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

    Directory of Open Access Journals (Sweden)

    Kent C

    2014-06-01

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

  4. Risk factors for the occurrence of cardiac arrhythmias in patients on continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Canziani, M E; Saragoça, M A; Draibe, S A; Barbieri, A; Ajzen, H

    1993-01-01

    In order to evaluate the risk factors for the occurrence of ventricular arrhythmias (VA) in continuous ambulatory peritoneal dialysis (CAPD), we studied 47 patients by echocardiography, dipyridamole-thallium tests, and biochemical profile. We observed that the group with VA had a greater cardiac mass index dependent only on an increased left ventricular internal diameter. Septum and posterior wall thickness, as well as biochemical variables, were not associated with the presence of VA in CAPD patients. In addition, altered myocardial perfusion was not associated with VA in these patients. PMID:8399625

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

    Directory of Open Access Journals (Sweden)

    Xiaoguang Fan

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

  6. 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.

  7. Ambulatory electrocardiology.

    Science.gov (United States)

    Romero, Iñaki

    2013-01-01

    About 50 years ago, Norman Jefferis Holter invented a device that opened the possibility of recording heart activity over long periods of time. This invention, together with the rapid developments in electronics, has enabled a revolutionary change in the diagnosis and management of cardiac diseases. Ambulatory cardiac monitors have decreased in size to the point of becoming wearable or implantable and are able to monitor heart activity for months or even years. In addition, new telecommunication systems allow clinicians to remotely access cardiac events and to respond within a short period of time. Novel advances in computing and algorithm development are expanding the clinical applications of ambulatory devices with more complex automatic interpretation of the electrocardiographic signal. This article reviews the state of the art of these techniques from both clinical and technical approaches, covering a historic perspective up to today, and discusses current applications, challenges, and future directions. PMID:23422020

  8. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... Webinars Publications & Resources Clinical Practice Guidelines SAMBA Link Digital ... We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, encourages research ...

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

    Science.gov (United States)

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

    2014-05-01

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

  10. [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

  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 - State

    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. Ambulatory Surgical Measures - National

    Data.gov (United States)

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

  14. 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...

  15. 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

  16. 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.

  17. Ambulatory anaesthesia and cognitive dysfunction

    DEFF Research Database (Denmark)

    Rasmussen, Lars S; Steinmetz, Jacob

    2015-01-01

    anaesthesia in the outpatient setting. Cognitive complications such as delirium and postoperative cognitive dysfunction are less frequent in ambulatory surgery than with hospitalization. SUMMARY: The elderly are especially susceptible to adverse effects of the hospital environment such as immobilisation...

  18. 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 (Psurgeries. Almost half of patients with an SSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%-91.33%) and specificity was 99.94% (99.89%-99.97%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938.

  19. 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

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

    Directory of Open Access Journals (Sweden)

    Clarissa P. Souza

    2008-08-01

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

  1. 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.

  2. 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

  3. 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

  4. 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...

  5. 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.

  6. 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

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

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2016-06-01

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

  8. 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

  9. 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

  10. 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 ...

  11. 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

  12. Towards ambulatory mental stress measurement from physiological parameters

    NARCIS (Netherlands)

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

    2013-01-01

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

  13. 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

  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. Ambulatory spine surgery: a survey study.

    Science.gov (United States)

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

    2014-08-01

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

  17. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin

    2007-01-01

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

  18. 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.

  19. 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…

  20. 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.

  1. 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...

  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. Factors influencing dietary protein sources in the PREMIER trial population.

    Science.gov (United States)

    Lin, Pao-Hwa; Miwa, Saki; Li, Yi-Ju; Wang, Yanfang; Levy, Erma; Lastor, Katherine; Champagne, Catherine

    2010-02-01

    Previous research suggests that protein intake, particularly plant protein, may benefit blood pressure control. However, very little has been published regarding protein sources in diets of US adults and factors influencing these choices. The purpose of this report is to describe specific sources of animal and plant proteins in diets of PREMIER clinical trial participants at baseline and how the PREMIER intervention, along with participant demographics, affected protein sources. Adult participants (n=809) who completed the 18-month PREMIER lifestyle intervention trial and had at least one diet recall at each of three study visits were included. Participants were recruited from four clinical centers in the Eastern, Southern, and Northeastern regions of United States. The PREMIER trial, conducted from 1999 to 2002, compared the impact on blood pressure of two structured behavioral interventions focusing on the traditional lifestyle modifications for blood pressure control with or without the Dietary Approaches to Stop Hypertension dietary pattern. Protein sources were assessed by two unannounced 24-hour recalls at each of three study visits. Differences in protein sources were mainly related to participant demographics, with relatively moderate impact of the intervention. The top four protein sources for all the study participants were poultry, dairy, refined grains and beef, each contributing approximately 10% to 17% in descending order to the total protein intake at baseline. Animal and plant protein each comprised approximately 66% and 34%, respectively, to the total daily protein intake at baseline, and such overall contribution pattern remained relatively constant over time. However, sex, race, age, and body weight status all influenced contribution patterns from different food groups significantly. These influences significantly impact choice and are essential elements to consider when designing intervention programs to alter protein contributions from animal

  4. 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...

  5. 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 ...

  6. Setting up of ambulatory hysteroscopy service.

    Science.gov (United States)

    Kolhe, Shilpa

    2015-10-01

    There is an obvious trend towards developing ambulatory procedures in gynaecology with ambulatory hysteroscopy as its mainstay. In the recent years, the fast pace of modern technological advances in gynaecologic endoscopy, and particularly in the field of hysteroscopy, have been both thrilling and spectacular. Despite this, the uptake of operative hysteroscopy in ambulatory settings has been relatively slow. There is some apprehension amongst gynaecologists to embark on therapeutic outpatient hysteroscopy, and an organisational change is required to alter the mindset. Although there are best practice guidelines for outpatient hysteroscopy, there are unresolved issues around adequate training and accreditation of future hysteroscopists. Virtual-reality simulation training for operative hysteroscopy has shown promising preliminary results, and it is being aggressively evaluated and validated. This review article is an attempt to provide a useful practical guide to all those who wish to implement ambulatory hysteroscopy services in their outpatient departments. PMID:25979350

  7. 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.

  8. 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

  9. 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...

  10. 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...

  11. 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...

  12. Twenty-five years of ambulatory laparoscopic cholecystectomy.

    Science.gov (United States)

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

    2016-10-01

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

  13. 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.

  14. 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.

  15. 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

  16. 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...

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. Planning an ambulatory care joint venture.

    Science.gov (United States)

    Harpster, L M

    1988-01-01

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

  4. 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

  5. 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.

  6. 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...

  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

    2012-02-01

    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.

  9. 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.

  10. Cochlear implant in an ambulatory surgery center.

    Science.gov (United States)

    Joseph, Aimee M; Lassen, L Frederick

    2013-02-01

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

  11. 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...

  12. The evolution of ambulatory ECG monitoring.

    Science.gov (United States)

    Kennedy, Harold L

    2013-01-01

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

  13. 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,…

  14. 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

  15. 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...

  16. 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.

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

    Directory of Open Access Journals (Sweden)

    Guillaume eAndeol

    2015-01-01

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

  18. Psychosocial aspects of ambulatory pediatrics.

    Science.gov (United States)

    Jellinek, M S; Slovik, L; Murphy, J M; Herzog, D; Beresin, E

    1990-10-01

    The ability to interview is an essential skill that continues to develop throughout a pediatrician's professional life. Interviewing is a complex procedure that requires in-depth understanding of medical illness, child development, individual and family dynamics, cultural variations, and self-awareness--your personal values and response to crisis, serious illness, and stress. Interviewing is learned by thoughtful reflection of each interview as well as more formally through the use of videotape and attending observation. Each interview is an opportunity to develop a relationship and add a bit of experience that is unique to the patient or parent and potentially useful in understanding more in the future. Although this procedure receives little formal attention, the interview is often the primary vehicle for making the diagnosis, relating to the child and family, and easing emotional suffering and can be a source of satisfaction for the many hours of hard work. PMID:2245654

  19. [Quality assurance in ambulatory surgery].

    Science.gov (United States)

    Hansis, M L

    2004-02-01

    Surgery in outpatients and surgery under hospital conditions should provide the patient with the same high level of quality and the same low risk level. The one-person surgery practice is able to offer the patient a classic "one client-one customer" relation. Thus, the continuity of treatment is optimal. On the other hand, intervening systemic complications are more easily managed by the multidisciplinary staff of a hospital with its equipment. The weaknesses of both principles can be counteracted by employing special precautions in organization. The future of surgery is to be seen in combined forms, for example, in-sourcing of a surgeon from private practice into a hospital. PMID:14991173

  20. 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.

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

    Science.gov (United States)

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

    2015-03-01

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

  2. 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.

  3. 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.

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

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

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

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

    Science.gov (United States)

    Levy, Margaret

    1988-01-01

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

  6. 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…

  7. [25 years of organized ambulatory heart sport in Luxembourg. The development of a sustained rehabilitation model].

    Science.gov (United States)

    Delagardelle, Charles; Feiereisen, Patrick

    2011-01-01

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

  8. [25 years of organized ambulatory heart sport in Luxembourg. The development of a sustained rehabilitation model].

    Science.gov (United States)

    Delagardelle, Charles; Feiereisen, Patrick

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Reza Mokhtarpour

    2009-07-01

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

  10. Hepatic Dysfunction in Ambulatory Patients With Heart Failure

    Science.gov (United States)

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

    2013-01-01

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

  11. Managing hypertension with ambulatory blood pressure monitoring.

    Science.gov (United States)

    White, William B; Gulati, Vinay

    2015-02-01

    There has been a dramatic shift in the manner in which blood pressure (BP) is measured to provide far more comprehensive clinical information than that provided by a single set of office BP readings. Extensive clinical and epidemiological research shows an important role of ambulatory BP monitoring (ABPM) in the management of hypertensive patients. A 24-h BP profile helps to determine the absence of nocturnal dipping status and evaluate BP control in patients on antihypertensive therapy. The ability to detect white-coat or masked hypertension is enhanced by ambulatory BP monitoring. In 2001, the Center for Medicare and Medicaid Services approved ABPM for reimbursement for the identification of patients with white-coat hypertension. In 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidelines that recommended the routine use of ABPM in all patients suspected of having hypertension. The European Society of Hypertension (ESH) 2013 guidelines also support greater use of ABPM in clinical practice. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to its cost, the complexity of data evaluation, as well as patient inconvenience. In this review, we evaluate the clinical importance of ABPM, highlighting its role in the current management of hypertension.

  12. 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.

  13. 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...

  14. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1979-09-01

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

  16. Computer database of ambulatory EEG signals.

    Science.gov (United States)

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

    1987-01-01

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

  17. Ambulatory ST segment monitoring after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1994-01-01

    The prevalence of transient myocardial ischaemia after myocardial infarction seems to be lower than in other subgroups with coronary artery disease. In postinfarction patients, however, a greater proportion of ischaemic episodes are silent. At present there is substantial evidence that transient...... ischaemia provides prognostic information in different subsets of patients with previous myocardial infarction, but there is considerable disagreement about how this is expressed in terms of cardiac events. Small patient numbers, patient selection, and different timing of ambulatory monitoring are proposed...... be that it can be performed early after infarction at the time of maximum risk. Secondly, it can be performed in most patients after infarction, including those recognised as being at high risk who are unable to perform an exercise stress test....

  18. 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.

