Reactions (SONAR)

    OpenAIRE

    Maxwell, Whitney D.; Bennett, Charles L.

    2012-01-01

    Patients with cancer are at increased risk for venous thromboembolism (VTE). Factors related to cancer type, site, stage, duration, and extent of disease contribute to the oncology patient’s risk of VTE. Patient-specific factors such as history of prior VTE and comorbidity are also contributory. The role of treatment-related factors, including chemotherapy regimen, has been a focus of recent investigation because most cases of VTE in the oncology setting occur in ambulatory patients. Thus, an...

  4. 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

  5. Predictors of health-related quality of life in adult ambulatory independence neuromuscular disease patients

    International Nuclear Information System (INIS)

    To evaluate the health related quality of life (HRQoL) of totally independent ambulatory neuromuscular disease (NMD) patients in comparison with age matched healthy control subjects, and to assess associations between socio demographic variables and HRQoL in totally independent NMD patients. Ninety-nine adult patients with a diagnosis of NMD referred to the Physical Therapy Department of the Health Sciences Faculty of Hacettepe University, Ankara, Turkey between 2007 and 2009 were included in the study. The Functional Independence Measurement and the Nottingham Health Profile (NHP) were the main outcomes to assess independence level in activities of daily living and quality of life. The HRQoL score as measured by NHP was high (worse) in patients than healthy controls, and the difference between the 2 groups was significant for energy, physical mobility, and total score. Employed NMD patients scored significantly lower (better) than those unemployed in the majority of NHP domains. The genders and duration of illness displayed no significant difference in all dimension scores. All NMD patients had a poorer HRQoL than with healthy subjects with respect to energy, physical mobility dimensions, and total score. Furthermore, occupation was found to be a main factor that affects HRQoL in adult ambulatory NMD patients. (author)

  6. 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.

  7. The Ambulatory Diagnostic and Treatment Center: A Unique Model for Educating Medical Trainees and Providing Expedited Care.

    Science.gov (United States)

    Serrao, Richard A; Orlander, Jay D

    2016-05-01

    In this article, the authors reexamine the Ambulatory Diagnostic and Treatment Center (ADTC) model, which uniquely combines the education of trainees with the care of referred patients at one Veterans Affairs medical center. As an ambulatory clinic with an inpatient mind-set, the ADTC uses a series of closely spaced outpatient appointments that are longer than typical ambulatory visits, offering a VIP-level of evaluation with the patient-centered goal of expedited diagnosis and treatment. Faculty triage patients by weighing factors such as urgency, educational value, complexity, and instability of diseases in conjunction with the resources, availability, and appropriateness of other services within the medical center.The ADTC's unique focus on the education of trainees in comparison with other clinical rotations is evident in the ratio of learning to patient care. This intensive training environment expects postgraduate year 2 and 3 internal medicine residents and fourth-year medical students to read, reflect, and review literature daily. This mix of education and care delivery is ripe for reexploration in light of recent calls for curriculum reform amidst headlines exposing delays in veterans' access to care.A low-volume, high-intensity clinic like the ADTC can augment the clinical services provided by a busy primary care and subspecialty workforce without losing its emphasis on education. Other academic health centers can learn from this model and adapt its structure in settings where accountable care organizations and education meet. PMID:26839944

  8. Effects of demographic factors and information sources on United States consumer perceptions of animal welfare.

    Science.gov (United States)

    McKendree, M G S; Croney, C C; Widmar, N J O

    2014-07-01

    As consumers have become more interested in understanding how their food is produced, scrutiny and criticism have increased regarding intensified food animal production methods. Resolution of public concerns about animal agricultural practices depends on understanding the myriad factors that provide the basis for concerns. An online survey of 798 U.S. households was conducted to investigate relationships between household characteristics (demographics, geographic location, and experiences) and level of concern for animal welfare as well as sources used to obtain information on the subject. Because recent media attention has focused on animal care practices used in the U.S. swine industry, respondents were also asked specific questions pertaining to their perceptions of pig management practices and welfare issues and their corresponding pork purchasing behavior. Respondents reporting higher levels of concern about animal welfare were more frequently female, younger, and self-reported members of the Democratic Party. Fourteen percent of respondents reported reduction in pork consumption because of animal welfare concerns with an average reduction of 56%. Over half of the respondents (56%) did not have a primary source for animal welfare information; those who identified a primary information source most commonly used information provided by animal protection organizations, the Humane Society of the United States (HSUS), and People for the Ethical Treatment of Animals (PETA). Midwest participants were significantly, at the 5% significance level, less concerned about domestic livestock animal welfare and more frequently reported not having a source for animal welfare information than those from other regions of the United States. Overall, the U.S. livestock and poultry industries and other organizations affiliated with animal agriculture appear to be less used public sources of information on animal welfare than popular animal protection organizations. Improved

  9. Benefiting from ambulatory EHR implementation: solidarity, six sigma, and willingness to strive.

    Science.gov (United States)

    Zaroukian, Michael H; Sierra, Arlene

    2006-01-01

    Ambulatory electronic health record systems have the potential to improve healthcare quality. Optimizing the value of EHR implementation requires that providers and staff become effective and efficient EHR users so paper charts are no longer required or desired. Transitioning from paper charts to EHR systems requires new learning, significant effort, and workflow changes associated with an initial adverse effect on provider efficiency. This case study describes how timely EHR implementation and regular use in a large academic internal medicine clinic was encouraged, achieved, and demonstrated. Critical success factors included readiness to change, solidarity in EHR use, a commitment to striving, and process improvement strategies that used the EHR system to repair suboptimal clinic workflows. Observed benefits include improvements in patient access, workflow efficiency, communication, decision support use, and financial performance. These success factors and implementation strategies may help others seeking to encourage greater adoption and use of EHRs. PMID:16429959

  10. Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

    Science.gov (United States)

    Powers, Sharon; Bacon, Cynthia Thornton

    2016-01-01

    The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges. PMID:27259130

  11. Blood Pressure Measurement: Clinic, Home, Ambulatory, and Beyond

    OpenAIRE

    Drawz, Paul E; ABDALLA, MOHAMED; Rahman, Mahboob

    2012-01-01

    Blood pressure has traditionally been measured in the clinic setting using the auscultory method and a mercury sphygmomanometer. Technological advances have led to improvements in measuring clinic blood pressure and allowed for measuring blood pressures outside the clinic. This review outlines various methods for evaluating blood pressure and the clinical utility of each type of measurement. Home blood pressures and 24 hour ambulatory blood pressures have improved our ability to evaluate risk...

  12. Ambulatory anesthesia in plastic surgery: opportunities and challenges

    OpenAIRE

    Facque AR; Taub PJ

    2015-01-01

    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 ...

  13. Ambulatory anesthesia in plastic surgery: opportunities and challenges

    OpenAIRE

    Facque, Alexander

    2015-01-01

    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 procedure...

  14. Analysis of Patient Service Time in Ambulatory Clinics: Patient Tracking

    OpenAIRE

    Zerbe, Tony R.; Zerbe, Shirleen D.

    1990-01-01

    Historically, analysis of patient service time (patient tracking) in ambulatory clinics has been performed manually. A case study of Eye and Ear Clinic in Pittsburgh, PA, revealed that this approach to patient data collection was prone to clerical error and did not satisfy the clinic's information-processing needs. Initial attempts at automation identified the features required of a successful computerized scheduling and patient tracking system.

  15. Ambulatory surgery for the patient with breast cancer: current perspectives

    OpenAIRE

    Tan, Ern Yu; Pek, Chong Han; Tey,Boon Lim, John

    2016-01-01

    Chong Han Pek,1 John Tey,2 Ern Yu Tan1 1Department of General Surgery, 2Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore Abstract: Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefit...

  16. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    OpenAIRE

    Wong, Jean; Shah, Ushma; Wong, David

    2015-01-01

    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 concep...

  17. Use of extramural ambulatory care curricula in postgraduate medical training

    OpenAIRE

    Talwalkar, Jaideep S.; Satcher, D’Juanna; Turner, Teri L.; Sisson, Stephen D.; Fenick, Ada M.

    2015-01-01

    Introduction Extramural curricula developed for the purpose of sharing with other institutions have been designed to improve education on important topics in ambulatory care. We sought to assess the usage rates of these curricula among paediatric, internal medicine, and combined medicine-paediatrics residency programmes in the United States. Methods Surveys on aspects of trainee continuity clinic were sent to paediatric and medicine-paediatrics programme directors in 2012. Surveys contained a...

  18. Ambulatory assessed implicit affect is associated with salivary cortisol

    OpenAIRE

    Joram eMossink; Bart eVerkuil; Andreas Michael Burger; Tollenaar, Marieke S.; Brosschot, Jos F.

    2015-01-01

    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 assoc...

  19. Ambulatory assessed implicit affect is associated with salivary cortisol

    OpenAIRE

    Mossink, Joram C. L.; Verkuil, Bart; Burger, Andreas M.; Tollenaar, Marieke S.; Brosschot, Jos F.

    2015-01-01

    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-h ambulatory study we examined whether cortisol levels were associat...

  20. Influenza A Outbreak in an Ambulatory Stem Cell Transplant Center

    OpenAIRE

    Apewokin, Senu; Vyas, Keyur; Lester, Laura K.; Grazzuitti, Monica; Haselow, Dirk T.; Wolfe, Frankie; Roberts, Michelle; Bellamy, William; Kumar, Naveen Sanath; Hunter, Dolris; Lee, Jeannette; Laudadio, Jennifer; Wheeler, J. Gary; Bradsher, Robert

    2014-01-01

    Background  In the era of cost-consciousness regarding healthcare , provision of medical services in an outpatient setting has become increasingly attractive. We report an influenza outbreak in an ambulatory stem cell transplant center in 2013 that highlights unique identification and infection control challenges in this setting. Methods  Nasopharyngeal swabs were performed on patients with suspected influenza-like illnesses (ILI), defined by subjective fever or measured temperature of ≥37.7°...

  1. Development of Ambulatory Quality Assurance Program Using Computerized Medical Records

    OpenAIRE

    Shrader, J.; Wright, C; Mieczkowski, L.; McDonald, S.

    1993-01-01

    As part of the computerization of the ambulatory teaching facility for our residency program, we have successfully utilized a comprehensive computerized medical records system to develop a specific quality assurance program. Our QA program includes allergy audits, health screening audits, drug utilization and recall audits, and nursing care plan audits. With a computerized QA program, specific question about individual patients as well as questions regarding our patient population are quickly...

  2. Reproducibility of ambulatory oesophageal pH monitoring.

    OpenAIRE

    Johnsson, F; Joelsson, B

    1988-01-01

    To evaluate the reproducibility of ambulatory 24 hour intraoesophageal pH monitoring, 20 patients were randomly selected to undergo two consecutive investigations. Fifteen patients were classified as either abnormal, or normal on both test days. The amount of acid reflux, expressed as percentage of time with oesophageal pH below 4.0 during the two 24 hour periods, showed 77% concordance. The upright and recumbent periods of measurement showed different degrees of concordance: 83% and 62%, res...

  3. Gait improvement surgery in ambulatory children with diplegic cerebral palsy

    OpenAIRE

    Terjesen, Terje; Lofterød, Bjørn; Skaaret, Ingrid

    2015-01-01

    Background and purpose Instrumented 3-D gait analyses (GA) in children with cerebral palsy (CP) have shown improved gait function 1 year postoperatively. Using GA, we assessed the outcome after 5 years and evaluated parental satisfaction with the surgery and the need for additional surgery. Patients and methods 34 ambulatory children with spastic diplegia had preoperative GA. Based on this GA, the children underwent 195 orthopedic procedures on their lower limbs at a mean age of 11.6 (6–19) y...

  4. Feasibility study of renewable energy source, explosion in India with regard to regional environmental factors

    International Nuclear Information System (INIS)

    In the context of global warming and growing energy needs, there is a need for exploration of alternative source of energy. The main renewable energy sources are: (1) solar (2) wind (3) biomass (4) geothermal. By far the largest energy resource is the sun. Using one ten-thousandth part of the incoming sunlight would cover the whole energy demand of mankind. Based on the raw energy source, power plants convert any source of energy (thermal, solar, wind, nuclear etc.) into electrical energy. Kinetic energy of wind can be used to run turbines. Wind can reach much higher densities than solar irradiance. Forms of energy such as wind are considered short term energy storage, whereas energy in biomass is accumulated over a period of months or years. Solid biomass such as combustible field crops or firewood is burnt to heat water or turbines. A literature survey is carried out to estimate the potential of each renewable energy resource in various parts of country. The economic factors involved and the policies and regulations in place are also considered in the present study. Parameters like exploration costs, capital expenditure, legal procedures involved, licences needed are considered in order to judge the viability of an investment. The objective of the study is to come up with a possible plan of region-wise exploitation of these alternative renewable resources in India

  5. 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.

  6. 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%).

  7. Ambulatory Versus Inpatient Rotations in Teaching Third-Year Students Internal Medicine

    OpenAIRE

    Kalet, Adina; Schwartz, Mark D.; Capponi, Louis J; Mahon-Salazar, Carol; Bateman, W Barry

    1998-01-01

    We studied 63 randomly selected third-year students who split their 10-week medicine clerkship between ambulatory and inpatient components. Compared with their inpatient experience, during the ambulatory rotation, the 63 students felt more like doctors, more responsible for patients, and more able to know and help their patients. Students reported that ambulatory attending staff appeared happier and less stressed, and did not embarrass them as frequently. Compared with their 619 “inpatient” c...

  8. An assessment of 24-hour ambulatory EEG/ECG monitoring in a neurology clinic.

    OpenAIRE

    Cull, R. E.

    1985-01-01

    The relative merits of 24-hour ambulatory EEG/ECG monitoring and routine EEG recording have been compared in a group of 62 patients attending a neurological clinic because of episodes of loss of consciousness. Overall, ambulatory EEG abnormalities were detected in 21 cases (34%) compared with 16 cases (26%) for routine EEG. Ambulatory EEG mainly improved the detection of generalised paroxysmal activity, but in some cases lateralised abnormalities were detected which were not present on the ro...

  9. Ambulatory arterial stiffness index and 24-hour ambulatory pulse pressure as predictors of mortality in Ohasama, Japan

    OpenAIRE

    Asayama, Kei; Metoki, Hirohito; Imai, Yutaka; Satoh, Hiroshi; Ohkubo, Takayoshi; Li, Yan; Kikuya, Masahiro; Thijs, Lutgarde; Staessen, Jan A.; Hoshi, Haruhisa; Wang, Ji-Guang; Dolan, Eamon; Hashimoto, Junichiro; O'Brien, Eoin; Obara, Taku

    2007-01-01

    BACKGROUND AND PURPOSE: Ambulatory arterial stiffness index (AASI) and pulse pressure (PP) are indexes of arterial stiffness and can be computed from 24-hour blood pressure recordings. We investigated the prognostic value of AASI and PP in relation to fatal outcomes. METHODS: In 1542 Ohasama residents (baseline age, 40 to 93 years; 63.4% women), we applied Cox regression to relate mortality to AASI and PP while adjusting for sex, age, BMI, 24-hour MAP, smoking and drinking habits, diabetes me...

  10. 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

    2016-01-01

    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. PMID:27118739

  11. Sources

    International Nuclear Information System (INIS)

    This paper discusses the sources of radiation in the narrow perspective of radioactivity and the even narrow perspective of those sources that concern environmental management and restoration activities at DOE facilities, as well as a few related sources. Sources of irritation, Sources of inflammatory jingoism, and Sources of information. First, the sources of irritation fall into three categories: No reliable scientific ombudsman to speak without bias and prejudice for the public good, Technical jargon with unclear definitions exists within the radioactive nomenclature, and Scientific community keeps a low-profile with regard to public information. The next area of personal concern are the sources of inflammation. This include such things as: Plutonium being described as the most dangerous substance known to man, The amount of plutonium required to make a bomb, Talk of transuranic waste containing plutonium and its health affects, TMI-2 and Chernobyl being described as Siamese twins, Inadequate information on low-level disposal sites and current regulatory requirements under 10 CFR 61, Enhanced engineered waste disposal not being presented to the public accurately. Numerous sources of disinformation regarding low level radiation high-level radiation, Elusive nature of the scientific community, The Federal and State Health Agencies resources to address comparative risk, and Regulatory agencies speaking out without the support of the scientific community

  12. Spatiotemporal variations of ambient PM10 source contributions in Beijing in 2004 using positive matrix factorization

    Science.gov (United States)

    Xie, S. D.; Liu, Z.; Chen, T.; Hua, L.

    2008-05-01

    Source contributions to ambient PM10 (particles with an aerodynamic diameter of 10 μm or less) in Beijing, China were determined with positive matrix factorization (PMF) based on ambient PM10 composition data including concentrations of organic carbon (OC), elemental carbon (EC), ions and metal elements, which were simultaneously obtained at six sites through January, April, July and October in 2004. Results from PMF indicated that seven major sources of ambient PM10 were urban fugitive dust, crustal soil, coal combustion, secondary sulfate, secondary nitrate, biomass burning with municipal incineration, and vehicle emission, respectively. In paticular, urban fugitive dust and crustal soil as two types of dust sources with similar chemical characteristics were differentiated by PMF. Urban fugitive dust contributed the most, accounting for 34.4% of total PM10 mass on an annual basis, with relatively high contributions in all four months, and even covered 50% in April. It also showed higher contributions in southwestern and southeastern areas than in central urban areas. Coal combustion was found to be the primary contributor in January, showing higher contributions in urban areas than in suburban areas with seasonal variation peaking in winter, which accounted for 15.5% of the annual average PM10 concentration. Secondary sulfate and secondary nitrate combined as the largest contributor to PM10 in July and October, with strong seasonal variation peaking in summer, accounting for 38.8% and 31.5% of the total PM10 mass in July and October, respectively. Biomass burning with municipal incineration contributions were found in all four months and accounted for 9.8% of the annual average PM10 mass concentration, with obviously higher contribution in October than in other months. Incineration sources were probably located in southwestern Beijing. Contribution from vehicle emission accounted for 5.0% and exhibited no significant seasonal variation. In sum, PM10 source

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

    International Nuclear Information System (INIS)

    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

  14. 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 gases (carbon monoxide [CO], ozone [O₃], nitrogen oxide [NO], oxides of nitrogen [NO(x)], nitrogen dioxide [NO₂], sulfur dioxide [SO₂], methane [CH₄], nonmethane hydrocarbon [NMHC]) have been conducted to study the effect of physicochemical factors on the PM10 concentration. In addition, this study includes source apportionment of PM10 in 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. PMID:26030827

  15. Prognostic significance of hyponatremia among ambulatory patients with heart failure and preserved and reduced ejection fractions.

    Science.gov (United States)

    Bavishi, Chirag; Ather, Sameer; Bambhroliya, Arvind; Jneid, Hani; Virani, Salim S; Bozkurt, Biykem; Deswal, Anita

    2014-06-01

    Hyponatremia in heart failure (HF) is an established predictor of adverse outcomes in hospitalized patients with reduced ejection fraction (EF). However, there is a paucity of data in ambulatory patients with HF with preserved ejection fraction (HFpEF). We examined the prevalence, risk factors, and long-term outcomes of hyponatremia (serum sodium ≤135 mEq/L) in ambulatory HFpEF and HF with reduced EF (HFrEF) in a national cohort of 8,862 veterans treated in Veterans Affairs clinics. Multivariable logistic regression models were used to identify factors associated with hyponatremia, and multivariable Cox proportional hazard models were used for analysis of outcomes. The cohort consisted of 6,185 patients with HFrEF and 2,704 patients with HFpEF with a 2-year follow-up. Hyponatremia was present in 13.8% and 12.9% patients in HFrEF and HFpEF, respectively. Hyponatremia was independently associated with younger age, diabetes, lower systolic blood pressure, anemia, body mass index <30 kg/m(2), and spironolactone use, whereas African-American race and statins were inversely associated. In multivariate analysis, hyponatremia remained a significant predictor of all-cause mortality in both HFrEF (hazards ratio [HR] 1.26, 95% confidence interval [CI] 1.11 to 1.44, p <0.001) and HFpEF (HR 1.40, 95% CI 1.12 to 1.75, p = 0.004) and a significant predictor of all-cause hospitalization in patients with HFrEF (HR 1.18, 95% CI 1.07 to 1.31, p = 0.001) but not in HFpEF (HR 1.08, 95% CI 0.92 to 1.27, p = 0.33). In conclusion, hyponatremia is prevalent at a similar frequency of over 10% in ambulatory patients with HFpEF and HFrEF. Hyponatremia is an independent prognostic marker of mortality across the spectrum of patients with HFpEF and HFrEF. In contrast, it is an independent predictor for hospitalization in patients with HFrEF but not in patients with HFpEF. PMID:24837261

  16. 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.

  17. 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.

  18. Evaluation of bone metabolism in patients with chronic renal failure treated by continuous ambulatory peritoneal dialysis

    International Nuclear Information System (INIS)

    Bone metabolism inpatients with chronic renal failure treated by continuous ambulatory peritoneal dialysis (CAPD) was evaluated. IRMA, RRA and RIA were used to detect PTH, 25 (OH)D3, 1,25(OH)2D3, BGP, Ca and P levels in the blood of 24 CAPD patients. PTH and BGP were increased in uremic patients ad decreased after CAPD. 25(OH)D3 and 1,25 (OH)2D3 were decreased in the patients, but their levels were not changed further after CAPD. PTH had negative correlation with 25 (OH)D3 (r = -0.379, P 2D3 (r = -0.451, P < 0.01). PTH had positive correlation with BGP (r 0.501, P < 0.01) in CAPD patients, and the correlativity was decreased by CAPD. The results showed: PTH hypersecretion is a main factor inducing bone metabolism disturbance, and bone turnover rate is decreased in these patients by CAPD

  19. Polychlorinated biphenyl congeners in river sediments: distribution and source identification using multivariate factor analysis.

    Science.gov (United States)

    Jin, Ronghu; Park, Seok-Un; Park, Jong-Eun; Kim, Jong-Guk

    2012-04-01

    To assess the level of polychlorinated biphenyl (PCB) contamination and identify their sources, surface sediments were collected from selected locations along Nakdong River, Korea, and analyzed for 209 PCB congeners using high-resolution gas chromatography/high-resolution mass spectroscopy. PCB levels ranged from 0.124 to 79.2 ng/g dry weight (coplanar PCBs 0.295 to 5720 pg/g dry), which were similar to those of three other major rivers (Han, Geum, and Youngsan rivers) in Korea but slightly lower than those in neighboring countries. Regarding homologue composition, tetra-CBs were most abundant in most samples, but some samples with much higher PCBs concentrations had relatively lower proportions of tetra-CBs and higher proportions of penta- to hepta-CBs. To identify the sources of PCBs in sediment samples, principal component analysis/absolute principal component scores (PCA/APCS), positive matrix factorization (PMF), and multiple linear regression (MLR) were used with the congener composition of aroclors (1242, 1248, 1254, and 1260) and the flue gas of waste incinerators (data obtained from a previous article) as source profiles. Results showed that the three models showed similar source apportionments. Most sediment samples with lower PCB concentrations had higher proportions of incineration-derived materials, and some sediment samples with much higher PCB concentrations had higher proportions of aroclor 1260. This occurred because many industrial facilities, such as landfill leachate-treatment facilities, were gathered around sampling points with high PCB concentrations, and high-chlorinated PCBs are more stable in the elution process of landfill leachate than the incineration process. PCB concentrations estimated by APCS, PMF, and MLR were similar to the measured values with coefficients of determination ranging from 0.77 to 0.99. PMID:22052328

  20. Identification of potential sources and source regions of fine ambient particles measured at Gosan background site in Korea using advanced hybrid receptor model combined with positive matrix factorization

    Science.gov (United States)

    Han, J. S.; Moon, K. J.; Kim, Y. J.

    2006-11-01

    The size- and time-resolved measurement of particulate trace elements was made using an eight-stage Davis Rotating Unit for Monitoring sampler and synchrotron X-ray fluorescence system from 29 March to 29 May in 2002 at Gosan, Korea, which is one of the representative background sites in east Asia. As a result, continuous 3-hour average concentrations were obtained for 19 elements including S, Si, Al, Fe, Ca, Cl, Cu, Zn, Ti, K, Mn, Pb, Ni, V, Se, As, Rb, Cr, and Br. Positive matrix factorization (PMF) method was applied to the size-resolved aerosol data sets in order to identify the possible sources and to estimate their contribution to particulate matter mass in each size range. Twelve sources were then resolved in the fine size range (0.07 ˜ 1.15 μm), including continental aerosol, biomass burning, coal combustion, oil heating furnace, residual oil fired boiler, municipal incineration, nonferrous metal source, ferrous metal source, gasoline vehicle, diesel vehicle, copper smelter, and volcanic emission. A newly developed hybrid receptor model, concentration, retention time, and source emission weighted trajectory (CRSWT), was then applied to the source intensities derived from the PMF analysis by incorporating meteorological and source inventory information of the study region in order to suggest the regional information of long-range transported fine aerosol sources. The CRSWT model was able to resolve highly potential source areas and pathways for the fine ambient aerosol at the Gosan background site.

  1. Factors influencing perceptions of domestic energy information: Content, source and process

    International Nuclear Information System (INIS)

    Reducing household energy consumption is an essential element of the UK Government's carbon reduction strategy. Whilst increased knowledge alone will not necessarily lead to tangible actions on the part of consumers, knowledge of various kinds is, we argue, still important if domestic energy usage is to be reduced. In an attempt to ‘educate’ the public, governments have typically resorted to ‘mass information’ campaigns that have been considered largely unsuccessful. Yet understanding what alternative forms of learning could be cultivated has been limited by the dearth of research that explores whether and why people consider information about energy and energy saving to be useful. By exploring this, we can move towards an understanding of how knowledge about energy saving can be better shared and communicated, enabling more meaningful learning to take place. Drawing on in-depth qualitative data with fifty-five participants, this paper highlights a range of factors that affect perceptions of energy information. It argues that these factors are not discrete, but are interlinked. A fundamentally different model of knowledge exchange is needed for more effective learning about energy saving to occur. A number of implications for policy are proposed in our conclusions. - Highlights: • A range of factors influence perceptions of energy information. These factors are interlinked. • Energy information perceived as more relevant when it could be ‘anchored’ to everyday frames of understanding. • Both qualified ‘experts’ and peers with personal experience valued as potential information sources. • ‘One-way’ information communication perceived negatively. Two-way information exchange built trust and a sense of control. • Participants’ active information assessment very different to the passive consumer assumed by knowledge-deficit model

  2. 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…

  3. 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

  4. Improving outpatient access and patient experiences in academic ambulatory care.

    Science.gov (United States)

    O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

    2012-02-01

    Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume. PMID:22193182

  5. 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.

  6. Spallation Neutron Source Availability Top-Down Apportionment Using Characteristic Factors and Expert Opinion

    International Nuclear Information System (INIS)

    Apportionment is the assignment of top-level requirements to lower tier elements of the overall facility. A method for apportioning overall facility availability requirements among systems and subsystems is presented. Characteristics that influence equipment reliability and maintainability are discussed. Experts, using engineering judgment, scored each characteristic for each system whose availability design goal is to be established. The Analytic Hierarchy Process (AHP) method is used to produce a set of weighted rankings for each characteristic for each alternative system. A mathematical model is derived which incorporates these weighting factors. The method imposes higher availability requirements on those systems in which an incremental increase in availability is easier to achieve, and lower availability requirements where greater availability is more difficult and costly. An example is given of applying this top-down apportionment methodology to the Spallation Neutron Source (SNS) facility

  7. 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.

  8. 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...

  9. 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. PMID:24882135

  10. 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.

  11. The long-term effect of ambulatory oxygen in normoxaemic COPD patients

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Martinez, Gerd; Lange, Peter

    2013-01-01

    To study the long-term benefits of ambulatory oxygen (AO) in combination with pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients experiencing exertional desaturation.......To study the long-term benefits of ambulatory oxygen (AO) in combination with pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients experiencing exertional desaturation....

  12. 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... OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM FOR...

  13. Sources

    OpenAIRE

    2015-01-01

    Sources Fondation Pablo Iglesias. Alcala de Henares. Sections : Archives privées de Manuel ArijaArchives extérieuresArchives FNJS de EspañaPrensa Archives Générales de l’Administration. Alcala de Henares. Sections : Opposition au franquismeSig. 653 Sig TOP 82/68.103-68.602.Índice de las cartas colectivas, Relaciones, Cartas al Ministro de Información de Marzo de 1965. c.662. Sources cinématographiques Filmothèque Nationale d’Espagne.NO.DO. N° 1157C. 08/03/1965.aguirre Javier, Blanco vertical....

  14. Genospecies and virulence factors of Aeromonas species in different sources in a North African country

    Science.gov (United States)

    Ghenghesh, Khalifa Sifaw; Ahmed, Salwa F.; Cappuccinelli, Piero; Klena, John D.

    2014-01-01

    Introduction Aeromonads of medical importance have been reported from numerous clinical, food, and water sources, but identification of genospecies and virulence factors of Aeromonas species from countries in North Africa and the Middle East are few. Methods In total 99 Aeromonas species isolates from different sources (diarrheal children [n=23], non-diarrheal children [n=16], untreated drinking water from wells [n=32], and chicken carcasses [n=28]) in Tripoli, Libya, were included in the present investigation. Genus identification was confirmed by biochemical analysis, and genospecies were determined using a combination of 16S rDNA variable region and gyrB sequence analysis. Polymerase chain reaction (PCR) was used to detect genes encoding toxins from 52 of the isolates. Results We identified 44 isolates (44%) as A. hydrophila (3 [3.0%] subspecies anaerogenes, 23 [23%] subspecies dhakensis, and 18 [18%] subspecies ranae); 27 isolates (27%) as A. veronii; 23 isolates (23%) as A. caviae; and 5 isolates (5.0%) as other genospecies. The genes encoding aerolysin (aer), cytolytic enterotoxin (act), and A. hydrophila isolate SSU enterotoxin (ast) were detected in 45 (87%), 4 (7.7%), and 9 (17%) of the 52 isolates tested, respectively. The gene encoding an extracellular lipase (alt) was not detected. Conclusion The majority of aeromonads from Libya fall within three genospecies (i.e. A. hydrophila, A. veronii, and A. caviae), and genes coding for toxin production are common among them. PMID:25216211

  15. Genospecies and virulence factors of Aeromonas species in different sources in a North African country

    Directory of Open Access Journals (Sweden)

    Khalifa Sifaw Ghenghesh

    2014-09-01

    Full Text Available Introduction: Aeromonads of medical importance have been reported from numerous clinical, food, and water sources, but identification of genospecies and virulence factors of Aeromonas species from countries in North Africa and the Middle East are few. Methods: In total 99 Aeromonas species isolates from different sources (diarrheal children [n=23], non-diarrheal children [n=16], untreated drinking water from wells [n=32], and chicken carcasses [n=28] in Tripoli, Libya, were included in the present investigation. Genus identification was confirmed by biochemical analysis, and genospecies were determined using a combination of 16S rDNA variable region and gyrB sequence analysis. Polymerase chain reaction (PCR was used to detect genes encoding toxins from 52 of the isolates. Results: We identified 44 isolates (44% as A. hydrophila (3 [3.0%] subspecies anaerogenes, 23 [23%] subspecies dhakensis, and 18 [18%] subspecies ranae; 27 isolates (27% as A. veronii; 23 isolates (23% as A. caviae; and 5 isolates (5.0% as other genospecies. The genes encoding aerolysin (aer, cytolytic enterotoxin (act, and A. hydrophila isolate SSU enterotoxin (ast were detected in 45 (87%, 4 (7.7%, and 9 (17% of the 52 isolates tested, respectively. The gene encoding an extracellular lipase (alt was not detected. Conclusion: The majority of aeromonads from Libya fall within three genospecies (i.e. A. hydrophila, A. veronii, and A. caviae, and genes coding for toxin production are common among them.