  19. 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

  20. Source apportionment and location by selective wind sampling and Positive Matrix Factorization.

    Science.gov (United States)

    Venturini, Elisa; Vassura, Ivano; Raffo, Simona; Ferroni, Laura; Bernardi, Elena; Passarini, Fabrizio

    2014-10-01

    In order to determine the pollution sources in a suburban area and identify the main direction of their origin, PM2.5 was collected with samplers coupled with a wind select sensor and then subjected to Positive Matrix Factorization (PMF) analysis. In each sample, soluble ions, organic carbon, elemental carbon, levoglucosan, metals, and Polycyclic Aromatic Hydrocarbons (PAHs) were determined. PMF results identified six main sources affecting the area: natural gas home appliances, motor vehicles, regional transport, biomass combustion, manufacturing activities, and secondary aerosol. The connection of factor temporal trends with other parameters (i.e., temperature, PM2.5 concentration, and photochemical processes) confirms factor attributions. PMF analysis indicated that the main source of PM2.5 in the area is secondary aerosol. This should be mainly due to regional contributions, owing to both the secondary nature of the source itself and the higher concentration registered in inland air masses. The motor vehicle emission source contribution is also important. This source likely has a prevalent local origin. The most toxic determined components, i.e., PAHs, Cd, Pb, and Ni, are mainly due to vehicular traffic. Even if this is not the main source in the study area, it is the one of greatest concern. The application of PMF analysis to PM2.5 collected with this new sampling technique made it possible to obtain more detailed results on the sources affecting the area compared to a classical PMF analysis. PMID:24488520

  1. Comparison of analytic source models for head scatter factor calculation and planar dose calculation for IMRT

    Energy Technology Data Exchange (ETDEWEB)

    Yan Guanghua [Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, FL 32611 (United States); Liu, Chihray; Lu Bo; Palta, Jatinder R; Li, Jonathan G [Department of Radiation Oncology, University of Florida, Gainesville, FL 32610-0385 (United States)

    2008-04-21

    The purpose of this study was to choose an appropriate head scatter source model for the fast and accurate independent planar dose calculation for intensity-modulated radiation therapy (IMRT) with MLC. The performance of three different head scatter source models regarding their ability to model head scatter and facilitate planar dose calculation was evaluated. A three-source model, a two-source model and a single-source model were compared in this study. In the planar dose calculation algorithm, in-air fluence distribution was derived from each of the head scatter source models while considering the combination of Jaw and MLC opening. Fluence perturbations due to tongue-and-groove effect, rounded leaf end and leaf transmission were taken into account explicitly. The dose distribution was calculated by convolving the in-air fluence distribution with an experimentally determined pencil-beam kernel. The results were compared with measurements using a diode array and passing rates with 2%/2 mm and 3%/3 mm criteria were reported. It was found that the two-source model achieved the best agreement on head scatter factor calculation. The three-source model and single-source model underestimated head scatter factors for certain symmetric rectangular fields and asymmetric fields, but similar good agreement could be achieved when monitor back scatter effect was incorporated explicitly. All the three source models resulted in comparable average passing rates (>97%) when the 3%/3 mm criterion was selected. The calculation with the single-source model and two-source model was slightly faster than the three-source model due to their simplicity.

  2. Comprehensive ambulatory medicine training for categorical internal medicine residents.

    Science.gov (United States)

    Bharel, Monica; Jain, Sharad; Hollander, Harry

    2003-04-01

    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 medicine subspecialties. Third-year residents spend 2 months on an advanced ambulatory rotation. The curriculum was started in July 2000 and has been highly regarded by the house staff, with statistically significant improvements in the PGY2 and PGY3 evaluation scores. By enhancing outpatient clinical teaching and didactics with an emphasis on the specific needs of our residents, we have been able to reframe the thinking and attitudes of a group of inpatient-oriented residents. PMID:12709096

  3. Ambulatory Pessary Trial Unmasks Occult Stress Urinary Incontinence

    Directory of Open Access Journals (Sweden)

    Bilal Chughtai

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Mette Korshøj

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

  5. 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.

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

    Science.gov (United States)

    Wilhelm, Frank H; Grossman, Paul

    2010-07-01

    Questionnaire and interview assessment can provide reliable data on attitudes and self-perceptions on emotion, and experimental laboratory assessment can examine functional relations between stimuli and reactions under controlled conditions. On the other hand, ambulatory assessment is less constrained and provides naturalistic data on emotion in daily life, with the potential to (1) assure external validity of laboratory findings, (2) provide normative data on prevalence, quality and intensity of real-life emotion and associated processes, (3) characterize previously unidentified emotional phenomena, and (4) model real-life stimuli for representative laboratory research design. Technological innovations now allow for detailed ambulatory study of emotion across domains of subjective experience, overt behavior and physiology. However, methodological challenges abound that may compromise attempts to characterize biobehavioral aspects of emotion in the real world. For example, emotional effects can be masked by social engagement, mental and physical workloads, as well as by food intake and circadian and quasi-random variation in metabolic activity. The complexity of data streams and multitude of factors that influence them require a high degree of context specification for meaningful data interpretation. We consider possible solutions to typical and often overlooked issues related to ambulatory emotion research, including aspects of study design decisions, recording devices and channels, electronic diary implementation, and data analysis. PMID:20132861

  7. 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....

  8. 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

  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. 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.

  11. 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.

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    Kirby John R

    2005-10-01

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

  14. Peritonitis during continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Rubin, J; Rogers, W A; Taylor, H M; Everett, E D; Prowant, B F; Fruto, L V; Nolph, K D

    1980-01-01

    We initiated a therapeutic program of continuous ambulatory peritoneal dialysis for patients with chronic renal failure. Our program resulted in many episodes of peritonitis arising from contamination due to the technical aspects of the procedure. Microbiologic evaluation showed that 73% of 97 episodes were culture positive, with gram-positive organisms causing most of the cases, especially early in dialysis. Gram-negative rods tended to occur later. Gram stains of dialysate effluent resulted in a disappointingly low yield of only 9% positivity. Cell counts were a dependable indicator of the presence of peritoneal inflammation and also of therapeutic success. Most patients responded well to intraperitoneal cephalothin, 125 mg/L for 10 to 14 d. The occurrence of peritonitis resulted in 0.93 years of hospitalization during the total of 15.45 patient-years on dialysis, which essentially negated the financial advantages of this method of treatment of chronic renal failure. For this to be a successful mode of therapy, advances in the prevention of peritonitis must be made. PMID:6985785

  15. 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

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

    DEFF Research Database (Denmark)

    Schmidt, Mikkel Nørgaard

    , in which a number of methods for single-channel source separation based on non-negative matrix factorization are presented. In the papers, the methods are applied to separating audio signals such as speech and musical instruments and separating different types of tissue in chemical shift imaging....

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

    NARCIS (Netherlands)

    Langers, Dave R. M.

    2009-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

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

  19. 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...... routed to incineration. Emission factors ranged from 27 to 40kg CO2/GJ. The results appeared most sensitive towards variations in waste composition and water content. Recycling rates and lower heating values could not be used as simple indicators of the resulting emission factors for residual household...

  20. 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

  1. 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.

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    Eng MR

    2015-07-01

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

  4. 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

  5. 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.

  6. Ambulatory laparoscopic cholecystectomy: A single center experience

    Directory of Open Access Journals (Sweden)

    Cagri Tiryaki

    2016-01-01

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

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

    Science.gov (United States)

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

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-06-15

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

  9. 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.

  10. 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.

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

    OpenAIRE

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

    2015-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-12-21

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

  13. 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

  14. 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

  15. 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 ...

  16. 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

  17. Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery

    Science.gov (United States)

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

    2015-01-01

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

  18. [Interprofessional pill box management in an ambulatory care setting].

    Science.gov (United States)

    Abrecht, Loïc; Anchisi, Annick; Widmer, Daniel; Bugnon, Olivier; Du Pasquier, Sophie; Jotterand, Sébastien; Karlen, Martine; Herzig, Lilli

    2014-11-26

    Complex multimorbid patients are now more common in ambulatory care and the management of their medication more frequently needs interprofessional collaboration. This qualitative study explored health professional's main challenges when introducing, preparing and sharing the use of a pill box for a patient. Another objective of this study was to explore options for improving care in these situations.

  19. 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.

  20. Utilizing ambulatory blood pressure recordings to evaluate antihypertensive drug therapy.

    Science.gov (United States)

    White, W B

    1992-04-30

    Until recently, the efficacy and pharmacodynamics of antihypertensive agents were assessed by resting blood pressure measurements in the doctor's office or a research clinic. The limitations of the office or clinic blood pressure measurement include the lack of representation (from recording only 1 point of time in the dosing schedule), the effects of the doctor's office on the patient's blood pressure, and, perhaps more relevant, observer bias. Ambulatory monitoring of the blood pressure has gained worldwide acceptance as an alternative method to assess antihypertensive drug efficacy and the time-effect relation of a drug. The ambulatory monitoring devices have been refined and are smaller, more precise, and more reliable than earlier recording models. Although there are no reference standards for analysis of ambulatory blood pressure data, international consensus groups are presently addressing this problem. Key roles for ambulatory blood pressure recordings in clinical trials of antihypertensive agents now include determination of the entry criteria for patients, improving the assessment of peak/trough pharmacodynamics in the patient's own environment (including nocturnal/sleep readings), and evaluating efficacy through calculation of the hypertensive burden, or blood pressure load. PMID:1575177

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

    Science.gov (United States)

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

    2015-03-21

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

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

    Science.gov (United States)

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

    2015-01-01

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

  3. 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

  4. Pharmacological treatment of ambulatory schizophrenic patients in Belgium

    Directory of Open Access Journals (Sweden)

    Reginster J-Y

    2006-05-01

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

  5. 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

  6. 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

  7. 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

  8. 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.

  9. 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

  10. 76 FR 6572 - Non-Ambulatory Disabled Veal Calves and Other Non-Ambulatory Disabled Livestock at Slaughter...

    Science.gov (United States)

    2011-02-07

    ... euthanized. The second petition, submitted by Farm Sanctuary, requests that the Agency amend the Federal meat... prevent potential human exposure to the Bovine Spongiform Encephalopathy (BSE)agent (``Prohibition of the... Slaughter'' (72 FR 38700)). The Agency had prohibited the slaughter of non-ambulatory disabled cattle...

  11. 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.

  12. 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%).

  13. 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

  14. sources

    Directory of Open Access Journals (Sweden)

    Shu-Yin Chiang

    2002-01-01

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

  15. 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...

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    Kollias, Anastasios; Stergiou, George S

    2014-01-01

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

  18. 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)

  19. 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.

  20. 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....

  1. 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.

  2. 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

  3. 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

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

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

    Science.gov (United States)

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

    1997-04-01

    The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care. PMID:10181605

  10. 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 ...

  11. 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...

  12. 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...

  13. 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...

  14. 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…

  15. 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

  16. Factors affecting the suitability of fly ash as source material for geopolymers

    Energy Technology Data Exchange (ETDEWEB)

    E.I. Diaz; E.N. Allouche; S. Eklund [Louisiana Tech University, Ruston, LA (United States). Department of Civil Engineering

    2010-05-15

    The suitability of fly ash stock piles for geopolymer manufacturing was studied. The results of chemical analyses, X-ray diffraction (XRD) and particle size distribution (PSD) of five sources of fly ash obtained from coal-fired power generating plants in the US are presented. Geopolymer paste and concrete specimens were prepared from each stock pile. The specimens were subjected to an array of chemical and mechanical tests including XRD, RAMAN spectroscopy, setting time and compressive strength. A correlation study was undertaken comparing the fly ash precursor chemical and crystallographic compositions as well as particle size distribution, with the mechanical and chemical characteristics of the resulting geopolymer. Factors inherent to the fly ash stockpile such as particle size distribution, degree of vitrification and location of the glass diffraction maximum were found to play an important role in the fresh and hardened properties of the resulting geopolymer. 26 refs., 7 figs., 2 tabs.

  17. 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

  18. 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.

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

    Science.gov (United States)

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

    2015-08-01

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

  20. 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.

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

    Science.gov (United States)

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

    2013-08-01

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

  2. 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.

  3. 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...

  4. 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.

  5. 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.

  6. 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...

  7. 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

  8. 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

  9. 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

  10. 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.

  11. HW 02-3 AMBULATORY CENTRAL BLOOD PRESSURE: WHAT IS THE EVIDENCE FOR VALIDATION?

    Science.gov (United States)

    Weber, Thomas

    2016-09-01

    Validation of a medical device measuring a biomarker is a complex process, involving technical aspects (What is actually measured by the device, and how is this done ? Is the measurement reproducible ? Is there a gold standard for measurement of the particular biomarker ? If yes, how accurate and how precise are the measurements by the device, compared to the gold standard ?) and clinical aspects (Do the measurements predict outcome ? If yes, is there added value, when standard clinical parameters are considered ? Is there a treatment strategy, based on the mesurements of the novel device ? Is this strategy cost-effective ?). When ambulatory central blood pressure is considered, which technical steps are necessary to perform the measurements ? First, waveforms need to be acquired, which can be done with a regular high-quality cuff at the brachial artery or with a wrist-watch-like tonometer at the radial artery. These waveforms need calibration with brachial blood pressure, which can be systolic / diastolic or mean / diastolic pressure. Then, an algorithm (for example, a transfer-function, a n-point moving average filter, ...) is used to convert brachial into central systolic pressure (or, in case of transfer functions, central waveforms). All of these steps have to be carefully validated (waveform acquisition, brachial pressures, transfer functions,...). When the entire system is to be tested, invasive validation studies are performed, typically in patients undergoing cardiac catheterization for clinical indications, using pressure-sensor-tipped (preferred) or fluid-filled catheters. In these studies, it appears that the most important source of error is calibration with non-invasive brachial blood pressure, whereas waveform acquisitions and transfer functions in general are quite robust. We recently observed that the use of mean and diastolic pressure for calibration (instead of systolic and diastolic pressure) may improve accuracy. This may be explained by the

  12. 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

  13. 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.

  14. 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.

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Stierer TL

    2015-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Clays Els

    2012-11-01

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

  18. [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

  19. 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

  20. 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

  1. 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.

  2. International accreditation of ambulatory surgical centers and medical tourism.

    Science.gov (United States)

    McGuire, Michael F

    2013-07-01

    The two forces that have driven the increase in accreditation of outpatient ambulatory surgery centers (ASC's) in the United States are reimbursement of facility fees by Medicare and commercial insurance companies, which requires either accreditation, Medicare certification, or state licensure, and state laws which mandate one of these three options. Accreditation of ASC's internationally has been driven by national requirements and by the competitive forces of "medical tourism." The three American accrediting organizations have all developed international programs to meet this increasing demand outside of the United States. PMID:23830758

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

    Directory of Open Access Journals (Sweden)

    Jeong Su Lee

    2014-08-01

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

  4. 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...

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

    DEFF Research Database (Denmark)

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

    2004-01-01

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

  6. 78 FR 56711 - Health Insurance Exchanges; Application by the Accreditation Association for Ambulatory Health...

    Science.gov (United States)

    2013-09-13

    ... accreditation program to conduct surveys for ambulatory surgery centers that wish to participate in the Medicare... HUMAN SERVICES Centers for Medicare & Medicaid Services Health Insurance Exchanges; Application by the Accreditation Association for Ambulatory Health Care To Be a Recognized Accrediting Entity for the...

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

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng

    2014-01-01

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

  8. 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....

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

    Data.gov (United States)

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

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

    Data.gov (United States)

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  12. 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

  13. 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

  14. 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

  15. 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).

  16. AMBULATORY CARE SENSITIVE CONDITIONS: DIAGNOSTIC RELIABILITY IN SOUTHERN BRAZIL

    Directory of Open Access Journals (Sweden)

    Rafael Antoniazzi Abaid

    2014-12-01

    Full Text Available Introduction: Ambulatory Care Sensitive Conditions (ACSC are illnesses that could be prevented with adjusted ambulatorial care. ACSC have been used as indicator in effectiveness of the primary healthcare attention, through the evaluation of hospital admissions. However, we do not have studies to certify the reliability of diagnosis of ACSC in our country. Objective: To determine if the classification of ACSC from the main diagnostic field of the authorization of hospital internment (AHI is reliable. Methods: Transversal study carried through February of 2010 to January of 2011, in the city of Santa Cruz of Sul (RS. A random sample of 389 medical records was selected and evaluated by two medical appraisers. The main diagnosis in the AHI was compared with the classification in ACSC or not ACSC given for the appraisers after the study of each medical record. Kappa ratio agreement was used to calculate the reliability of the ACSC diagnostic. Results: The ratio of agreement between diagnosis from the AIH and CSAP assessment contained in the records was 92%, with a kappa coefficient of 0,784. Conclusions: The diagnostic of ACSC found in main diagnostic field of AHI showed agreement ratios over expected by chance, with kappa value equal to 0.784 and the correlation rated between substantial and almost perfect.

  17. Wearable and superhydrophobic hardware for ambulatory biopotential acquisition.

    Science.gov (United States)

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

    2013-01-01

    Wearable monitoring devices are a promising trend for ambulatory and real time biosignal processing, because they improve access and coverage by means of comfortable sensors, with real-time communication via mobile networks. In this paper, we present a garment for ambulatory electrocardiogram monitoring, a smart t-shirt with a textile electrode that conducts electricity and has a coating designed to preserve the user's hygiene, allowing long-term mobile measurements. Silicon dioxide nanoparticles were applied on the surface of the textile electrodes to preserve conductivity and impart superhydrophobic properties. A model to explain these results is proposed. The best result of this study is obtained when the contact angles between the fluid and the fabric exceeded 150°, while the electrical resistivity remained below 5 Ω·cm, allowing an acquisition of high quality electrocardiograms in moving patients. Thus, this tool represents an interesting alternative for medium and long-term measurements, preserving the textile feeling of clothing and working under motion conditions. PMID:24110070

  18. Ambulatory blood pressure monitoring: coming of age in nephrology.

    Science.gov (United States)

    Townsend, R R; Ford, V

    1996-11-01

    The number of patients undergoing ambulatory blood pressure monitoring (ABPM) and the number of publications using this technique to evaluate the risks and effects of high blood pressure on target organs has been increasing, and dramatically so, in the last 5 years. Much of this growth has centered on the role of the blood pressure load (the percentage of systolic or diastolic readings above a preset value during a specific time period) and the changes in blood pressures levels that occur, with sleep. Although many studies are focused on the interaction between blood pressure (as assessed by ABPM) and the heart, interest is growing in the application of ABPM to the practice of nephrology. This paper discusses some of the technical aspects of ABPM, followed by a review of five areas of clinical research using ABPM, and which are relevant to renal medicine: microalbuminuria, renal function, renovascular hypertension, dialysis (hemodialysis and continuous ambulatory peritoneal dialysis), and transplantation. Despite a general lack of reimbursement for performance of the ABPM procedure, the growth in its usage and the willingness of clinicians to withhold or alter therapy on the basis of ABPM readings is testimony to its clinical value in the management of hypertension. PMID:8959618

  19. 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

  20. 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...

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

    Science.gov (United States)

    Guha, Abhinav

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

  2. 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

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. 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.

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

    Science.gov (United States)

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

    2015-07-01

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

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

    Science.gov (United States)

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

    2015-07-01

    A large fraction of factor VIII in blood originates from liver sinusoidal endothelial cells although extrahepatic sources also contribute to plasma factor VIII levels. Identification of cell-types other than endothelial cells with the capacity to synthesize and release factor VIII will be helpful for therapeutic approaches in hemophilia A. Recent cell therapy and bone marrow transplantation studies indicated that Küpffer cells, monocytes and mesenchymal stromal cells could synthesize factor VIII in sufficient amount to ameliorate the bleeding phenotype in hemophilic mice. To further establish the role of blood cells in expressing factor VIII, we studied various types of mouse and human hematopoietic cells. We identified factor VIII in cells isolated from peripheral and cord blood, as well as bone marrow. Co-staining for cell type-specific markers verified that factor VIII was expressed in monocytes, macrophages and megakaryocytes. We additionally verified that factor VIII was expressed in liver sinusoidal endothelial cells and endothelial cells elsewhere, e.g., in the spleen, lungs and kidneys. Factor VIII was well expressed in sinusoidal endothelial cells and Küpffer cells isolated from human liver, whereas by comparison isolated human hepatocytes expressed factor VIII at very low levels. After transplantation of CD34(+) human cord blood cells into NOD/SCIDγNull-hemophilia A mice, fluorescence activated cell sorting of peripheral blood showed >40% donor cells engrafted in the majority of mice. In these animals, plasma factor VIII activity 12 weeks after cell transplantation was up to 5% and nine of 12 mice survived after a tail clip-assay. In conclusion, hematopoietic cells, in addition to endothelial cells, express and secrete factor VIII: this information should offer further opportunities for understanding mechanisms of factor VIII synthesis and replenishment. PMID:25911555

  10. 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

  11. 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....

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

    Science.gov (United States)

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

    2007-01-01

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

  13. 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...

  14. 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)

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

    Science.gov (United States)

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

    1999-01-01

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

  16. Ambulatory Blood Pressure Monitoring – Clinical Practice Recommendations

    Directory of Open Access Journals (Sweden)

    Katalin Mako

    2016-09-01

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

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

    DEFF Research Database (Denmark)

    Joffe, P; Henriksen, Jens Henrik Sahl

    1995-01-01

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

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

    Science.gov (United States)

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

    2008-01-01

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

  19. 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 twice the SD of the within-participant differences between repeat recordings, and expressed it as a percentage of four times the SD of the mean of the paired measurements. RESULTS: Mean AASI (crude or derived by time-weighted or robust regression) and 24-h pulse pressure (PP) were similar on repeat...

  20. [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

  1. 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...... relative aerobic workload and ABP were significant. CONCLUSIONS: Because workers may have an elevated relative aerobic workload for several hours each working day, this relationship may elucidate a mechanism behind the increased risk for cardiovascular disease among workers exposed to high levels...

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

    Science.gov (United States)

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

    1994-01-01

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

  3. 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.

  4. Varied factors affect shrimp prices, sales. Spanish study finds wild sourcing, brands key to consumer choices.

    OpenAIRE

    Fernández Polanco, José Manuel; Llorente García, Ignacio; Luna Sotorrío, Ladislao

    2012-01-01

    In a review of hundreds of prawn sales offerings, four factors were ound to help prawns obtain above-average prices in the Spanish market. The most relevant was wild origin, which caused significant price increases in almost all cases. Brand was the second most mportant factor contributing to higher prices. Larger prawns with higher prices were preferred over smaller prawns. Although less important, fresh or defrosted prawns drew higher prices than frozen prawns.

  5. 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

  6. 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…

  7. Contribution of residential wood combustion and other sources to hourly winter aerosol in Northern Sweden determined by positive matrix factorization

    Directory of Open Access Journals (Sweden)

    P. Krecl

    2008-07-01

    Full Text Available The combined effect of residential wood combustion (RWC emissions with stable atmospheric conditions, which frequently occurs in Northern Sweden during wintertime, can deteriorate the air quality even in small towns. To estimate the contribution of RWC to the total atmospheric aerosol loading, positive matrix factorization (PMF was applied to hourly mean particle number size distributions measured in a residential area in Lycksele during winter 2005/2006. The sources were identified based on the particle number size distribution profiles of the PMF factors, the diurnal contributions patterns estimated by PMF for both weekends and weekdays, and correlation of the modeled particle number concentration per factor with measured aerosol mass concentrations (PM10, PM1, and light-absorbing carbon MLAC Through these analyses, the factors were identified as local traffic (factor 1, local RWC (factor 2, and local RWC plus long-range transport (LRT of aerosols (factor 3. In some occasions, the PMF model could not separate the contributions of local RWC from background concentrations since their particle number size distributions partially overlapped. As a consequence, we report the contribution of RWC as a range of values, being the minimum determined by factor 2 and the possible maximum as the contributions of both factors 2 and 3. A multiple linear regression (MLR of observed PM10, PM1, total particle number, and MLAC concentrations is carried out to determine the source contribution to these aerosol variables. The results reveal RWC is an important source of atmospheric particles in the size range 25–606 nm (44–57%, PM10 (36–82%, PM1 (31–83%, and MLAC (40–76% mass concentrations in the winter season. The contribution from RWC is especially large on weekends between 18:00 LT and midnight whereas local traffic emissions show similar contributions

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  9. 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.

  10. 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...

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

    Science.gov (United States)

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

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

    Data.gov (United States)

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

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

    Science.gov (United States)

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

    2009-07-01

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

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

    Science.gov (United States)

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

    2011-12-01

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

  17. Comparison Between Ambulatory and Conventional Urodynamics of the Modified Orthotopic Hautmann Neobladder

    OpenAIRE

    Apostolos, Malioris; Georgios, Dimitriadis; Spyridon, Kampantais; Georgios, Gkotsos; Ioannis, Vakalopoulos; Stavros, Ioannidis; Konstantinos, Hatzimoutatidis; Dimitrios, Hatzichristou

    2015-01-01

    Purpose: The aim of the present study was to determine the diagnostic accuracy of conventional and ambulatory urodynamic studies (UDS) in estimating neobladder function. Methods: We evaluated 32 patients who underwent radical cystectomy and orthotopic Hautmann W neobladder with Abol-Enein-Ghoneim uretero-intestinal anastomosis for bladder cancer. The patients were initially examined by using both conventional and ambulatory UDS. Results: Conventional UDS detected a very high mean intravesical...

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

    LENUS (Irish Health Repository)

    Uzochukwu, I

    2016-06-01

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

  19. 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...