  16. 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...

  17. 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.

  18. The application of factor analysis to identify sources in Klang valley aerosol

    International Nuclear Information System (INIS)

    Chemical composition of fine (PM2.5) aerosol samples collected for the 5 years period (2001-2005) using Gent Stacked filter unit sampler at Klang Valley (30 10 30 N, 1010 43 24 E) were analysed using Neutron Activation Analysis (NAA) and Proton Induced X-ray Emission (PIXE). Results of the study show that the major component of the fine aerosol was black carbon and sulfur with mass concentration range from 4.4 - 6.7 μg m -3, respectively. The total fine aerosol mass concentration were in the ranged of 25 - 31 μg m-3 with the reconstructed mass was about 50 % as relative to the gravimetric mass. Statistical method, factor analysis with varimax approach has been applied to the aerosol composition data for the fingerprint identification. The analysis produces five identified fingerprint represent soil, industry, motor vehicles/ biomass burning and Pb and Zn sources. There is also an unidentified source that could be related to unknown industrial activities. (author)

  19. Nonnegative signal factorization with learnt instrument models for sound source separation in close-microphone recordings

    Science.gov (United States)

    Carabias-Orti, Julio J.; Cobos, Máximo; Vera-Candeas, Pedro; Rodríguez-Serrano, Francisco J.

    2013-12-01

    Close-microphone techniques are extensively employed in many live music recordings, allowing for interference rejection and reducing the amount of reverberation in the resulting instrument tracks. However, despite the use of directional microphones, the recorded tracks are not completely free from source interference, a problem which is commonly known as microphone leakage. While source separation methods are potentially a solution to this problem, few approaches take into account the huge amount of prior information available in this scenario. In fact, besides the special properties of close-microphone tracks, the knowledge on the number and type of instruments making up the mixture can also be successfully exploited for improved separation performance. In this paper, a nonnegative matrix factorization (NMF) method making use of all the above information is proposed. To this end, a set of instrument models are learnt from a training database and incorporated into a multichannel extension of the NMF algorithm. Several options to initialize the algorithm are suggested, exploring their performance in multiple music tracks and comparing the results to other state-of-the-art approaches.

  20. 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

  1. 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

  2. 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

  3. Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder.

    Science.gov (United States)

    Ebner-Priemer, Ulrich W; Welch, Stacy S; Grossman, Paul; Reisch, Thomas; Linehan, Marsha M; Bohus, Martin

    2007-04-15

    Many experts now believe that pervasive problems in affect regulation constitute the central area of dysfunction in borderline personality disorder (BPD). However, data is sparse and inconclusive. We hypothesized that patients with BPD, in contrast to healthy gender and nationality-matched controls, show a higher frequency and intensity of self-reported emotions, altered physiological indices of emotions, more complex emotions and greater problems in identifying specific emotions. We took a 24-hour psychophysiological ambulatory monitoring approach to investigate affect regulation during everyday life in 50 patients with BPD and in 50 healthy controls. To provide a typical and unmanipulated sample, we included only patients who were currently in treatment and did not alter their medication schedule. BPD patients reported more negative emotions, fewer positive emotions, and a greater intensity of negative emotions. A subgroup of non-medicated BPD patients manifested higher values of additional heart rate. Additional heart rate is that part of a heart rate increase that does not directly result from metabolic activity, and is used as an indicator of emotional reactivity. Borderline participants were more likely to report the concurrent presence of more than one emotion, and those patients who just started treatment in particular had greater problems in identifying specific emotions. Our findings during naturalistic ambulatory assessment support emotional dysregulation in BPD as defined by the biosocial theory of [Linehan, M.M., 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. The Guildford Press, New York.] and suggest the potential utility for evaluating treatment outcome. PMID:17321599

  4. The treatment of ambulatory venous ulcer patients with warming therapy.

    Science.gov (United States)

    Cherry, G W; Wilson, J

    1999-09-01

    The standard treatment for ambulatory patients with venous ulcers is compression therapy. The aim of the present study was to develop a warming regimen to treat venous ulcers, which could be easily used by patients in their home or work environment. Five patients with a mean age of 66 years (51-80) who had venous ulcers for an average of 8 months (3-13) were treated with zip-up compression stockings (gradient compression 40 mmHg at the ankle) and a warming dressing. The latter was controlled by the patient to warm the ulcer to 38 degrees C for 1 hour three times daily. Warming therapy was carried out for 2 weeks and patients' ulcers were monitored for healing for 12 weeks. In all but one of the patients following warming therapy, there was marked increase in granulation tissue as well as a decrease in pain. Four of the five patients completely healed during the 12-week period. In conclusion, this study has demonstrated that warming therapy can be used by ambulatory patients with venous ulcers in conjunction with compression therapy. A randomized prospective study is in progress. PMID:10655876

  5. Descriptive data on cardiovascular and metabolic risk factors in ambulatory and non-ambulatory adults with cerebral palsy

    Directory of Open Access Journals (Sweden)

    P.G. McPhee

    2015-12-01

    Full Text Available Forty-two participants with cerebral palsy were recruited for a study examining traditional and novel indicators of cardiovascular risk (McPhee et al., 2015 [1]. Data pertaining to the prevalence of obesity, smoking, hypertension, and metabolic risk are provided. These data are presented along with the scoring methods used in evaluation of the study participants. Percentages are included for comparative purposes with the existing literature.

  6. 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 PMID:26796983

  7. Sources

    OpenAIRE

    2011-01-01

    A. SOURCES STATISTIQUES 1. Statistiques générales Annuaire statistique international, SDN (à partir de 1926). Mémorandum sur le commerce international et sur les balances des paiements, annuel à partir de 1927 (numéros rétrospectifs 1912-1926, 1913-1927), [3 volumes : aperçu général ; balances des paiements ; statistiques du commerce extérieur ; utilise les données nationales disponibles. Très utile]. Annuaire statistique de la France. Annuaire statistique de la Belgique. Statistiques économi...

  8. Sources

    OpenAIRE

    2013-01-01

    I–SOURCES MANUSCRITES Archivio di Stato di Roma (ASR) Presidenza dell’Annona e Grascia : bb. 67-68, Lista dei misuratori del grano, 1658-1660. bb. 352-377, Nota dei grani introdotti e venduti in Roma, 1657-1715. bb. 412-419, Ristretto delle assegne dei grani date dai mercanti, 1680-1687. b. 1470, Registro delle lettere del Prefetto dell’Annona, 1659-1660. b. 1706, Libri di entrata e uscita dei grani dell’abbondanza (Ripetta), 16581670. bb. 1930-1931, Debiti e crediti dei fornai, 1658-1660. b....

  9. Sources

    OpenAIRE

    2014-01-01

    Sources éditées : ABADAL i de VINYALS, Ramon d', Catalunya carolingia, II, Els diplomes carolingis a Catalunya, 2 vol., Barcelone, 1926-1952, cit. CC. ACHERY, D', Luc, Spicilegium sive collectio veterum aliquot scriptorum..., E. Baluze et E. Martène éd., Paris, 1723, tome 3. ALART, Bernard, Privilèges et titres relatifs aux franchises, institutions et propriétés communales de Roussillon et de Cerdagne depuis le xie siècle jusqu 'à l'an 1660... Première partie, Perpignan, 1878. ALART, Bernard,...

  10. Search Strategy of Detector Position For Neutron Source Multiplication Method by Using Detected-Neutron Multiplication Factor

    International Nuclear Information System (INIS)

    In this paper, an alternative definition of a neutron multiplication factor, detected-neutron multiplication factor kdet, is produced for the neutron source multiplication method..(NSM). By using kdet, a search strategy of appropriate detector position for NSM is also proposed. The NSM is one of the practical subcritical measurement techniques, i.e., the NSM does not require any special equipment other than a stationary external neutron source and an ordinary neutron detector. Additionally, the NSM method is based on steady-state analysis, so that this technique is very suitable for quasi real-time measurement. It is noted that the correction factors play important roles in order to accurately estimate subcriticality from the measured neutron count rates. The present paper aims to clarify how to correct the subcriticality measured by the NSM method, the physical meaning of the correction factors, and how to reduce the impact of correction factors by setting a neutron detector at an appropriate detector position

  11. 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.

  12. 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.

  13. A reliable and simple method for identifying at start patients with tuberculosis of the spine suitable for ambulatory chemotherapy

    Directory of Open Access Journals (Sweden)

    Sriram K

    2006-01-01

    Full Text Available Background : Ambulatory chemotherapy is very effective in the treatment of spinal tuberculosis, involving vertebral bodies, without paraplegia. However, some patients with thoracic disease could develop worsening of kyphosis. It would be helpful to predict which patients were unlikely to develop severe kyphosis. Methods : Step-wise discriminant analysis on the 10-year data of 79 patients treated with ambulatory chemotherapy showed that the angle of kyphosis on admission and the site of the lesion were associated with an angle of 50 0 or less at 10 years. An equation based on these factors was evolved to give a discriminant function (D value. Results : Of 51 patients with an angle of 50˚ or less at 10 years, 47 had a D value of 0.499 or less, giving a predictive accuracy of 92%. Of 28 patients who had an angle of more than 50˚ at 10 years, 5 had a D value of 0.499 or less (false-negativity of 18%. Considering the initial angle, which was much more important (p< 0.0001 than the site of the lesion (P< 0.03, 46 of the patients with an angle of 50˚ or less at 10 years had an initial angle of 30˚ or less (predictive accuracy of 90%; 3 of the patients who had an angle of more than 500 at 10 years had an initial angle of 30˚ or less (false-negativity of 11%. Conclusion : If the angle of kyphosis on admission is 300 or less, ambulatory chemotherapy could be confidently prescribed. The method is reliable and simple.

  14. Source and risk factors of a cutaneous anthrax outbreak, Jiangsu, Eastern China, 2012.

    Science.gov (United States)

    Hu, J L; Cui, L L; Bao, C J; Tan, Z M; Rutherford, S; Ying, L; Zhang, M L; Zhu, F C

    2016-09-01

    Anthrax is still a severe public health problem and threat to human health. A cutaneous anthrax outbreak occurred in Jiangsu Province, a non-endemic anthrax region of eastern China, from July to August 2012. Epidemiological and laboratory investigation were initiated to trace the source of infection and identify the risk factors of the outbreak. On 25 July 2012, 17 persons were exposed to a sick cow, which had been imported from northeast China a few days previously. Of the 17 exposed, eight developed symptoms between 1 and 8 days and were diagnosed as cutaneous anthrax cases. Three main genes of Bacillus anthracis were detected from both human and cow meat samples, indicating that the outbreak was associated with this infected cow. A retrospective cohort study showed that contact with blood and presence of skin damage contributed to the case infection with B. anthracis. The outbreak highlights the need to enhance quarantine for imported livestock, which should have been vaccinated prior to importation, the significance of education for high-risk individuals, and training for primary healthcare workers even in anthrax-free areas. PMID:27277672

  15. [Source emission characteristics and impact factors of volatile halogenated organic compounds from wastewater treatment plant].

    Science.gov (United States)

    He, Jie; Wang, Bo-Guang; Liu, Shu-Le; Zhao, De-Jun; Tang, Xiao-Dong; Zou, Yu

    2011-12-01

    A low enrichment method of using Tenax as absorbent and liquid nitrogen as refrigerant has been established to sample the volatile halogenated organic compounds in Guangzhou Liede municipal wastewater treatment plant as well as its ambient air. The composition and concentration of target halogenated hydrocarbons were analyzed by combined thermal desorption/GC-MS to explore its sources profile and impact factors. The result showed that 19 halogenated organic compounds were detected, including 11 halogenated alkanets, 3 halogenated alkenes, 3 halogenated aromatic hydrocarbons and 2 haloesters, with their total concentrations ranged from 34.91 microg x m(-3) to 127.74 microg x m(-3) and mean concentrations ranged from n.d. to 33.39 microg x m(-3). Main pollutants of the studied plant were CH2Cl2, CHCl3, CFC-12, C2H4Cl2, CFC-11, C2HCl3 and C2Cl4, they came from the wastewater by volatilization. Among the six processing units, the dehydration room showed the highest level of halogenated organic compounds, followed by pumping station, while the sludge thickener was the lowest. The emissions from pumping station, aeration tank and biochemical pool were significantly affected by temperature and humidity of environment. PMID:22468521

  16. Analysis of factors affecting the accuracy, reproducibility, and interpretation of microbial community carbon source utilization patterns

    Science.gov (United States)

    Haack, S.K.; Garchow, H.; Klug, M.J.; Forney, L.J.

    1995-01-01

    We determined factors that affect responses of bacterial isolates and model bacterial communities to the 95 carbon substrates in Biolog microliter plates. For isolates and communities of three to six bacterial strains, substrate oxidation rates were typically nonlinear and were delayed by dilution of the inoculum. When inoculum density was controlled, patterns of positive and negative responses exhibited by microbial communities to each of the carbon sources were reproducible. Rates and extents of substrate oxidation by the communities were also reproducible but were not simply the sum of those exhibited by community members when tested separately. Replicates of the same model community clustered when analyzed by principal- components analysis (PCA), and model communities with different compositions were clearly separated un the first PCA axis, which accounted for >60% of the dataset variation. PCA discrimination among different model communities depended on the extent to which specific substrates were oxidized. However, the substrates interpreted by PCA to be most significant in distinguishing the communities changed with reading time, reflecting the nonlinearity of substrate oxidation rates. Although whole-community substrate utilization profiles were reproducible signatures for a given community, the extent of oxidation of specific substrates and the numbers or activities of microorganisms using those substrates in a given community were not correlated. Replicate soil samples varied significantly in the rate and extent of oxidation of seven tested substrates, suggesting microscale heterogeneity in composition of the soil microbial community.

  17. Determinants of patient satisfaction in ambulatory oncology: a cross sectional study based on the OUT-PATSAT35 questionnaire

    Directory of Open Access Journals (Sweden)

    Nguyen Thanh Vân France

    2011-12-01

    Full Text Available Abstract Background The aim of this study was to identify factors associated with satisfaction with care in cancer patients undergoing ambulatory treatment. We investigated associations between patients' baseline clinical and socio-demographic characteristics, as well as self-reported quality of life, and satisfaction with care. Methods Patients undergoing ambulatory chemotherapy or radiotherapy in 2 centres in France were invited, at the beginning of their treatment, to complete the OUT-PATSAT35, a 35 item and 13 scale questionnaire evaluating perception of doctors, nurses and aspects of care organisation. Additionally, for each patient, socio-demographic variables, clinical characteristics and self-reported quality of life using the EORTC QLQ-C30 questionnaire were recorded. Results Among 692 patients included between January 2005 and December 2006, only 6 were non-responders. By multivariate analysis, poor perceived global health strongly predicted dissatisfaction with care (p Conclusions A number of clinical of socio-demographic factors were significantly associated with different scales of the satisfaction questionnaire. However, the main determinant was the patient's global health status, underlining the importance of measuring and adjusting for self-perceived health status when evaluating satisfaction. Further analyses are currently ongoing to determine the responsiveness of the OUT-PATSAT35 questionnaire to changes over time.

  18. Acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure

    Directory of Open Access Journals (Sweden)

    Crivaldo Gomes Cardoso Jr

    2010-01-01

    Full Text Available Hypertension is a ubiquitous and serious disease. Regular exercise has been recommended as a strategy for the prevention and treatment of hypertension because of its effects in reducing clinical blood pressure; however, ambulatory blood pressure is a better predictor of target-organ damage than clinical blood pressure, and therefore studying the effects of exercise on ambulatory blood pressure is important as well. Moreover, different kinds of exercise might produce distinct effects that might differ between normotensive and hypertensive subjects. The aim of this study was to review the current literature on the acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure in normotensive and hypertensive subjects. It has been conclusively shown that a single episode of aerobic exercise reduces ambulatory blood pressure in hypertensive patients. Similarly, regular aerobic training also decreases ambulatory blood pressure in hypertensive individuals. In contrast, data on the effects of resistance exercise is both scarce and controversial. Nevertheless, studies suggest that resistance exercise might acutely decrease ambulatory blood pressure after exercise, and that this effect seems to be greater after low-intensity exercise and in patients receiving anti-hypertensive drugs. On the other hand, only two studies investigating resistance training in hypertensive patients have been conducted, and neither has demonstrated any hypotensive effect. Thus, based on current knowledge, aerobic training should be recommended to decrease ambulatory blood pressure in hypertensive individuals, while resistance exercise could be prescribed as a complementary strategy.

  19. Optimising postoperative pain management in the ambulatory patient.

    Science.gov (United States)

    Shang, Allan B; Gan, Tong J

    2003-01-01

    Over 60% of surgery is now performed in an ambulatory setting. Despite improved analgesics and sophisticated drug delivery systems, surveys indicate that over 80% of patients experience moderate to severe pain postoperatively. Inadequate postoperative pain relief can prolong recovery, precipitate or increase the duration of hospital stay, increase healthcare costs, and reduce patient satisfaction. Effective postoperative pain management involves a multimodal approach and the use of various drugs with different mechanisms of action. Local anaesthetics are widely administered in the ambulatory setting using techniques such as local injection, field block, regional nerve block or neuraxial block. Continuous wound infusion pumps may have great potential in an ambulatory setting. Regional anaesthesia (involving anaesthetising regional areas of the body, including single extremities, multiple extremities, the torso, and the face or jaw) allows surgery to be performed in a specific location, usually an extremity, without the use of general anaesthesia, and potentially with little or no sedation. Opioids remain an important component of any analgesic regimen in treating moderate to severe acute postoperative pain. However, the incorporation of non-opioids, local anaesthetics and regional techniques will enhance current postoperative analgesic regimens. The development of new modalities of treatment, such as patient controlled analgesia, and newer drugs, such as cyclo-oxygenase-2 inhibitors, provide additional choices for the practitioner. While there are different routes of administration for analgesics (e.g. oral, parenteral, intramuscular, transmucosal, transdermal and sublingual), oral delivery of medications has remained the mainstay for postoperative pain control. The oral route is effective, the simplest to use and typically the least expensive. The intravenous route has the advantages of a rapid onset of action and easier titratibility, and so is recommended for the

  20. Positive matrix factorization and trajectory modelling for source identification: A new look at Indian Ocean Experiment ship observations

    Science.gov (United States)

    Bhanuprasad, S. G.; Venkataraman, Chandra; Bhushan, Mani

    The sources of aerosols on a regional scale over India have only recently received attention in studies using back trajectory analysis and chemical transport modelling. Receptor modelling approaches such as positive matrix factorization (PMF) and the potential source contribution function (PSCF) are effective tools in source identification of urban and regional-scale pollution. In this work, PMF and PSCF analysis is applied to identify categories and locations of sources that influenced surface concentrations of aerosols in the Indian Ocean Experiment (INDOEX) domain measured on-board the research vessel Ron Brown [Quinn, P.K., Coffman, D.J., Bates, T.S., Miller, T.L., Johnson, J.E., Welton, E.J., et al., 2002. Aerosol optical properties during INDOEX 1999: means, variability, and controlling factors. Journal of Geophysical Research 107, 8020, doi:10.1029/2000JD000037]. Emissions inventory information is used to identify sources co-located with probable source regions from PSCF. PMF analysis identified six factors influencing PM concentrations during the INDOEX cruise of the Ron Brown including a biomass combustion factor (35-40%), three industrial emissions factors (35-40%), primarily secondary sulphate-nitrate, balance trace elements and Zn, and two dust factors (20-30%) of Si- and Ca-dust. The identified factors effectively predict the measured submicron PM concentrations (slope of regression line=0.90±0.20; R2=0.76). Probable source regions shifted based on changes in surface and elevated flows during different times in the ship cruise. They were in India in the early part of the cruise, but in west Asia, south-east Asia and Africa, during later parts of the cruise. Co-located sources include coal-fired electric utilities, cement, metals and petroleum production in India and west Asia, biofuel combustion for energy and crop residue burning in India, woodland/forest burning in north sub-Saharan Africa and forest burning in south-east Asia. Significant findings

  1. 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

  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 in...... Nijmegen (mean age = 46.2 years; 76.3% with systolic and diastolic hypertension) and 145 patients enrolled in the Systolic Hypertension in Europe (Syst-Eur) trial (71.0 years) underwent 24-h BP monitoring at a median interval of 8 and 31 days, respectively. We used the repeatability coefficient, which is...... were approximately 30%. Differences in AASI between paired recordings were correlated with differences in the goodness of fit (r2) of the AASI regression line as well as with differences in the night-to-day BP ratio. However, in sensitivity analyses stratified for type of hypertension, r2, or dipping...

  3. [Low-power Wireless Micro Ambulatory Electrocardiogram Node].

    Science.gov (United States)

    Cai, Zhipeng; Luo, Kan; Li, Jianqing

    2016-02-01

    Ambulatory electrocardiogram (ECG) monitoring can effectively reduce the risk and death rate of patients with cardiovascular diseases (CVDs). The Body Sensor Network (BSN) based ECG monitoring is a new and efficien method to protect the CVDs patients. To meet the challenges of miniaturization, low power and high signal quality of the node, we proposed a novel 50 mmX 50 mmX 10 mm, 30 g wireless ECG node, which includes the single-chip an alog front-end AD8232, ultra-low power microprocessor MSP430F1611 and Bluetooth module HM-11. The ECG signal quality is guaranteed by the on-line digital filtering. The difference threshold algorithm results in accuracy of R-wave detection and heart rate. Experiments were carried out to test the node and the results showed that the pro posed node reached the design target, and it has great potential in application of wireless ECG monitoring. PMID:27382732

  4. Ambulatory major surgery of benign tumors of the thyroid gland

    International Nuclear Information System (INIS)

    A descriptive and prospective study on the practice of ambulatory major surgery to eliminate benign tumours of the thyroid gland, was carried out in the General Surgery Service of 'Dr. Joaquin Castillo Duany' Teaching Clinical Surgical Hospital in Santiago de Cuba during the years 1996-2008, both included, through a previous clinical evaluation of 74 patients in the Endocrinology Outpatient Department, where it was decided that they could definitely have a surgical treatment. The female sex, the age groups from 31 to 45 years, the hemithyroidectomy as surgical technique, acupuncture as analgesic procedure and the follicular adenoma as cytohistological result prevailed in the case material. Mild complications occurred in 5 members of the sample, but recovery was absolute in all, so that even 72 of them were discharged before the 24 hours. Due to its good acceptance, this surgical method is beneficial for patient and hospital institutions.(author)

  5. Accelerometer recorder and display system for ambulatory patients

    Science.gov (United States)

    Berka, Martin; Żyliński, Marek; Niewiadomski, Wiktor; Cybulski, Gerard

    2015-09-01

    This paper presents the design of a compact, wearable, rechargeable acceleration recorder to support long-term monitoring of ambulatory patients with motor disorders, and of software to display and analyze its output. The device consists of a microcontroller, operational amplifier, accelerometer, SD card, indicator LED, rechargeable battery, and associated minor components. It can operate for over a day without charging and can continuously collect data for three weeks without downloading to an outside system, as currently configured. With slight modifications, this period could be extended to several months. The accompanying software provides flexible visualization of the acceleration data over long periods, basic file operations and compression for easier archiving, annotation of segments of interest, and functions for calculation of various parameters and detection of immobility and vibration frequencies. Applications in analysis of gait and other movements are discussed.

  6. Worksite Physical Activity Intervention for Ambulatory Clinic Nursing Staff.

    Science.gov (United States)

    Tucker, Sharon; Farrington, Michele; Lanningham-Foster, Lorraine M; Clark, M Kathleen; Dawson, Cindy; Quinn, Geralyn J; Laffoon, Trudy; Perkhounkova, Yelena

    2016-07-01

    Health behaviors, including physical activity (PA), of registered nurses (RNs) and medical assistants (MAs) are suboptimal but may improve with worksite programs. Using a repeated-measures crossover design, the authors explored if integrating a 6-month worksite non-exercise activity thermogenesis (NEAT) intervention, with and without personalized health coaching via text messaging into workflow could positively affect sedentary time, PA, and body composition of nursing staff without jeopardizing work productivity. Two ambulatory clinics were randomly assigned to an environmental NEAT intervention plus a mobile text message coaching for either the first 3 months (early texting group, n = 27) or the last 3 months (delayed texting group, n = 13), with baseline 3-month and 6-month measurements. Sedentary and PA levels, fat mass, and weight improved for both groups, significantly only for the early text group. Productivity did not decline for either group. This worksite intervention is feasible and may benefit nursing staff. PMID:27143144

  7. 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

    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 Joaquin Valley contributing most of the CH4 and much of the measured N2O at Bakersfield. Agriculture is observed to provide another major source of N2O, while vehicle emissions are found to be an insignificant source of N2O, contrary to the current statewide greenhouse gas inventory which includes vehicles as a major source. Our PMF source apportionment also produces an evaporative/fugitive factor but its relative lack of CH4 contributions points to removal processes from vented emissions in the surrounding O&G industry and the overwhelming dominance of the dairy CH4 source. In the CABERNET experiments, we report enhancements of CH4 from a number of sources spread across the spatial domain of the Central Valley that improves our understanding of their distribution and relative strengths. We observe large enhancements of CH4 mixing ratios over the dairy and feedlot intensive regions of Central Valley corresponding with significant flux estimates that are larger than CH4 emission rates reported in the greenhouse

  8. 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).

  9. Approximating model for multilayer gamma-ray buildup factors by transmission matrix method: Application to point isotropic source geometry

    International Nuclear Information System (INIS)

    An approximating formula recently proposed by the authors for gamma-ray buildup factors of multilayered shields is applied to point isotropic source problems. The formula, which is formulated in vector form with a four-group approximation, handles the gamma-ray energy spectrum directly and uses the transmission and albedo matrices to take gamma-ray transmission and backscattering effects into consideration. The gamma-ray transmission and back-scattering probabilities through a 1-mean-free-path- (mfp-) thick shell depend on the shell curvature. This phenomenon plays an important role in simulating the gamma-ray buildup factor in point isotropic source geometry. In this model, the dependence is described by simplified expressions. The feasibility of the formula for systematically describing the point isotropic buildup factors was tested by using buildup factors calculated by the Monte Carlo method as reference data. The materials used in the tests were water, iron, and lead, and the source energies assumed were 0.5, 1, and 10 MeV. Through the tests, the method was found to reproduce the reference data of double-layered shields of these materials very well. With the same parameters, the buildup factors of three-layered shields are also reproducible. Buildup factors computed with two different group structures were examined to test the adequacy of the energy group structure adopted. The group structure previously adopted was found to be adequate in the energy range of 0.5 to 10 MeV

  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. 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...

  12. Peritonitis due to Brevibacterium otitidis in a patient undergoing continuous ambulatory peritoneal dialysis.

    OpenAIRE

    Wauters, Georges; Van Bosterhaut, B; Avesani, V; Cuvelier, R.; Charlier, Jacqueline; Janssens, Michèle; Delmée, Michel

    2000-01-01

    Brevibacterium otitidis is a coryneform rod and, as far as is known, is isolated only from infected ears. We report the first known case of peritonitis caused by B. otitidis in a patient undergoing continuous ambulatory peritoneal dialysis.

  13. Peritonitis by Scedosporium apiospermum in a patient undergoing continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    SEVERO Luiz Carlos

    1999-01-01

    Full Text Available A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection.

  14. Prospective Risk Factors for Adolescent PTSD: Sources of Differential Exposure and Differential Vulnerability

    Science.gov (United States)

    Milan, Stephanie; Zona, Kate; Acker, Jenna; Turcios-Cotto, Viana

    2013-01-01

    There are two types of risk factors for developing PTSD: factors that increase the likelihood of experiencing a potentially traumatizing event and factors that increase the likelihood of developing symptoms following such events. Using prospective data over a two-year period from a large, diverse sample of urban adolescents (n = 1242, Mean age =…

  15. 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

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

    Science.gov (United States)

    Kuang, B. Y.; Lin, P.; Huang, X. H. H.; Yu, J. Z.

    2015-02-01

    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 were found to correlate with biomass burning (BB) tracers (i.e., levoglucosan and K) and secondary species (e.g., SO42- and NH4+), 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 study of HULIS be

  17. 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

  18. Apportionment of atmospheric aerosols collected over Hungary to sources by target transformation factor analysis

    International Nuclear Information System (INIS)

    Wind-sector related regional signatures deduced from PIXE data revealed a major contribution of Middle-East Europe to the atmospheric aerosol loading in Europe. This is in accordance with the findings of a Swedish and a Turkish group. The characteristics of the local aerosols are given in terms of source profiles and source scores. (orig.)

  19. The development of a shared governance model in the ambulatory setting.

    Science.gov (United States)

    Smolensky, L A; Zuzak, C; Adams, J; Mackaly, L

    1999-01-01

    Many individuals within the ambulatory division have benefited both personally and professionally as a result of this shared governance model and its concepts. Staff who rarely volunteered for projects became involved, and others developed their leadership skills. Although the ambulatory division's shared governance model did not reach maturity, many tasks were accomplished through collaborative efforts. As a result, there were many positive staff outcomes such as a greater understanding of their workplace, and a greater appreciation of their peers. PMID:10711156

  20. Ambulatory oral surgery: 1-year experience with 11 680 patients from Zagreb district, Croatia

    OpenAIRE

    Jokić, Dražen; Macan, Darko; Perić, Berislav; Tadić, Marinka; Biočić, Josip; Đanić, Petar; Brajdić, Davor

    2013-01-01

    Aim To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Methods Sociodemographic and clinical data on 11 680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess th...

  1. Results of ambulatory arterial blood pressure monitoring in children with obesity

    OpenAIRE

    Faruk Öktem

    2010-01-01

    Objectives: The relationship between obesity and essential hypertension is well known. In this study, we aimed to evaluate ambulatory arterial blood pressure monitoring of obese and non-obese children who had similar demographic characteristics.Materials and methods: Seventy one children and adolescents (n=39 obesity, n=32 controls) were studied. Blood pressure of the children were measured by 24 hour ambulatory blood pressure monitoring device.Results: Obese children had significantly higher...

  2. A qualitative analysis of an electronic health record (EHR) implementation in an academic ambulatory setting

    OpenAIRE

    Kahyun Yoon-Flannery; Stephanie Zandieh; Gilad Kuperman; Daniel Langsam; Daniel Hyman; Rainu Kaushal

    2008-01-01

    Objectives To determine pre-implementation perspectives of institutional, practice and vendor leadership regarding best practice for implementation of two ambulatory electronic health records (EHRs) at an academic institution. Design Semi-structured interviews with ambulatory care network and information systems leadership, medical directors, practice managers and vendors before EHR implementation. Results were analysed using grounded theory with ATLAS.ti version 5.0. Measurements Quali...

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

    OpenAIRE

    Detmer Don E; Kouroubali Angelina; Lorenzi Nancy M; Bloomrosen Meryl

    2009-01-01

    Abstract Background Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and pro...

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

    Science.gov (United States)

    Edjabou, Maklawe Essonanawe; Boldrin, Alessio; Scheutz, Charlotte; Astrup, Thomas Fruergaard

    2015-12-01

    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/employee/year was source-sorted, with a considerably high purity of 99%. Residual waste amounted to 10 ± 5 kg/employee/year and consisted mainly of paper (29 ± 13%), plastic (23 ± 9%) and missorted food waste (24 ± 16%). The moisture content of source-sorted food waste was significantly higher (8%) than missorted food waste, and the methane potential of source-sorted food waste was 463 ± 42 mL CH4/g VS. These results show that food waste in office areas offers promising potential for relatively easily collectable and pure source-sorted food waste, suggesting that recycling targets for food waste could be achieved with reasonable logistical ease in office areas. PMID:26260965

  5. Economic viability and critical influencing factors assessment of black water and grey water source-separation sanitation system.

    Science.gov (United States)

    Thibodeau, C; Monette, F; Glaus, M; Laflamme, C B

    2011-01-01

    The black water and grey water source-separation sanitation system aims at efficient use of energy (biogas), water and nutrients but currently lacks evidence of economic viability to be considered a credible alternative to the conventional system. This study intends to demonstrate economic viability, identify main cost contributors and assess critical influencing factors. A technico-economic model was built based on a new neighbourhood in a Canadian context. Three implementation scales of source-separation system are defined: 500, 5,000 and 50,000 inhabitants. The results show that the source-separation system is 33% to 118% more costly than the conventional system, with the larger cost differential obtained by lower source-separation system implementation scales. A sensitivity analysis demonstrates that vacuum toilet flow reduction from 1.0 to 0.25 L/flush decreases source-separation system cost between 23 and 27%. It also shows that high resource costs can be beneficial or unfavourable to the source-separation system depending on whether the vacuum toilet flow is low or normal. Therefore, the future of this configuration of the source-separation system lies mainly in vacuum toilet flow reduction or the introduction of new efficient effluent volume reduction processes (e.g. reverse osmosis). PMID:22170836

  6. Duty factor variation possibility from 1% to 100% with PKU microwave driven Cs-free volume H− sources

    International Nuclear Information System (INIS)

    Microwave driven cesium-free volume H− sources, that have the ability to deliver tens of mA H− 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− sources can deliver tens of mA H− 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− current increases with RF power linearly. Details will be presented in the paper

  7. Duty factor variation possibility from 1% to 100% with PKU microwave driven Cs-free volume H(-) sources.

    Science.gov (United States)

    Peng, S X; Zhang, T; Ren, H T; Zhang, A L; Xu, Y; Zhang, J F; Guo, Z Y; Chen, J E

    2016-02-01

    Microwave driven cesium-free volume H(-) sources, that have the ability to deliver tens of mA H(-) 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(-) sources can deliver tens of mA H(-) 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(-) current increases with RF power linearly. Details will be presented in the paper. PMID:26932007

  8. Duty factor variation possibility from 1% to 100% with PKU microwave driven Cs-free volume H- sources

    Science.gov (United States)

    Peng, S. X.; Zhang, T.; Ren, H. T.; Zhang, A. L.; Xu, Y.; Zhang, J. F.; Guo, Z. Y.; Chen, J. E.

    2016-02-01

    Microwave driven cesium-free volume H- sources, that have the ability to deliver tens of mA H- 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- sources can deliver tens of mA H- 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- current increases with RF power linearly. Details will be presented in the paper.

  9. Nonnegative Matrix Factor 2-D Deconvolution for Blind Single Channel Source Separation

    DEFF Research Database (Denmark)

    Schmidt, Mikkel N.; Mørup, Morten

    2006-01-01

    We present a novel method for blind separation of instruments in polyphonic music based on a non-negative matrix factor 2-D deconvolution algorithm. Using a model which is convolutive in both time and frequency we factorize a spectrogram representation of music into components corresponding to...... individual instruments. Based on this factorization we separate the instruments using spectrogram masking. The proposed algorithm has applications in computational auditory scene analysis, music information retrieval, and automatic music transcription....

  10. FACTORS AFFECTING PREFERRED SOURCES OF INFORMATION: EXPLORING THE IMPACT OF TRUST, JOB SATISFACTION AND COMMUNICATION EFFECTIVENESS

    OpenAIRE

    Zeffane, Rachid

    2006-01-01

    The paper draws on longitudinal survey data involving 824 employees from a small food processing organization operating in NSW (Australia). It explores the impact of job attitudes (including aspects of job satisfaction and commitment), communication and trust on preferences of three types of information sources : (1) “Grassroots/Consultative Channels” (i.e. colleague co-workers, unions and the consultative committee as helpful sources of information and feedback channels); (2) “Management Cha...

  11. Nonnegative signal factorization with learnt instrument models for sound source separation in close-microphone recordings

    OpenAIRE

    Carabias Orti, Julio J; Cobos, M??ximo; Vera Candeas, Pedro; Rodr??guez Serrano, Francisco J

    2013-01-01

    Close-microphone techniques are extensively employed in many live music recordings, allowing for interference rejection and reducing the amount of reverberation in the resulting instrument tracks. However, despite the use of directional microphones, the recorded tracks are not completely free from source interference, a problem which is commonly known as microphone leakage. While source separation methods are potentially a solution to this problem, few approaches take into account the huge am...

  12. 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.

  13. Defining Content for a Competency-based (CanMEDS) Postgraduate Curriculum in Ambulatory Care: a Delphi Study

    OpenAIRE

    Wong, René

    2012-01-01

    Background Ambulatory training in internal medicine has been noted to be dysfunctional and inadequate. In this study, we developed a set of competency-based outcomes specific to ambulatory care to guide the design, implementation and evaluation of instructional events to ensure that societal needs are addressed. Methods In 2007 a Delphi technique was used to reach consensus and define the priorities for competency-based training in ambulatory care for internal medicine residents. Four groups ...

  14. 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.......1%. In conclusion, the IDACO observations support the concept that BP variability adds to risk stratification, but above all highlight that 24-h ambulatory BP level remains the main predictor to be considered in clinical practice....

  15. Ambulatory Blood Pressure Monitoring-Derived Short-Term Blood Pressure Variability in Primary Aldosteronism.

    Science.gov (United States)

    Grillo, Andrea; Bernardi, Stella; Rebellato, Andrea; Fabris, Bruno; Bardelli, Moreno; Burrello, Jacopo; Rabbia, Franco; Veglio, Franco; Fallo, Francesco; Carretta, Renzo

    2015-08-01

    The aim of this study was to investigate the short-term blood pressure (BP) variability (BPV) derived from ambulatory blood pressure monitoring (ABPM) in patients with primary aldosteronism (PA), either idiopathic hyperaldosteronism (IHA) or aldosterone-producing adenoma (APA), in comparison with patients with essential hypertension (EH) and normotensive (NT) controls. Thirty patients with PA (16 with IHA and 14 with APA), 30 patients with EH, and 30 NT controls, matched for sex, age, body mass index, and antihypertensive therapy, were studied. The standard deviation (SD) of 24-hour, daytime, and nighttime BP; 24-hour weighted SD of BP; and 24-hour BP average real variability were not different between patients with PA and those with EH (P=not significant). All BPV indices were higher in patients with PA, either IHA or APA subtypes, and patients with EH, compared with NT controls (P<.001 to P<.05). ABPM-derived short-term BPV is increased in patients with PA, and it may represent an additional cardiovascular risk factor in this disease. The role of aldosterone excess in BPV has to be clarified. PMID:25880017

  16. Ambulatory blood pressure monitoring in solid organ transplantation.

    Science.gov (United States)

    Ramesh Prasad, G V

    2012-01-01

    Solid organ transplant recipients are at an increased risk for hypertension and cardiovascular disease. To assist in their management, 24-h ambulatory blood pressure monitoring (ABPM) has become increasingly used in both clinical research settings and practice. ABPM has been used to better define post-transplant hypertension incidence and prevalence in different solid organ transplantation populations. ABPM provides additional information on cardiovascular risk beyond that obtained by clinic-based readings, based on its ability to assess 24-h blood pressure (BP) load, detect nocturnal non-dipping, and predict target organ damage. It has provided some assurance about the safety of living kidney donation. Information from ABPM can be used to guide living kidney donor selection, and because ABPM-related data has been correlated with clinically important kidney and heart transplant recipient outcomes, it may be a valuable adjunct in their management. Despite these advantages, barriers to wider use of ABPM include expense, clinical inertia in hypertension management, lack of prospective clinical trial data, and clinical problems that compete with hypertension for attention such as acute or chronic allograft dysfunction. The increasing amount of research and clinical use for ABPM may allow for closer assessment and intervention to help address the increased cardiovascular risk faced by many solid organ transplant recipients. PMID:22220828

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

    International Nuclear Information System (INIS)

    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

  18. Silent myocardial ischemia evaluated by ambulatory left ventricular function monitoring

    Energy Technology Data Exchange (ETDEWEB)

    Imai, Kamon; Yumikura, Sei; Araki, Yasushi; Ando, Tatsuo; Saito, Satoshi; Ozawa, Yukio; Hatano, Michinobu; Kamata, Rikisaburo (Nihon Univ., Tokyo (Japan). School of Medicine)

    1989-12-01

    To determine whether left ventricular function is less disturbed in asymptomatic ischemia than in symptomatic ischemia, exercise-induced left ventricular function was measured in beat-to-beat using an ambulatory left ventricular function monitoring system. The study subjects were 22 patients with coronary artery disease. Supine and sitting ergometer exercise tests were performed. Of 44 exercise tests, 33 showed significant ST depression on electro-cardiograms. Among these 33, 17 were asymptomatic: 16, symptomatic. The left ventricular functions during exercise of these 33 were analyzed and compared with those of five normal controls. The changes in end-diastolic volume were not so significant either in controls or in the asymptomatic and symptomatic groups, but the changes in end-systolic volume were reversed in the diseased group, particularly in the symptomatic group. The changes in ejection fraction (EF), therefore, were significantly negative in the diseased group, particularly in the symptomatic group. The correlation between exercise-induced left ventricular dysfunction and symptoms was evaluated among the 33 patients. Symptoms were present in 35% (6/17) in <10% decrease in EF, 44% (4/9) in 10{approx}15% decrease, and 85% (6/7)in {ge}15% decrease, respectively. Thus, asymptomatic ischemia represents a lesser degree of myocardial ischemia as indicated by mild left ventricular dysfunction, compared with symptomatic ischemia. However, some cases of severe myocardial ischemia did not develop symptoms. We concluded that silent myocardial ischemia is responsible for a lesser degree of myocardial ischemia and decreased pain perception. (author).

  19. Mobile Personal Health System for Ambulatory Blood Pressure Monitoring

    Science.gov (United States)

    Felix, Vanessa G.; Ostos, Rodolfo; Gonzalez, Jesus A.; Cervantes, Armando; Ochoa, Armando; Ruiz, Carlos; Ramos, Roberto; Maestre, Gladys E.

    2013-01-01

    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. PMID:23762189

  20. 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. PMID:19265856

  1. Development and application of a general purpose ambulatory monitor.

    Science.gov (United States)

    Petley, G W; Clitheroe, S; Clewlow, F; Deakin, C D; Chauhan, A J

    1998-01-01

    This paper details the development and application of a multi-channel, general purpose, lightweight, portable monitor. The monitor is constructed with separate analogue and digital circuitry so that a dedicated analogue board may be developed for each new application with the same general purpose digital board, the latter requiring only changes to the firmware. At the heart of the digital circuit is an Arizona Microchip PIC 16C64 microcontroller, which can communicate with a computer via a serial port and perform both simple and relatively complex data analysis prior to storing data in memory. The low-power design enables the circuit to operate for potentially longer than a week on one set of batteries. Designed with medical applications in mind, preliminary data from three studies utilising the monitor are described. These include measurements of bladder pressure, personal exposure to pollutant gases and body temperature. The studies demonstrate the system's versatility in a variety of investigations requiring different signal processing and sampling protocols. It is hoped that, in the future, this ambulatory device will contribute to the diagnosis, treatment and understanding of a wide variety of disease conditions. PMID:9664283

  2. Ambulatory anesthetic care in pediatric tonsillectomy: challenges and risks

    Directory of Open Access Journals (Sweden)

    Collins C

    2015-11-01

    Full Text Available Corey Collins Massachusetts Eye and Ear Infirmary, Department of Anesthesiology, Harvard Medical School, Boston, MA, USA Abstract: Pediatric tonsillectomy is a common surgery around the world. Surgical indications are obstructive sleep apnea and recurrent tonsillitis. Despite the frequency of tonsillectomy in children, most aspects of perioperative care are supported by scant evidence. Recent guidelines provide important recommendations although clinician adherence or awareness of published guidance is variable and inconsistent. Current guidelines establish criteria for screening children for post-tonsillectomy observation, though most are based on low-grade evidence or consensus. Current recommendations for admission are: age <3 years; significant obstructive sleep apnea; obesity; and significant comorbid medical conditions. Recent reports have challenged each criterion and recommend admission criteria that are based on clinically relevant risks or observed clinical events such as adverse respiratory events in the immediate recovery period. Morbidity and mortality are low though serious complications occur regularly and may be amenable to improvements in postoperative monitoring, improved analgesic regimens, and parental education. Careful consideration of risks attributable to individual patients is vital to determine overall suitability for ambulatory discharge. Keywords: adverse airway events, complications, guidelines, mortality, OSA, pediatric anesthesia

  3. Laboratory evaluation of urinary tract infections in an ambulatory clinic.

    Science.gov (United States)

    Carroll, K C; Hale, D C; Von Boerum, D H; Reich, G C; Hamilton, L T; Matsen, J M

    1994-01-01

    A 4-month evaluation of ambulatory patients with a suspicion of a urinary tract infection was performed. Specific objectives included assessment of five urinary screening methods, reevaluation of the necessity of the phenylethyl alcohol plate (PEA), and cost-effectiveness of screening for low colony count bacteriuria. Urine samples were collected as midstream, clean-caught specimens. A total of 142 samples, 87 from 79 symptomatic patients and 55 negative controls, were evaluated. All urine specimens were cultured using a 0.01 mL loop and a 0.001 mL loop onto Columbia sheep blood agar, MacConkey agar, and PEA agar. Twenty-four specimens (17%) were sterile, 64 (45%) were contaminated, and 54 (38%) were infected. Five urine screening methods were performed. These tests and their associated sensitivity and specificity are as follows. The Chemstrip 9 (Behring, Inc., Somerville, NJ) for leukocyte esterase and nitrate, 67%, 98%; microscopic analysis on spun urine, 79%, 93%; methylene blue stain for pyuria, 60%, 99%; Gram stain for pyuria, 45%, 93%; Gram stain for bacteriuria, 65%, 75%; and the URISCREEN (Analytab Products, Plainview, NY), 92%, 89%. Inclusion of a PEA plate for isolation of gram-positive organisms provided no additional information. Routine culture of urine samples at 10(-2) mL increased the contamination rate by 19%. PMID:7506476

  4. Influence of Information Sources on Hepatitis B Screening Behavior and Relevant Psychosocial Factors Among Asian Immigrants

    Science.gov (United States)

    Tanaka, Miho; Strong, Carol; Lee, Sunmin; Juon, Hee-Soon

    2012-01-01

    This study examines how different information sources relate to Health Belief Model (HBM) constructs, hepatitis B virus (HBV) knowledge, and HBV screening. The Maryland Asian American Liver Cancer Education Program administered a survey of 877 Asian immigrants. The most common sources of information identified by the multiple-answer questions were newspapers (39.8%), physicians (39.3%), friends (33.8%), TV (31.7%), and the Internet (29.5%). Path analyses—controlling for age, sex, educational level, English proficiency, proportion of life in U.S., health insurance coverage, and family history of HBV infection—showed that learning about HBV from physicians had the strongest direct effect; friends had a marginal indirect effect. Perceived risk, benefits, and severity played limited roles in mediation effects. Path analysis results differed by ethnicity. Physician-based HBV screening intervention would be effective, but should be complemented with community health campaigns through popular information sources for the uninsured. PMID:23238580

  5. Adesão medicamentosa em idosos em seguimento ambulatorial Medicine adeshion in eldery people in an ambulatorial attendance

    Directory of Open Access Journals (Sweden)

    Fernanda Aparecida Cintra

    2010-11-01

    Full Text Available Este estudo objetivou avaliar a adesão ao tratamento medicamentoso em idosos em seguimento ambulatorial e identificar os fatores relacionados a esta adesão. Foram entrevistados 165 idosos em seguimento ambulatorial no Hospital das Clínicas da Universidade Estadual de Campinas (Unicamp, São Paulo. Utilizou-se instrumento próprio, com informações relativas à identificação dos sujeitos, dados de saúde autorreferidos e relativos à terapêutica medicamentosa. Os dados foram submetidos às análises descritiva e de comparação. A maioria dos idosos revelou adesão ao tratamento (88,5%, dentre os quais 91,1% moravam acompanhados. Os idosos que moravam sozinhos apresentaram três vezes mais chances de não aderência ao tratamento (OR: 3,655. Os efeitos colaterais dos medicamentos mostraram sete vezes mais chances de não aderência (OR: 7,092. Os fatores combinados que apresentaram maior chance de predizer a não adesão à terapêutica foram "mora sozinho" (OR: 4,346 e "efeitos colaterais" (OR: 8,219.The objectives of this study were to evaluate the elderly drug adhesion in an outpatient geriatric service linked to the State University Hospital of Campinas (São Paulo, Brazil as well as to identify the related events to this adhesion. One hundred sixty five elders were submitted to an interview. It was used an instrument to collect information about the patients' identification, besides the self-reported state of health and drug utilization. The data were evaluated through the descriptive and comparative analysis. They showed that most of the elderly (88.5% have confirmed the drug adhesion and among them 91.1% were living with company. The elderly who were living alone presented three-time more chance of non-adhesion to the drug therapy (OR: 3.655. Those that have referred drug side effects presented seven-time more chance of non-adhesion (OR: 7.092. The associated events which better predict the drug non-adhesion were: "living alone" (OR

  6. Size-resolved source apportionment of ambient particles by positive matrix factorization at Gosan background site in East Asia

    Science.gov (United States)

    Han, J. S.; Moon, K. J.; Lee, S. J.; Kim, Y. J.; Ryu, S. Y.; Cliff, S. S.; Yi, S. M.

    2006-01-01

    Size- and time-resolved aerosol samples were collected using an eight-stage Davis rotating unit for monitoring (DRUM) sampler from 29 March to 29 May in 2002 at Gosan, Jeju Island, Korea, which is one of the representative background sites in East Asia. These samples were analyzed using synchrotron X-ray fluorescence for 3-h average concentrations of 19 elements consisting of S, Si, Al, Fe, Ca, Cl, Cu, Zn, Ti, K, Mn, Pb, Ni, V, Se, As, Rb, Cr, Br. The size-resolved data sets were then analyzed using the positive matrix factorization (PMF) technique in order to identify possible sources and estimate their contribution to particulate matter mass. PMF analysis uses the uncertainty of the measured data to provide an optimal weighting. Fifteen sources were resolved in eight size ranges (0.07~12 μm) and included continental soil, local soil, sea salt, biomass/biofuel burning, coal combustion, oil heating furnace, residual oil fired boiler, municipal incineration, nonferrous metal source, ferrous metal source, gasoline vehicle, diesel vehicle, copper smelter and volcanic emission. PMF analysis of size-resolved source contributions showed that natural sources represented by local soil, sea salt and continental soil contributed about 79% to the predicted primary particulate matter (PM) mass in the coarse size range (1.15~12 μm). On the other hand, anthropogenic sources such as coal combustion and biomass/biofuel burning contributed about 60% in the fine size range (0.56~2.5 μm). The diesel vehicle source contributed the most in the ultra-fine size range (0.07~0.56 μm) and was responsible for about 52% of the primary PM mass.

  7. Size-resolved source apportionment of ambient particles by positive matrix factorization at Gosan background site in East Asia

    Directory of Open Access Journals (Sweden)

    J. S. Han

    2006-01-01

    Full Text Available Size- and time-resolved aerosol samples were collected using an eight-stage Davis rotating unit for monitoring (DRUM sampler from 29 March to 29 May in 2002 at Gosan, Jeju Island, Korea, which is one of the representative background sites in East Asia. These samples were analyzed using synchrotron X-ray fluorescence for 3-h average concentrations of 19 elements consisting of S, Si, Al, Fe, Ca, Cl, Cu, Zn, Ti, K, Mn, Pb, Ni, V, Se, As, Rb, Cr, Br. The size-resolved data sets were then analyzed using the positive matrix factorization (PMF technique in order to identify possible sources and estimate their contribution to particulate matter mass. PMF analysis uses the uncertainty of the measured data to provide an optimal weighting. Fifteen sources were resolved in eight size ranges (0.07~12 μm and included continental soil, local soil, sea salt, biomass/biofuel burning, coal combustion, oil heating furnace, residual oil fired boiler, municipal incineration, nonferrous metal source, ferrous metal source, gasoline vehicle, diesel vehicle, copper smelter and volcanic emission. PMF analysis of size-resolved source contributions showed that natural sources represented by local soil, sea salt and continental soil contributed about 79% to the predicted primary particulate matter (PM mass in the coarse size range (1.15~12 μm. On the other hand, anthropogenic sources such as coal combustion and biomass/biofuel burning contributed about 60% in the fine size range (0.56~2.5 μm. The diesel vehicle source contributed the most in the ultra-fine size range (0.07~0.56 μm and was responsible for about 52% of the primary PM mass.

  8. Factors Influencing Cotton Farmers’ Perceptions about the Importance of Information Sources in Precision Farming Decisions

    OpenAIRE

    Velandia, Margarita M.; Lambert, Dayton M.; Mendieta, Maria P.; Roberts, Roland K.; Larson, James A.; Burton C. English; Roderick M. Rejesus; Mishra, Ashok K.

    2011-01-01

    Information generated by precision farming technologies is of particular importance to producers. Precision farming technologies implies the ability to improve the management of production factors using site-specific information. This study examines factors influencing cotton farmers’ perceptions about the importance of crop consultants, farm input dealerships, Extension, other farmers, trade shows, the Internet and printed news/media for making precision farming decisions using a rank ordere...

  9. Determination Of Correction Factor Of Efficiency Of Plate Radiation Source For HPGe Detector

    International Nuclear Information System (INIS)

    This paper report the result of determination of correction factor of efficiency of HPGe detector for plate sample using combined method of measurement and calculation by making model of plate gamma radiation sample consisted of a uniform distribution of point gamma radiation sample in plate sample. The experiment data are presented in the form graph of the efficiency correction factor versus gamma energy for different the diameter of sample and the distance between sample and detector. The experimental result show that the bigger the diameter of the sample the higher the efficiency correction factor is. However the the shorter the distance between the sample and the detector the lower the efficiency correction factor is. The efficiency correction factor of the detector for gamma energy of 60 keV at the distance of 0.6 cm and for 3 cm diameter of sample is about 9%. It can be concluded that the efficiency correction factor is seriously affected by the diameter of the sample and the distance between the sample and the detector

  10. Identification of Metal Emissions from Adjacent Point Sources in Northern Norway Using Moss Biomonitoring and Factor Analysis

    International Nuclear Information System (INIS)

    Atmospheric deposition of 34 trace elements around an iron smelter complex in a town in northern Norway was studied in 2000 and 2005 using neutron activation analysis of naturally growing moss. Specific contributions from two adjacent but distinct smelters and changes in operation that had occurred between the two sampling years were identified by factor analysis, and relative contributions from the two sources at different sampling sites were demonstrated by means of the factor scores. In 2000 emission from a ferroalloy smelter (Smelter I) caused substantial deposition of Cr and Fe, and this smelter was also the main source of Al, V, Co, Ni, As, Mo, and W. Another nearby plant (Smelter II) recovering metals from used materials caused considerable deposition of Mn and Zn and was also the main source of Sb and W deposition. Following a transition from ferrochrome to ferromanganese production Smelter I in 2005 showed substantial deposition of Mn. This smelter also still was the main source of Cr, Co, Ni, As, and Mo. Smelter II maintained a considerable Zn deposition and showed increased emissions of Sb and W. In most of the urban area the contribution from Smelter I was dominant. (authors)

  11. Identification of metal emissions from adjacent point sources in Northern Norway using moss biomonitoring and factor analysis

    International Nuclear Information System (INIS)

    Atmospheric deposition of 34 trace metals around an iron-smelter complex in a town in Northern Norway was studied in 2000 and 2005 using neutron activation analysis of naturally growing moss. Specific contributions from two adjacent but distinct smelters and changes in operation that had occurred between the two sampling years were identified by factor analysis, and relative contributions from the two sources at different sampling sites were demonstrated by means of the factor scores. In 2000, emission from a ferroalloy smelter (Smelter I) caused substantial deposition of Cr and Fe, and this smelter was also the main source of Al, V, Co, Ni, As, Mo, and W. Another nearby plant (Smelter II) recovering metals from used materials caused considerable deposition of Mn and Zn and was also the main source of Sb and W deposition. Following a transition from ferrochrome to ferromanganese production, Smelter I in 2005 showed substantial deposition of Mn. This smelter was also still the main source of Cr, Co, Ni, As, and Mo. Smelter II maintained a considerable Zn deposition and showed increased emissions of Sb and W. In most of the urban area the contribution from Smelter I was dominant. An exception was two sites in the north-east direction from the industries, where emissions from Smelter II dominated in 2000 as well as in 2005

  12. Exploring the Factors Influencing the Adoption of Open Source Software in Western Cape Schools

    Science.gov (United States)

    Johnston, Kevin; Begg, Shameemah; Tanner, Maureen

    2013-01-01

    Open Source Software (OSS) presents many benefits to both the private and the public sectors, and has proven to be a viable solution in schools. Although a policy mandating the use of OSS exists in the Western Cape province of South Africa, very few schools in the province have adopted OSS. The education system in South Africa is currently facing…

  13. Open Source Software in Medium Size Organizations: Key Factors for Adoption

    Science.gov (United States)

    Solomon, Jerry T.

    2010-01-01

    For-profit organizations are constantly evaluating new technologies to gain competitive advantage. One such technology, application software, has changed significantly over the past 25 years with the introduction of Open Source Software (OSS). In contrast to commercial software that is developed by private companies and sold to organizations, OSS…

  14. 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.

  15. Contextual Factors, Knowledge Processes and Performance in Global Sourcing of IT Services: An Investigation in China

    OpenAIRE

    Rong Du; Shizhong Ai; Pamela Abbott; Yingqin Zheng

    2011-01-01

    Copyright @ 2011, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Reuse of this article has been approved by the publisher. In this paper, the authors explore the influences of two major contextual factors—supplier team members’ cultural understanding and trust relationship—on knowledge processes and performance in global sourcing of IT services. The authors discuss a joint investigation conducted by a cross-cultur...

  16. Sources of Machine-Tool Industry Leadership in the 1990s: Overlooked Intrafirm Factors

    OpenAIRE

    CHUMA Hiroyuki

    2001-01-01

    Through the use of extensive field research and an original international questionnaire, the main sources of the leapfrogging development of the Japanese machine-tool industry in the past 19 years were investigated. Past studies have emphasized the strategic R&D alliance with superlative computerized numerical control (CNC) makers, the extensive use of outsourcing from excellent precision parts' suppliers, and the extraordinary development of automakers. This paper critically considered these...

  17. The effects of emission sources and meteorological factors on sulphur dioxide concentration of Great Isfahan, Iran

    Science.gov (United States)

    Hosseiniebalam, Fahimeh; Ghaffarpasand, Omid

    2015-01-01

    The great Isfahan has experienced an almost fast industrialization during the last years. The different factories and industries near that, cause one of the important environmental problems, air pollution, which has not enough investigated before in this area. The hourly, diurnal and seasonal variations of SO2 concentration as one of the most dangerous air pollutants, are studied to clarify the rule of industry on the air pollution problem. The data had been measured continuously from April 2006 to March 2007 at two stations, Lale & Azadi. The air pollution concentrations in an urban area have a close relationship with meteorological factors. Hence, the variation of SO2 concentration is analysed respect to the meteorological factors such as temperature, relative humidity, wind speed, solar radiation, and pressure. Moreover, the studied air pollutant is also statistically investigated through correlation analysis and step-wise multiple linear regression equation. It was observed that electric power plant near the Isfahan, Montazeri, has significant effects on the SO2 concentration in the east and north of Isfahan. Long-term pattern of Isfahan winds which is westerly during the winter and spring, and easterly during the summer and autumn, was recognized as one of another important factors influenced the SO2 concentration variations. It is also achieved that meteorological factors have considerable contribution, R2 = 52%, on the SO2 concentration variation and temperature has largest effect among the others.

  18. Determinants of patient satisfaction in ambulatory oncology: a cross sectional study based on the OUT-PATSAT35 questionnaire

    International Nuclear Information System (INIS)

    The aim of this study was to identify factors associated with satisfaction with care in cancer patients undergoing ambulatory treatment. We investigated associations between patients' baseline clinical and socio-demographic characteristics, as well as self-reported quality of life, and satisfaction with care. Patients undergoing ambulatory chemotherapy or radiotherapy in 2 centres in France were invited, at the beginning of their treatment, to complete the OUT-PATSAT35, a 35 item and 13 scale questionnaire evaluating perception of doctors, nurses and aspects of care organisation. Additionally, for each patient, socio-demographic variables, clinical characteristics and self-reported quality of life using the EORTC QLQ-C30 questionnaire were recorded. Among 692 patients included between January 2005 and December 2006, only 6 were non-responders. By multivariate analysis, poor perceived global health strongly predicted dissatisfaction with care (p < 0.0001). Patients treated by radiotherapy (vs patients treated by chemotherapy) reported lower levels of satisfaction with doctors' technical and interpersonal skills, information provided by caregivers, and waiting times. Patients with primary head and neck cancer (vs other localisations), and those living alone were less satisfied with information provided by doctors, and younger patients (< 55 years) were less satisfied with doctors' availability. A number of clinical of socio-demographic factors were significantly associated with different scales of the satisfaction questionnaire. However, the main determinant was the patient's global health status, underlining the importance of measuring and adjusting for self-perceived health status when evaluating satisfaction. Further analyses are currently ongoing to determine the responsiveness of the OUT-PATSAT35 questionnaire to changes over time

  19. Concerns of stem cell transplant patients during routine ambulatory assessment

    Directory of Open Access Journals (Sweden)

    Klein C

    2013-01-01

    Full Text Available Lisa Kennedy Sheldon,1 Maryum Kazmi,1 Cynthia Klein,2 Donna L Berry31University of Massachusetts Boston, Boston, MA, 2Seattle Cancer Care Alliance, Seattle, WA, 3Phyllis Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USABackground: Stem cell transplant (SCT is a treatment choice for many hematological malignancies. There is currently a lack of evidence regarding the self-reported concerns of SCT patients before and after SCT.Aim and design: This exploratory study performed a secondary analysis of self-reported, written concerns of SCT patients before and after transplant to determine patients' concerns.Methods: Content analysis of text box entries of SCT patients collected between 2005 and 2007 at the Seattle Cancer Care Alliance. Text box entries were collected as part of symptom assessment using the Electronic Self-Report Assessment – Cancer instrument. The assessment was presented to 137 patients undergoing SCT at two time points: prior to ambulatory visits before any therapy had begun (T1 and at the first visit after hospital discharge following SCT (T2.Results: Text box entries were made before (n = 52 and after (n = 87 the transplant, resulting in 139 text box entries made by 137 patients representing 133 concerns. Using content analysis, the entries were categorized and ranked according to frequency. After symptom concerns, patients ranked work and financial issues the most frequent concerns prior to SCT. After SCT, symptoms remained the most frequently entered area of concern, followed by survival.Conclusion: Oncology providers need to assess SCT patients for work and financial concerns before and after transplant. Appropriate and timely referrals may ease the burden of these concerns for patients. Thus, assessment of financial and work concerns by the oncology team should be an integral part of quality health care for patients undergoing SCT.Keywords: self-report, electronic

  20. 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.