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

    Science.gov (United States)

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

    2016-03-01

    This study aimed to analyse the existence of an association between social class (categorized by type of occupation) and the occurrence of A(H1N1)pmd09 infection and hospitalization for two seasons (2009-2010 and 2010-2011). This multicentre study compared ambulatory A(H1N1)pmd09 confirmed cases with ambulatory controls to measure risk of infection, and with hospitalized A(H1N1)pmd09 confirmed cases to asses hospitalization risk. Study variables were: age, marital status, tobacco and alcohol use, pregnancy, chronic obstructive pulmonary disease, chronic respiratory failure, cardiovascular disease, diabetes, chronic liver disease, body mass index >40, systemic corticosteroid treatment and influenza vaccination status. Occupation was registered literally and coded into manual and non-manual worker occupational social class groups. A conditional logistic regression analysis was performed. There were 720 hospitalized cases, 996 ambulatory cases and 1062 ambulatory controls included in the study. No relationship between occupational social class and A(H1N1)pmd09 infection was found [adjusted odds ratio (aOR) 0·97, 95% confidence interval (CI) 0·74-1·27], but an association (aOR 1·53, 95% CI 1·01-2·31) between occupational class and hospitalization for A(H1N1)pmd09 was observed. Influenza vaccination was a protective factor for A(H1N1)pmd09 infection (aOR 0·41, 95% CI 0·23-0·73) but not for hospitalization. We conclude that manual workers have the highest risk of hospitalization when infected by influenza than other occupations but they do not have a different probability of being infected by influenza. PMID:26271901

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

    Science.gov (United States)

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

    2016-03-01

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

  2. 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.

  3. 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...

  4. 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...

  5. [Ambulatory care nursing sites in Italy: results of a pilot study].

    Science.gov (United States)

    Alvaro, Rosaria; Venturini, Giulia; Tartaglini, Daniela; Vellone, Ercole; De Marinis, Maria Grazia

    2009-01-01

    The aim of this study was to map existing ambulatory care nursing sites in Italy, compare operational and organizational methodologies used, and evaluate visibility of the sites in health institutions and the community. Nurses' level of satisfaction with this work experience was also evaluated. The American Academy of Ambulatory Care Nursing and American Nurses Association definition of ambulatory care nursing (1997) was used to select sites for the study. Two hundred fifty ambulatory care sites meeting this definition were listed, most of which provide clinical and educational services to oncology and cardiology patients. Surgical sites provide treatment of surgical wounds and stomas. Results of the study show that ambulatory care nursing sites are not uniformly distributed across Italy and a greater concentration of sites can be found in northern Italy with respect to central and southern Italy. Nurses report having greater professional autonomy and an excellent level of satisfaction. All interviewed nurses attend specific training and continuing education courses. Ambulatory care sites are managed by nurses; medical consultations are requested when necessary and home assistance is assured through coordination with general practitioners. PMID:19629150

  6. 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.

  7. 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.

  8. 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)...

  9. 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. ...

  10. 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

  11. Contextual and Community Factors Associated with Youth Access to Cigarettes through Commercial Sources

    Science.gov (United States)

    Grube, Joel W.; Friend, Karen B.

    2012-01-01

    Objectives This study examines contextual and community level characteristics associated with youth access to tobacco through commercial sources in 50 non-contiguous mid-sized California communities. Methods The study is based on data from access surveys conducted by 4 confederate buyers (2 males and 2 females) in 997 tobacco outlets. City demographics, adult smoking prevalence and measures of tobacco outlet density, local tobacco retailer licensing and cigarette tax were included. Results Multilevel regression analyses indicated that buyer actual age, a male clerk and asking young buyers about their age were related to successful cigarette purchases. Buyer actual age and minimum age signs increased the likelihood that clerks will request an ID. At the community level, higher percentage of minors, higher education, and a greater percentage of African Americans were associated with increased likelihood of a successful purchase. Lower percentage of minors, lower education, lower percentage of African Americans, and having a local tobacco retailer licensing were associated with retailer asked for ID. Additionally, supermarkets charged significantly more for a pack of cigarettes than small markets whereas smoke/tobacco shops and drug stores/pharmacies charged less. Higher prices were associated with higher median household income and greater percentage of Hispanics. Findings about community characteristics, however, differed by cigarette brand. Conclusions This study enhances our understanding of the associations between contextual and community characteristics and youth access to tobacco through commercial sources which can help policymakers to identify and target at-risk communities and outlets to decrease youth access to tobacco. PMID:23092887

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Clodnițchi Roxana

    2015-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Maryam Alinezhad Namaghi

    2014-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Maryam Alinezhad Namaghi

    2014-03-01

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

  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. 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).

  20. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-01-01

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

  2. 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

  3. Mobile Personal Health System for Ambulatory Blood Pressure Monitoring

    Directory of Open Access Journals (Sweden)

    Luis J. Mena

    2013-01-01

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

  4. 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

  5. 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...

  6. 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...

  7. 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.

  8. 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

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    Yen-Chun Chou

    2010-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-01-01

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

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

    Science.gov (United States)

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

    2008-06-01

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

  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. 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

  15. 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.

  16. 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

  17. 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.

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

    Science.gov (United States)

    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 the frequency of diagnoses and differences in sex and age. Results The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P apicoectomies were performed among female patients (P < 0.001). A greater prevalence of periodontal disease was found in patients residing in Zagreb than in patients residing in rural areas. Conclusion The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients’ awareness of the importance of oral health. PMID:23444246

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

    Science.gov (United States)

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

    2015-04-01

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

  3. 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

  4. 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.

  5. 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

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

    Science.gov (United States)

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

    2015-12-01

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

  7. 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

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

    Directory of Open Access Journals (Sweden)

    Parvizi MM

    2016-09-01

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

  9. 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.

  10. 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

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

    Science.gov (United States)

    Pracht, Etienne E; Bass, Elizabeth

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nahin Hussain

    2013-01-01

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

  13. 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 26371593

  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...

  15. 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...

  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. 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

  18. 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...

  19. 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.

  20. [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

  1. 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.

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

    Science.gov (United States)

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

    2010-06-15

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

  3. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

  5. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-01-01

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

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

    CERN Document Server

    Rekik, Jihen Drira; Ghezala, Henda Ben

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Marcus Machado Ramos Souza de Souza

    2012-02-01

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

  9. 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.

  10. 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.

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

    Science.gov (United States)

    Calvani, Maura; Comito, Giuseppina; Giannoni, Elisa; Chiarugi, Paola

    2012-01-01

    Intratumoral hypoxia is a major obstacle in the development of effective cancer chemotherapy, decreasing the efficacy of anti-neoplastic drugs in several solid tumours. The hypoxic environment, through its master regulator hypoxia inducible factor-1 (HIF-1), is able to maintain an anti-apoptotic potential through activation of critical genes associated with drug resistance. Besides affecting metabolism and motility of tumour cells, hypoxia also paradoxically increases production of reactive oxygen species (ROS), which contribute to stabilize HIF-1 through a redox-mediated inhibition of its proteolysis. Here we reported that 1% O(2) hypoxia increases the resistance of human metastatic melanoma cells to conventional chemotherapy with etoposide, and that the increase in chemoresistance strongly depends on ROS delivery due to hypoxia. We reported a biphasic redox-dependent role of HIF-1, involving mitochondrial complex III and NADPH oxidase as oxidants sources, synergising in enhancing survival to chemotherapy. The feed-forward loop engaged by hypoxia involves first an HIF-1-dependent vascular endothelial growth factor-A (VEGF-A) autocrine production and, in the later phase, activation of NADPH oxidase from VEGF/VEGFR2 interaction, finally leading to a further redox-dependent long lasting stabilization of HIF-1. We therefore identified a redox-dependent circuitry linking hypoxia-driven ROS to VEGF-A secretion and to enhanced melanoma cell survival to etoposide chemotherapy. PMID:23144690

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    Maura Calvani

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

  14. 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

  15. 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.

  16. 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

  17. 75 FR 14606 - Medicare Program; Request for Nominations to the Advisory Panel on Ambulatory Payment...

    Science.gov (United States)

    2010-03-26

    ...; Center for Medicare Management, Hospital & Ambulatory Policy Group, Division of Outpatient Care; 7500... components of the Medicare hospital Outpatient Prospective Payment System (OPPS). The Charter requires that... consist of a chair and up to 15 members who are full- time employees of hospitals, hospital systems,...

  18. Auricular Acupuncture for Pain Relief after Ambulatory Knee Arthroscopy—A Pilot Study

    Directory of Open Access Journals (Sweden)

    Taras I. Usichenko

    2005-01-01

    Full Text Available Auricular acupuncture (AA is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points or sham procedure (three non-acupuncture points on the auricular helix before ambulatory knee arthroscopy. Permanent press AA needles were retained in situ for one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg, P = 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy.

  19. 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

  20. 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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  2. 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...

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

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Kofoed, Klaus

    2013-01-01

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

  4. 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.

  5. 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…

  6. The Effects of Choice Making on Toy Engagement in Nonambulatory and Partially Ambulatory Preschool Students

    Science.gov (United States)

    Liso, Danielle R.

    2010-01-01

    This study evaluated the effects of an experimenter-delivered choice-making procedure. Three nonambulatory and partially ambulatory preschoolers were given access to six teacher-nominated preferred toys in two conditions: child choice and interventionist choice. Using an alternating treatment design and a 10-second momentary time-sampling…

  7. 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

  8. 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

  9. Reliability of the EK scale, a functional test for non-ambulatory persons with Duchenne dystrophy

    DEFF Research Database (Denmark)

    Steffensen, Birgit F.; Hyde, Sylvia A.; Attermann, Jørn;

    2002-01-01

    The EK {Egen Klassifikation} scale was developed to assess overall functional ability in the non-ambulatory stage of Duchenne muscular dystrophy (DMD). The purpose of this study was to examine the reliability of the EK scale. Six subjects with DMD, selected as representative of the entire range...

  10. Ambulatory surgery center market share and rates of outpatient surgery in the elderly.

    Science.gov (United States)

    Hollenbeck, Brent K; Hollingsworth, John M; Dunn, Rodney L; Zaojun Ye; Birkmeyer, John D

    2010-12-01

    Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P < .01). For all 4 procedures, adjusted rates of procedures were significantly higher in HSAs with the highest ASC market share. The greatest difference, both in relative and absolute terms, was observed for patients undergoing cystoscopy. In areas of high ASC market share, the age-adjusted rate of cystoscopy was nearly 3-fold higher than in areas with low ASC market share (34.5 vs 11.9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

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

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Kofoed, Klaus

    2013-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

  13. 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)

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  15. 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…

  16. 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…

  17. Impact of natalizumab on ambulatory improvement in secondary progressive and disabled relapsing-remitting multiple sclerosis.

    Directory of Open Access Journals (Sweden)

    Diego Cadavid

    Full Text Available BACKGROUND: There is an unmet need for disease-modifying therapies to improve ambulatory function in disabled subjects with multiple sclerosis. OBJECTIVES: Assess the effects of natalizumab on ambulatory function in disabled subjects with relapsing-remitting multiple sclerosis (RRMS or secondary progressive multiple sclerosis (SPMS. METHODS: We retrospectively reviewed ambulatory function as measured by timed 25-foot walk (T25FW in clinical trial subjects with an Expanded Disability Status Scale score ≥3.5, including RRMS subjects from the phase 3 AFFIRM and SENTINEL trials, relapsing SPMS subjects from the phase 2 MS231 study, and nonrelapsing SPMS subjects from the phase 1b DELIVER study. For comparison, SPMS subjects from the intramuscular interferon beta-1a (IM IFNβ-1a IMPACT study were also analyzed. Improvement in ambulation was measured using T25FW responder status; response was defined as faster walking times over shorter (6-9-month or longer (24-30-month treatment periods relative to subjects' best predose walking times. RESULTS: There were two to four times more T25FW responders among disabled MS subjects in the natalizumab arms than in the placebo or IM IFNβ-1a arms. Responders walked 25 feet an average of 24%-45% faster than nonresponders. CONCLUSION: Natalizumab improves ambulatory function in disabled RRMS subjects and may have efficacy in disabled SPMS subjects. Confirmation of the latter finding in a prospective SPMS study is warranted.

  18. The Prognostic Value of Ambulatory Heart Rate Revisited in 6928 Subjects from 6 Populations

    DEFF Research Database (Denmark)

    Hansen, Tine Willum; Thijs, Lutgarde; Staessen, Jan A.;

    2008-01-01

    The evidence relating mortality and morbidity to heart rate remains inconsistent. We performed 24-hour ambulatory blood pressure monitoring in 6928 subjects (not on β-blockers; mean age: 56.2 years; 46.5% women) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay...