  1. Ambulatory assessed implicit affect is associated with salivary cortisol.

    Science.gov (United States)

    Mossink, Joram C L; Verkuil, Bart; Burger, Andreas M; Tollenaar, Marieke S; Brosschot, Jos F

    2015-01-01

    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-h 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 min 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. PMID:25713550

  2. Factors that Influence the Cutaneous Synthesis and Dietary Sources of Vitamin D

    OpenAIRE

    Chen, Tai C.; Chimeh, Farhad; Lu, Zhiren; Mathieu, Jeffrey; Person, Kelly S; Zhang, Anqi; Kohn, Nathan; Martinello, Steven; Berkowitz, Roger; Holick, Michael F.

    2007-01-01

    The major sources of vitamin D for most humans are casual exposure of the skin to solar ultraviolet B (UVB;290–315 nm) radiation and from dietary intake. The cutaneous synthesis of vitamin D is a function of skin pigmentation and of the solar zenith angle which depends on latitude, season, and time of day. In order to mimic the natural environment of skin to sunlight exposure, we therefore measured serum 25-hydroxyvitamin D levels in volunteers with different skin types following repeated UV ...

  3. Graphite reflecting characteristics and shielding factors for Miniature Neutron Source Reactors

    Energy Technology Data Exchange (ETDEWEB)

    Albarhoum, M., E-mail: pscientific1@aec.org.s [Department of Nuclear Engineering, Atomic Energy Commission, P.O. Box 6091, Damascus (Syrian Arab Republic)

    2011-01-15

    The usability of graphite as a reflector for MNSRs is investigated in this paper. Its use is optimized and shielding factors are calculated. Graphite seems to be compatible with liquid water. As a reflector, graphite proves to be usable as well, but it decreases the fuel cycle lifetime by about 7%. To optimize its use the average worth reactivity of the unit volume was assessed for the different modes of filling the shim tray of the reactor with graphite which were: RIOS, RIOC, ROIS, and ROIC modes for the radial direction, and ASM, and ACM modes for the axial one. This quantity was found to be maximum for the ROIC mode reaching more than 0.01 mk/cm{sup 3}. The shielding factors for the radial and axial filling modes were found to be 0.7101 and 0.6266, respectively.

  4. Graphite reflecting characteristics and shielding factors for Miniature Neutron Source Reactors

    International Nuclear Information System (INIS)

    The usability of graphite as a reflector for MNSRs is investigated in this paper. Its use is optimized and shielding factors are calculated. Graphite seems to be compatible with liquid water. As a reflector, graphite proves to be usable as well, but it decreases the fuel cycle lifetime by about 7%. To optimize its use the average worth reactivity of the unit volume was assessed for the different modes of filling the shim tray of the reactor with graphite which were: RIOS, RIOC, ROIS, and ROIC modes for the radial direction, and ASM, and ACM modes for the axial one. This quantity was found to be maximum for the ROIC mode reaching more than 0.01 mk/cm3. The shielding factors for the radial and axial filling modes were found to be 0.7101 and 0.6266, respectively.

  5. Source characterization of Highly Oxidized Multifunctional Compounds in a Boreal Forest Environment using Positive Matrix Factorization

    OpenAIRE

    Yan, Chao; Nie, Wei; Äijälä, Mikko; Rissanen, Matti P.; Canagaratna, Manjula R.; Massoli, Paola; Junninen, Heikki; Jokinen, Tuija; Sarnela, Nina; Häme, Silja; Schobesberger, Siegfried; Canonaco, Francesco; Prevot, Andre S. H.; Petäjä, Tuukka; Kulmala, Markku

    2016-01-01

    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)...

  6. Power Factor Correction in Voltage Source Inverter under Unbalanced Three-Phase Voltage Supply Conditions

    Czech Academy of Sciences Publication Activity Database

    Chomát, Miroslav; Schreier, Luděk

    Rio de Janeiro : IEEE Service Center, 2003, s. -. ISBN 0-7803-7912-8. [IEEE International Symposium on Industrial Electronics - ISIE 2003. Rio de Janeiro (BR), 09.06.2003-11.06.2003] R&D Projects: GA ČR GA102/02/0554 Institutional research plan: CEZ:AV0Z2057903 Keywords : unbalanced voltage supply * power factor correction * DC-link current pulsations Subject RIV: JA - Electronics ; Optoelectronics, Electrical Engineering

  7. Technological Innovation as a Factor of Demand for Energy Sources in Automotive Industry

    OpenAIRE

    Tatiana Mitrova; Vyacheslav Kulagin; Dmitry Grushevenko; Ekaterina Grushevenko

    2015-01-01

    The issue of forecasting demand for liquid fuels has become particularly significant in recent years with technological development and much tougher inter-fuel competition in the transport sector. In future, these developments could radically transform the oil, gas, and electricity markets. Therefore there is a greater need for improved forecasting methods that take into account the dynamics of market factors, primarily those related to the use of new technologies. ...

  8. 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

  9. 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. PMID:27105434

  10. Improving Clinical Workflow in Ambulatory Care: Implemented Recommendations in an Innovation Prototype for the Veteran’s Health Administration

    Science.gov (United States)

    Patterson, Emily S.; Lowry, Svetlana Z.; Ramaiah, Mala; Gibbons, Michael C.; Brick, David; Calco, Robert; Matton, Greg; Miller, Anne; Makar, Ellen; Ferrer, Jorge A.

    2015-01-01

    Introduction: Human factors workflow analyses in healthcare settings prior to technology implemented are recommended to improve workflow in ambulatory care settings. In this paper we describe how insights from a workflow analysis conducted by NIST were implemented in a software prototype developed for a Veteran’s Health Administration (VHA) VAi2 innovation project and associated lessons learned. Methods: We organize the original recommendations and associated stages and steps visualized in process maps from NIST and the VA’s lessons learned from implementing the recommendations in the VAi2 prototype according to four stages: 1) before the patient visit, 2) during the visit, 3) discharge, and 4) visit documentation. NIST recommendations to improve workflow in ambulatory care (outpatient) settings and process map representations were based on reflective statements collected during one-hour discussions with three physicians. The development of the VAi2 prototype was conducted initially independently from the NIST recommendations, but at a midpoint in the process development, all of the implementation elements were compared with the NIST recommendations and lessons learned were documented. Findings: Story-based displays and templates with default preliminary order sets were used to support scheduling, time-critical notifications, drafting medication orders, and supporting a diagnosis-based workflow. These templates enabled customization to the level of diagnostic uncertainty. Functionality was designed to support cooperative work across interdisciplinary team members, including shared documentation sessions with tracking of text modifications, medication lists, and patient education features. Displays were customized to the role and included access for consultants and site-defined educator teams. Discussion: Workflow, usability, and patient safety can be enhanced through clinician-centered design of electronic health records. The lessons learned from implementing

  11. Keeping it real--building an ROI model for an ambulatory EMR initiative that the physician practices espouse.

    Science.gov (United States)

    Mullen, Rńee; Donnelly, John T

    2006-01-01

    The ambulatory electronic medical record initiative at Magic Valley Regional Medical Center (MVRMC) in South Central Idaho underwent a rigorous product evaluation process that resulted in one of the market-leading EMR products being selected for implementation. MVRMC includes four business entities, including a 213-bed regional hospital and a 19-practice management services organization. Early in the process, the organization viewed buy-in from its physicians as a critical success factor. The physicians had been integral to product selection, and it was equally important for them to trust the economic model for its acquisition-especially because it was likely that they would be asked to put "some skin in the game." To make this initiative economically feasible, MVRMC received a grant from Agency for Healthcare Research and Quality based on the potential impact of the endeavor on healthcare delivery in the region. However, because the functional analysis did not result in the selection of the least expensive product, the AHRQ grant would only help defray the startup expenses, but not ongoing support and maintenance expenses after implementation; these costs would be borne by anticipated increases in the practice's revenue or reduction in its operating expenses. The ROI model would need to explain how each practice, from the single physician specialist to an almost 20-physician family practice, could pay for the desirable outcomes discussed during the selection phase of the project. The physicians, who had participated in technology initiatives in the past, were skeptical that cost-justifying an IT system was realistic, even though they recognized the potential benefits it could have on the quality and consistency of the care. Because some process standardization within and between practices would be needed to use electronic charting effectively, it was important that the ROI model did not outweigh the benefits of an as-yet untested operational workflow that

  12. 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.

  13. 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

  14. 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.

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

    DEFF Research Database (Denmark)

    Krogh-Madsen, Rikke; Thyfault, John P; Broholm, Christa; Mortensen, Ole Hartvig; Olsen, Rasmus H.; Mounier, Remi; Plomgaard, Peter; van Hall, Gerrit; Booth, Frank W; Pedersen, Bente K

    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 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 healthy young men decreased their daily activity level from a mean of 10,501+/-808 to 1,344+/-33 steps/day for 2 wk. Hyperinsulinemic-euglycemic clamps with stable isotopes and muscle biopsies, maximal oxygen consumption (VO2 max) tests, and blood samples were performed pre- and postintervention...

  16. 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 =…

  17. 45 CFR 170.304 - Specific certification criteria for Complete EHRs or EHR Modules designed for an ambulatory setting.

    Science.gov (United States)

    2010-10-01

    ... or EHR Modules designed for an ambulatory setting. 170.304 Section 170.304 Public Welfare DEPARTMENT... for Complete EHRs or EHR Modules designed for an ambulatory setting. The Secretary adopts the following certification criteria for Complete EHRs or EHR Modules designed to be used in an...

  18. Access to water source, latrine facilities and other risk factors of active trachoma in Ankober, Ethiopia.

    Directory of Open Access Journals (Sweden)

    Ilya Golovaty

    Full Text Available OBJECTIVE: This study aims to determine the prevalence and correlates of active trachoma in Ankober, Ethiopia. METHODS: A cross-sectional community-based study was conducted during July 2007. A total of 507 children (ages 1-9 years, from 232 households were included in the study. All children were examined for trachoma by ophthalmic nurses using the WHO simplified clinical grading system. Interviews and observations were used to assess risk factors. Logistic regression procedures were used to determine associations between potential risk factors and signs of active trachoma. RESULTS: Overall, the prevalence of active trachoma was found to be 53.9% (95%CI 49.6%-58.2%. Presence of fly-eye (fly contact with the eyelid margin during eye examination (Odds Ratio (OR = 4.03 95% CI 1.40-11.59, absence of facial cleanliness (OR = 7.59; 95%CI 4.60-12.52, an illiterate mother (OR = 5.88; 95%CI 2.10-15.95, lack of access to piped water (OR = 2.19; 95%CI 1.14-6.08, and lack of access to latrine facilities (OR = 4.36; 95%CI 1.49-12.74 were statistically significantly associated with increased risk of active trachoma. CONCLUSION: Active trachoma among children 1-9 years of age in Ankober is highly prevalent and significantly associated with a number of risk factors including access to water and latrine facilities. Trachoma prevention programs that include improved access to water and sanitation, active fly control, and hygiene education are recommended to lower the burden of trachoma in Ankober, Ethiopia.

  19. Measurement of compensation factors for coincidence in detection of Co-60 in solid source

    International Nuclear Information System (INIS)

    For some isotopes with cascade gamma-ray emission, for instance, Co-60 with two gamma rays of 1173.2 keV and 1332.5 keV, coincidence in detection would occur, which would reduce the count rate in full-energy-peak. And for some multi-ray isotopes, count rate in some full-energy-peak may increase, while some others decreasing. Usually the effect of coincidence can be neglected if the standard source or sample is far enough away from the detector, say, 25 cm in some common situations. But in the paper, in order to obtain enough precision in a limited period of time, the low-activity environmental sample was placed about 1 cm away from the detector, which would cause a considerable effect of coincidence. To reduce this deviation induced by coincidence, it is necessary to do some compensation in the process of detection. (authors)

  20. 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...

  1. Dietary Sources of Fiber Intake and Its Association with Socio-Economic Factors among Flemish Preschool Children

    OpenAIRE

    Inge Huybrechts; Herman Van Oyen; John Van Camp; Guy De Backer; Stefaan De Henauw; Stefanie Vandevijvere; Willem De Keyzer; Selin Bolca; Yi Lin

    2011-01-01

    The objectives were to assess total dietary fiber intake, identify the major sources of dietary fiber, and examine its association with socio-economic factors among Flemish preschoolers. Three-day estimated dietary records were collected from a representative sample of preschoolers 2.5–6.5 years old (n = 661; 338 boys, 323 girls). The mean dietary fiber intake (13.4 g/d) was lower than the intake level recommended by the Belgian Superior Health Council (70% boys and 81% girls below the guidel...

  2. 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......% of men, 62% of women) engaged in non-ambulatory activities during the registration period. The most frequently reported non-ambulatory activity was cycling, especially as transportation, which was reported by 39% (men: 31%, women: 48%) with a mean of 125 min/week (men: 107, women: 138 min/week). Our...... (13-14% increase) vs. 1875–1886 step equivalents/day for women (22% increase), thus significantly higher for women compared to men, p=0.03) Conclusion In populations like the Danish, where cycling and other non-ambulatory activities are popular, it will be relevant to account for these activities when...

  3. Evaluation of Faculty Members’ and Students’ Attitude Towards Ambulatory Teaching Quality

    Directory of Open Access Journals (Sweden)

    M. Ghafari, M.D.

    Full Text Available Background and purpose: Ambulatory medicine is one of the most important parts of medical education. Due to its profound relation with professional future of physicians, ambulatory medicine is especially under attention and many studies have been performed to survey its quality and to design some ways to promote it. There is obvious deficiency in our evidence about ambulatory medicine. The aim of this study was to survey the quality of teaching of the ambulatory medicine from the viewpoint of the faculty members and students of medical faculty of Mazandaran.Materials and Methods: This was a descriptive and cross-sectional study. The study's population consisted of students, residents and clinical faculty members who were included by simple sampling. Data collection was performed by a questionnaire with 22 questions about demographic and educational variables as well as respondents’ opinions about environmental conditions, independent activities, instructors’ supervision, and social training in the ambulatory clinics. The validity of the questionnaire was controlled by content validity with expertise consultation, and its reliability was controlled by test-retest(r=0.85. Data were analyzed using spss13 software.Results: Response rate was 79%, the mean age of 36 faculties was 43.6+- 8.7 years and 32% of them were female. The mean age of 146 students was 25+-3.6 years and 61% were female. The attitude of the majority of the students (88.3% towards the quality of ambulatory teaching was negative, but majority of faculties (66.7% had positive attitudes. There was no significant difference among teaching departments. Attitude of junior trainees was even worse. Attitude of faculty members and students was similar towards inappropriate physical environment of ambulatory clinics, but it was significantly different from independent activities of trainees in clinics (p=0.000; relational drugs prescription (p=0.000; management (p=0.004, and supervision

  4. 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.

  5. Aluminum concentrations in serum, dialysate, urine and bone among patients undergoing continuous ambulatory peritoneal dialysis (CAPD)

    DEFF Research Database (Denmark)

    Joffe, P; Olsen, F; Heaf, J G;

    1989-01-01

    Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations in the d......Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations...

  6. [Methodology of a cooperative study of response predictors in ambulatory depressive syndrome treated with nomifensine].

    Science.gov (United States)

    Spriet, A; Beiler, D; Dechorgnat, J; Chigot, C D; Rössner, M; Simon, P

    1978-06-28

    A multicentric therapeutic survey on ambulatory depressive patients has been designed so as to get data allowing response-prediction. The protocol included:--selection of non psychotic ambulatory depressive patients--one month's treatment with nomifensine--collection of data consisting mainly in a series of visual analogue scales, scored by a phisician and given in several random orders to avoid error of proximity. Data treatment indluded:--a step of checking and codification--the study of relations between global appraisal and characteristics of subjects--the study of initial profile of responders and non-responders, using discriminant analysis and correspondance factorial analysis. PMID:673807

  7. 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.

  8. Determination of the K shell oscillator strengths and the imaginary form factors of atoms using a weak beta source

    Energy Technology Data Exchange (ETDEWEB)

    Hosur, Savita B; Badiger, N M; Naik, L R [Department of Physics, Karnatak University, Dharwad-580 003 (India)], E-mail: nagappa123@yahoo.co.in

    2008-05-14

    The K shell oscillator strengths and the imaginary form factors of Gd, Hf and Ta atoms have been determined using a novel method. In this method, bremsstrahlung photons produced by beta particles from a weak beta source of {sup 90}Sr-{sup 90}Y in a nickel foil are incident on an elemental target and the transmitted spectrum of photons emerging from the target is measured using an ORTEC make HPGe detector coupled to 8 K multichannel analyser. The recorded spectrum shows a sudden drop at the K shell binding energy of the target atom and an exponential decrease in the intensity above the K shell binding energy. These portions have been used to determine the K shell binding energy, photoelectric cross-section at the K edge, the K shell oscillator strength and the imaginary form factor of the elements Gd, Hf and Ta. Good agreement between the experimental and the theoretical values is observed.

  9. Determination of the K shell oscillator strengths and the imaginary form factors of atoms using a weak beta source

    International Nuclear Information System (INIS)

    The K shell oscillator strengths and the imaginary form factors of Gd, Hf and Ta atoms have been determined using a novel method. In this method, bremsstrahlung photons produced by beta particles from a weak beta source of 90Sr-90Y in a nickel foil are incident on an elemental target and the transmitted spectrum of photons emerging from the target is measured using an ORTEC make HPGe detector coupled to 8 K multichannel analyser. The recorded spectrum shows a sudden drop at the K shell binding energy of the target atom and an exponential decrease in the intensity above the K shell binding energy. These portions have been used to determine the K shell binding energy, photoelectric cross-section at the K edge, the K shell oscillator strength and the imaginary form factor of the elements Gd, Hf and Ta. Good agreement between the experimental and the theoretical values is observed

  10. German ambulatory care physicians' perspectives on clinical guidelines – a national survey

    Directory of Open Access Journals (Sweden)

    Böcken Jan

    2006-07-01

    Full Text Available Abstract Background There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a clinical practice guidelines (CPG and b evidence based medicine (EBM The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. Methods Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale. 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi2 test was used to investigate distribution of two or more categorical variables. Results Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP as well as general practitioners (GP agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP or specialists (S (Student's t-test mean GP 2.57, S 2.84, p Conclusion Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs.

  11. Patterns of global gene expression in rat skeletal muscle during unloading and low-intensity ambulatory activity

    Science.gov (United States)

    Bey, Lionel; Akunuri, Nagabhavani; Zhao, Po; Hoffman, Eric P.; Hamilton, Deborah G.; Hamilton, Marc T.

    2003-01-01

    Physical inactivity and unloading lead to diverse skeletal muscle alterations. Our goal was to identify the genes in skeletal muscle whose expression is most sensitive to periods of unloading/reduced physical activity and that may be involved in triggering initial responses before phenotypic changes are evident. The ability of short periods of physical activity/loading as an effective countermeasure against changes in gene expression mediated by inactivity was also tested. Affymetrix microarrays were used to compare mRNA levels in the soleus muscle under three experimental treatments (n = 20-29 rats each): 12-h hindlimb unloading (HU), 12-h HU followed by 4 h of intermittent low-intensity ambulatory and postural activity (4-h reloading), and control (with ambulatory and postural activity). Using a combination of criteria, we identified a small set of genes (approximately 1% of 8,738 genes on the array or 4% of significant expressed genes) with the most reproducible and largest responses to altered activity. Analysis revealed a coordinated regulation of transcription for a large number of key signaling proteins and transcription factors involved in protein synthesis/degradation and energy metabolism. Most (21 of 25) of the gene expression changes that were downregulated during HU returned at least to control levels during the reloading. In surprising contrast, 27 of 38 of the genes upregulated during HU remained significantly above control, but most showed trends toward reversal. This introduces a new concept that, in general, genes that are upregulated during unloading/inactivity will be more resistant to periodic reloading than those genes that are downregulated. This study reveals genes that are the most sensitive to loading/activity in rat skeletal muscle and indicates new targets that may initiate muscle alterations during inactivity.

  12. 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.

  13. Photon buildup factors in some dosimetric materials for heterogeneous radiation sources.

    Science.gov (United States)

    Kurudirek, Murat

    2014-03-01

    Effective photon energy absorption (EABF(eff)) and exposure buildup factors (EBF(eff)) have been calculated based on the effective energy concept, for some dosimetric materials such as water, polymethyl methacrylate (PMMA), polystyrene, solid water (WT1), RW3 (Goettingen Water 3), and ABS (acrylonitrile butadiene styrene), for MV X-rays and (60)Co gamma rays. Firstly, the equivalent atomic numbers (Z(eq)) of the given materials have been determined using the effective photon energies (E eff). Then, the five-parameter geometric progression (G-P) fitting approximation has been used to calculate both EABF(eff) and EBF(eff) values. Since the G-P fitting parameters are not available for the E eff values of the given materials, a linear interpolation in which a function of the logarithm of the variable is used has been performed, in order to calculate the parameters in each E eff, which will be further used for the determination of EABF(eff) and EBF(eff). In the present paper, water equivalence properties of the given materials are also discussed based on the effective buildup factors. In this study, special emphasis is placed on the calculation of EABF(eff) and EBF(eff) values of different materials for photons that are not monoenergetic but heterogeneous in energy, to obtain an initial and prior knowledge of the probable energy and buildup of photons at locations of interest, i.e., to understand whether the real absorbed dose occurs at the surface or somewhere inside the medium of interest. PMID:24287785

  14. Characterization factors for water footprint considering the scarcity of green and blue water sources

    Science.gov (United States)

    Oki, T.; Kondo, T.; Pokhrel, Y. N.; Hanasaki, N.

    2011-12-01

    The original concept of virtual water trade was invented to illustrate how much water demand can be reduced by importing food products (Allan 1996), and expanded for meat products and industrial products (Oki and Kanae, 2004). However, there was a confusion between "virtual trade of water" (original) and "trade of virtual water" (misinterpretation but widely accepted), and "virtual water" has been recognized as how much water was used to produce the commodity. Then, the concept has some analogy to carbon footprint (CFP) which is an indicator of total emission of greenhouse gases, and nowadays called water footprint (WFP, Hoekstra, 2004). However, WFP itself is just an inventory of water usages under the framework of life cycle assessment (LCA), and the volume of WFP does not necessary reflect the environmental impacts of water usages because consumptive water use of 100 liter from ground water in arid regions just before rainy season would have more environmental impacts than consumptive water use of 100 liter from rain water in humid regions during snow melt season. In the case of CFP, the emissions of five greenhouse gases except for CO2 were converted into CO2 equivalent volumes by considering the sensitivity for the global warming potential, and summed up into CFP. Here, we propose a new idea objectively determining the weights (characterization factors) for blue water usages, such as from river and ground water, to be converted into green water equivalent in each region and time. The weights are inversely proportional to the area required to obtain the same amount of green water, and water balance model can provide the basic information. The new concept was applied to the WFP of Japan through the imports of major crops. As an inventory, WFP was 15.5 km3/y of rain water, 2.2 km3/y of river water, and 2.0 km3/y of non-renewable and non-local water (NRNL water) for year 2000, however, considering the proposed characterization factors in each region (0.5 x 0

  15. Greenhouse gas sources in the southern San Joaquin Valley of California derived from Positive Matrix Factorization of CalNex 2010 observations

    Science.gov (United States)

    Guha, A.; Gentner, D. R.; Weber, R.; Baer, D. S.; Gardner, A.; Provencal, R. A.; Goldstein, A. H.

    2012-12-01

    Quantifying the contributions of methane (CH4) and nitrous oxide (N2O) emission from sources in the southern San Joaquin valley is important for validation of the statewide greenhouse gas (GHG) inventory and subsequent AB32 law (California Global Warming Solutions Act 2006) implementation. The state GHG inventory is largely based on activity data and emission factor based estimates. The "bottom-up" emission factors for CH4 and N2O have large uncertainties and there is a lack of adequate "top-down" measurements to characterize emission rates from sources. Emissions from non-CO2 GHG sources display spatial heterogeneity and temporal variability, and are thus, often, poorly characterized. The Central Valley of California is an agriculture and industry intensive region with large concentration of dairies, refineries and active oil fields which are known CH4 sources while agricultural soil management and vehicular combustion are known sources of N2O. In summer of 2010, GHG sources in the southern San Joaquin valley were investigated as part of the CalNex (California at the Nexus of Air Quality and Climate Change) campaign. Measurements of GHG gases (CO2, CH4, and N2O) and the combustion tracer CO were performed at the Bakersfield super-site over a period of six weeks using fast response lasers based on cavity enhanced absorption spectroscopy (LGR Inc. CA). Coincident measurements of hundreds of volatile organic compounds (VOCs) served as anthropogenic and biogenic tracers of the GHG sources at local and regional levels. We present the results of Positive Matrix Factorization (PMF) analysis applied to the GHGs, CO, and 60 VOCs to define dominant source emission profiles. Seven source factors were identified and used to attribute the contribution of regional sources to enhancements above the background. Dairy operations were found to be the largest CH4 source in the region with approximately 80% of the regional emissions attributed to the 'dairy' factor. Factors dominated

  16. 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.

  17. 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

  18. 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.

  19. Influence of environmental factors on dissolved nitrate stable isotopes under denitrifying conditions - carbon sources and water isotopes

    Science.gov (United States)

    Wunderlich, A.; Meckenstock, R.; Einsiedl, F.

    2012-04-01

    Stable isotopes in dissolved nitrate are regularly used to identify sources of nitrate contamination in aquifers and water bodies. A dual isotope plot of 15N and 18O in nitrate can provide good evidence of the origin of such pollution as various sources have different isotopic signatures. Microbial denitrification changes both isotopic values by removing nitrate with lighter isotopes first, thereby increasing δ18O as well as δ15N. This change can distort the determination of sources but also has the potential to be used to identify and quantify microbial denitrification. Previous studies found a wide range of enrichment factors (ɛ) that did not allow conclusions towards the extent of microbial denitrification. However, it was found that during denitrification at each respective field site or laboratory experiment, there was a constant ratio in increase of the values of δ18O in relation to δ15N. That ratio was, however, not constant across field sites and the values published range from below 0.5 to more than 1.0. The reasons for these variations in enrichment factors and relative enrichment of oxygen compared to nitrogen are yet unknown. We conducted microcosm experiments with three different bacterial species to elucidate possible influences of environmental factors on these parameters. As a result we conclude that the type of carbon source available to denitrifying bacteria can play a role in the value of the enrichment factors, but not in the relative enrichment of the two isotopes. Specifically we found that complex hydrocarbons (toluene, benzoate) produce significantly different enrichment factors in nitrate than a simple hydrocarbon substrate (acetate). The relative enrichment of δ18O compared to δ15N was 0.86. We hypothesise that this influence is based on a variation in process kinetics of cross-membrane nitrate transport in relation to intracellular nitrate reduction. The core of the hypothesis is that nitrate transport into the cell becomes rate

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

    Directory of Open Access Journals (Sweden)

    C. Shim

    2007-11-01

    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.

  1. 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.

  2. Extracellular matrix is a source of mitogenically active platelet-derived growth factor.

    Science.gov (United States)

    Field, S L; Khachigian, L M; Sleigh, M J; Yang, G; Vandermark, S E; Hogg, P J; Chesterman, C N

    1996-08-01

    Platelet-derived growth factor (PDGF) is a chemotactic and mitogenic agent for fibroblasts and smooth muscle cells and plays a key role in the development of atherosclerotic lesions. PDGF is produced by a number of normal and transformed cell types and occurs as homo- or heterodimers of A and B polypeptide chains. Using Chinese hamster ovary (CHO) cells transfected with various forms of PDGF, we have previously shown that PDGF A(s) (short splice version) is secreted, PDGF A(l) (long splice version) predominantly extracellular matrix-associated, and PDGF B divided between medium, cells, and matrix. In the present study we have demonstrated the mitogenic activity of matrix-localized PDGF in artificial and more physiologically relevant models by culturing Balb/c-3T3 cells (3T3), human foreskin fibroblasts (HFF), and rabbit aortic smooth muscle cells (SMC) on extracellular matrix (ECM) laid down by PDGF-expressing CHO cells and human umbilical vein endothelial cells (HUVEC). These cells responded to the local growth stimulus of PDGF-containing CHO ECM and HUVEC ECM. We showed that 3T3 cells required proteolytic activity to utilize matrix-localized PDGF, as aprotinin and epsilon-ACA inhibited growth and 3T3 cells were shown to possess plasminogen activator activity. HFF and SMC did not appear to require proteolytic activity (including metalloproteinase and serine protease activity) as a prerequisite for mitogenesis but were able to access immobilized PDGF by contact with the matrix. An understanding of the mechanisms whereby the utilization of stored PDGF is controlled in situations of excessive cellular proliferation will aid in the development of therapy for these conditions. PMID:8707868

  3. 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

    2015-03-01

    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 (pfarms in the mid

  4. 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. PMID:27100329

  5. Factoring

    OpenAIRE

    Lenstra, Arjen K.

    1994-01-01

    Factoring, finding a non-trivial factorization of a composite positive integer, is believed to be a hard problem. How hard we think it is, however, changes almost on a daily basis. Predicting how hard factoring will be in the future, an important issue for cryptographic applications of composite numbers, is therefore a challenging task. The author presents a brief survey of general purpose integer factoring algorithms and their implementations

  6. Role Model Ambulatory Care Clinical Training Site in a Community-Based Pharmacy.

    Science.gov (United States)

    Magarian, Edward O.; And Others

    1993-01-01

    An interdisciplinary project provided ambulatory care clinical training for pharmacy and nursing students in community-based pharmacies, promoting early detection and medical follow-up of common health problems within the community. Students learned new clinical skills in patient health assessment, new diagnostic technologies, patient education…

  7. Integrated Clinical Geriatric Pharmacy Clerkship in Long Term, Acute and Ambulatory Care.

    Science.gov (United States)

    Polo, Isabel; And Others

    1994-01-01

    A clinical geriatric pharmacy clerkship containing three separate practice areas (long-term, acute, and ambulatory care) is described. The program follows the medical education clerkship protocol, with a clinical pharmacy specialist, pharmacy practice resident, and student. Participation in medical rounds, interdisciplinary conferences, and…

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

    DEFF Research Database (Denmark)

    Brader, Lea Johanne; Uusitupa, M; Dragsted, Lars Ove;

    2014-01-01

    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...

  9. Ambulatory esophageal manometry/pH-metry discriminates between patients with different esophageal symptoms.

    Science.gov (United States)

    Paterson, W G; Beck, I T; Wang, H

    1996-02-01

    Ambulatory esophageal manometry/pH-metry has been used primarily in patients with chest pain of presumed esophageal origin, and it is unclear whether the discriminating power of this test applies to other esophageal symptoms. In the present study, prolonged ambulatory manometry/pH recordings were compared in 17 healthy controls, 12 patients with atypical chest pain, and 11 patients with chest pain and nonstructural dysphagia using the Synectics microdigitrapper system. Chest pain patients tended to have higher values for all the pH variables, but their esophageal motility parameters were no different than controls. On the other hand, the chest pain plus dysphagia group was characterized by a significantly lower proportion of propagated contractions between 10 and 5 cm above the lower esophageal sphincter. This group also tended to have a higher frequency of high-amplitude or prolonged-duration contractions. In comparison to the results of standard stationary esophageal manometry, the prolonged ambulatory recordings were more sensitive in detecting esophageal motor dysfunction in the two patient groups. This study suggests that quantitative analysis of ambulatory pH/motility recordings is a sensitive method of evaluating patients with suspected esophageal dysfunction. PMID:8601383

  10. 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

  11. 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…

  12. Risk prediction models for mortality in ambulatory patients with heart failure: a systematic review

    OpenAIRE

    Alba, Ana C; Agoritsas, Thomas; Jankowski, Milosz; Courvoisier, Delphine; Walter, Stephen D.; Guyatt, Gordon H; Ross, Heather J

    2013-01-01

    Optimal management of heart failure requires accurate assessment of prognosis. Many prognostic models are available. Our objective was to identify studies that evaluate the use of risk prediction models for mortality in ambulatory patients with heart failure and describe their performance and clinical applicability.

  13. 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...

  14. Higher monetary incentives led to a lowered response rate in ambulatory patients: a randomized trial

    NARCIS (Netherlands)

    Koetsenruijter, J.; Lieshout, J. van; Wensing, M.

    2015-01-01

    OBJECTIVES: Monetary incentives can increase response rate in patient surveys, but calibration of the optimal incentive level is required. Our aim was to assess the effect of different monetary incentives on response rates to calibrate the optimal monetary incentive for ambulatory patients. STUDY DE

  15. Primary Care, Ambulatory Care, and Family Medicine: Overlapping But Not Synonymous

    Science.gov (United States)

    Reynolds, Robert E.

    1975-01-01

    Defines and depicts graphically the relationships between primary, secondary, and tertiary care functions (from least to most intensified phases of medical care); ambulatory care (care of sick or well people not confined to bed); and family medicine (an emerging medical discipline focusing on complete and longterm care of the family). (JT)

  16. 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 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. PMID:26371593

  17. 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

  18. 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...

  19. Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions

    NARCIS (Netherlands)

    Freund, T.; Campbell, S.M.; Geissler, S.; Kunz, C.U.; Mahler, C.; Peters-Klimm, F.; Szecsenyi, J.

    2013-01-01

    PURPOSE: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex c

  20. 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...

  1. Ambulatory Care Sensitive Conditions in Persons with an Intellectual Disability--Development of a Consensus

    Science.gov (United States)

    Balogh, Robert S.; Ouellette-Kuntz, Helene; Brownell, Marni; Colantonio, Angela

    2011-01-01

    Background: There is evidence that the primary care provided for persons with an intellectual disability living in the community has been inadequate. Hospitalization rates for ambulatory care sensitive (ACS) conditions are considered an indicator for access to, and quality of, primary care. The objective of this research was to identify ACS…

  2. Health system support and health system strengthening: two key facilitators to the implementation of ambulatory tuberculosis treatment in Uzbekistan.

    Science.gov (United States)

    Kohler, Stefan; Asadov, Damin Abdurakhimovich; Bründer, Andreas; Healy, Sean; Khamraev, Atadjan Karimovich; Sergeeva, Natalia; Tinnemann, Peter

    2015-12-01

    Uzbekistan inherited a hospital-based health system from the Soviet Union. We explore the health system-related challenges faced during the scale-up of ambulatory (outpatient) treatment for drug-susceptible and drug-resistant tuberculosis (TB) in Karakalpakstan in Uzbekistan. Semi-structured interviews were conducted with key informants of the TB services, the ministries of health and finance, and their TB control partners. Structural challenges and resource needs were both discussed as obstacles to the expansion of ambulatory TB treatment. Respondents stated need for revising the financing mechanisms of the TB services to incentivize referral to ambulatory TB treatment. An increased workload and need for transportation in ambulatory TB care were also pointed out by respondents, given the quickly rising outpatient numbers but per capita financing of outpatient care. Policy makers showed strong interest in good practice examples for financing ambulatory-based management of TB in comparable contexts and in guidance for revising the financing of the TB services in a way that strengthens ambulatory TB treatment. To facilitate changing the model of care, TB control strategies emphasizing ambulatory care in hospital-oriented health systems should anticipate health system support and strengthening needs, and provide a plan of action to resolve both. Addressing both types of needs may require not only involving TB control and health financing actors, but also increasing knowledge about viable and tested financing mechanisms that incentivize the adoption of new models of care for TB. PMID:27406392

  3. Ambulatory and central haemodynamics during progressive ascent to high-altitude and associated hypoxia.

    Science.gov (United States)

    Schultz, M G; Climie, R E D; Sharman, J E

    2014-12-01

    High-altitude hypoxia causes major cardiovascular changes, which may result in raised resting brachial blood pressure (BP). However, the effect of high-altitude hypoxia on more sensitive measures of BP control (such as 24 h ambulatory BP and resting central BP) is largely unknown. This study aimed to assess this and compare high-altitude responses to resting brachial BP, as well as determine the haemodynamic correlates of acute mountain sickness (AMS) during a progressive trekking ascent to high-altitude. Measures of oxygen saturation (pulse oximetry), 24 h ambulatory BP, resting brachial and central BP (Pulsecor) were recorded in 10 adults (aged 27±4, 30% male) during a 9-day trek to Mount Everest base camp, Nepal. Data were recorded at sea level (stage 1; <450 m above sea level (ASL)) and at progressive ascension to 3440 m ASL (stage 2), 4350 m ASL (stage 3) and 5164 m ASL (stage 4). The Lake Louise score (LLS) was used to quantify AMS symptoms. Total LLS increased stepwise from sea level to stage 4 (0.3±0.7 vs 4.4±2.0, P=0.012), whereas oxygen saturation decreased to 77±9% (P=0.001). The highest recordings of 24 h ambulatory, daytime, night time, brachial and central systolic BP and diastolic BP were achieved at stage 3, which were significantly greater than at sea level (P<0.005 for all). Twenty-four-hour ambulatory heart rate (HR) and night HR correlated with oxygen saturation (r=-0.741 and -0.608, both P<0.001) and total LLS (r=0.648 and r=0.493, both P<0.001). We conclude that 24 h ambulatory BP, central BP and HR are elevated during high-altitude hypoxia, but AMS symptoms are only related to tachycardia. PMID:24621622

  4. 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

    OpenAIRE

    Luiz Eduardo Imbelloni; Eneida Maria Vieira; Marildo Assunção Gouveia; José Antônio Cordeiro

    2004-01-01

    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 h...

  5. Assessment of pedometer-determined physical activity in Danish adults: the importance of non-ambulatory activities

    OpenAIRE

    Rothausen, Berit Worm; Gille, Maj-Britt; Biltoft-Jensen, Anja Pia; Raustorp, Anders; Matthiessen, Jeppe

    2009-01-01

    Purpose To estimate mean values of steps/day in a representative sample of Danish adults (15-75 years) using two different conversion methods for non-ambulatory (non-step) activities. Methods A simple random sample comprising 229 adults (52% men) from the Danish National Survey of Dietary Habits 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 w...

  6. Source identification of different size fraction of PM10 using factor analysis at residential cum commercial area of Nagpur city.

    Science.gov (United States)

    Pipalatkar, P P; Gajghate, D G; Khaparde, V V

    2012-02-01

    Particulate size distribution of PM(10) and associated trace metal concentrations has been carried out in residential cum commercial area of Mahal at Nagpur city. Sampling for size fraction of particulate matter was performed during winter season using eight-stage cascade impactor with a pre-separator and toxic metals were analyzed using inductively coupled plasma-optical emission spectroscopy (ICP-OES). The average concentration of PM(10) and fine particulate matter (effective cut of aerodynamic diameter ≤2.2 μm) was found to be 300 and 136.7 μg/m(3), respectively which was exceeding limit of Central Pollution Control Board. Maximum mass concentration of 41 μg/m(3) in size range of 9.0-10.0 μm and minimum mass concentration of 19 μg/m(3) in size range 2.2-3.3 μm was observed. Metals (Sr, Ni and Zn) were found to large proportions in below 0.7 μm particle size and could therefore pass directly into the alveoli region of human respiratory system. Factor analysis results indicated combustion and vehicular emission as the dominant source in fine mode and resuspended dust was dominant in medium mode while crustal along with vehicular source was major in coarse mode of particulate matter. PMID:22033656

  7. Factors Influencing the Electron Yield of Needle-Ring Pulsed Corona Discharge Electron Source for Negative Ion Mobility Spectrometer

    Science.gov (United States)

    Liu, Xin; Li, Shengli; Li, Mingshu

    2013-12-01

    A simple negative ion mobility spectrometer (IMS) is designed and used to investigate the factors that influence the number and efficiency of electrons generated by the needle-ring pulsed corona discharge electron source. Simulation with Ansoft Maxwell 12 is carried out to analyze the electric field distribution within the IMS, and to offer the basis and foundation for analyzing the measurement results. The measurement results of the quantities of electrons show that when the drift electric field strength and the ring inner diameter rise, both the number of effective electrons and the effective electron rate are increased. When the discharge voltage becomes stronger, the number of effective electrons goes up while the effective electron rate goes down. In light of the simulation results, mechanisms underlying the effects of drift electric field strength, ring inner diameter, and discharge voltage on the effective electron number and effective electron rate are discussed. These will make great sense for designing negative ion mode IMS using the needle-ring pulsed corona discharge as the electron source.

  8. Factors controlling global tropospheric ozone: roles of isoprene chemistry, tropospheric halogen chemistry, convection, and lightning NOx sources

    Science.gov (United States)

    Hu, L.; Jacob, D. J.; Zhang, Y.; Liu, X.; Zhang, L.

    2015-12-01

    Ozone is central to our understanding of tropospheric oxidant chemistry through its driving of radical cycles. Yet our understanding of factors determining its spatial distribution and long-term trend is still poor. In this work, we use the GEOS-Chem chemical transport model as a platform to test our current knowledge of key factors controlling tropospheric ozone. We evaluate the most recent GEOS-Chem simulation against in-situ data using ozonesonde networks from WOUDC and NOAA-GMD and using aircraft observations from MOZAIC/IAGOS, to examine the vertical distribution of modeled tropospheric ozone. Satellite observed ozone data from OMI (Ozone Monitoring Instrument) are used to assess the spatial distribution of the predicted ozone concentrations. We also examine different versions of GEOS-Chem outputs from historical benchmarks and from sensitivity runs (such as changing in chemistry and meteorological fields) for their capabilities to reproduce observed tropospheric ozone patterns. In this presentation, we interpret these analyses in terms of present understanding in isoprene chemistry, tropospheric bromine chemistry, lightning NOx sources and deep convection, and examine their implications for key model processes controlling the abundance and variability of global tropospheric ozone.

  9. 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.

  10. [Responses of alpine grassland landscape in the source region of Shule River Basin to topographical factors and frozen ground types].

    Science.gov (United States)

    Chen, Jian-Jun; Yi, Shu-Hua; Qin, Yu; Wang, Xiao-Yun

    2014-06-01

    This paper retrieved the fractional vegetation cover of alpine grassland in the source region of the Shule River Basin based on Chinese environmental satellite (HJ-1A/1B) images and field data, and analyzed the response of the vegetation cover to topographic factors and types of frozen ground. The results showed that the vegetation coverage of this region was low with large spatial heterogeneity and high degree of dispersion. The landscape consisted mainly of non-vegetation surface types, eg. ice, snow, the bare rock gravel land and bare land. Slopes and aspects were the main limiting factors of vegetation distribution. The average vegetation coverage decreased with the increase of slope. The average vegetation coverage was the lowest on the sunny slope, and the highest on the shady slope. There were significant differences of vegetation coverage among different types of frozen ground. The distribution of vegetation coverage presented a reversed "U" curve trend by extremely stable permafrost, stable permafrost, sub-stable permafrost, transition permafrost, unstable permafrost and seasonal frost, and the average vegetation coverage was the highest in the sub-stable permafrost. PMID:25223013

  11. 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.

  12. Combining parallel factor analysis and machine learning for the classification of dissolved organic matter according to source using fluorescence signatures.

    Science.gov (United States)

    Cuss, C W; McConnell, S M; Guéguen, C

    2016-07-01

    Parallel factor (PARAFAC) analysis of dissolved organic matter (DOM) fluorescence has facilitated a surge of investigation into its biogeochemical cycling. However, rigorous, PARAFAC-based methods for holistically distinguishing DOM sources are lacking. This study classified 1029 PARAFAC-analyzed excitation-emission matrices (EEMs) measured using DOM isolated from 24 different leaf leachates, rivers, and organic matter standards using four machine learning methods (MLM). EEMs were also divided into subsets to assess the impact of experimental treatments (i.e. whole EEMs, size fractionation, mixtures, quenching) and dataset properties (i.e. different numbers of EEMs from each leachate/river) on classification. A split-half validated, 10-component PARAFAC model was extended to 12 components to remove consistent peaks evident in model residuals. The 12-component model performed better than the 10-component model, correctly classifying up to 80 additional EEMs, when the dataset included size-fractionated DOM or several different sources (i.e. many leaf species and rivers); however, the 10-component model performed better for whole-sample EEMs when comparing leaf leachates to rivers. The MLM correctly classified whole EEMs of riverine DOM by source with up to 87.0% accuracy, leachates with up to 92.5% accuracy, and distinguished leachates from rivers with 97.2% accuracy. A difference of up to 17.3% in classification accuracy was observed depending on the MLM method used with the following order: multilayer perceptron = support vector machine > k-nearest neighbours ≫ decision tree; however, performances differed widely depending on the data subset. Classification accuracy for whole and size-fractionated rivers compared to whole and size-fractionated leachates using N-way partial least-squares discriminant analysis (NPLS-DA; 97.7%) was similar to that achieved using MLM. Combining MLM with PARAFAC is an effective method for classifying DOM based on its

  13. Assessment of the neutron emission anisotropy factor of a sealed AmBe source by means of measurements and Monte Carlo simulations

    International Nuclear Information System (INIS)

    The neutron emission anisotropy factor of a sealed Americium–Beryllium source is experimentally determined and compared to Monte Carlo simulations. The measurements were done at the Italian Institute for Metrology of Ionizing Radiations using a long counter neutron detector and a “X.3” type AmBe sealed neutron source. Experimental data are compared to simulations performed with the MCNP code where the precise structure of the source is taken into account starting from its technical design. The contributions of the single structural parts are described to point out the effective sources of the emission anisotropy

  14. Assessment of the neutron emission anisotropy factor of a sealed AmBe source by means of measurements and Monte Carlo simulations

    Energy Technology Data Exchange (ETDEWEB)

    Loreti, S.; Pietropaolo, A., E-mail: antonino.pietropaolo@enea.it

    2015-10-11

    The neutron emission anisotropy factor of a sealed Americium–Beryllium source is experimentally determined and compared to Monte Carlo simulations. The measurements were done at the Italian Institute for Metrology of Ionizing Radiations using a long counter neutron detector and a “X.3” type AmBe sealed neutron source. Experimental data are compared to simulations performed with the MCNP code where the precise structure of the source is taken into account starting from its technical design. The contributions of the single structural parts are described to point out the effective sources of the emission anisotropy.

  15. 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

  16. Dependence of Yb-169 absorbed dose energy correction factors on self-attenuation in source material and photon buildup in water

    International Nuclear Information System (INIS)

    Purpose: Absorbed dose energy correction factors, used to convert the absorbed dose deposited in a LiF thermoluminescent dosimeter (TLD) into the clinically relevant absorbed dose to water, were obtained for both spherical volumetric sources and for the model 4140 HDR Yb-169 source. These correction factors have a strong energy dependence below 200 keV; therefore, spectral changes were quantified as Yb-169 photons traveled through both source material (Yb2O3) and water with the corresponding absorbed dose energy correction factors, f(r,θ), calculated as a function of location in a phantom. Methods: Using the MCNP5 Monte Carlo radiation transport simulation program, the Yb-169 spectrum emerging from spherical Yb2O3 sources (density 6.9 g/cm3) with radii between 0.2 and 0.9 mm were analyzed and their behavior compared against those for a point-source. The absorbed dose deposited to both LiF and H2O materials was analyzed at phantom depths of 0.1-10 cm for each source radius and the absorbed dose energy correction factor calculated as the ratio of the absorbed dose to water to that of LiF. Absorbed dose energy correction factors for the Model 4140 Yb-169 HDR brachytherapy source similarly were obtained and compared against those calculated for the Model M-19 Ir-192 HDR source. Results: The Yb-169 average spectral energy, emerging from Yb2O3 spherical sources 0.2-0.9 mm in radius, was observed to harden from 7% to 29%; as these photons traveled through the water phantom, the photon average energy softened by as much as 28% at a depth of 10 cm. Spectral softening was dependent on the measurement depth in the phantom. Energy correction factors were found to vary both as a function of source radius and phantom depth by as much as 10% for spherical Yb2O3 sources. The Model 4140 Yb-169 energy correction factors depended on both phantom depth and reference angle and were found to vary by more than 10% between depths of 1 and 10 cm and angles of 0 deg. and 180 deg. This was

  17. Replacing Ambulatory Surgical Follow-Up Visits With Mobile App Home Monitoring: Modeling Cost-Effective Scenarios

    OpenAIRE

    Armstrong, Kathleen A; Semple, John L; Coyte, Peter C.

    2014-01-01

    Background Women’s College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile ap...

  18. Relationship of 24-hour ambulatory blood pressure and heart rate with markers of hepatic function in cirrhotic patients

    OpenAIRE

    Stergiou George S; Dourakis Spyros P; Alexopoulou Alexandra; Tzamouranis Dimitris G

    2010-01-01

    Abstract Background There is evidence that in cirrhotic patients, certain hemodynamic parameters, such as blood pressure and heart rate, are related to the severity of liver disease. This study investigated whether non-invasive 24-hour ambulatory blood pressure and heart rate are more closely associated with markers of liver disease severity than conventional office measurements. Methods Ambulatory patients with cirrhosis underwent office blood pressure and heart rate measurements, 24-hour am...

  19. The AmBulatory Closure Device Percutaneous Intervention (ABCD-PCI) study: a single-center experience

    OpenAIRE

    Falcone, Adam M.; Bose, Rahul; Stoler, Robert C; Kim, Michael; Laible, Emily; Kang, Lucy; Waters, Kim; Dunkerley, Janet; Choi, James W.

    2011-01-01

    The AmBulatory Closure Device Percutaneous Intervention (ABCD-PCI) study is a multicenter randomized prospective controlled trial evaluating the safety of and patient satisfaction with same-day discharge following ambulatory percutaneous intervention with a closure device. This article reviews the findings from a single center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, from October 2008 through April 2010, with 23 patients in the same-day discharge group and 21 patients in th...

  20. Assessment of ambulatory activity in the Republic of Korea Navy submarine crew.

    Science.gov (United States)

    Choi, Seong-Woo; Lee, Jae-Ho; Jang, Young-Keun; Kim, Jung-Ryul

    2010-01-01

    A submarine crew in the Republic of the Korea Navy experienced significant physical inactivity during undersea deployment because of the narrow and confined space. Physical inactivity is known to be associated with a number of adverse health conditions in the long-term perspective. This study aimed to assess the ambulatory activity of submarine crew using pedometers. Study subjects (n=109) were the submarine crew from two diesel submarines and personnel from the Submarine Command. The subjects wore pedometers at their waistline and recorded their walking steps daily for a month. The submarine crew walked more than 7000 steps/day on average during the stationed period. However, the ambulatory activity of the submarine crew greatly declined to a level of around 2000 steps/day during deployment, which corresponded to the sedentary status category. Active exercise is recommended for the submarine crew to prevent potential adverse health outcomes related to the physical inactivity. PMID:21226392

  1. 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

    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...... number of daily steps induced a significant reduction of 17% in the glucose infusion rate (GIR) during the clamp. This reduction was due to a decline in peripheral insulin sensitivity with no effect on hepatic endogenous glucose production. The insulin-stimulated ratio of pAkt(thr308)/total Akt decreased...... 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...

  2. 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.

  3. The employee-safety and infection-control manual: guidelines for the ambulatory health care center.

    Science.gov (United States)

    Stone, R

    1991-04-01

    The ambulatory health care center has an empirical need to maintain adequate policies and procedures designed to safeguard the health and physical safety of both clients and employees. Of particular concern is the health care worker's risk of injury or exposure to infection. This article discusses the development of a comprehensive employee-safety and infection-control manual. Such a manual can assist in the accreditation of an ambulatory health care center by a national accrediting organization, and can also serve as a risk-management tool. An example of a manual's table of contents, a specific policy/procedure, a waiver form regarding human immunodeficiency virus exposure, and a hepatitis B virus "vaccination status" form are provided. Additionally, two "quick-look" texts are presented as examples of fast reference guides for common safety practices and the treatment of the employee with a health-threatening exposure. PMID:1905791

  4. Brief Bedside Refresher Training to Practice Cardiopulmonary Resuscitation Skills in the Ambulatory Surgery Center Setting.

    Science.gov (United States)

    Kemery, Stephanie; Kelly, Kelley; Wilson, Connie; Wheeler, Corrine A

    2015-08-01

    Cardiac arrest can occur in any health care setting at any time, requiring nursing staff to be prepared to quickly and adequately perform basic cardiopulmonary resuscitation (CPR). Currently, the American Heart Association certifies health care providers in Basic Life Support (BLS) for a 2-year period, but evidence indicates that psychomotor skills decline well before the end of the certification time frame. Nurses in the ambulatory surgery setting expressed concern regarding their ability to implement CPR successfully, given the infrequent occurrence of cardiac and respiratory arrests. Using a study by Niles et al. as a model, the authors piloted the implementation of brief CPR refresher training at the bedside of an ambulatory surgery center to assess and increase nurse confidence in BLS skills. PMID:26247660

  5. Holmium Laser Enucleation of the Prostate (HoLEP in Ambulatory Surger

    Directory of Open Access Journals (Sweden)

    Marc Fourmarier

    2015-05-01

    Full Text Available The focus of this work is the need to give an update on the holmium laser enucleation of the prostate (HoLEP technique in ambulatory surgery. Indeed, over the last two decades, there has been a significant change in surgical treatment of benign prostatic hyperplasia. Laser surgery has been growing in popularity as an alternative to standard transurethral prostatectomy. Our goal was to analyse the opportunity to perform HoLEP in one-day surgery. Furthermore, there is a willingness of the French Ministry of Health to develop this kind of management. A pilot study was performed in 50 selected patients to evaluate HoLEP feasibility in ambulatory surgery from June 2013 to April 2014. The results were good with minimal morbidity and a high satisfaction rate, but excellent organisation is necessary, leaving no room for improvisation.

  6. Preoperative Ambulatory Inspiratory Muscle Training in Patients Undergoing Esophagectomy. A Pilot Study

    OpenAIRE

    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 wo...

  7. Integrity of the Anterior Visual Pathway and Its Association with Ambulatory Performance in Multiple Sclerosis

    OpenAIRE

    Swathi Balantrapu; Brian M. Sandroff; Pula, John H.; Motl, Robert W.

    2013-01-01

    Background. Retinal nerve fiber layer thickness (RNFLT) and total macular volume (TMV) represent markers of neuroaxonal degeneration within the anterior visual pathway that might correlate with ambulation in persons with multiple sclerosis (MS). Objective. This study examined the associations between RNFLT and TMV with ambulatory parameters in MS. Methods. Fifty-eight MS patients underwent a neurological examination for generation of an expanded disability status scale (EDSS) score and measur...

  8. Ambulatory Blood Pressure Monitoring and Circadian Rhythm of Blood Pressure in Diabetes Mellitus

    OpenAIRE

    Elena Matteucci; Ottavio Giampietro

    2013-01-01

    Systolic and diastolic blood pressures display a circadian rhythmicity that can be assessed by 24-hour ambulatory blood pressure monitoring and analysed using the cosinor procedure. Altered characteristics to the circadian rhythm of blood pressure, which may result in adverse health outcomes, have been observed in both prediabetes and diabetes. We have investigated the circadian variability of blood pressure in patients with type 1 and type 2 diabetes. Chronobiologically interpreted ambulator...

  9. 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.

  10. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings

    OpenAIRE

    Sen S.; Bowen JF; Ganetsky VS; Hadley D; Melody K; Otsuka S; Vanmali R; Thomas T

    2014-01-01

    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...

  11. 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.

  12. Ambulatory Assessment - Monitoring Behavior in Daily Life Settings: A Behavioral-Scientific Challenge of Psychology

    OpenAIRE

    Fahrenberg, Jochen; Myrtek, Michael; Pawlik, Kurt; Perrez, Meinrad

    2009-01-01

    Abstract. Ambulatory assessment refers to the use of computer-assisted methodology for self-reports, behavior records, or physiological measurements, while the participant undergoes normal daily activities. Since the 1980s, portable microcomputer systems and physiological recorders/analyzers have been developed for this purpose. In contrast to their use in medicine, these new methods have hardly entered the domain of psychology. Questionnaire methods are still preferred, in spite of the known...

  13. 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…

  14. Pharmacokinetics of Quinupristin-Dalfopristin in Continuous Ambulatory Peritoneal Dialysis Patients

    OpenAIRE

    Johnson, Curtis A.; Taylor, Claude A.; Zimmerman, Stephen W.; Bridson, William E.; Chevalier, Paul; Pasquier, Olivier; Baybutt, Robert I.

    1999-01-01

    Quinupristin-dalfopristin may be useful for treatment of organisms causing peritoneal dialysis-related peritonitis, including methicillin-resistant coagulase-negative staphylococci, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. The pharmacokinetic profiles of single intravenous doses of this combination streptogramin antibiotic of 7.5 mg/kg of body weight were characterized for eight noninfected patients receiving continuous ambulatory peritoneal dialysis....

  15. Acute Hydrothorax Complicating continuous Ambulatory Peritoneal Dialysis: A Case Report and Review of Literature

    OpenAIRE

    Kechrid Mohammad; Malik Ghulam; Shaikh Jamil; Al-Mohaya Suleiman; Al-Wakeel Jamal; El Gamal Hazem

    1999-01-01

    We describe here hydrothorax that occurred in a patient on continuous ambulatory peritoneal dialysis (CAPD) and highlight the problems of diagnosis and management. A 48 years-old man with history of obstructive uropathy secondary to urolithiasis was stared on CAPD when he reached end-stage renal failure. Two months later, he was admitted with two days history of shortness of breath on exertion and dry cough increasing in supine position. Chest examination was suggestive of right sided pleural...

  16. MRI in the diagnosis of a peritoneal leak in continuous ambulatory peritoneal dialysis

    International Nuclear Information System (INIS)

    Mechanical problems in continuous ambulatory peritoneal dialysis (CAPD) can result in ultrafiltration failure and disruption of CAPD therapy. The recently described tool of CT peritoneography with water-soluble contrast medium has the disadvantage of radiation and instillation of nephrotoxic substances. We report a child with a peritoneal leak diagnosed by MRI after instillation of a gadodiamide-dialysate mixture. This method provided good anatomical detail without radiation or nephrotoxic agents. (orig.)

  17. General anesthesia plus ilioinguinal nerve block versus spinal anesthesia for ambulatory inguinal herniorrhapy

    OpenAIRE

    Lucía Vizcaíno-Martínez; Manuel Ángel Gómez-Ríos; Beatriz López-Calviño

    2014-01-01

    Objective: The aim was to evaluate general anesthesia (GA) plus ilioinguinal nerve block (IIB) versus spinal anesthesia (SA) in patients scheduled for ambulatory inguinal hernia repair regarding pain management, anesthesia recovery and reducing potential complications. Materials and Methods: A double-blind, prospective, randomized, controlled study in patients American Society of Anesthesiologists I-III randomized into two groups: GA plus IIB group, induction of anesthesia with propofol, main...

  18. Ambulatory Blood Pressure Monitoring in Individuals with HIV: A Systematic Review and Meta-Analysis

    OpenAIRE

    Kent, Shia T; Bromfield, Samantha G.; Burkholder, Greer A.; Falzon, Louise; Oparil, Suzanne; Overton, Edgar T.; Mugavero, Michael J.; Schwartz, Joseph E.; Shimbo, Daichi; Muntner, Paul

    2016-01-01

    Introduction Abnormal diurnal blood pressure (BP) rhythms may contribute to the high cardiovascular disease risk in HIV-positive (HIV+) individuals. To synthesize the current literature on ambulatory BP monitoring (ABPM) in HIV+ individuals, a systematic literature review and meta-analysis were performed. Methods Medical databases were searched through November 11, 2015 for studies that reported ABPM results in HIV+ individuals. Data were extracted by 2 reviewers and pooled differences betwee...

  19. 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.

  20. German ambulatory care physicians' perspectives on clinical guidelines – a national survey

    OpenAIRE

    Böcken Jan; Dieterle Wilfried E; Schnee Melanie; Kempkens Daniela; Butzlaff Martin; Rieger Monika A

    2006-01-01

    Abstract Background There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM) The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. Methods Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Lik...

  1. Interactive Multimodal Ambulatory Monitoring to Investigate the Association between Physical Activity and Affect

    OpenAIRE

    UlrichW.Ebner-Priemer; MartinaK.Kanning; GerhardMutz

    2013-01-01

    Although there is a wealth of evidence that physical activity has positive effects on psychological health, a large proportion of people are inactive. Data regarding counts, steps, and movement patterns are limited in their ability to explain why people remain inactive. We propose that multimodal ambulatory monitoring, which combines the assessment of physical activity with the assessment of psychological variables, helps to elucidate real world physical activity. Whereas physical activit...

  2. Effects of Occupational Noise Exposure on 24-Hour Ambulatory Vascular Properties in Male Workers

    OpenAIRE

    Chang, Ta-Yuan; Su, Ta-Chen; Lin, Shou-Yu; Jain, Ruei-Man; Chan, Chang-Chuan

    2007-01-01

    Background Epidemiologic studies have demonstrated that occupational noise exposure is associated with hypertension, but the related mechanism in vascular structural changes is unclear. Objective This panel study aimed to investigate effects of occupational noise exposure on ambulatory vascular structural properties in male workers. Methods We recruited 20 volunteers and divided them into a high-noise–exposure group of 15 and a low-noise–exposure group of 5 based on environmental noise measur...