  19. Ambulatory Activity of Children with Cerebral Palsy: Which Characteristics Are Important?

    Science.gov (United States)

    van Wely, Leontien; Becher, Jules G.; Balemans, Astrid C. J.; Dallmeijer, Annet J.

    2012-01-01

    Aim: To assess ambulatory activity of children with cerebral palsy (CP), aged 7 to 13 years, and identify associated characteristics. Method: Sixty-two children with spastic CP (39 males, 23 females; mean age 10y 1mo, SD 1y 8mo; age range 7-13y), classified as Gross Motor Function Classification System (GMFCS) levels I to III, participated.…

  20. Accelerometry: A Feasible Method to Quantify Physical Activity in Ambulatory and Nonambulatory Adolescents with Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Jan Willem Gorter

    2012-01-01

    Full Text Available Objective. To determine the feasibility of physical activity monitoring in adolescents with cerebral palsy (CP. Methods. A convenience sample of ambulatory and non-ambulatory adolescents (N=23; 17 males, 6 females; mean age 13.5 y, SD 2.6 y; Gross Motor Function Classification System (GMFCS distribution: n=9 Level I, n=5 Level II, n=5 Level III, n=4 Level IV was recruited. Physical activity (PA was objectively assessed using the ActiGraph GT1M activity monitor. Discomfort or adverse effects of wearing the accelerometers were recorded by participants. Levels of physical activity were determined as total PA, light PA (LPA, moderate PA (MPA, moderate-to-vigorous (MVPA, and vigorous PA (VPA using cut-points recently validated for CP. Results. Most participants showed little reluctance. Mean daily MVPA for all participants was 30.7 minutes (SD 30.3, which corresponded to 2.7 (SD 2.4 minutes of MVPA per hour or 4.5% (SD 3.9 of the total monitoring time. Total PA and MVPA were greatest in ambulatory youth (GMFCS levels I and II compared with youth who use a walking aid or wheelchair (GMFCS levels III and IV (P<0.05. Conclusion(s. The results support the use of the accelerometer as a feasible and useful measure of activity in ambulatory and nonambulatory adolescents with CP.

  1. 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

  2. Is There Any Infl uence of the Ambulatory Status of Children with Myelomeningocele on Their Clinical and Renal Outcomes?

    Directory of Open Access Journals (Sweden)

    Meryem BENZER

    2012-09-01

    Full Text Available OBJECTIVE: The aim of this study is to evaluate the infl uence of the ambulatory status of children with MMC on renal functions, clinical and radiological fi ndings. MATERIAL and METHODS: The records of 83 children with MMC between 2005-2010 were reviewed retrospectively. The ambulatory status of the patients was classifi ed as independent walkers (walks without assistive appliances, assisted walkers (requires walking aid, and non-ambulatory (wheelchair bound and the patient characteristics were evaluated according to the ambulatory status. RESULTS: The mean age was 7.1±0.61 years and median follow-up was 58 (32-97 months. Thirtyseven patients (44.6% had been operated in the fi rst three days of life. The patients with earlier initiation of follow-up earlier had less hydronephrosis and trabeculated bladder. Sixty-one children (73.5% were non-ambulatory, 14 (16.9% were assisted walkers and eight (9.6% were independent walkers. GFR was less than 80 ml/minute/1.73m² in six patients. There were no relation between ambulatory status and patients' renal functions, radiological and clinical fi ndings. CONCLUSION: Ambulatory status does not infl uence renal functions, clinical and radiological fi ndings of children with MMC. Beginning follow-up earlier may lead to fewer complications such as hydronephrosis and deformed and trabeculated bladder. Besides, patients operated in the fi rst three days of life were more compliant with regular follow-ups.

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

    Science.gov (United States)

    Nousratpour, A.

    2011-12-01

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

  4. Chronobiologically Interpreted Ambulatory Blood Pressure Monitoring in Health and Disease.

    Science.gov (United States)

    Halberg, Franz; Mult, Hc; Cornélissen, Germaine; Hillman, Dewayne; Beaty, Larry A; Hong, Shiyu; Schwartzkopff, Othild; Watanabe, Yoshihiko; Otsuka, Kuniaki; Siegelova, Jarmila

    2012-05-01

    To detect vascular variability anomalies (VVAs), a blood pressure and heart rate profile around the clock for at least 7 days is a start. As a minimum, measurement every 60 or preferably 30 minutes for a week is needed, to be continued if abnormality is found, to assess the about 24-hour (circadian) variability that exists in all individuals. As a first dividend, one then also obtains a glimpse of 2 of the very many longer-than-circadian periodicities, the biological half-week and week. Certainly if we can have sensors and computer chips in our cars that continuously monitor the pressure over a tire's life, we should be able to do the same job for ourselves for diagnostic and therapeutic decisions. Healthcare today emphasizes wellness with recommendations for exercise and a proper diet, yet these evaluations may not be adequate. BP may be measured at a visit to the doctor or before an exercise session, along with measuring body weight and performing a physical exam. The seeds of disease are planted long before they are visible, and what appears to be normal from a conventional point of view may in fact actually be abnormal. Hidden alterations of physiological function, masked by the body's remarkable adaptive capabilities, may become visible through a new diagnostic and therapeutic realm-chronobiology-that reveals hitherto unseen abnormalities. The tools of chronobiology may yield additional dividends, such as the detection of physiological "loads" related to stress and stress relief and the undesirable effcts of space weather upon personal events such as sudden cardiac death, societal events like terrorism and war, and natural disasters. Chronobiologi cally interpreted automatic ambulatory BP and heart rate (HR) monitoring (C-ABPM) may detect the antecedents of these types of events. C-ABPM is of interest in preventive cardiology, since it reveals new diagnoses as vascular variability anomalies (VVAs) and renders previous conventional diagnoses more reliable, such

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

    Directory of Open Access Journals (Sweden)

    Larisa Kastykpaeva

    2011-04-01

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

  6. 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

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

    Science.gov (United States)

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

    2016-04-01

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

  8. 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.

  9. Diagnostic thresholds for ambulatory blood pressure moving lower: a review based on a meta-analysis-clinical implications

    DEFF Research Database (Denmark)

    Hansen, T.W.; Kikuya, M.; Thijs, L.;

    2008-01-01

    Upper limits of normal ambulatory blood pressure (ABP) have been a matter of debate in recent years. Current diagnostic thresholds for ABP rely mainly on statistical parameters derived from reference populations. Recent findings from the International Database of Ambulatory Blood Pressure....../75 mm Hg, 130/85 mm Hg, and 110/70 mm Hg, respectively, and those for ambulatory hypertension were 130/80 mm Hg, 140/85 mm Hg, and 120/70 mm Hg. However, in clinical practice, any diagnostic threshold for blood pressure needs to be assessed in the context of the patient's overall risk profile. The IDACO...

  10. 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...

  11. 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;

    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 was converted to step equivalents using 1) a simple conversion method (SCM) adding 200 step equivalents...

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

    OpenAIRE

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

    2016-01-01

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

  13. 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...

  14. 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

  15. 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.

  16. 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

  17. Tratamento ambulatorial da endocardite bacteriana estreptocócica Tratamiento clínico de la endocarditis bacteriana estreptocócica Ambulatory treatment of streptococcal bacterial endocarditis

    Directory of Open Access Journals (Sweden)

    Sirio Hassem Sobrinho

    2010-04-01

    Full Text Available A endocardite bacteriana é uma grave doença infecciosa cujo tratamento é tradicionalmente feito com o paciente internado. recebendo medicação intravenosa. A possibilidade de tratamento domiciliar ou ambulatorial. em casos estritamente selecionados. é atraente tanto do ponto de vista social quanto do econômico. Apresentamos o relato de 6 pacientes com diagnóstico de endocardite bacteriana por Streptococcus. tratados parcial ou integralmente em regime ambulatorial. Todos evoluíram sem complicações e com resolução completa do quadro infeccioso.La endocarditis bacteriana es una severa enfermedad infecciosa cuyo tratamiento se hace tradicionalmente con el paciente internado, recibiendo medicación intravenosa. La posibilidad de tratamiento domiciliar o clínico, en casos estrictamente seleccionados, es atractivo desde el punto de vista social como del económico. Presentamos el caso clínico de 6 pacientes con diagnóstico de endocarditis bacteriana por streptococcus, tratados parcial o integralmente en régimen ambulatorio. Todos evolucionaron sin complicaciones y con resolución completa del cuadro infeccioso.Bacterial endocarditis is a severe infectious disease. of which treatment is traditionally carried out in hospitalized patients through intravenous medication. The possibility of at-home or ambulatory treatment. for stringently selected cases. is attractive from the social as well as from the economic point of view. We report 6 patients with a diagnosis of bacterial endocarditis caused by Streptococcus. treated partially or completely on an outpatient basis. All of them evolved without complications and presented complete resolution of the infection.

  18. Ambulatory Surgical Facilities, cruical infrastructures, Published in 2007, 1:100000 (1in=8333ft) scale, Marion County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:100000 (1in=8333ft) scale, was produced all or in part from Field Survey/GPS information as of 2007. It...

  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. 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...

  1. 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...

  2. Fatores associados ao abandono de acompanhamento ambulatorial em um serviço de assistência especializada em HIV/aids na cidade do Rio de Janeiro, RJ Factors associated with HIV/AIDS treatment dropouts in a special care unit in the City of Rio de Janeiro, RJ, Brazil

    Directory of Open Access Journals (Sweden)

    Louise Bastos Schilkowsky

    2011-06-01

    Full Text Available OBJETIVO: Este estudo visou a identificar fatores associados ao abandono do serviço de saúde por pacientes com HIV/aids. MÉTODOS: O estudo foi desenvolvido no Serviço de Assistência Especializada de um hospital universitário do Rio de Janeiro, considerando uma amostra estratificada de pacientes adultos, incluindo todos os casos de abandono (155 e 44,0% dos 790 casos em acompanhamento regular. Análises bivariadas visaram a identificar associações entre o abandono do serviço de saúde e variáveis demográficas, socioeconômicas e clínicas. Um modelo de regressão logística e um modelo de Cox foram utilizados para a identificação dos efeitos independentes das variáveis explicativas sobre o risco de abandono, no segundo caso incorporando a informação sobre a ocorrência do desfecho no decorrer do tempo. RESULTADOS: Os pacientes tinham em média 35 anos, sendo predominantemente do sexo masculino (66,4% e de nível socioeconômico baixo (45%. Em ambos os modelos, mostraram-se consistentemente associados ao risco de abandono estar desempregado ou possuir vínculo instável, usar drogas ilícitas e ter antecedentes psiquiátricos - associação positiva; e idade, ter o diagnóstico de aids e ter usado vários esquemas antirretrovirais - associação negativa. Na regressão logística, mostrou-se também positivamente associado à ocorrência de abandono o tempo entre o diagnóstico e a primeira consulta, enquanto no modelo Cox, o hazard de ocorrência de abandono mostrou-se positivamente associado a ser solteiro e negativamente associado a ter nível de escolaridade mais elevado. CONCLUSÕES: Os resultados deste trabalho permitem a identificação de pacientes com HIV/aids mais vulneráveis ao abandono do serviço de saúde.OBJECTIVE: This study aimed to identify factors associated with the health care of patients with HIV/AIDS who drop out. METHODS: The study was developed in a specialized health care unit of a University hospital in

  3. A New Source Apportionment Method of Maxed Dust Source Based on Cluster Analysis and Factor Analysis%基于聚类分析和因子分析的混合尘源解析新方法

    Institute of Scientific and Technical Information of China (English)

    郑雪峰; 邹长武; 印红玲

    2011-01-01

    The cluster analysis and factor analysis methods were successfully used to solve the problem of multicollinearity in CMB ( chemical mass balance)model. First the cluster analysis was used to analyse the colinearity among the emission sources, then the main factors of the emission sources with strong colinearity were selected by principal component analysis. Bring them and other single sources into the CMB to calculate.Finally returned the main factors contribution to single source of mixed dust sources, the contribution of each emission sources could be acquired.Compared with the other methods,the results showed that the analytical results were realistic and the method was feasible.%运用聚类分析扣因子分析来解决大气颗粒物源解析CMB模型(化学质量平衡模型)在解析混合尘源中遇到的共线性问题.即通过聚类分析对排放源进行共线性强弱分类,根据分析结果对其中共线性较强的一类(扬尘类源)提取主因子,并和其他独立尘源共同带入CMB模型进行计算.最后将主因子贡献量返回,得到各个源贡献值.通过和其他方法的效果进行比较,结果表明,该方法解析结果符合实际,具有可行性.