  3. Prognostic implications of exercise induced and ambulatory ischemia in patients with stable angina pectoris

    OpenAIRE

    Forslund, Lennart

    1999-01-01

    Results from exercise testing and ambulatory ECG registration were studied in 809 patients with stable angina pectoris; special attention was paid to signs of ischemia during both tests. Autonomic nervous system activity was investigated by measurements of heart rate variability (HRV) and catecholamines in plasma and urine. At baseline, the patients were compared with 50 age and sex matched controls. Prognostic implications of HRV, catecholamine levels, signs of ischemia dur...

  4. 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.

  5. Specific opsonic activity for staphylococci in peritoneal dialysis effluent during continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Nielsen, H; Espersen, F; Kharazmi, A;

    1992-01-01

    In a prospective study of intraperitoneal opsonins in 30 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), the IgG concentration, the fibronectin concentration, the specific antistaphylococcal antibody level, and the opsonic activity against Staphylococcus epidermidis were...... measured in peritoneal dialysis effluent from the initiation of CAPD and monthly for 6 months. Significant correlation was found between the four assays, but the interindividual and intraindividual variations were considerable. No statistically significant correlation was observed between susceptibility...

  6. 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...

  7. 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.

  8. Patient cost-sharing for ambulatory neuropsychiatric services in Abu Dhabi, UAE

    OpenAIRE

    Hamidi, Samer; Abouallaban, Yousef; Alhamad, Sultan; Meirambayeva, Aizhan

    2016-01-01

    Background and objectives Neuropsychiatric disorders are of high concern and burden of disease in the United Arab Emirates (UAE). The aim of this study is to describe patient cost-sharing patterns, insurance coverage of ambulatory neuropsychiatric disorders, and utilization of neuropsychiatric services in Abu Dhabi. Methods The study utilized the data published by Health Authority-Abu Dhabi (HAAD) and the American Center for Psychiatry and Neurology (ACPN) records in Abu Dhabi. The data were ...

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

    OpenAIRE

    Cheng-Hua Ni; Wen-Hsuan Hou; Ching-Chiu Kao; Ming-Li Chang; Lee-Fen Yu; Chia-Che Wu; Chiehfeng Chen

    2013-01-01

    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 aromath...

  10. Endoscopic treatment of vesicoureteral reflux in a paediatric surgery ambulatory unit

    OpenAIRE

    Fernando Rivilla

    2011-01-01

    BACKGROUND: Vesicoureteral reflux (VUR) is a major urological problem in children. Its incidence ranges from 1 to 3% in healthy children. MATERIALS AND METHODS: We treated 38 children and analysed their data on age, sex, reflux grade, laterality, and results of endoscopic treatment (ET), at the different grades of reflux. All children were operated on an Ambulatory Surgery basis, studying the complications and post-operative course. RESULTS: Thirty-eight patients were operated during a period...

  11. Standardizing Assessment of Competences and Competencies of Oncology Nurses Working in Ambulatory Care.

    Science.gov (United States)

    Beaver, Clara; Magnan, Morris A; Henderson, Denise; DeRose, Patricia; Carolin, Kathleen; Bepler, Gerold

    2016-01-01

    A nursing quality consortium standardized nursing practice across 17 independently functioning ambulatory oncology sites. Programs were developed to validate both competences and competencies. One program assessed nine competences needed to develop systems of care to detect and treat treatment-related side effects. A second program was developed to assess competencies needed to prevent harm to oncology patients. This manuscript describes a successful approach to standardizing nursing practice across geographically distant academic and community sites. PMID:26985750

  12. Anticoagulation in atrial fibrillation. Is there a gap in care for ambulatory patients?

    OpenAIRE

    2004-01-01

    OBJECTIVE: Atrial fibrillation (AF) substantially increases risk of stroke. Evidence suggests that anticoagulation to reduce risk is underused (a "care gap"). Our objectives were to clarify measures of this gap in care by including data from family physicians and to determine why eligible patients were not receiving anticoagulation therapy. DESIGN: Telephone survey of family physicians regarding specific patients in their practices. SETTING: Nova Scotia. PARTICIPANTS: Ambulatory AF patients n...

  13. From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care

    OpenAIRE

    Wilf-Miron, R; Lewenhoff, I; Benyamini, Z; Aviram, A

    2003-01-01

    

 The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1) errors inevitably occur and usually derive from faulty system design, not from negligence; (2) accident prevention should be an ongoing process based on open and full reporting; (3) major accidents are only the "tip of the iceberg" of processes that indicate possi...

  14. Microrespirometric determination of the effectiveness factor and biodegradation kinetics of aerobic granules degrading 4-chlorophenol as the sole carbon source.

    Science.gov (United States)

    Vital-Jacome, Miguel; Buitrón, Germán; Moreno-Andrade, Ivan; Garcia-Rea, Victor; Thalasso, Frederic

    2016-08-01

    In this study, a microrespirometric method was used, i.e., pulse respirometry in microreactors, to characterize mass transfer and biodegradation kinetics in aerobic granules. The experimental model was an aerobic granular sludge in a sequencing batch reactor (SBR) degrading synthetic wastewater containing 4-chlorophenol as the sole carbon source. After 15 days of acclimation, the SBR process degraded 4-chlorophenol at a removal rate of up to 0.9kg CODm(-3)d(-1), and the degradation kinetics were well described by the Haldane model. The microrespirometric method consisted of injecting pulses of 4-chlorophenol into the 24 wells of a microreactor system containing the SBR samples. From the respirograms obtained, the following five kinetic parameters were successfully determined during reactor operation: (i) Maximum specific oxygen uptake rate, (ii) substrate affinity constant, (iii) substrate inhibition constant, (iv) maximum specific growth rate, and (v) cell growth yield. Microrespirometry tests using granules and disaggregated granules allowed for the determination of apparent and intrinsic parameters, which in turn enabled the determination of the effectiveness factor of the granular sludge. It was concluded that this new high-throughput method has the potential to elucidate the complex biological and physicochemical processes of aerobic granular biosystems. PMID:27054670

  15. Dietary Sources of Fiber Intake and Its Association with Socio-Economic Factors among Flemish Preschool Children

    Directory of Open Access Journals (Sweden)

    Inge Huybrechts

    2011-03-01

    Full Text Available The objectives were to assess total dietary fiber intake, identify the major sources of dietary fiber, and examine its association with socio-economic factors among Flemish preschoolers. Three-day estimated dietary records were collected from a representative sample of preschoolers 2.5–6.5 years old (n = 661; 338 boys, 323 girls. The mean dietary fiber intake (13.4 g/d was lower than the intake level recommended by the Belgian Superior Health Council (70% boys and 81% girls below the guidelines. The most important contributor was the group of bread and cereals (29.5%, followed by fruits (17.8%, potatoes and grains (16.0%, energy-dense, low-nutritious foods (12.4%, and vegetables (11.8%. Multiple linear regression analyses showed that total fiber intake was associated with maternal education and parents’ employment. Overall, fiber intakes from high-nutritious foods (vegetables and fruits were higher in preschoolers of higher educated mothers and those with one or both parents being employed. In conclusion, the majority of the preschoolers had dietary fiber intakes below the recommended level. Hence, dietary fiber should be promoted among parents of preschoolers and low socio-economic status families should be addressed in particular.

  16. Gene expression of fibroblast growth factors in human gliomas and meningiomas: demonstration of cellular source of basic fibroblast growth factor mRNA and peptide in tumor tissues.

    OpenAIRE

    J.A. Takahashi; Mori, H.; Fukumoto, M; Igarashi, K; Jaye, M; Oda, Y.; Kikuchi, H; Hatanaka, M

    1990-01-01

    The growth autonomy of human tumor cells is considered due to the endogenous production of growth factors. Transcriptional expression of candidates for autocrine stimulatory factors such as basic fibroblast growth factor (FGF), acidic FGF, and transforming growth factor type beta were determined in human brain tumors. Basic FGF was expressed abundantly in 17 of 18 gliomas, 20 of 22 meninglomas, and 0 of 5 metastatic brain tumors. The level of mRNA expression of acidic FGF in gliomas was signi...

  17. 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.

  18. Ambulatory blood pressure monitoring of patients with heart failure: a new prognosis marker

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    Manoel F. Canesin

    2002-01-01

    Full Text Available OBJECTIVE: To evaluate the relationship between 24-hour ambulatory arterial blood pressure monitoring and the prognosis of patients with advanced congestive heart failure. METHODS: We studied 38 patients with NYHA functional class IV congestive heart failure, and analyzed left ventricular ejection fraction, diastolic diameter, and ambulatory blood pressure monitoring data. RESULTS: Twelve deaths occurred. Left ventricular ejection fraction (35.2±7.3% and diastolic diameter (72.2±7.8mm were not correlated with the survival. The mean 24-hour (SBP24, waking (SBPw, and sleeping (SBPs systolic pressures of the living patients were higher than those of the deceased patients and were significant for predicting survival. Patients with mean SBP24, SBPv, and SBPs > or = 105mmHg had longer survival (p=0.002, p=0.01 and p=0.0007, respectively. Patients with diastolic blood pressure sleep decrements (dip and patients with mean blood pressure dip or = 105 mmHg CONCLUSION: Ambulatory blood pressure monitoring appears to be a useful method for evaluating patients with congestive heart failure.

  19. Tolerability of the Oscar 2 ambulatory blood pressure monitor among research participants: a cross-sectional repeated measures study

    Directory of Open Access Journals (Sweden)

    Hinderliter Alan L

    2011-04-01

    Full Text Available Abstract Background Ambulatory blood pressure monitoring (ABPM is increasingly used to measure blood pressure (BP in research studies. We examined ease of use, comfort, degree of disturbance, reported adverse effects, factors associated with poor tolerability, and association of poor tolerability with data acquisition of 24-hour ABPM using the Oscar 2 monitor in the research setting. Methods Sixty adults participating in a research study of people with a history of borderline clinic BP reported on their experience with ABPM on two occasions one week apart. Poor tolerability was operationalized as an overall score at or above the 75th percentile using responses to questions adapted from a previously developed questionnaire. In addition to descriptive statistics (means for responses to Likert-scaled "0 to 10" questions and proportions for Yes/No questions, we examined reproducibility of poor tolerability as well as associations with poor tolerability and whether poor tolerability was associated with removal of the monitor or inadequate number of BP measurements. Results The mean ambulatory BP of participants by an initial ABPM session was 148/87 mm Hg. After wearing the monitor the first time, the degree to which the monitor was felt to be cumbersome ranged from a mean of 3.0 to 3.8, depending on whether at work, home, driving, or other times. The most bother was interference with normal sleeping pattern (mean 4.2. Wearers found the monitor straightforward to use (mean 7.5. Nearly 67% reported that the monitor woke them after falling asleep, and 8.6% removed it at some point during the night. Reported adverse effects included pain (32%, skin irritation (37%, and bruising (7%. Those categorized as having poor tolerability (kappa = 0.5 between sessions, p = 0.0003 were more likely to report being in fair/poor health (75% vs 22%, p = 0.01 and have elevated 24-hour BP average (systolic: 28% vs 17%, p = 0.56; diastolic: 30% vs 17%, p = 0.37. They were

  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. 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.

  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. 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

  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. PMID:27442226

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

    Science.gov (United States)

    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 distance: 175 μm), centered on the circular Bruch’s membrane opening. The borders of the LC were defined as the visible limits of the LC pores. The correlation of LC thickness with Humphrey field analyzer-measured mean deviation (MD; SITA standard 24–2), circumpapillary retinal nerve fiber layer thickness (cpRNFLT), the vertical cup-to-disc (C/D) ratio, and tissue mean blur rate (MBR) was determined with Spearman's rank correlation coefficient. The relationship of LC thickness with age, axial length, intraocular pressure (IOP), MD, the vertical C/D ratio, central corneal thickness (CCT), and tissue MBR was determined with multiple regression analysis. Average LC thickness and the correlation between LC thickness and MD were compared in patients with the glaucomatous enlargement (GE) optic disc type and those with non-GE disc types, as classified with Nicolela’s method. Results We found that average LC thickness in the 16 grid points was significantly associated with overall LC thickness (r = 0.77, P Glaucoma patients with the GE disc type, who predominantly have large cupping, had lower LC thickness even with similar glaucoma severity. PMID:27100404

  6. Unplanned admissions following ambulatory plastic surgery--a retrospective study.

    OpenAIRE

    A. Mandal; Imran, D.; McKinnell, T.; G. S. Rao

    2005-01-01

    INTRODUCTION: Admission for overnight or longer hospital stay from a day-case unit is an unwelcome event. This audit was designed to identify the incidence of unplanned admissions and also to detect the potential factors for such overstays. PATIENTS AND METHODS: Details of plastic surgical day-case patients were obtained from the hospital records for a period of 6 months (February 2002 to July 2002). RESULTS: The total number of unplanned admissions was 28 (3.55%). High rates were recorded in...

  7. 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

  8. Source apportionment of PAHs in surface sediments using positive matrix factorization combined with GIS for the estuarine area of the Yangtze River, China.

    Science.gov (United States)

    Yu, Wenwen; Liu, Ruimin; Wang, Jiawei; Xu, Fei; Shen, Zhenyao

    2015-09-01

    This study used PMF and geostatistics to quantify sources of PAHs based on 30 samples tested for 16 PAHs in surface sediment from the Yangtze River Estuary (YRE) in February 2011. The results demonstrated that the total PAH concentrations varied from 65.07 to 954.52 ng g(-1) with a mean value of 224.00 ng g(-1). In the inner estuary, the mean of the total PAH concentrations was 229.89 ng g(-1), and the high molecular weight of four-to-six-ring PAHs accounted for 51.83% of PAHs. In the adjacent East Sea, the mean value was 218.85 ng g(-1) and the high molecular weight PAHs accounted for approximately 54% of total PAHs. A three-factor modeling result from PMF provided the most satisfactory analysis of PAH sources. Coke plant emissions and biomass combustion, which contributed 45.64% of the pollution, were the most important sources, and pollutants from these sources were primarily concentrated in the southern branch of the estuary. Gasoline fuel combustion accounted for approximately 40% of the pollution, and the major contaminated area was in the northern region. Petrogenic sources (14.70%) also influenced the estuary, especially in the northeastern region. Water currents and source locations affected the impacted regions of PMF factors; the surrounding natural and artificial influences were also considered. PMID:25966456

  9. 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.

  10. Relationship of 24-hour ambulatory blood pressure and heart rate with markers of hepatic function in cirrhotic patients

    Directory of Open Access Journals (Sweden)

    Stergiou George S

    2010-12-01

    Full Text Available Abstract Background There is evidence that in cirrhotic patients, certain hemodynamic parameters, such as blood pressure and heart rate, are related to the severity of liver disease. This study investigated whether non-invasive 24-hour ambulatory blood pressure and heart rate are more closely associated with markers of liver disease severity than conventional office measurements. Methods Ambulatory patients with cirrhosis underwent office blood pressure and heart rate measurements, 24-hour ambulatory blood pressure monitoring and blood laboratory tests. Results Fifty-one patients (32 men, mean age 57.4 ± 11.3 years completed the study. Twenty six patients had compensated liver cirrhosis (group A and 25 patients had more advanced liver disease (group B. Group A and B patients differed significantly both in ambulatory asleep diastolic blood pressure (p Conclusions Heart rate seems to be a more reliable marker of ongoing liver dysfunction than blood pressure. Evaluation of blood pressure and heart rate with 24-hour ambulatory measurement does not seem to offer more information than conventional office measurements.

  11. The prevalence of urinary incontinence in elderly Canadians and its association with dementia, ambulatory function, and institutionalization

    Directory of Open Access Journals (Sweden)

    Truls Østbye

    2009-10-01

    Full Text Available  Study objectives:  Design and setting:  Main results:  Conclusion:  Key words:   urinary incontinence; dementia; institutionalization; community-institutional relationsUrinary incontinence is a prevalent condition among the elderly, and is associated withage, dementia, and ambulatory function. Although incontinence is highly prevalent among institutionalizedpersons, the majority of persons with incontinence live in the community.Overall, 16.9% of the women and 8.0% of the men reported incontinence, the numbersfor daily incontinence were 7.0% and 5.2% respectively. The prevalence increased by age, severity ofdementia, and decreasing ambulatory function. It is calculated that 69% of elderly men and 73% ofelderly women with any incontinence live in the community. 31% of the male and 32% of the femalepatients have some kind or severity of dementia, and 21% of the men and 27% of the women havedecreased ambulatory function. One half of the persons with incontinence live in the community, withno cognitive or ambulatory impairment.Population based multi-centre survey with stratified random sampling all overCanada. Randomly selected persons aged 65 and over were interviewed. Those having cognitive impairment(n=1614, a randomly selected sample of those without (n=731 and an institutional sample(n=1255 underwent clinical assessment.Data from The Canadian Study of Health and Aging are analysed for prevalence ofurinary incontinence, and its association with dementia, ambulatory function, and institutionalization.ABSTRACT

  12. 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

  13. Characterization of concentration, particle size distribution, and contributing factors to ambient hexavalent chromium in an area with multiple emission sources

    Science.gov (United States)

    Yu, Chang Ho; Huang, Lihui; Shin, Jin Young; Artigas, Francisco; Fan, Zhi-hua (Tina)

    2014-09-01

    Airborne hexavalent chromium (Cr(VI)) is a known pulmonary carcinogen and can be emitted from both natural and anthropogenic sources, including diesel emissions. However, there is limited knowledge about ambient Cr(VI) concentration levels and its particle size distribution. This pilot study characterized ambient Cr(VI) concentrations in the New Jersey Meadowlands (NJ ML) district, which is close to the heavily trafficked New Jersey Turnpike (NJTPK) as well as Chromium Ore Processing Residue (COPR) waste sites. Monitoring was simultaneously conducted at two sites, William site (∼50 m from NJTPK) and MERI site (∼700 m from NJTPK). The distance between the two sites is approximately 6.2 km. Ambient Cr(VI) concentrations and PM2.5 mass concentrations were concurrently measured at both sites during summer and winter. The summer concentrations (mean ± S.D. [median]), 0.13 ± 0.06 [0.12] ng/m3 at the MERI site and 0.08 ± 0.05 [0.07] ng/m3 at the William site, were all significantly higher than the winter concentrations, 0.02 ± 0.01 [0.02] ng/m3 and 0.03 ± 0.01 [0.03] ng/m3 at the MERI and William sites, respectively. The site difference (i.e., MERI > William) was observed for summer Cr(VI) concentrations; however, no differences for winter and pooled datasets. These results suggest higher Cr(VI) concentrations may be attributed from stronger atmospheric reactions such as photo-oxidation of Cr(III) to Cr(VI) in the summer. The Cr(VI) distribution as a function of particle size, ranging from 0.18 to 18 μm, was determined at the William site. It was found that Cr(VI) was enriched in the particles less than 2.5 μm in diameter (PM2.5). This finding suggested potential health concerns, because PM2.5 are easily inhaled and deposited in the alveoli. A multiple linear regression analysis confirmed ambient Cr(VI) concentrations were significantly affected by meteorological factors (i.e., temperature and humidity) and reactive gases/particles (i.e., O3, Fe and Mn).

  14. Evaluation of the area factor used in the RESRAD code for the estimation of airborne contaminant concentrations of finite area sources

    International Nuclear Information System (INIS)

    The area factor is used in the RESRAD code to estimate the airborne contaminant concentrations for a finite area of contaminated soils. The area factor model used in RESRAD version 5.70 and earlier (referred to as the old area factor) was a simple, but conservative, mixing model that tended to overestimate the airborne concentrations of radionuclide contaminants. An improved and more realistic model for the area factor (referred to here as the new area factor) is described in this report. The new area factor model is designed to reflect site-specific soil characteristics and meteorological conditions. The site-specific parameters considered include the size of the source area, average particle diameter, and average wind speed. Other site-specific parameters (particle density, atmospheric stability, raindrop diameter, and annual precipitation rate) were assumed to be constant. The model uses the Gaussian plume model combined with contaminant removal processes, such as dry and wet deposition of particulates. Area factors estimated with the new model are compared with old area factors that were based on the simple mixing model. In addition, sensitivity analyses are conducted for parameters assumed to be constant. The new area factor model has been incorporated into RESRAD version 5.75 and later

  15. Atherogenic Risk Factors and Hearing Thresholds

    DEFF Research Database (Denmark)

    Frederiksen, Thomas Winther; Ramlau-Hansen, Cecilia Høst; Stokholm, Zara Ann;

    2014-01-01

    children's day care units, financial services and 10 manufacturing trades. Associations between atherogenic risk factors (blood lipids, glycosylated hemoglobin, smoking habits, body mass index (BMI), and ambulatory blood pressure) and hearing thresholds were analyzed using multiple linear regression models...... associated with increased low-frequency hearing thresholds, but only at a borderline level of statistical significance. Associations were generally strongest with hearing levels of the worst hearing ear. We found no statistically significant associations between atherogenic risk factors and high...

  16. 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. PMID:24882026

  17. Twenty-four-hour ambulatory oesophageal pH monitoring: experience in The Netherlands.

    Science.gov (United States)

    Klinkenberg-Knol, E C; Ogilvie, A C; Meuwissen, S G

    1989-03-01

    Twenty-four-hour ambulatory oesophageal pH monitoring has become a major diagnostic method for the evaluation of gastro-oesophageal reflux disease. Essential requirements for registration and reproduction of the pH are reliable pH electrodes, well-performed calibration and optimal reproduction and analysis of the signal. The most commonly used pH probes in The Netherlands are not-combined monocrystalline antimony electrodes (Synectics Ltd, Sweden) and combined glass electrodes (Ingold and Radiometer). For diagnostic intra-oesophageal pH measurements both types are suitable; for research purposes, especially intragastric, glass electrodes are preferable. In The Netherlands several types of solid-state recorders are commercially available: all fulfill the conditions necessary to produce reliable registrations. In the present study, available measuring systems in The Netherlands and current practices associated with ambulatory pH monitoring were evaluated. Inquiry among the Dutch pH registration centres showed that more than half were using Synectics electrodes and equipment. Positioning of the pH probe was based on manometry (25%), fluoroscopy (22%) or endoscopy (20%). In the initial phase there were many problems, especially related to ignorance of the complicated registration procedure. For ambulatory pH measurements we recommend a simple datalogger with a sufficient memory capacity and direct interface with a PC, a combined glass electrode positioned 5 cm above the manometrically determined lower oesophageal sphincter. For clinical interpretation of the results the percentage of time with pH below 4 is probably the most reliable parameter for the detection of pathological gastrooesophageal reflux. PMID:2657460

  18. 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 <0.040). Similar inverse associations were observed for paraxanthine and theophylline. Adjusted night-time systolic blood pressure in the first (lowest), second, third, and fourth (highest) quartile of paraxanthine urinary excretions were 110.3, 107.3, 107.3, and 105.1 mm Hg, respectively (P trend <0.05). No associations of urinary excretions with diastolic blood pressure were generally found, and 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. PMID:25489060

  19. Reliability of respiratory tidal volume estimation by means of ambulatory inductive plethysmography.

    Science.gov (United States)

    Grossman, Paul; Spoerle, Monika; Wilhelm, Frank H

    2006-01-01

    Ambulatory monitoring of ventilatory parameters in everyday life, field research and clinical situations may offer new insights into respiratory functioning in health and disease. Recent technological advances that employ ambulatory inductive plethysmography could make monitoring of respiration outside the clinic and laboratory feasible. Inductive plethysmography provides a method for nonintrusive assessment of both timing (e.g. respiration rate) and volumetric parameters (e.g. tidal volume and minute ventilation), by which tidal volume is initially calibrated to direct measures of volume. Estimates of tidal volume assessed by this technique have been validated in laboratory investigations, usually examining within-individual relations to direct measures over a large range of tidal volume variation. However, the reliability of individual differences in tidal volume or other breathing parameters has not been tested under naturalistic measurement conditions using inductive plethysmography. We examined the test-retest reliability of respiration rate, tidal volume and other volumetric parameters of breathing over a period of six weeks of repeated measurements during baseline conditions and breathing exercises with 16 healthy freely moving volunteers in a Yoga course. Reliability of measurement was evaluated by calculating the average week-to-week between-subject correlation coefficients for each physiological measure. Additionally because body-mass index has been previously positively correlated to tidal volume, we also assessed this relationship as an external criterion of validity of tidal volume estimation. Regarding the latter, similar correlations to those previous studies were found (r = 0.6). Furthermore, reliability estimates were high and consistent across respiratory measures (typically r's = 0.7-0.8). These results suggest the validity of ambulatory inductive plethysmographic measurement of respiration, at least under relatively sedentary conditions

  20. Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care

    DEFF Research Database (Denmark)

    Thomsen, Linda Aagaard; Winterstein, Almut G; Søndergaard, Birthe;

    2007-01-01

    (1993-March 2007), EMBASE (1980-February 2007), and Web of Science (1945-March 2007). Key words included medication error, adverse drug reaction, iatrogenic disease, outpatient, ambulatory care, primary health care, general practice, patient admission, hospitalization, observational study, retrospective.......5 per 1000 person-months. Cardiovascular drugs, analgesics, and hypoglycemic agents together accounted for 86.5% of pADEs, and 77.2% of pADEs resulted in symptoms of the central nervous system, electrolyte/renal system, and gastrointestinal tract. Medication errors resulting in pADEs occurred in the...

  1. Big data and ambulatory care: breaking down legal barriers to support effective use.

    Science.gov (United States)

    Thorpe, Jane Hyatt; Gray, Elizabeth Alexandra

    2015-01-01

    Big data is heralded as having the potential to revolutionize health care by making large amounts of data available to support care delivery, population health, and patient engagement. Critics argue that big data's transformative potential is inhibited by privacy requirements that restrict health information exchange. However, there are a variety of permissible activities involving use and disclosure of patient information that support care delivery and management. This article presents an overview of the legal framework governing health information, dispels misconceptions about privacy regulations, and highlights how ambulatory care providers in particular can maximize the utility of big data to improve care. PMID:25401945

  2. The open source software alternative : Factors and their impact on the decision-making process at Swedish municipalities

    OpenAIRE

    Karlsson, Tobias; Andersson, Henrik

    2005-01-01

    Arguably, the Schumpeterian ideology of “creative destruction” saying that eventually even the most secure monopoly will be destroyed by a new technology, a new idea, or a shift in tastes could be applied to open source software. Currently, the proprietary software holds a strong position in the software market. Nevertheless, one could see a surge in articles and acceptance among organisations concerning open source software. Proprietary software companies like Microsoft are still gaining gro...

  3. Impact of an Elective Course in Community and Ambulatory Care Pharmacy Practices on Student Perception of Patient Care.

    Science.gov (United States)

    Barnes, Kelli D; Maguire, Michelle; Bennett, Marialice S

    2015-09-25

    Objective. To determine the impact of an elective course on students' perception of opportunities and of their preparedness for patient care in community and ambulatory pharmacy settings. Design. Each course meeting included a lecture and discussion to introduce concepts and active-learning activities to apply concepts to patient care or practice development in a community or ambulatory pharmacy setting. Assessment. A survey was administered to students before and after the course. Descriptive statistics were used to assess student responses to survey questions, and Wilcoxon signed rank tests were used to analyze the improvement in student responses with an alpha level set at 0.05. Students felt more prepared to provide patient care, develop or improve a clinical service, and effectively communicate recommendations to other health care providers after course completion. Conclusion. This elective course equipped students with the skills necessary to increase their confidence in providing patient care services in community and ambulatory settings. PMID:27168617

  4. Microglia and macrophages are major sources of locally produced transforming growth factor-beta1 after transient middle cerebral artery occlusion in rats

    DEFF Research Database (Denmark)

    Lehrmann, E; Kiefer, R; Christensen, Thomas;

    1998-01-01

    The potentially neurotrophic cytokine transforming growth factor-beta1 (TGF-beta1) is locally expressed following human stroke and experimental ischemic lesions, but the cellular source(s) and profile of induction have so far not been established in experimental focal cerebral ischemia. This study...... middle cerebral artery. Six hours after ischemia, an early and transient neuronal and microglial expression of TGF-beta1 mRNA was observed in the extraischemic cingulate and frontal cortices. Both early and protracted expression of TGF-beta1 mRNA in the caudate-putamen and neocortical infarcts and in the...

  5. Calculations of effective conversion factors (Sv/Gy) of photons emitted from a Tc-99m source used in nuclear medicine

    International Nuclear Information System (INIS)

    An accurate effective dose of a human exposed to external radiation could not be assessed very well, because the estimation of the equivalent doses of his each organ or tissue was very difficult. Therefore, in general some simple methods adopting the operational quantity instead of the equivalent dose were designed and used. However, these methods aiming the dose estimation in the safety side gave a lager value than the true effective dose. Therefore, we tried to obtain a more precise effective dose of a human by using effective conversion factors (Sv/Gy) calculated from photon spectra, measured with spectrometer, using conversion factors given in the ICRP Publication 74. The energy spectra of photons irradiated from a technetium-99m (99mTc) source or 99mTc-HMDP patients were measured with a high-purity germanium (HP-Ge) semiconductor detector and analyzed with a multi-channel pulse-height analyzer. The data acquisitions of the energy spectra were performed at 5, 50, 100 and 150 cm distances from the 99mTc source or the 99mTc-HMDP patients, then a scattering material consist of combinations of four acrylic phantoms was set in a place between the detector and the source. In this article, we showed effective conversion factors based on the photon spectrum of 99mTc. In the 99mTc source study, the spectra at various distances showed good agreements each other without the spectrum at 5 cm distance. As thick, more increased scattering ingredients of photons were observed in the spectra. The phenomenon was remarkable in the low energy area of the spectrum. Conversion factors in the two energy ranges with low cutoffs of 10 and 30 keV expressed different tendency at short distances from the 99mTc source. More increased conversion factors were observed in low cutoff of larger energy between 10 and 20 keV, but when the cutoff energy exceeded 20 keV, the factors were saturated gentry. The conversion factors in the 99mTc-HMDP patients study were very similar to those in the 99m

  6. 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

  7. Estado nutricional e hábitos alimentares de dependentes químicos em tratamento ambulatorial

    OpenAIRE

    Isadora Borne Ferreira; Camila Bosse Paiva; Joana Corrêa de Magalhães Narvaez; Vera Lucia Bosa

    2015-01-01

    Objetivo Identificar o estado nutricional e hábitos alimentares de pacientes masculinos em recuperação de dependência química em acompanhamento ambulatorial de uma unidade de adição. Métodos Estudo transversal com 25 pacientes adultos em tratamento ambulatorial para dependência química. Foram aferidos parâmetros antropométricos (peso, estatura, circunferência da cintura e índice de massa corporal) e de composição corporal (bioimpedância elétrica), e foram investigados hábitos alimentares (Que...

  8. 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

    2009-01-01

    Full Text Available An extensive database of organochlorine (OC pesticide concentrations measured at the Norwegian Arctic Monitoring Station 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.