  4. 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

  5. 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

  6. Effects of Baroreflex Activation Therapy on Ambulatory Blood Pressure in Patients With Resistant Hypertension.

    Science.gov (United States)

    Wallbach, Manuel; Lehnig, Luca-Yves; Schroer, Charlotte; Lüders, Stephan; Böhning, Enrico; Müller, Gerhard A; Wachter, Rolf; Koziolek, Michael J

    2016-04-01

    Baroreflex activation therapy (BAT) has been demonstrated to decrease office blood pressure (BP) in the randomized, double-blind Rheos trial. There are limited data on 24-hour BP changes measured by ambulatory BP measurements (ABPMs) using the first generation rheos BAT system suggesting a significant reduction but there are no information about the effect of the currently used, unilateral BAT neo device on ABPM. Patients treated with the BAT neo device for uncontrolled resistant hypertension were prospectively included into this study. ABPM was performed before BAT implantation and 6 months after initiation of BAT. A total of 51 patients were included into this study, 7 dropped out from analysis because of missing or insufficient follow-up. After 6 months, 24-hour ambulatory systolic (from 148 ± 17 mm Hg to 140 ± 23 mm Hg, Phypertension. Randomized controlled trials are needed to evaluate BAT effects on ABPM in patients with resistant hypertension accurately.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    Mean daytime ambulatory blood pressure (BP) values are considered to be lower than conventional BP values, but data on this relation among younger individuals treatment from 13...... population-based cohorts. We compared individual differences between daytime ambulatory and conventional BP according to 10-year age categories. Age-specific prevalences of white coat and masked hypertension were calculated. Among individuals aged 18 to 30, 30 to 40, and 40 to 50 years, mean daytime BP.......2 mm Hg for diastolic BP; all Phypertension exponentially increased from 2.2% to 19.5% from those aged 18 to 30 years to those aged ≥70 years, with little variation between men and women (8.0% versus 6.1%; P=0.0003). Masked hypertension was more prevalent among men...

  8. 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

    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...... by astronauts on the International Space Station. ABSTRACT: Acute weightlessness in space induces a fluid shift leading to central volume expansion. Simultaneously, blood pressure is either unchanged or decreased slightly. Whether these effects persist for months in space is unclear. Twenty-four hour ambulatory...... brachial arterial pressures were automatically recorded at 1–2 h intervals with portable equipment in eight male astronauts: once before launch, once between 85 and 192 days in space on the International Space Station and, finally, once at least 2 months after flight. During the same 24 h, cardiac output...

  9. Volume of Cataract Surgery and Surgeon Gender: The Florida Ambulatory Surgery Center Experience 2005 Through 2012.

    Science.gov (United States)

    French, Dustin D; Margo, Curtis E; Campbell, Robert R; Greenberg, Paul B

    2016-01-01

    Cataract is the most common surgically reversible cause of vision loss and the most common major surgical procedure performed in the United States. To understand how gender composition might affect differences in health services, we examined the surgeon gender-specific rates of routine cataract surgery performed in ambulatory surgical centers in Florida. Routine cataract surgeries were identified through the Florida Agency for Health Care Administration (AHCA) ambulatory surgery center dataset. The background of individual surgeons was determined by linking license numbers in the dataset to physician profiles publicly available from AHCA. From 2005 through 2012, women ophthalmologists in Florida performed roughly half the annual rate of cataract surgery as their male counterparts. This difference is not explained by greater time in clinical practice for men. Further investigation into the causes of this gender-volume disparity is warranted to determine what roles choice and barriers may play.

  10. 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;

    2002-01-01

    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......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......, 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 intake...

  11. 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...

  12. Treatable renal failure found in non-ambulatory Duchenne muscular dystrophy patients.

    Science.gov (United States)

    Motoki, Takahiro; Shimizu-Motohashi, Yuko; Komaki, Hirofumi; Mori-Yoshimura, Madoka; Oya, Yasushi; Takeshita, Eri; Ishiyama, Akihiko; Saito, Takashi; Nakagawa, Eiji; Sugai, Kenji; Murata, Miho; Sasaki, Masayuki

    2015-10-01

    Duchenne muscular dystrophy (DMD) is a progressive muscular disorder in which respiratory and heart failures are the main causes of death. Intensive intervention in respiratory and cardiac function has dramatically improved the prognosis; however, dysfunction in other multiple organs may emerge in the later stages of the disease. We report the case of four non-ambulatory DMD patients who presented with renal failure. Common findings included decreased fluid intake, use of diuretics, and presence of chronic heart failure. The levels of serum cystatin C (CysC), a marker of kidney function unaffected by reduced muscle mass, were elevated in all four patients. In two patients, renal failure improved by increasing fluid intake, and discontinuing or reducing the dose of diuretics. The findings suggest that non-ambulatory DMD patients are at a risk of reduced kidney perfusion, which potentially leads to prerenal failure. Therefore, in DMD patients, dehydration signs and CysC levels should be monitored.

  13. 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.

  14. Mood-congruent memory in daily life: evidence from interactive ambulatory monitoring.

    Science.gov (United States)

    Loeffler, Simone N; Myrtek, Michael; Peper, Martin

    2013-05-01

    Evidence from the psychological laboratory indicates that emotional states tend to facilitate the encoding and retrieval of stimuli of the same emotional valence. To explore mood-congruent memory and the role of arousal in daily life, we applied a new interactive ambulatory technique. Psychophysiological arousal as indexed by non-metabolic heart rate, self-reported emotions and situational information were assessed during 24-h recordings in 70 healthy participants. The emotional state was used to trigger word list presentations on a minicomputer. Our results show that psychophysiological arousal at the time of encoding enhanced the recall of negative words in negative emotional conditions, whereas low psychophysiological arousal facilitated recall of positive words. In positive contexts, mood congruency was more prominent when arousal was low. These results demonstrate how automated experimentation with an ambulatory technique may help to assess emotional memory in real-world contexts, thus providing new methods for diverse fields of application.

  15. 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......Background/objectives:Dietary pattern is central in the prevention of hypertension and blood pressure (BP)-related diseases. A diet based on healthy Nordic foods may have a favourable impact on BP. The objective was to clarify whether a Nordic alternative for a healthy food pattern would have...... products of Nordic origin. The mean nutrient intake in the Nordic countries formed the control diet, embracing wheat products, dairy fat-based spread and a lower intake of fruits, vegetables and fish. Diets were isoenergetic. Ambulatory BP was monitored and 24-h urine was collected before and after 12...

  16. 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

  17. Source apportionment of the ambient PM2.5 across St. Louis using constrained positive matrix factorization

    NARCIS (Netherlands)

    Amato, F.; Hopke, P.K.

    2012-01-01

    In most cases, receptor models are applied to data from a single monitoring site even if there are multiple sampling locations in a given urban area. When it can be reasonably expected that the sites are affected by the same set of sources, it is possible to use the spatial variability of the source

  18. 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.

  19. Long-term therapy for heart failure with continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    McKinnie, J J; Bourgeois, R J; Husserl, F E

    1985-06-01

    This article reports the treatment with continuous ambulatory peritoneal dialysis of a patient with intractable congestive heart failure secondary to an ischemic cardiomyopathy. Although the use of peritoneal dialysis to treat refractory heart failure is not new, the advent of an effective continuous peritoneal dialysis system has allowed its use over prolonged periods of time. The two-year treatment interval described herein represents the longest reported application of this technique, to the best of our knowledge.

  20. 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...

  1. 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...

  2. 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...

  3. 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.

  4. Continuous ambulatory peritoneal dialysis: three-year experience at one center.

    Science.gov (United States)

    Nolph, K D; Sorkin, M; Rubin, J; Arfania, D; Prowant, B; Fruto, L; Kennedy, D

    1980-05-01

    Three years of clinical experience with continuous ambulatory peritoneal dialysis are summarized. Serum urea nitrogen, creatinine, hematocrit, nerve conduction velocity, calcium, inorganic phosphorus, serum proteins, and electrolytes have been maintained in acceptable ranges. Peritonitis, although reduced in incidence because of solutions in plastic bags and a new adapter, is still a problem. Excessive carbohydrate absorption, obesity, and high serum triglyceride concentrations may be long-term problems in some patients. PMID:7387001

  5. Quality of Ambulatory Care in Medicare Advantage HMOs and Traditional Medicare

    OpenAIRE

    Ayanian, John Z.; Landon, Bruce E.; Robert C. Saunders; Pawlson, L. Greg; Newhouse, Joseph P.

    2013-01-01

    To compare quality of care nationally between Medicare Advantage health maintenance organizations (HMOs) and traditional Medicare and determine how various types of Medicare HMOs differed in quality from traditional Medicare, we assessed performance measures of the quality of ambulatory care from the among beneficiaries matched by demographic characteristics within local areas during 2003-2009. HMO enrollees were consistently more likely than traditional Medicare beneficiaries to receive appr...

  6. Ambulatory hernia surgery under local anesthesia is feasible and safe in obese patients.

    Science.gov (United States)

    Acevedo, A; León, J

    2010-02-01

    Ambulatory hernia surgery under local anesthesia is becoming more widely used worldwide. Although many reports include obese patients, there are no studies that report specifically on the feasibility and safety of ambulatory hernia surgery in this category of patients. This paper documents our experience in this respect. The present investigation is an observational study performed at the CRS Hernia Center, Santiago, Chile, on 510 obese and 1,521 non-obese patients with all kinds of hernias susceptible to ambulatory hernia repair under local anesthesia. Both tissue and mesh repairs were performed. Obesity was defined as a body mass index (BMI) greater than 30. Patients with a BMI greater than 45 were excluded from this study. Operative time and pain experienced during the intervention were recorded. During the controls performed by a staff member at the 7th postoperative day, a questionnaire was answered by each patient regarding satisfaction, complaints, and postoperative pain. A second questionnaire was completed on the 30th postoperative day. Satisfaction and pain were both measured by means of a 10-point visual analog scale (VAS). The mean age was similar in both groups (51 years for non-obese and 52 years for obese patients). Obesity was present in 38.3% of women and in 17.5% of men (P ambulatory abdominal wall hernia repair under local anesthesia is feasible in obese patients. Because of the increased length of surgery in these patients, monitored sedation and prophylactic antibiotic cover should be used. The slight decrease in patient satisfaction is balanced by the lower risks and higher costs associated with full general anesthetic.

  7. 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....

  8. 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...

  9. 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...

  10. 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.

  11. 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.

  12. Translating caring theory across the continuum from inpatient to ambulatory care.

    Science.gov (United States)

    Tonges, Mary; McCann, Meghan; Strickler, Jeff

    2014-06-01

    While theory-based practice is a Magnet® characteristic, translating theories to practice remains challenging. As a result, theory-guided practice remains an ideal rather than a realized goal in many organizations. This article provides an overview of a research-derived caring theory, a translational model for theory-driven practice, implementation of a delivery model designed to translate theory across the acute and ambulatory care continuum, and resulting outcomes in oncology clinics and the emergency department.

  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. Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy

    DEFF Research Database (Denmark)

    Brix, Lone Dragnes; Thillemann, Theis Muncholm; Nikolajsen, Lone

    2016-01-01

    anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING: Data from 144 patients were available for analysis (LA + S...... was shorter (P anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy....

  15. 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...

  16. 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...

  17. Outcome tools used for ambulatory children with cerebral palsy: responsiveness and minimum clinically important differences

    OpenAIRE

    Oeffinger, D; Bagley, A; Rogers, S.; Gorton, G; Kryscio, R; Abel, M.; Damiano, D; Barnes, D.; Tylkowski, C

    2008-01-01

    This prospective longitudinal multicenter study of ambulatory children with cerebral palsy (CP) examined changes in outcome tool score over time, tool responsiveness, and used a systematic method for defining minimum clinically important differences (MCIDs). Three hundred and eighty-one participants with CP (Gross Motor Function Classification System [GMFCS] Levels I–III; age range 4–18y, mean age 11y [SD 4y 4mo]; 265 diplegia, 116 hemiplegia; 230 males, 151 females). At baseline and follow-u...

  18. 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.

  19. 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).

  20. [Influence of treatment with olmesartan on ambulatory blood pressure monitoring parameters in patients with arterial hypertension].

    Science.gov (United States)

    Bregvadze, T R; Tseluĭko, V I; Mishchuk, N E

    2013-12-01

    Hypertension is the most common disease of the cardiovascular system. Active treatment of hypertension with adequate control of blood pressure (BP) can prevent complications, improve life quality and increase life expectancy. One of the interesting new antihypertensive agents, from the group of angiotensin receptor blockers is olmesartan. The obvious advantages of ambulatory blood pressure monitoring to traditional one-time measurements of BP make this method perspective for quality control of anti-hypertensive therapy. The aim of this study was to evaluate the influence of treatment with olmesartan on ambulatory blood pressure monitoring parameters in patients with hypertension. 38 out-patients with hypertension at the age of 25-84 years (mean 55,3±10,6) were studied. Patients received olmesartan 20 mg daily as monotherapy (20 patients (52,6%)) or in combination with other antihypertensive agents (18 patients (47,4%)). Treatment continued for 6 months. The complex examination included: measurement of office brachial BP, electrocardiography, echocardiography and ambulatory blood pressure monitoring (ABPM). As a result of treatment, office BP and diurnal BP, according to ABPM, significantly decreased; the favorable circadian BP profile dynamics were found: significantly less frequently observed lack of reduction in BP during night (daily index - non-dipper) - 18% vs. 64% (p treatment of hypertensive patients with olmesartan provides significant decline not only in office BP, but also in diurnal BP, normalizes BP of active and passive periods, also - daily index and reduces BP variability.

  1. Compensatory movements during functional activities in ambulatory children with Duchenne muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Joyce Martini

    2014-01-01

    Full Text Available Objective: During the transitional phase (ambulatory to non-ambulatory, synergies characterize the evolution of Duchenne muscular dystrophy (DMD. This study was performed to describe and quantify compensatory movements while sitting down on/rising from the floor and climbing up/down steps. Method: Eighty videos (5 children × 4 assessments × 4 tasks were recorded quarterly in the year prior to gait loss. Compensatory movements from the videos were registered based on the Functional Evaluation Scale for DMD. Results: The most frequently observed compensatory movements were upper limb support on lower limbs/floor/handrail during all the tasks and lumbar hyperlordosis, trunk support on handrail, equinus foot, increased base of support, non-alternated descent, and pauses while climbing up/down steps. Conclusion: Climbing up/down steps showed a higher number of compensatory movements than sitting down on/rising from the floor, which seemed to be lost before climbing up/down steps in ambulatory children with DMD.

  2. 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.

  3. Twenty-Four-Hour Ambulatory Pulse Wave Analysis in Hypertension Management: Current Evidence and Perspectives.

    Science.gov (United States)

    Omboni, Stefano; Posokhov, Igor N; Kotovskaya, Yulia V; Protogerou, Athanase D; Blacher, Jacques

    2016-10-01

    The predictive value of vascular biomarkers such as pulse wave velocity (PWV), central arterial pressure (CAP), and augmentation index (AIx), obtained through pulse wave analysis (PWA) in resting conditions, has been documented in a variety of patient groups and populations. This allowed to make appropriate recommendations in clinical practice guidelines of several scientific societies. Due to advances in technologies, largely operator-independent methods are currently available for estimating vascular biomarkers also in ambulatory conditions, over the 24 h. According to the acceptable accuracy and reproducibility of 24-h ambulatory PWA, it appears to be a promising tool for evaluating vascular biomarkers in daily life conditions. This approach may provide an opportunity to further improve the early cardiovascular screening in subjects at risk. However, concerning the clinical use of PWA over the 24 h in ambulatory conditions at the moment, there is no sufficient evidence to support its routine clinical use. In particular, long-term outcome studies are needed to show the predictive value of 24-h PWV, CAP, and AIx values, provided by these devices, over and beyond peripheral blood pressure, and to answer the many technical and clinical questions still open. To this regard, the VASOTENS Registry, an international observational prospective study recently started, will help providing answers on a large sample of hypertensive patients recruited worldwide. PMID:27659178

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure.

    Science.gov (United States)

    Lang, C C; Chomsky, D B; Rayos, G; Yeoh, T K; Wilson, J R

    1997-01-01

    The purpose of this study was to determine whether skeletal muscle atrophy limits the maximal exercise capacity of stable ambulatory patients with heart failure. Body composition and maximal exercise capacity were measured in 100 stable ambulatory patients with heart failure. Body composition was assessed by using dual-energy X-ray absorption. Peak exercise oxygen consumption (VO2peak) and the anaerobic threshold were measured by using a Naughton treadmill protocol and a Medical Graphics CardioO2 System. VO2peak averaged 13.4 +/- 3.3 ml.min-1.kg-1 or 43 +/- 12% of normal. Lean body mass averaged 52.9 +/- 10.5 kg and leg lean mass 16.5 +/- 3.6 kg. Leg lean mass correlated linearly with VO2peak (r = 0.68, P < 0.01), suggesting that exercise performance is influences by skeletal muscle mass. However, lean body mass was comparable to levels noted in 1,584 normal control subjects, suggesting no decrease in muscle mass. Leg muscle mass was comparable to levels noted in 34 normal control subjects, further supporting this conclusion. These findings suggest that exercise intolerance in stable ambulatory patients with heart failure is not due to skeletal muscle atrophy.

  6. 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

  7. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Peng, S. X., E-mail: sxpeng@pku.edu.cn; Zhang, T.; Ren, H. T.; Xu, Y.; Zhang, J. F.; Guo, Z. Y. [State Key Laboratory of Nuclear Physics and Technology and Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871 (China); Zhang, A. L. [University of Chinese Academy of Sciences, Beijing 100049 (China); Chen, J. E. [State Key Laboratory of Nuclear Physics and Technology and Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871 (China); University of Chinese Academy of Sciences, Beijing 100049 (China)

    2016-02-15

    Microwave driven cesium-free volume H{sup −} sources, that have the ability to deliver tens of mA H{sup −} at 35 keV both in CW and 10% duty factor (100 Hz/1 ms), were developed at Peking University (PKU) [S. X. Peng et al., in Proceeding of IPAC 2015, WEPWA027, Richmond, Virginia, USA, 3–8 May 2015]. Recently, special efforts were paid on the investigation of duty factor variation possibility from 1% to 100% with them. Most of the experiments were carried out with a pulsed length (τ) of 1 ms and different intervals of 99 ms, 49 ms, 39 ms, 29 ms, 19 ms, 9 ms, 4 ms, 2 ms, 1 ms, 0.5 ms, and 0 ms, respectively. Other experiments were focused on CW operation and fixed duty factor of 1%. Experimental results prove that PKU H{sup −} sources can deliver tens of mA H{sup −} at duty factor from 1% to 100%. The RF power efficiency increases steadily with the increasing of duty factor from 1% to CW at a fixed pulsed length. Under a given duty factor and pulsed length, RF power efficiency keeps constant and the H{sup −} current increases with RF power linearly. Details will be presented in the paper.

  9. 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.

  10. The Influence of Domestic Overload on the Association between Job Strain and Ambulatory Blood Pressure among Female Nursing Workers

    Directory of Open Access Journals (Sweden)

    Luciana Fernandes Portela

    2013-11-01

    Full Text Available Evidence suggests that the workplace plays an important etiologic role in blood pressure (BP alterations. Associations in female samples are controversial, and the domestic environment is hypothesized to be an important factor in this relationship. This study assessed the association between job strain and BP within a sample of female nursing workers, considering the potential role of domestic overload. A cross-sectional study was conducted in a group of 175 daytime workers who wore an ambulatory BP monitor for 24 h during a working day. Mean systolic and diastolic BP were calculated. Job strain was evaluated using the Demand-Control Model. Domestic overload was based on the level of responsibility in relation to four household tasks and on the number of beneficiaries. After adjustments no significant association between high job strain and BP was detected. Stratified analyses revealed that women exposed to both domestic overload and high job strain had higher systolic BP at home. These results indicate a possible interaction between domestic overload and job strain on BP levels and revealed the importance of domestic work, which is rarely considered in studies of female workers.

  11. The influence of domestic overload on the association between job strain and ambulatory blood pressure among female nursing workers.

    Science.gov (United States)

    Portela, Luciana Fernandes; Rotenberg, Lucia; Almeida, Ana Luiza Pereira; Landsbergis, Paul; Griep, Rosane Harter

    2013-11-27

    Evidence suggests that the workplace plays an important etiologic role in blood pressure (BP) alterations. Associations in female samples are controversial, and the domestic environment is hypothesized to be an important factor in this relationship. This study assessed the association between job strain and BP within a sample of female nursing workers, considering the potential role of domestic overload. A cross-sectional study was conducted in a group of 175 daytime workers who wore an ambulatory BP monitor for 24 h during a working day. Mean systolic and diastolic BP were calculated. Job strain was evaluated using the Demand-Control Model. Domestic overload was based on the level of responsibility in relation to four household tasks and on the number of beneficiaries. After adjustments no significant association between high job strain and BP was detected. Stratified analyses revealed that women exposed to both domestic overload and high job strain had higher systolic BP at home. These results indicate a possible interaction between domestic overload and job strain on BP levels and revealed the importance of domestic work, which is rarely considered in studies of female workers.

  12. 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

  13. Left or right? Sources of political orientation: the roles of genetic factors, cultural transmission, assortative mating, and personality.

    Science.gov (United States)

    Kandler, Christian; Bleidorn, Wiebke; Riemann, Rainer

    2012-03-01

    In this study, we used an extended twin family design to investigate the influences of genetic and cultural transmission as well as different sources of nonrandom mating on 2 core aspects of political orientation: acceptance of inequality and rejecting system change. In addition, we studied the sources of phenotypic links between Big Five personality traits and political beliefs using self- and other reports. Data of 1,992 individuals (224 monozygotic and 166 dizygotic twin pairs, 92 unmatched twins, 530 spouses of twins, 268 fathers, and 322 mothers) were analyzed. Genetically informative analyses showed that political attitudes are genetically but not environmentally transmitted from parents to offspring and that a substantial proportion of this genetic variance can be accounted for by genetic variance in personality traits. Beyond genetic effects and genotypic assortative mating, generation-specific environmental sources act to increase twins' and spouses' resemblance in political beliefs. The results suggest multiple sources of political orientations in a modern democracy.

  14. Left or right? Sources of political orientation: the roles of genetic factors, cultural transmission, assortative mating, and personality.

    Science.gov (United States)

    Kandler, Christian; Bleidorn, Wiebke; Riemann, Rainer

    2012-03-01

    In this study, we used an extended twin family design to investigate the influences of genetic and cultural transmission as well as different sources of nonrandom mating on 2 core aspects of political orientation: acceptance of inequality and rejecting system change. In addition, we studied the sources of phenotypic links between Big Five personality traits and political beliefs using self- and other reports. Data of 1,992 individuals (224 monozygotic and 166 dizygotic twin pairs, 92 unmatched twins, 530 spouses of twins, 268 fathers, and 322 mothers) were analyzed. Genetically informative analyses showed that political attitudes are genetically but not environmentally transmitted from parents to offspring and that a substantial proportion of this genetic variance can be accounted for by genetic variance in personality traits. Beyond genetic effects and genotypic assortative mating, generation-specific environmental sources act to increase twins' and spouses' resemblance in political beliefs. The results suggest multiple sources of political orientations in a modern democracy. PMID:21988277

  15. Falls in ambulatory non-demented patients with Parkinson's disease.

    Science.gov (United States)

    Rascol, Olivier; Perez-Lloret, Santiago; Damier, Philippe; Delval, Arnaud; Derkinderen, Pascal; Destée, Alain; Meissner, Wassilios G; Tison, Francois; Negre-Pages, Laurence

    2015-10-01

    This study aimed at determining the prevalence of falling in PD patients, to assess generic and disease-specific clinical and pharmacological factors, relationship with health-related quality of life (HR-QoL) and changes in falls from OFF to ON in patients with motor fluctuations. Six-hundred and eighty-three PD patients of the COPARK survey were evaluated (11 had missing data and were excluded from the analysis). Patients with falls were identified as those with a UPDRS Item 13 ≥ 1 in the ON condition. All patients were assessed in a standardized manner [demographics, treatments, Unified PD Rating Scale (UPDRS), Hospital Anxiety and Depression Scale, Pittsburg questionnaire and HR-QoL scales (SF36, PDQ39)]. Falling was reported by 108/672 (16%) PD patients during the ON state and prevalence increased according to PD severity, from 5% in Hoehn and Yahr stage 1-60% in stage 4. Falling was significantly related to lower HR-QoL. Falling correlated with (1) generic factors such as female gender, age at the end of academic studies and diuretics consumption, (2) motor PD-specific factors including disease severity, frozen gait, difficulties when arising from a chair, dyskinesia and higher levodopa daily equivalent dose and (3) non-motor PD-specific factors such as orthostatic hypotension and hallucinations. Falling was more frequent in OFF than in ON in 48/74 (64%) patients with motor fluctuations and remained unchanged in 27 patients (36%). In summary, falling affected a significant proportion of PD patients, especially in advanced stages. It was associated with a variety of generic and PD-specific factors and was related to reduced HR-QoL. PMID:25845678

  16. 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...