  9. Changing sources and environmental factors reduce the rates of decline of organochlorine pesticides in the Arctic atmosphere

    Science.gov (United States)

    Becker, S.; Halsall, C. J.; Tych, W.; Kallenborn, R.; Schlabach, M.; Manø, S.

    2012-05-01

    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.

  10. 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.

  11. DEVELOPMENT OF NATIONAL EMISSIONS FACTORS FOR SOLID WASTEDISPOSAL ON LAND GREENHOUSE GAS SOURCE CATEGORY OF THE NATIONAL INVENTIONAL INVENTORY IN THE REPUBLIC OF MOLDOVA

    Directory of Open Access Journals (Sweden)

    Tatiana Tugui

    2006-06-01

    Full Text Available The paper summarizes the research results on development national emissions factor for the Greenhouse Gas Inventory (GHGI Source Category “6A Solid Waste Disposal on Land”. The obtained results offer the opportunity to improve the Intergovernmental Panel for Climate Change (IPCC methodologies and Emission Factors for assessing the GHG emissions originated from waste sector. The article contains relevant information on composition of landfill gases at managed and unmanaged solid waste disposal sites, as well as the municipal solid waste composition results, investigated during one year in the Republic of Moldova: from autumn, 2004 to summer, 2005.

  12. 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.

  13. Assessing the sources of uncertainty associated with the calculation of rainfall kinetic energy and the erosivity R factor. Application to the Upper Llobregat Basin, NE Spain

    Directory of Open Access Journals (Sweden)

    J. Latron

    2010-06-01

    Full Text Available The sources of uncertainty associated with the calculation of rainfall kinetic energy and rainfall erosivity were investigated when the USLE R factor was operationally calculated for a mountainous river basin (504 km2 in the Southeastern Pyrenees. Rainfall kinetic energy was first obtained at the scale of the rainfall event by means of sub-hourly precipitation tipping-bucket rain gauge records and updates of the Kinnell (1981 equation. Annual erosivity values for the nearby pluviometric stations were then derived from the linear regressions between daily rainfall erosivity and daily precipitation, obtained for two different seasons. Finally, maps for rainfall erosivity estimates were obtained from the station values with Thiessen polygons. The sources of uncertainty analysed were i the tipping-bucket instrumental errors, ii the efficiency of the Kinnell (1981 equation, iii the efficiency of the regressions between daily precipitation and kinetic energy, iv the temporal variability of annual rainfall erosivity values, and the spatial variability of v annual rainfall erosivity values and vi long-term R factor values. The results showed that the uncertainty associated with the calculation of rainfall kinetic energy from rainfall intensity at the event and station scales is highly relevant and must be taken into account for experimental or modelling purposes; for longer temporal scales, the relevance of this source of uncertainty remains high if there is a low variability of the types of rain. Temporal variability of precipitation at wider spatial scales is the main source of uncertainty when rainfall erosivity is to be calculated on an annual basis, whereas the uncertainty associated with the long-term R factor is rather low and less important than the uncertainty associated with the other RUSLE factors when operationally used for long-term soil erosion modelling.

  14. A novel approach combining self-organizing map and parallel factor analysis for monitoring water quality of watersheds under non-point source pollution

    OpenAIRE

    Yixiang Zhang; Xinqiang Liang; Zhibo Wang; Lixian Xu

    2015-01-01

    High content of organic matter in the downstream of watersheds underscored the severity of non-point source (NPS) pollution. The major objectives of this study were to characterize and quantify dissolved organic matter (DOM) in watersheds affected by NPS pollution, and to apply self-organizing map (SOM) and parallel factor analysis (PARAFAC) to assess fluorescence properties as proxy indicators for NPS pollution and labor-intensive routine water quality indicators. Water from upstreams and do...

  15. Astrocytes are the primary source of tissue factor in the murine central nervous system. A role for astrocytes in cerebral hemostasis.

    OpenAIRE

    Eddleston, M.; de la Torre, J C; Oldstone, M B; Loskutoff, D. J.; Edgington, T. S.; Mackman, N.

    1993-01-01

    Hemostasis in the brain is of paramount importance because bleeding into the neural parenchyma can result in paralysis, coma, and death. Consistent with this sensitivity to hemorrhage, the brain contains large amounts of tissue factor (TF), the major cellular initiator of the coagulation protease cascades. However, to date, the cellular source for TF in the central nervous system has not been identified. In this study, analysis of murine brain sections by in situ hybridization demonstrated hi...

  16. 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

  17. Oral Ambulatory Treatment of Acute Osteomyelitis in Children: A Case-Control Study.

    Science.gov (United States)

    Roul-Levy, Antoine; Looten, Vincent; Bachy, Manon; Grimprel, Emmanuel; Carbajal, Ricardo; Vialle, Raphaël

    2016-03-01

    The treatment of acute hematogenous osteomyelitis has evolved in recent years to a shorter parenteral treatment with an early switch to the oral route. Current publications recommend a 2- to 4-day parenteral treatment before the oral switch. We retrospectively analyzed a series of 45 children aged 1 to 11 years and treated in our department for acute osteomyelitis without severity criterion. Nineteen of 45 patients were treated by an exclusive ambulatory oral treatment by amoxicillin and clavulanic acid. Twenty six of 45 patients had a 2- to 4-day parenteral treatment before the oral switch. The minimum follow-up was 6 months. The primary endpoint was a clinical, radiographic, and biologic healing, 6 months after the beginning of the treatment. The secondary endpoints evaluated were the length of hospitalization, the total duration of treatment, and the type of antibiotic used. On the primary endpoint, we did not find any significant difference between the 2 treatments (P = 0.38). On the duration of treatment, we found a significant difference (P = 0.049) in favor of oral treatment. The ambulatory oral treatment by amoxicillin and clavulanic acid seems to be a valid alternative to the classical parenteral then oral sequence in the treatment of acute hematogenous osteomyelitis in children without severity criterion. PMID:26928094

  18. Integrity of the Anterior Visual Pathway and Its Association with Ambulatory Performance in Multiple Sclerosis

    Science.gov (United States)

    Sandroff, Brian M.; Pula, John H.; Motl, Robert W.

    2013-01-01

    Background. Retinal nerve fiber layer thickness (RNFLT) and total macular volume (TMV) represent markers of neuroaxonal degeneration within the anterior visual pathway that might correlate with ambulation in persons with multiple sclerosis (MS). Objective. This study examined the associations between RNFLT and TMV with ambulatory parameters in MS. Methods. Fifty-eight MS patients underwent a neurological examination for generation of an expanded disability status scale (EDSS) score and measurement of RNFLT and TMV using optical coherence tomography (OCT). Participants completed the 6-minute walk (6MW) and the timed 25-foot walk (T25FW). The associations were examined using generalized estimating equation models that accounted for within-patient, inter-eye correlations, and controlled for disease duration, EDSS score, and age. Results. RNFLT was not significantly associated with 6MW (P = 0.99) or T25FW (P = 0.57). TMV was significantly associated with 6MW (P = 0.023) and T25FW (P = 0.005). The coefficients indicated that unit differences in 6MW (100 feet) and T25FW (1 second) were associated with 0.040 and −0.048 unit differences in TMV (mm3), respectively. Conclusion. Integrity of the anterior visual pathway, particularly TMV, might represent a noninvasive measure of neuroaxonal degeneration that is correlated with ambulatory function in MS. PMID:23864950

  19. Integrity of the Anterior Visual Pathway and Its Association with Ambulatory Performance in Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Swathi Balantrapu

    2013-01-01

    Full Text Available Background. Retinal nerve fiber layer thickness and total macular volume (TMV represent markers of neuroaxonal degeneration within the anterior visual pathway that might correlate with ambulation in persons with multiple sclerosis (MS. Objective. This study examined the associations between and TMV with ambulatory parameters in MS. Methods. Fifty-eight MS patients underwent a neurological examination for generation of an expanded disability status scale (EDSS score and measurement of and TMV using optical coherence tomography (OCT. Participants completed the 6-minute walk (6MW and the timed 25-foot walk (T25FW. The associations were examined using generalized estimating equation models that accounted for within-patient, inter-eye correlations, and controlled for disease duration, EDSS score, and age. Results. was not significantly associated with 6MW or T25FW . TMV was significantly associated with 6MW and T25FW . The coefficients indicated that unit differences in 6MW (100 feet and T25FW (1 second were associated with 0.040 and −0.048 unit differences in TMV (mm3, respectively. Conclusion. Integrity of the anterior visual pathway, particularly TMV, might represent a noninvasive measure of neuroaxonal degeneration that is correlated with ambulatory function in MS.

  20. Accelerometry and Its Association With Objective Markers of Walking Limitations in Ambulatory Adults With Multiple Sclerosis

    Science.gov (United States)

    Motl, Robert W.; Dlugonski, Deirdre; Suh, Yoojin; Weikert, Madeline; Fernhall, Bo; Goldman, Myla

    2011-01-01

    Objective To validate accelerometry based on its correlations with 6-minute walk distance (6MWD) and oxygen cost of walking as objective markers of walking limitations in multiple sclerosis (MS). Design Cross-sectional. Setting Laboratory and general community. Participants Ambulatory participants with MS (N=26) who resided in the local community. Interventions Not applicable. Main Outcome Measures Patient Determined Disease Steps (PDDS) scale and Multiple Sclerosis Walking Scale-12 (MSWS-12); 6-minute walk test while wearing a portable metabolic unit for measuring the 6MWD and oxygen cost of walking; accelerometer during the waking hours of a 7-day period. Results The average of total daily movement counts from the accelerometer correlated significantly and strongly with MSWS-12 scores (ρ−.681, P=.001), PDDS scores (ρ−.609, P=.001), 6MWD (ρ.519, P=.003), and oxygen cost of walking (ρ−.541, P=.002). Conclusions We provide evidence that further supports the validity of accelerometry as a measure of walking limitations in ambulatory persons with MS. PMID:21112438

  1. Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    Jaime Corral-Peñafiel

    2013-09-01

    Full Text Available Obstructive sleep apnoea (OSA is a highly prevalent disorder associated with complications such as arterial hypertension, cardiovascular diseases and traffic accidents. The resources allocated for OSA are insufficient and OSA is a significant public health problem. Portable recording devices have been developed for the detection of OSA syndrome and have proved capable of providing an equivalent diagnosis to in-laboratory polysomnography (PSG, at least in patients with a high pre-test probability of OSA syndrome. PSG becomes important in patients who have symptoms and certain comorbidities such as chronic obstructive pulmonary disease or stroke, as well as in patients with a clinical history suggesting a different sleep disorder. Continuous positive airway pressure is the most effective treatment in OSA. Ambulatory monitoring of the therapeutic modalities has been evaluated to enhance the care process and reduce costs compared to the conventional approach, without sacrificing efficiency. This review evaluates the role of portable monitoring devices in the diagnostic process of OSA and the search for alternative strategies based on ambulatory management protocols.

  2. 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.

  3. The efficacy of ginger added to ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery

    Science.gov (United States)

    Mandal, Pragnadyuti; Das, Anjan; Majumdar, Saikat; Bhattacharyya, Tapas; Mitra, Tapobrata; Kundu, Ratul

    2014-01-01

    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. PMID:24497743

  4. Disparities in the use of ambulatory surgical centers: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Wei John T

    2009-07-01

    Full Text Available Abstract Background Ambulatory surgical centers (ASCs provide outpatient surgical services more efficiently than hospital outpatient departments, benefiting patients through lower co-payments and other expenses. We studied the influence of socioeconomic status and race on use of ASCs. Methods From the 2005 State Ambulatory Surgery Database for Florida, a cohort of discharges for urologic, ophthalmologic, gastrointestinal, and orthopedic procedures was created. Socioeconomic status was established at the zip code level. Logistic regression models were fit to assess associations between socioeconomic status and ASC use. Results Compared to the lowest group, patients of higher socioeconomic status were more likely to have procedures performed in ASCs (OR 1.07 CI 1.05, 1.09. Overall, the middle socioeconomic status group was the most likely group to use the ASC (OR 1.23, CI 1.21 to 1.25. For whites and blacks, higher status is associated with increased ASC use, but for Hispanics this relationship was reversed (OR 0.84 CI 0.78, 0.91. Conclusion Patients of lower socioeconomic status treated with outpatient surgery are significantly less likely to have their procedures in ASCs, suggesting that less resourced patients are encountering higher cost burdens for care. Thus, the most economically vulnerable group is unnecessarily subject to higher charges for surgery.

  5. 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.

  6. 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.

  7. Effects of sodium intake on cardiovascular variables in humans during posture changes and ambulatory conditions

    DEFF Research Database (Denmark)

    Damgaard, Morten; Gabrielsen, Anders; Heer, Martina; Warberg, Jørgen; Bie, Peter; Christensen, Niels Juel; Norsk, Peter

    2002-01-01

    The hypothesis was tested that cardiac output (CO) and stroke volume (SV) are increased by a moderate physiological elevation in sodium intake with a more pronounced effect in the ambulatory upright seated than supine position. Fourteen healthy males were investigated during ambulatory and...... controlled laboratory conditions at the end of two consecutive 5-day periods with sodium intakes of 70 (low) and 250 (high) mmol/24 h or vice versa, respectively. Comparing high and low sodium intake, plasma volume and plasma protein concentrations were 9 and 8% higher in the seated and the supine position......, respectively. When seated during laboratory conditions, CO was 5.3 +/- 0.2 l/min on the high sodium intake vs. 4.8 +/- 0.2 l/min on the low (P < 0.05), and SV was 81 +/- 3 vs. 68 +/- 3 ml (P < 0.05). In the supine position, SV was 107 +/- 3 ml on the high vs. 99 +/- 3 ml (P < 0.05) on the low sodium intake...

  8. 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.

  9. Comparing Team-Based and Mixed Active-Learning Methods in an Ambulatory Care Elective Course

    Science.gov (United States)

    Franks, Andrea S.; Guirguis, Alexander B.; George, Christa M.; Howard-Thompson, Amanda; Heidel, Robert E.

    2010-01-01

    Objectives To assess students' performance and perceptions of team-based and mixed active-learning methods in 2 ambulatory care elective courses, and to describe faculty members' perceptions of team-based learning. Methods Using the 2 teaching methods, students' grades were compared. Students' perceptions were assessed through 2 anonymous course evaluation instruments. Faculty members who taught courses using the team-based learning method were surveyed regarding their impressions of team-based learning. Results The ambulatory care course was offered to 64 students using team-based learning (n = 37) and mixed active learning (n = 27) formats. The mean quality points earned were 3.7 (team-based learning) and 3.3 (mixed active learning), p < 0.001. Course evaluations for both courses were favorable. All faculty members who used the team-based learning method reported that they would consider using team-based learning in another course. Conclusions Students were satisfied with both teaching methods; however, student grades were significantly higher in the team-based learning course. Faculty members recognized team-based learning as an effective teaching strategy for small-group active learning. PMID:21301594

  10. 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. PMID:23415709

  11. Source apportionment with uncertainty estimates of fine particulate matter in Ostrava, Czech Republic using Positive Matrix Factorization

    Science.gov (United States)

    A 14-week investigation during a warm and cold seasons was conducted to improve understanding of air pollution sources that might be impacting air quality in Ostrava, the Czech Republic. Fine particulate matter (PM2.5) samples were collected in consecutive 12-h day and night incr...

  12. K-shell jump ratios and jump factors for molybdenum and silver by using 2D-geometrical configuration and a weak gamma source

    International Nuclear Information System (INIS)

    The article presents a simple method of measuring K-shell absorption jump ratios and jump factors for elements in the field of X-ray spectroscopy. The K-shell jump ratios and jump factors for Molybdenum and Silver are measured by adopting 2ŏ-geometrical configuration and a weak gamma source. The characteristic K X-ray photons are excited in the targets using 32.8 keV barium X-ray photons from a weak 137Cs radioactive source that is produced due to the internal conversion of cesium nucleus (IC). The fluorescent K X-ray photons are detected using low energy Si(Li) detector coupled to a 8k multichannel analyser. The K X-ray intensity ratios from X-ray fluorescent spectrum are measured experimentally, the total atomic attenuation cross section and the total atomic scattering cross sections are calculated using WinXcom software. The K-shell jump factor and jump ratio are computed using the measured K X-ray intensity ratios and the calculated Ka, X-ray production cross section. The computed values of K-shell jump factor and jump ratio for molybdenum and silver are compared with the theoretical values and others' experimental data and are presented. The amount of uncertainty in the experimental measurement of K X-ray intensity ratios is less than 5%. Thus the 2ŏ-geometrical configuration method with weak gamma source can be an alternative simple method to measure the jump factors and the jump ratios of pure elements in the field of X-ray spectroscopy. (author)

  13. Adesão ao tratamento e controle da pressão arterial por meio da monitoração ambulatorial de 24 horas Blood pressure treatment adherence and control through 24-hour ambulatory monitoring

    Directory of Open Access Journals (Sweden)

    Guilherme Brasil Grezzana

    2013-04-01

    Full Text Available FUNDAMENTO: A hipertensão arterial sistêmica (HAS é um importante fator de risco cardiovascular, no entanto os níveis de controle pressórico persistem inadequados. A avaliação da adesão ao tratamento anti-hipertensivo com a utilização da monitoração ambulatorial da pressão arterial (MAPA de 24 horas pode representar um importante auxílio na busca de metas de controle da HAS. OBJETIVO: Avaliar a adesão ao tratamento anti-hipertensivo e a sua relação com os valores de PA obtidos pela MAPA de 24 horas entre pacientes hipertensos de centros de atenção primária à saúde (APS. MÉTODOS: Estudo transversal com 143 pacientes hipertensos de amostra representativa de serviço de APS do município de Antônio Prado, RS. Foi realizada aplicação do teste de Morisky e Green para avaliar a aderência ao tratamento e a verificação do número de medicamentos utilizados, seguida pela aplicação da MAPA de 24 horas. RESULTADOS: Observou-se que 65,7% da amostra foram considerados aderentes ao tratamento proposto, 20,3% eram moderadamente aderentes, enquanto somente 14% foram classificados como não aderentes. Do total de 143 pacientes avaliados, 79 (55,2% foram identificados como HAS controlada (130/80 mmHg, 103 (72% apresentaram ausência de descenso noturno da PA e 60 (41,9% não estavam controlados durante o período de vigília. CONCLUSÃO: Verificamos, no presente estudo, que não há um controle adequado da HAS, com consequente perda de oportunidade dos profissionais envolvidos na APS de ajuste adequado das metas de PA preconizados. Esse fato ocorre a despeito de apropriada adesão ao tratamento anti-hipertensivo dos pacientes vinculados ao ambulatório de APS.BACKGROUND: Although systemic arterial hypertension (SAH is an important cardiovascular risk factor, blood pressure level control often remains inadequate. Assessment of adherence to antihypertensive treatment through 24-hour ambulatory blood pressure monitoring (ABPM may

  14. 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. PMID:26636429

  15. Ambulatory but sedentary : Impact on cognition and the rest-activity rhythm in nursing home residents with dementia

    NARCIS (Netherlands)

    Eggermont, Laura H. P.; Scherder, Erik J. A.

    2008-01-01

    Physical activity has been positively associated with cognition and the rest-activity rhythm. In the present study, nursing staff classified ambulatory nursing home residents with moderate dementia either as active (n = 42) or as sedentary (n = 34). We assessed the rest-activity rhythm by means of a

  16. Effects of progressive fatigue and expertise on self-talk content in running: an ambulatory assessment approach

    NARCIS (Netherlands)

    Nieuwenhuys, A; Veltman, L.J.; Braakman-Jansen, L.M.A.; Davis, P.

    2013-01-01

    Effects of Progressive Fatigue and Expertise on Self-Talk Content in Running: An Ambulatory Assessment Approach Arne Nieuwenhuys (1)*, Laurens J. Veltman (2), Louise M.A. Braakman-Jansen (2), & Paul A. Davis (3) (1) Behavioural Science Institute, Radboud University Nijmegen, The Netherlands (2) Inst

  17. Ambulatory oesophageal pH monitoring : a comparison between antimony, ISFET, and glass pH electrodes

    NARCIS (Netherlands)

    Hemmink, Gerrit J. M.; Weusten, Bas L. A. M.; Oors, Jac; Bredenoord, Albert J.; Timmer, Robin; Smout, Andre J. P. M.

    2010-01-01

    Background and aim Ambulatory oesophageal pH-impedance monitoring is a widely used test to evaluate patients with reflux symptoms. Several types of pH electrodes are available: antimony, ion sensitive field effect transistor (ISFET), and glass electrodes. These pH electrodes have not been compared d

  18. Identifying consumer segments in health services markets: an application of conjoint and cluster analyses to the ambulatory care pharmacy market.

    Science.gov (United States)

    Carrol, N V; Gagon, J P

    1983-01-01

    Because of increasing competition, it is becoming more important that health care providers pursue consumer-based market segmentation strategies. This paper presents a methodology for identifying and describing consumer segments in health service markets, and demonstrates the use of the methodology by presenting a study of consumer segments in the ambulatory care pharmacy market. PMID:10262855

  19. 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.; Li, Y.; Boggia, J.; Bjorklund-Bodegard, K.; Torp-Pedersen, C.; Jeppesen, J.; Ibsen, H.; Staessen, J.A.

    2008-01-01

    /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...

  20. The Role of Rural Health Clinics in Hospitalization Due to Ambulatory Care Sensitive Conditions: A Study in Nebraska

    Science.gov (United States)

    Zhang, Wanqing; Mueller, Keith J.; Chen, Li-Wu; Conway, Kevin

    2006-01-01

    Context: Hospitalization due to ambulatory care sensitive conditions (ACSCs) is often used as an indicator for measuring access to primary care. Rural health clinics (RHCs) provide basic primary care services for rural residents in health professional shortage areas (HPSAs). The relationship between RHCs and ACSCs is unclear. Purpose: The purpose…

  1. Risk Stratification by 24-Hour Ambulatory Blood Pressure and Estimated Glomerular Filtration Rate in 5322 Subjects From 11 Populations

    DEFF Research Database (Denmark)

    Boggia, José; Thijs, Lutgarde; Li, Yan;

    2013-01-01

    subjects (median age, 51.8 years; 43.1% women) randomly recruited from 11 populations, who had baseline measurements of 24-hour ambulatory blood pressure (ABP(24)) and eGFR. We computed hazard ratios using multivariable-adjusted Cox regression. Median follow-up was 9.3 years. In fully adjusted models...

  2. Nasal Carriage and Peritonitis by Staphylococcus Aureus in Patients on Continuous Ambulatory Peritoneal Dialysis: a prospective study

    NARCIS (Netherlands)

    G.J.A. Wanten; P. van Oost; P.M. Schneeberger (Peter); M.I. Koolen (Marianne)

    1996-01-01

    textabstractThe objective of this study was to establish whether or not patients on continuous ambulatory peritoneal dialysis (CAPD) using current infection control measures who are nasal carriers of staphylococcus aureus are at risk for the development of S. aureus peritonitis.

  3. Hospitalisation Rates for Ambulatory Care Sensitive Conditions for Persons with and without an Intellectual Disability--A Population Perspective

    Science.gov (United States)

    Balogh, R.; Brownell, M.; Ouellette-Kuntz, H.; Colantonio, A.

    2010-01-01

    Background: There is evidence that persons with an intellectual disability (ID) face barriers to primary care; however, this has not been extensively studied at the population level. Rates of hospitalisation for ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. The objective of the study was…

  4. Main influence factors on the final energy generation cost of a nuclear power plant in comparison with other energy sources

    International Nuclear Information System (INIS)

    The main factors in the construction and in the operation of nuclear power plants that affect the final energy generation cost are presented. The structure of the energy generation cost, of the nuclear fuel cost and the total investment are studied. (E.G.)

  5. 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 Salmonella...... methods, such as abattoir hygiene, logistic slaughter and decontamination, adjusting for the Danish herd and abattoir structure....

  6. MUTIRÕES DE COLECISTECTOMIA POR VIDEOLAPAROSCOPIA EM REGIME DE CIRURGIA AMBULATORIAL INTENSIVE PROGRAM OF VIDEOLAPAROSCOPY CHOLECYSTECTOMY ON AN AMBULATORY SURGERY BASIS

    Directory of Open Access Journals (Sweden)

    J.S. Santos

    2001-01-01

    Full Text Available Introdução: As listas de espera para colecistectomia, associadas à elevada demanda dos leitos e salas cirúrgicas dos Hospitais Universitários, são incentivos para adoção de novos programas de assistência. Objetivo: Avaliar o processo de organização e os resultados clínicos dos Mutirões de Colecistectomia por Videolaparoscopia, em regime de Cirurgia Ambulatorial. Pacientes e Métodos: Dentre os 314 pacientes portadores de colelitíase sintomática que aguardavam cirurgia no HCFMRP-USP, 160 foram selecionados para tratamento em regime ambulatorial. Uma equipe multiprofissional, formada por cirurgiões, anestesistas, enfermeiros e assistentes sociais, programou 4 mutirões para serem realizados em fins de semana, em função da disponibilidade do bloco cirúrgico e da sala de recuperação pós-anestésica. Mediante avaliação retrospectiva, foram analisados 79 prontuários dos pacientes operados nos Mutirões I e II (Grupo A e 79 dos 80 operados nos Mutirões III e IV (Grupo B. Análise estatística: teste de Wilcoxon e exato de Fisher (pIntroduction: The growing list of patients awaiting cholecystectomy, together with the great demand for beds and operating rooms at University Hospitals have encouraged the adoption of different solutions. Objective: To evaluate the process of organization and the clinical results of intensive programs of cholecystectomy by videolaparoscopy on an ambulatory surgery basis. Methods: Among the 314 patients with symptomatic cholelithiasis who were waiting for surgery at HCFMRP-USP, 160 were selected for treatment on an ambulatory basis. A multiprofessional team consisting of surgeons, anesthesiologists, nurses and social workers scheduled 4 intensive programs to be performed on weekends according to the availability of the surgical block and of the post-anesthesia recovery room. In a retrospective evaluation, the authors analyzed 79 medical records of patients operated upon in the intensive programs I

  7. Effects of geometrical factors on iron loss increase in wound toroidal cores energized by pulse width modulated voltage sources

    International Nuclear Information System (INIS)

    The pulse width modulated (PWM) inverter power supplies have been used increasingly to drive many electromagnetic devices for various purposes. When typical magnetic cores are energized by such voltage waveforms, additional iron losses occur due to distorted flux waveform. Most of these losses are due to an increase in frequency dependent losses. It should be noted that core geometry may also affect total power loss increase under PWM voltage excitation. This is because of a different magnetization process with respect to sinusoidal excitation. The effects of geometrical factors on magnetic properties of wound toroidal cores made of 3% grain oriented electrical steel were investigated. The results indicated that geometrical factors affect an iron loss increase under PWM voltage excitation as well as under sinusoidal excitation. The aspect ratio is particularly important in this regard

  8. Literature search on risk factors for sarcoma: PubMed and Google Scholar may be complementary sources

    OpenAIRE

    Zamprogno Emanuele; Rossi Carlo R; Fadda Emanuela; Mastrangelo Giuseppe; Buja Alessandra; Cegolon Luca

    2010-01-01

    Abstract Background Within the context of a European network dedicated to the study of sarcoma the relevant literature on sarcoma risk factors was collected by searching PubMed and Google Scholar, the two information storage and retrieval databases which can be accessed without charge. The present study aims to appraise the relative proficiency of PubMed and Google Scholar. Findings Unlike PubMed, Google Scholar does not allow a choice between "Human" and "Animal" studies, nor between "Classi...

  9. Linking fecal bacteria in rivers to landscape, geochemical, and hydrologic factors and sources at the basin scale.

    Science.gov (United States)

    Verhougstraete, Marc P; Martin, Sherry L; Kendall, Anthony D; Hyndman, David W; Rose, Joan B

    2015-08-18

    Linking fecal indicator bacteria concentrations in large mixed-use watersheds back to diffuse human sources, such as septic systems, has met limited success. In this study, 64 rivers that drain 84% of Michigan's Lower Peninsula were sampled under baseflow conditions for Escherichia coli, Bacteroides thetaiotaomicron (a human source-tracking marker), landscape characteristics, and geochemical and hydrologic variables. E. coli and B. thetaiotaomicron were routinely detected in sampled rivers and an E. coli reference level was defined (1.4 log10 most probable number⋅100 mL(-1)). Using classification and regression tree analysis and demographic estimates of wastewater treatments per watershed, septic systems seem to be the primary driver of fecal bacteria levels. In particular, watersheds with more than 1,621 septic systems exhibited significantly higher concentrations of B. thetaiotaomicron. This information is vital for evaluating water quality and health implications, determining the impacts of septic systems on watersheds, and improving management decisions for locating, constructing, and maintaining on-site wastewater treatment systems. PMID:26240328

  10. 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

  11. Effects of ecological factors and human activities on nonpoint source pollution in the upper reach of the Yangtze River and its management strategies

    Directory of Open Access Journals (Sweden)

    X. W. Ding

    2014-01-01

    Full Text Available The effects of ecological and human activities on nonpoint source (NPS pollution are key issues for sustainable water resources management. In this study, the Improved Export Coefficient Model and the Revised Universal Soil Loss Equation were adopted to estimate the annual loads of NPS pollutants during the period from 1960 through 2003 in the upper reach of the Yangtze River (URYR. Ecological factors and human activities affecting NPS pollution were distinguished and their respective effects were assessed. Variations of the dominant cause (between ecological factors and human activities were presented. Furthermore, the combined effect of them on NPS pollution were successfully revealed. The results showed that the annual loads raised from ecological factors of dissolved nitrogen (DN and dissolved phosphorus (DP were relatively steady from 1960 to 2003. But those of sediment, absorbed nitrogen (AN and absorbed phosphorus (AP decreased during that period. In terms of the annual loads caused by human activities, those of dissolved pollutants increased from 1960 to 2000 and then fell. Those of sediment as well as absorbed pollutants peaked in 1980 and then decreased. Simultaneously, the dominant cause of DN loads shifted from ecological factors to human activities after 1980 while DP loads were mainly contributed by human activities. However, sediment, dissolved pollutants were primarily exported by ecological factors. Finally, strategies for managing anthropogenic activities were proposed and their effects on NPS pollution reduction were also depicted quantitatively.

  12. Effects of ecological factors and human activities on nonpoint source pollution in the upper reach of the Yangtze River and its management strategies

    Science.gov (United States)

    Ding, X. W.; Shen, Z. Y.; Liu, R. M.; Chen, L.; Lin, M.

    2014-01-01

    The effects of ecological and human activities on nonpoint source (NPS) pollution are key issues for sustainable water resources management. In this study, the Improved Export Coefficient Model and the Revised Universal Soil Loss Equation were adopted to estimate the annual loads of NPS pollutants during the period from 1960 through 2003 in the upper reach of the Yangtze River (URYR). Ecological factors and human activities affecting NPS pollution were distinguished and their respective effects were assessed. Variations of the dominant cause (between ecological factors and human activities) were presented. Furthermore, the combined effect of them on NPS pollution were successfully revealed. The results showed that the annual loads raised from ecological factors of dissolved nitrogen (DN) and dissolved phosphorus (DP) were relatively steady from 1960 to 2003. But those of sediment, absorbed nitrogen (AN) and absorbed phosphorus (AP) decreased during that period. In terms of the annual loads caused by human activities, those of dissolved pollutants increased from 1960 to 2000 and then fell. Those of sediment as well as absorbed pollutants peaked in 1980 and then decreased. Simultaneously, the dominant cause of DN loads shifted from ecological factors to human activities after 1980 while DP loads were mainly contributed by human activities. However, sediment, dissolved pollutants were primarily exported by ecological factors. Finally, strategies for managing anthropogenic activities were proposed and their effects on NPS pollution reduction were also depicted quantitatively.

  13. Fluid shifts, vasodilatation and ambulatory blood pressure reduction during long duration spaceflight

    DEFF Research Database (Denmark)

    Norsk, Peter; Asmar, Ali; Damgaard, Morten;

    2015-01-01

    activity, and the nightly dip is maintained in space.It remains a challenge to explore what causes the systemic vasodilatation leading to a reduction in blood pressure in space, and whether the unexpectedly high stroke volume and cardiac output can explain some vision acuity problems encountered by......KEY POINTS: Weightlessness in space induces initially an increase in stroke volume and cardiac output, accompanied by unchanged or slightly reduced blood pressure.It is unclear whether these changes persist throughout months of flight.Here, we show that cardiac output and stroke volume increase by...... 35–41% between 3 and 6 months on the International Space Station, which is more than during shorter flights.Twenty-four hour ambulatory brachial blood pressure is reduced by 8–10 mmHg by a decrease in systemic vascular resistance of 39%, which is not a result of the suppression of sympathetic nervous...

  14. Dislipemia in patients undergoing continuous ambulatory peritoneal dialysis: pharmacological therapy (simvastatin) versus hemodialysis.

    Science.gov (United States)

    Marangoni, R; Civardi, F; Masi, F; Cimino, R; Maltagliati, L; Romei Longhena, G

    1993-01-01

    Peritoneal dialysis can worsen dislipemia, which is frequent in chronically uremic patients. In order to verify the therapeutic possibilities, we retrospectively studied 20 chronically uremic patients who had been previously treated with continuous ambulatory peritoneal dialysis (CAPD) and who had developed an IV-type dislipemia. Twelve have continued CAPD treatment and have been simultaneously treated with simvastatin; 8 have withdrawn from CAPD and have begun HD, without any antidislipemic pharmacological support. The results, after 3, 6, 12, and 18 months of treatment, showed the following: in patients treated with CAPD and simvastatin, highly significant decreases were noted in total cholesterol (T-cho) and triglycerides (TG) (p dislipemia only, can continue the treatment, because simvastatin is capable of correcting dislipemia, while those patients who have displemia as well as other complications strictly due to CAPD must abandon treatment and must be transferred to extracorporeal methods. PMID:8399632

  15. An ECG ambulatory system with mobile embedded architecture for ST-segment analysis.

    Science.gov (United States)

    Miranda-Cid, Alejandro; Alvarado-Serrano, Carlos

    2010-01-01

    A prototype of a ECG ambulatory system for long term monitoring of ST segment of 3 leads, low power, portability and data storage in solid state memory cards has been developed. The solution presented is based in a mobile embedded architecture of a portable entertainment device used as a tool for storage and processing of bioelectric signals, and a mid-range RISC microcontroller, PIC 16F877, which performs the digitalization and transmission of ECG. The ECG amplifier stage is a low power, unipolar voltage and presents minimal distortion of the phase response of high pass filter in the ST segment. We developed an algorithm that manages access to files through an implementation for FAT32, and the ECG display on the device screen. The records are stored in TXT format for further processing. After the acquisition, the system implemented works as a standard USB mass storage device. PMID:21095640

  16. Risk Stratification by Ambulatory Blood Pressure Monitoring Across JNC Classes of Conventional Blood Pressure

    DEFF Research Database (Denmark)

    Brguljan-Hitij, Jana; Thijs, Lutgarde; Li, Yan;

    2014-01-01

    BACKGROUND: Guidelines propose classification of conventional blood pressure (CBP) into normotension (<120/<80 mm Hg), prehypertension (120-139/80-89 mm Hg), and hypertension (≥140/≥90 mm Hg). METHODS: To assess the potential differential contribution of ambulatory blood pressure (ABP) in predict......BACKGROUND: Guidelines propose classification of conventional blood pressure (CBP) into normotension (...) in predicting risk across CBP strata, we analyzed outcomes in 7,826 untreated people recruited from 11 populations. RESULTS: During an 11.3-year period, 809 participants died (276 cardiovascular deaths) and 639, 383, and 225 experienced a cardiovascular, cardiac, or cerebrovascular event. Compared...... with normotension (n = 2,639), prehypertension (n = 3,076) carried higher risk (P ≤ 0.015) of cardiovascular (+41%) and cerebrovascular (+92%) endpoints; compared with hypertension (n = 2,111) prehypertension entailed lower risk (P ≤ 0.005) of total mortality (-14%) and cardiovascular mortality (-29...

  17. Acute Hydrothorax Complicating continuous Ambulatory Peritoneal Dialysis: A Case Report and Review of Literature.

    Science.gov (United States)

    Kechrid, M C; Malik, G H; Shaikh, J F; Al-Mohaya, S; Al-Wakeel, J S; El Gamal, H

    1999-01-01

    We describe here hydrothorax that occurred in a patient on continuous ambulatory peritoneal dialysis (CAPD) and highlight the problems of diagnosis and management. A 48 years-old man with history of obstructive uropathy secondary to urolithiasis was stared on CAPD when he reached end-stage renal failure. Two months later, he was admitted with two days history of shortness of breath on exertion and dry cough increasing in supine position. Chest examination was suggestive of right sided pleural effusion confusion confirmed by chest X-ray. Radioisotope Technetium 99m labeled albumin instilled through the peritoneal catheter was detected in the right pleural fluid confirming the peritoneo-pleural leak. The peritoneal dialysis (PD) was discontinued and the patient was switched to hemodialysis. The pleural effusion subsided and has not recurred for the following three years. PMID:18212427

  18. Acute Hydrothorax Complicating continuous Ambulatory Peritoneal Dialysis: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Kechrid Mohammad

    1999-01-01

    Full Text Available We describe here hydrothorax that occurred in a patient on continuous ambulatory peritoneal dialysis (CAPD and highlight the problems of diagnosis and management. A 48 years-old man with history of obstructive uropathy secondary to urolithiasis was stared on CAPD when he reached end-stage renal failure. Two months later, he was admitted with two days history of shortness of breath on exertion and dry cough increasing in supine position. Chest examination was suggestive of right sided pleural effusion confusion confirmed by chest X-ray. Radioisotope Technetium 99m labeled albumin instilled through the peritoneal catheter was detected in the right pleural fluid confirming the peritoneo-pleural leak. The peritoneal dialysis (PD was discontinued and the patient was switched to hemodialysis. The pleural effusion subsided and has not recurred for the following three years.

  19. Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease.

    Science.gov (United States)

    Pogue, Velvie; Rahman, Mahboob; Lipkowitz, Michael; Toto, Robert; Miller, Edgar; Faulkner, Marquetta; Rostand, Stephen; Hiremath, Leena; Sika, Mohammed; Kendrick, Cynthia; Hu, Bo; Greene, Tom; Appel, Lawrence; Phillips, Robert A

    2009-01-01

    Ambulatory blood pressure (ABP) monitoring provides unique information about day-night patterns of blood pressure (BP). The objectives of this article were to describe ABP patterns in African Americans with hypertensive kidney disease, to examine the joint distribution of clinic BP and ABP, and to determine associations of hypertensive target organ damage with clinic BP and ABP. This study is a cross-sectional analysis of baseline data from the African American Study of Kidney Disease Cohort Study. Masked hypertension was defined by elevated daytime (>or= 135/85 mm Hg) or elevated nighttime (>or= 120/70 mm Hg) ABP in those with controlled clinic BP (disease, in large part because of increased nighttime BP. Whether lowering nighttime BP improves clinical outcomes is unknown but should be tested given the substantial burden of BP-related morbidity in this population. PMID:19047584

  20. 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 and...... energy in organisational aspects of care that could be better used in direct interaction with patients. DESIGN: Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding...... satisfaction with working conditions. SETTING: Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care. KEY MEASURES FOR IMPROVEMENT: Waiting time and time wasted during consultations; calmer working situation at the clinic...

  1. 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; Asayama, Kei; Boggia, José; Hansen, Tine W.; Liu, Yan-Ping; Ohkubo, Takayoshi; Björklund-Bodegård, Kristina; Jeppesen, Jørgen; Dolan, Eamon; Torp-Pedersen, Christian; Kuznetsova, Tatiana; Stolarz-Skrzypek, Katarzyna; Tikhonoff, Valérie; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Sandoya, Edgardo; Kawecka-Jaszcz, Kalina; Imai, Yutaka; Mena, Luis J.; Wang, Jiguang; O’Brien, Eoin; Verhamme, Peter; Filipovský, Jan; Maestre, Gladys E.; Staessen, Jan A.

    2014-01-01

    person-years), the risk of cardiovascular (HR, 1.58; P=0.011) or cardiac (HR, 1.52; P=0.056) events increased only in the top PP tenth (mean, 60.6 mm Hg). Using stepwise increasing PP levels, the lower boundary of the 95% confidence interval of the successive thresholds did not cross unity. Among 3910......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 (<60 versus ≥60...... 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...

  2. Response of Ambulatory Human Subjects to Artificial Gravity (Short Radius Centrifugation)

    Science.gov (United States)

    Paloski, William H.; Arya, Maneesh; Newby, Nathaniel; Tucker, Jon-Michael; Jarchow, Thomas; Young, Laurence

    2006-01-01

    Prolonged exposure to microgravity results in significant adaptive changes, including cardiovascular deconditioning, muscle atrophy, bone loss, and sensorimotor reorganization, that place individuals at risk for performing physical activities after return to a gravitational environment. Planned missions to Mars include unprecedented hypogravity exposures that would likely result in unacceptable risks to crews. Artificial gravity (AG) paradigms may offer multisystem protection from the untoward effects of adaptation to the microgravity of space or the hypogravity of planetary surfaces. While the most effective AG designs would employ a rotating spacecraft, perceived issues may preclude their use. The questions of whether and how intermittent AG produced by a short radius centrifuge (SRC) could be employed have therefore sprung to the forefront of operational research. In preparing for a series of intermittent AG trials in subjects deconditioned by bed rest, we have examined the responses of several healthy, ambulatory subjects to SRC exposures.

  3. Sclerosing encapsulating peritonitis in chronic ambulatory peritoneal dialysis;preoperative catheter drainage : a case report

    International Nuclear Information System (INIS)

    Sclerosing encapsulating peritonitis is a well recognized, but uncommon, complication of chronic ambulatory peritoneal dialysis. I report a case of sclerosing encapsulating peritonitis in which percutaneous catheter drainage was performed preoperatively. Ultrasonography(US) and computed tomography(CT) showed a large multi-septated cystic mass which occupied nearly all the peritoneal cavity. Percutaneous drainage with two 8.5 French catheters was preoperatively performed under fluoroscopy and about 2100 ml of bloody fluid was drained for 20 days. On follow-up CT, the size of the cyst had significantly decreased and anoperation was performed. It is considered that percutaneous catheter drainage is useful in the preoperative decompression of sclerosing encapsulating peritonitis

  4. Influence of electrode placement on signal quality for ambulatory pregnancy monitoring.

    Science.gov (United States)

    Rooijakkers, M J; Song, S; Rabotti, C; Oei, S G; Bergmans, J W M; Cantatore, E; Mischi, M

    2014-01-01

    Noninvasive fetal health monitoring during pregnancy has become increasingly important in order to prevent complications, such as fetal hypoxia and preterm labor. With recent advances in signal processing technology using abdominal electrocardiogram (ECG) recordings, ambulatory fetal monitoring throughout pregnancy is now an important step closer to becoming feasible. The large number of electrodes required in current noise-robust solutions, however, leads to high power consumption and reduced patient comfort. In this paper, requirements for reliable fetal monitoring using a minimal number of electrodes are determined based on simulations and measurement results. To this end, a dipole-based model is proposed to simulate different electrode positions based on standard recordings. Results show a significant influence of bipolar lead orientation on maternal and fetal ECG measurement quality, as well as a significant influence of interelectrode distance for all signals of interest. PMID:24639888

  5. Influence of Electrode Placement on Signal Quality for Ambulatory Pregnancy Monitoring

    Directory of Open Access Journals (Sweden)

    M. J. Rooijakkers

    2014-01-01

    Full Text Available Noninvasive fetal health monitoring during pregnancy has become increasingly important in order to prevent complications, such as fetal hypoxia and preterm labor. With recent advances in signal processing technology using abdominal electrocardiogram (ECG recordings, ambulatory fetal monitoring throughout pregnancy is now an important step closer to becoming feasible. The large number of electrodes required in current noise-robust solutions, however, leads to high power consumption and reduced patient comfort. In this paper, requirements for reliable fetal monitoring using a minimal number of electrodes are determined based on simulations and measurement results. To this end, a dipole-based model is proposed to simulate different electrode positions based on standard recordings. Results show a significant influence of bipolar lead orientation on maternal and fetal ECG measurement quality, as well as a significant influence of interelectrode distance for all signals of interest.

  6. Experiment for ambulatory inhalation rehabilitation of occupational dust-radiation injuries of the respiratory system

    International Nuclear Information System (INIS)

    An experiment was carried out for ambulatory inhalation rehabilitation on a group of 172 subjects with pronounced injuries of the respiratory system. Parallely with them was a rehabilitated group of 8 pensioners. Because of the specific nature of the production etiopathogenetic complex including inhalation introduced radioactive and stable aerosols and their uninterrupted action during rehabilitation, the experiment conducted is of special importance for the perspective elaboration and implementation of health measures in a numerous contingent of workers in industrial important branches without discontinuing work. A positive effect was obtained in 54,2% of the treated non-smokers. No improvement was found of the objective ventilation indices of respiration in smokers and pensioners. As far as physical and anamnestic indices are concerned, such as rales, cough, dyspnea, pains in the chest etc., there was impovement in all treated subjects. Finally, some conclusions are drawn about the future trends of inhalation prophylaxis in the respective branches of production

  7. Comparative evaluation of an ambulatory EEG platform vs. clinical gold standard.

    Science.gov (United States)

    Jackson, Gregory; Radhu, Natasha; Sun, Yinming; Tallevi, Kevin; Ritvo, Paul; Daskalakis, Zafiris J; Grundlehner, Bernard; Penders, Julien; Cafazzo, Joseph A

    2013-01-01

    Electroencephalography (EEG) testing in clinical labs makes use of large amplifiers and complex software for data acquisition. While there are new ambulatory electroencephalogram (EEG) systems, few have been directly compared to a gold standard system. Here, an ultra-low power wireless EEG system designed by Imec is tested against the gold standard Neuroscan SynAmps2 EEG system, recording simultaneously from the same laboratory cap prepared with electrode gel. The data was analyzed using correlation analysis for both time domain and frequency domain data. The analysis indicated a high Pearson's correlation coefficient (mean=0.957, median=0.985) with high confidence (mean P=0.002) for 10-second sets of data transformed to the frequency domain. The time domain results had acceptable Pearson's coefficient (mean=0.580, median =0.706) with high confidence (mean P=0.008). PMID:24109914

  8. Addressing Pediatric Obesity in Ambulatory Care: Where Are We and Where Are We Going?

    Science.gov (United States)

    Lenders, Carine M; Manders, Aaron J; Perdomo, Joanna E; Ireland, Kathy A; Barlow, Sarah E

    2016-06-01

    Since the "2007 summary report of child and adolescent overweight and obesity treatment" published by Barlow, many obesity intervention studies have been conducted in pediatric ambulatory care. Although several meta-analyses have been published in the interim, many studies were excluded because of the focus and criteria of these meta-analyses. Therefore, the primary goal of this article was to identify randomized case-control trials conducted in the primary care setting and to report on treatment approaches, challenges, and successes. We have developed four themes for our discussion and provide a brief summary of our findings. Finally, we identified major gaps and potential solutions and describe several urgent key action items. PMID:27048522

  9. Marketing strategy adjustments in the ambulatory care center industry: implications for community pharmacy.

    Science.gov (United States)

    Phillips, J H

    1989-01-01

    Each stage of a product's life cycle requires marketing strategy modifications in response to changing demand levels. The purpose of this study was to investigate changes in ambulatory care center (ACC) operational characteristics indicative of product, market, and distribution channel adjustments that could have a competitive impact upon community pharmacy practice. A questionnaire was mailed to a national sample of 325 ACC managers. Evidence of new product feature additions includes increased emphasis on continued care and increased prevalence of prescription drug dispensing. Expansion into new market segments and distribution channels was demonstrated by increased participation in HMO and employer relationships. The observed adjustments in ACC marketing strategies present obvious challenges as well as less obvious opportunities for community pharmacy practice. PMID:10295634

  10. An analysis of revenues and expenses in a hospital-based ambulatory pediatric practice.

    Science.gov (United States)

    Berkelhamer, J E; Rojek, K J

    1988-05-01

    We developed a method of analyzing revenues and expenses in a hospital-based ambulatory pediatric practice. Results of an analysis of the Children's Medical Group (CMG) at the University of Chicago Medical Center demonstrate how changes in collection rates, practice expenses, and hospital underwriting contribute to the financial outcome of the practice. In this analysis, certain programmatic goals of the CMG are achieved at a level of just under 12,000 patient visits per year. At this activity level, pediatric residency program needs are met and income to the CMG physicians is maximized. An ethical problem from the physician's perspective is created by seeking profit maximization. To accomplish this end, the CMG physicians would have to restrict their personal services to only the better-paying patients. This study serves to underscore the importance of hospital-based physicians and hospital administrators structuring fiscal incentives for physicians that mutually meet the institutional goals for the hospital and its physicians. PMID:3358399

  11. Sources identification of the atmospheric aerosol at urban and suburban sites in Indonesia by positive matrix factorization

    International Nuclear Information System (INIS)

    Samples of fine and coarse fractions of airborne particulate matter were collected in Indonesia (west central Java) at an urban site in Bandung and in suburban Lembang from January 2002 to December 2004. The samples were collected using a Gent stacked filter sampler in two size fractions of 2.5-10 mass at both sites comes from soil dust and road dust. The biomass burning factor contributes about 40% of the PM2.5 mass in case of suburban Lembang and about 20% in urban Bandung

  12. Medication-related problem type and appearance rate in ambulatory hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Drayer Debra K

    2003-12-01

    Full Text Available 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 categorized by type and medication class. MRP appearance rate was determined as the number of MRP identified per month/number of months in study. The number of MRP per patient-drug exposures were determined using: {[(number of patients × (mean number of medications]/(number of months of study} /number of MRP identified. Results were expressed as mean ± standard deviation or percentages. Results Patients were 62.6 ± 15.9 years old, had 6.4 ± 2.0 comorbid conditions, were taking 12.5 ± 4.2 medications, and 15.7 ± 7.2 doses per day at baseline. Medication-dosing problems (33.5%, adverse drug reactions (20.7%, and an indication that was not currently being treated (13.5% were the most common MRP. 5,373 medication orders were reviewed and a MRP was identified every 15.2 medication exposures. Overall MRP appearance rate was 0.68 ± 0.46 per patient per month. Conclusion MRP continue to occur at a high rate in ambulatory HD patients. Healthcare providers taking care of HD patients should be aware of this problem and efforts to avoid or resolve MRP should be undertaken at all HD clinics.

  13. Results of ambulatory arterial blood pressure monitoring in children with obesity

    Directory of Open Access Journals (Sweden)

    Faruk Öktem

    2010-12-01

    Full Text Available Objectives: The relationship between obesity and essential hypertension is well known. In this study, we aimed to evaluate ambulatory arterial blood pressure monitoring of obese and non-obese children who had similar demographic characteristics.Materials and methods: Seventy one children and adolescents (n=39 obesity, n=32 controls were studied. Blood pressure of the children were measured by 24 hour ambulatory blood pressure monitoring device.Results: Obese children had significantly higher mean blood pressure values (systolic 121.9±11.7 mmHg, diastolic 70.2±5.3 mmHg than control subjects (systolic 109.3±6.7 mmHg, diastolic 65.1±4.6 mmHg, p0.05. Blood pressure load was found to be increased in obese children compared to the controls (%13.6±12.9 and %2.6±3.4, respectively; p<0.05. Serum total cholesterol and LDL-cholesterol levels of obese children (181.1±33.4 and 131.1±23.1mg/dl were significantly higher than those of the controls (134.3±11.1 and 103.3±14.2 mg/dl, p<0.05.Conclusions: Obesity in children and adolescents should not be regarded as variations of normality, but as abnormality with an extremely high risk for the development of hypertension and hyperlipidemia in adulthood.

  14. Need for insulin to control gestational diabetes is reflected in the ambulatory arterial stiffness index

    Directory of Open Access Journals (Sweden)

    Kärkkäinen Henna

    2013-01-01

    Full Text Available Abstract Background The aim was to evaluate the metabolic profile in conjunction with vascular function using the ambulatory arterial stiffness index (AASI in women with uncomplicated pregnancies and in women with gestational diabetes mellitus (GDM. Methods Plasma glucose, lipids, HOMA –IR (homeostasis model assessment of insulin resistance and AASI, as obtained from 24-hour ambulatory blood pressure monitoring in third trimester pregnancy and at three months postpartum, were measured in three groups of women: controls (N = 32, women with GDM on diet (N = 42 and women with GDM requiring insulin treatment (N = 10. Results Women with GDM had poorer glycemic control and higher HOMA-IR during and after pregnancy and their total and LDL (low density lipoprotein cholesterol levels were significantly higher after pregnancy than in the controls. After delivery, there was an improvement in AASI from 0.26 ± 0.10 to 0.17 ± 0.09 (P = 0.002 in women with GDM on diet, but not in women with GDM receiving insulin whose AASI tended to worsen after delivery from 0.30 ± 0.23 to 0.33 ± 0.09 (NS, then being significantly higher than in the other groups (P = 0.001-0.047. Conclusions Women with GDM had more unfavorable lipid profile and higher blood glucose values at three months after delivery, the metabolic profile being worst in women requiring insulin. Interestingly, the metabolic disturbances at three months postpartum were accompanied by a tendency towards arterial stiffness to increase in women requiring insulin.

  15. Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery

    Directory of Open Access Journals (Sweden)

    Soeteman M

    2015-03-01

    Full Text Available Marijn Soeteman,1 Vera Peters,2 Jamiu O Busari1,3 1Department of Pediatrics, Atrium Medical Center, Heerlen, 2Faculty of Health, Medicine and Life Sciences, 3Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands 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. Infrastructural changes to our clinic’s waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1 accessibility to caregivers and 2 quality of service and available amenities. Design: We conducted a multi-method survey using 1 a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2 specially designed questionnaires to investigate patients’ perceptions of our wait time and how to improve our services. Results: The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55% felt that 10–20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%. Finally, a large number of patients (97% were satisfied with the quality of service and with the accessibility to caregivers (94%. Conclusion: The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of

  16. Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of tramadol, metamizol, and paracetamol.

    Science.gov (United States)

    Rawal, N; Allvin, R; Amilon, A; Ohlsson, T; Hallén, J

    2001-02-01

    We compared in a prospective, randomized, double-blinded study the analgesic efficacy of three drugs in 120 ASA I and II patients scheduled to undergo ambulatory hand surgery with IV regional anesthesia. At discharge, oral analgesic tablets were prescribed as follows: tramadol 100 mg every 6 h, metamizol 1 g every 6 h, and paracetamol (acetaminophen) 1 g every 6 h. Rescue medication consisted of oral dextropropoxyphene 100 mg on demand. Analgesic efficacy was evaluated by self-assessment of pain intensity by visual analog score at six different time intervals during the 48-h study period. Patients also recorded global pain relief on a 5-grade scale, total number of study and rescue analgesic tablets, frequency and severity of adverse effects, sleep pattern, and overall satisfaction. None of the study drugs alone provided effective analgesia in all patients. The percentage of patients who required supplementary analgesics was 23% with tramadol, 31% with metamizol, and 42% with acetaminophen. Tramadol was the most effective analgesic, as evidenced by low pain scores, least rescue medication, and fewest number of patients with sleep disturbance. However, the incidence of side effects was also increased with tramadol. Seven patients (17.5%) withdrew from the study because of the severity of nausea and dizziness associated with the use of tramadol. Metamizol and acetaminophen provided good analgesia in about 70% and 60% of patients, respectively, with a decreased incidence of side effects. Despite receiving oral analgesic medication, up to 40% of patients undergoing hand surgery experienced inadequate analgesia in this controlled trial. Although tramadol was more effective, its use was associated with the highest frequency and intensity of adverse effects and the most patient dissatisfaction. Metamizol and acetaminophen provided good analgesia with a small incidence of side effects. For patients undergoing ambulatory hand surgery, postoperative pain can last longer than

  17. Residual renal function and nutritional status in patients on continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Jovanović Nataša

    2005-01-01

    Full Text Available Introduction During the last years, an increasing number of patients with end-stage renal failure caused by various underlying diseases, all over the world, is treated by renal replacement therapy. Nutritional status Malnutrition is often found in patients affected by renal failure; it is caused by reduced intake of nutritional substances due to anorexia and dietary restrictions hormonal and metabolic disorders, comorbid conditions and loss of proteins, amino-acids, and vitamins during the dialysis procedure itself. Nutritional status significantly affects the outcome of patients on chronic dialysis treatment. Recent epiodemiological trials have proved that survival on chronic continuous ambulatory peritoneal dialysis program depends more on residual renal function (RRF than on peritoneal clearances of urea and creatinine. Material and methods The aim of the study was to analyze the influence of RRF on common biochemical and anthropometric markers of nutrition in 32 patients with end-stage renal failure with various underlying diseases during the first 6 months on continuous ambulatory peritoneal dialysis (CAPD. The mean residual creatinine clearance was 8,3 ml/min and the mean RRF was 16,24 week in our patients at the beginning of the chronic peritoneal dialysis treatment. Results and conclusion During the follow-up, the RRF slightly decreased, while the nutritional status of patients significantly improved. Gender and age, as well as the leading disease and peritonitis didn't influence the RRF during the first 6 months of CAPD treatment. We found several positive correlations between RRF and laboratory and anthropometric markers of nutrition during the follow-up, proving the positive influence of RRF on nutritional status of patients on chronic peritoneal dialysis.

  18. Unsupervised machine-learning method for improving the performance of ambulatory fall-detection systems

    Directory of Open Access Journals (Sweden)

    Yuwono Mitchell

    2012-02-01

    Full Text Available Abstract Background Falls can cause trauma, disability and death among older people. Ambulatory accelerometer devices are currently capable of detecting falls in a controlled environment. However, research suggests that most current approaches can tend to have insufficient sensitivity and specificity in non-laboratory environments, in part because impacts can be experienced as part of ordinary daily living activities. Method We used a waist-worn wireless tri-axial accelerometer combined with digital signal processing, clustering and neural network classifiers. The method includes the application of Discrete Wavelet Transform, Regrouping Particle Swarm Optimization, Gaussian Distribution of Clustered Knowledge and an ensemble of classifiers including a multilayer perceptron and Augmented Radial Basis Function (ARBF neural networks. Results Preliminary testing with 8 healthy individuals in a home environment yields 98.6% sensitivity to falls and 99.6% specificity for routine Activities of Daily Living (ADL data. Single ARB and MLP classifiers were compared with a combined classifier. The combined classifier offers the greatest sensitivity, with a slight reduction in specificity for routine ADL and an increased specificity for exercise activities. In preliminary tests, the approach achieves 100% sensitivity on in-group falls, 97.65% on out-group falls, 99.33% specificity on routine ADL, and 96.59% specificity on exercise ADL. Conclusion The pre-processing and feature-extraction steps appear to simplify the signal while successfully extracting the essential features that are required to characterize a fall. The results suggest this combination of classifiers can perform better than MLP alone. Preliminary testing suggests these methods may be useful for researchers who are attempting to improve the performance of ambulatory fall-detection systems.

  19. Ambulatory measurement of knee motion and physical activity: preliminary evaluation of a smart activity monitor

    Directory of Open Access Journals (Sweden)

    Malchau Henrik

    2006-09-01

    Full Text Available Abstract Background There is currently a paucity of devices available for continuous, long-term monitoring of human joint motion. Non-invasive, inexpensive devices capable of recording human activity and joint motion have many applications for medical research. Such a device could be used to quantify range of motion outside the gait laboratory. The purpose of this study was to test the accuracy of the modified Intelligent Device for Energy Expenditure and Activity (IDEEA in measuring knee flexion angles, to detect different physical activities, and to quantify how often healthy subjects use deep knee flexion in the ambulatory setting. Methods We compared Biomotion Laboratory (BML "gold standard" data to simultaneous IDEEA measures of knee motion and gait, step up/down, and stair descent in 5 healthy subjects. In addition, we used a series of choreographed physical activities outside the BML to confirm the IDEEA's ability to accurately measure 7 commonly-performed physical activities. Subjects then continued data collection during ordinary activities outside the gait laboratory. Results Pooled correlations between the BML and IDEEA knee flexion angles were .97 +/- .03 for step up/down, .98 +/- .02 for stair descent, and .98 +/- .01 for gait. In the BML protocol, the IDEEA accurately identified gait, but was less accurate in identifying step up/down and stair descent. During sampling outside the BML, the IDEEA accurately detected walking, running, stair ascent, stair descent, standing, lying, and sitting. On average, subjects flexed their knees >120° for 0.17% of their data collection periods outside the BML. Conclusion The modified IDEEA system is a useful clinical tool for evaluating knee motion and multiple physical activities in the ambulatory setting. These five healthy subjects rarely flexed their knees >120°.

  20. Differentiating between light and deep sleep stages using an ambulatory device based on peripheral arterial tonometry

    International Nuclear Information System (INIS)

    The objective of this study is to develop and assess an automatic algorithm based on the peripheral arterial tone (PAT) signal to differentiate between light and deep sleep stages. The PAT signal is a measure of the pulsatile arterial volume changes at the finger tip reflecting sympathetic tone variations and is recorded by an ambulatory unattended device, the Watch-PAT100, which has been shown to be capable of detecting wake, NREM and REM sleep. An algorithm to differentiate light from deep sleep was developed using a training set of 49 patients and was validated using a separate set of 44 patients. In both patient sets, Watch-PAT100 data were recorded simultaneously with polysomnography during a full night sleep study. The algorithm is based on 14 features extracted from two time series of PAT amplitudes and inter-pulse periods (IPP). Those features were then further processed to yield a prediction function that determines the likelihood of detecting a deep sleep stage epoch during NREM sleep periods. Overall sensitivity, specificity and agreement of the automatic algorithm to identify standard 30 s epochs of light and deep sleep stages were 66%, 89%, 82% and 65%, 87%, 80% for the training and validation sets, respectively. Together with the already existing algorithms for REM and wake detection we propose a close to full stage detection method based solely on the PAT and actigraphy signals. The automatic sleep stages detection algorithm could be very useful for unattended ambulatory sleep monitoring assessing sleep stages when EEG recordings are not available