  17. Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City

    Directory of Open Access Journals (Sweden)

    Torres-Arreola Laura del Pilar

    2007-09-01

    Full Text Available Abstract Background In Mexico, inappropriate prescription of drugs with potential interactions causing serious risks to patient health has been little studied. Work in this area has focused mainly on hospitalized patients, with only specific drug combinations analyzed; moreover, the studies have not produced conclusive results. In the present study, we determined the frequency of potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age, who used Mexican Institute of Social Security (IMSS family medicine clinics. In addition, we aimed to identify the associated factors for these interactions. Methods We collected information on general patient characteristics, medical histories, and medication (complete data. The study included 624 ambulatory patients over 50 years of age, with non-malignant pain syndrome, who made ambulatory visits to two IMSS family medicine clinics in Mexico City. The patients received 7-day prescriptions for non-opioid analgesics. The potential interactions were identified by using the Thompson Micromedex program. Data were analyzed using descriptive, bivariate and multiple logistic regression analyses. Results The average number of prescribed drugs was 5.9 ± 2.5. About 80.0% of patients had prescriptions implying one or more potential drug-drug interactions and 3.8% of patients were prescribed drug combinations with interactions that should be avoided. Also, 64.0% of patients had prescriptions implying one or more potential drug disease interactions. The factors significantly associated with having one or more potential interactions included: taking 5 or more medicines (adjusted Odds Ratio (OR: 4.34, 95%CI: 2.76–6.83, patient age 60 years or older (adjusted OR: 1.66, 95% CI: 1.01–2.74 and suffering from cardiovascular diseases (adjusted OR: 7.26, 95% CI: 4.61–11.44. Conclusion The high frequency of prescription of drugs with potential drug interactions showed in

  18. 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.

  19. 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.

  20. 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.

  1. Risk factors for human salmonellosis originating from pigs, cattle, broiler chickens and egg laying hens: a combined case-control and source attribution analysis.

    Directory of Open Access Journals (Sweden)

    Lapo Mughini-Gras

    Full Text Available Several case-control studies have investigated risk factors for human salmonellosis while others have used Salmonella subtyping to attribute human infections to different food and animal reservoirs. This study combined case-control and source attribution data into a single analysis to explore risk factors at the point of exposure for human salmonellosis originating from four putative food-producing animal reservoirs (pigs, cattle, broilers and layers/eggs in the Netherlands. We confirmed that most human cases (∼ 90% were attributable to layers/eggs and pigs. Layers/eggs and broilers were the most likely reservoirs of salmonellosis in adults, in urban areas, and in spring/summer, whereas pigs and cattle were the most likely reservoirs of salmonellosis in children, in rural areas, and in autumn/winter. Several reservoir-specific risk factors were identified. Not using a chopping board for raw meat only and consuming raw/undercooked meat were risk factors for infection with salmonellas originating from pigs, cattle and broilers. Consuming raw/undercooked eggs and by-products were risk factors for layer/egg-associated salmonellosis. Using antibiotics was a risk factor for pig- and cattle-associated salmonellosis and using proton-pump inhibitors for salmonellosis attributable to any reservoir. Pig- and cattle-associated infections were also linked to direct contact with animals and environmental exposure (e.g. playing in sandboxes. Eating fish, meat in pastry, and several non-meat foods (fruit, vegetables and pasteurized dairy products were protective factors. Consuming pork and occupational exposure to animals and/or raw meats were protective against layer/egg-associated salmonellosis. We concluded that individuals acquiring salmonellosis from different reservoirs have different associated risk factors, suggesting that salmonellas may infect humans through various transmission pathways depending on their original reservoirs. The outcome of

  2. Digital Dermatitis in Dairy Cows: A Review of Risk Factors and Potential Sources of Between-Animal Variation in Susceptibility

    Directory of Open Access Journals (Sweden)

    Maeve A. Palmer

    2015-07-01

    Full Text Available Digital dermatitis (DD is a bacterial disease that primarily affects the skin on the heels of cattle. It is a major cause of lameness in dairy cows and a significant problem for the dairy industry in many countries, causing reduced animal welfare and economic loss. A wide range of infection levels has been found on infected farms, prompting investigations into both farm level and animal level risk factors for DD occurrence. There also appears to be individual variation between animals in susceptibility to the disease. The identification of factors affecting individual variation in susceptibility to DD might allow changes in breeding policies or herd management which could be used to reduce DD prevalence. Factors mentioned in the literature as possibly influencing individual variation in susceptibility to DD include physical factors such as hoof conformation and properties of the skin, physiological factors such as the efficacy of the immune response, and behavioural factors such as standing half in cubicles. Further work is required to determine the influence of these factors, identify the genetic basis of variation, clarify the level of heritability of DD susceptibility and to determine how this is correlated with production and health traits currently used in breeding programmes.

  3. 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.

  4. 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...

  5. 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...

  6. 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

  7. 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.

  8. 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.

  9. 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...

  10. Using Confirmatory Factor Analysis to Understand Executive Control in Preschool Children: Sources of Variation in Emergent Mathematic Achievement

    Science.gov (United States)

    Bull, Rebecca; Espy, Kimberly Andrews; Wiebe, Sandra A.; Sheffield, Tiffany D.; Nelson, Jennifer Mize

    2011-01-01

    Latent variable modeling methods have demonstrated utility for understanding the structure of executive control (EC) across development. These methods are utilized to better characterize the relation between EC and mathematics achievement in the preschool period, and to understand contributing sources of individual variation. Using the sample and…

  11. 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.

  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. Semi-quantitative and simulation analyses of effects of {gamma} rays on determination of calibration factors of PET scanners with point-like {sup 22}Na sources

    Energy Technology Data Exchange (ETDEWEB)

    Hasegawa, Tomoyuki [School of Allied Health Sciences, Kitasato University, 1-15-1, Kitasato, Minamiku, Sagamihara, Kanagawa, 252-0373 (Japan); Sato, Yasushi [National Institute of Advanced Industrial Science and Technology, 1-1-1, Umezono, Tsukuba, Ibaraki, 305-8568 (Japan); Oda, Keiichi [Tokyo Metropolitan Institute of Gerontology, 1-1, Nakamachi, Itabashi, Tokyo, 173-0022 (Japan); Wada, Yasuhiro [RIKEN Center for Molecular Imaging Science, 6-7-3, Minamimachi, Minatoshima, Chuo, Kobe, Hyogo, 650-0047 (Japan); Murayama, Hideo [National Institute of Radiological Sciences, 4-9-1, Anagawa, Inage, Chiba, 263-8555 (Japan); Yamada, Takahiro, E-mail: hasegawa@kitasato-u.ac.jp [Japan Radioisotope Association, 2-28-45, Komagome, Bunkyo-ku, Tokyo, 113-8941 (Japan)

    2011-09-21

    The uncertainty of radioactivity concentrations measured with positron emission tomography (PET) scanners ultimately depends on the uncertainty of the calibration factors. A new practical calibration scheme using point-like {sup 22}Na radioactive sources has been developed. The purpose of this study is to theoretically investigate the effects of the associated 1.275 MeV {gamma} rays on the calibration factors. The physical processes affecting the coincidence data were categorized in order to derive approximate semi-quantitative formulae. Assuming the design parameters of some typical commercial PET scanners, the effects of the {gamma} rays as relative deviations in the calibration factors were evaluated by semi-quantitative formulae and a Monte Carlo simulation. The relative deviations in the calibration factors were less than 4%, depending on the details of the PET scanners. The event losses due to rejecting multiple coincidence events of scattered {gamma} rays had the strongest effect. The results from the semi-quantitative formulae and the Monte Carlo simulation were consistent and were useful in understanding the underlying mechanisms. The deviations are considered small enough to correct on the basis of precise Monte Carlo simulation. This study thus offers an important theoretical basis for the validity of the calibration method using point-like {sup 22}Na radioactive sources.

  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 blood pressure monitoring-derived short-term blood pressure variability is increased in Cushing's syndrome.

    Science.gov (United States)

    Rebellato, Andrea; Grillo, Andrea; Dassie, Francesca; Sonino, Nicoletta; Maffei, Pietro; Martini, Chiara; Paoletta, Agostino; Fabris, Bruno; Carretta, Renzo; Fallo, Francesco

    2014-11-01

    Cushing's syndrome is associated with high cardiovascular morbility and mortality. Blood pressure (BP) variability within a 24-h period is increasingly recognized as an independent predictor of cardiovascular risk. The aim of our study was to investigate the short-term BP variability indices in Cushing's syndrome. Twenty-five patients with Cushing's syndrome (mean age 49 ± 13 years, 4 males; 21 Cushing's disease and 4 adrenal adenoma patients) underwent 24-h ambulatory BP monitoring (ABPM) and evaluation of cardiovascular risk factors. Cushing patients were divided into 8 normotensive (NOR-CUSH) and 17 hypertensive (HYP-CUSH) patients and were compared with 20 normotensive (NOR-CTR) and 20 hypertensive (HYP-CTR) age-, sex-, and BMI-matched control subjects. Short-term BP variability was derived from ABPM and calculated as the following: (1) standard deviation (SD) of 24-h, daytime, and nighttime BP; (2) 24-h weighted SD of BP; and (3) average real variability (ARV), i.e., the average of the absolute differences between consecutive BP measurements over 24 h. In comparison with controls, patients with Cushing's syndrome, either normotensive or hypertensive, had higher 24-h and daytime SD of BP, as well as higher 24-h weighted SD and ARV of BP (P = 0.03 to P CUSH or between HYP-CTR and HYP-CUSH subgroups. ABPM-derived short-term BP variability is increased in Cushing's syndrome, independent of BP elevation. It may represent an additional cardiovascular risk factor in this disease. The role of excess cortisol in BP variability has to be further clarified.

  16. 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

  17. 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

  18. 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

  19. 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.

  20. 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

  1. Manager's leadership is the main skill for ambulatory health care plan success.

    Science.gov (United States)

    Marin, Gustavo Horacio; Silberman, Martin; Colombo, Maria Virginia; Ozaeta, Belen; Henen, Jaime

    2015-01-01

    To demonstrate effectiveness of ambulatory health care plan implementation among institutions and variables associated with the differences observed. Randomized selection of primary health care (PHC) centers was done. Leadership ability of the plan manager was explored. Univariate/bivariate analyses were performed to observe correlation between variables. Two groups of PHC centers were established according to the efficacy of plan implementation: high and low performance. Differences between groups were observed (592%-1023% more efficacy in controls and practices; P < .001). Leadership was responsible for the main differences observed. Leadership of manager for implementation of the health care plan was the major important variable to reach the best efficacy standards.

  2. Morganella Morganii - A Rare Cause of Continuous Ambulatory Peritoneal Dialysis Peritonitis

    Directory of Open Access Journals (Sweden)

    Savaş SİPAHİ

    2014-05-01

    Full Text Available Nephrology professionals have selected continuous ambulatory peritoneal dialysis (CAPD as the best initial therapy for patients who have chronic renal failure. Among complications, peritonitis continues to be one of the most important complications of CAPD. The typical spectrum of organisms causing peritonitis include Gram-positives (67%, Gram-negative rods (28%, fungi (2.5%, and anaerobics (2.5 %. Among Gram-negative bacterial species, Escherichia coli, Acinetobacter species, and Enterobacter are the most seen pathogens. In this report, we present a case of CAPD peritonitis due to Morganella morganii. To our knowledge, this presentation is the second report of CAPD peritonitis due to M. morganii.

  3. [The social hygienic assessment of significance of diseases under organization of ambulatory polyclinic care].

    Science.gov (United States)

    Babenko, A I; Murakhovskiy, A G; Tomtchuk, A A; Bravve, Yu I

    2013-01-01

    The article presents the results of analysis of appealability of adult population of Omsk to municipal polyclinic on the subject of diseases. The coefficients of relative importance of different classes of diseases to determine the groups af their significance were calculated on the basis of integrated evaluation of common and primary morbidity and diseases of patients under dispensarization monitoring. The established character of formation of flows of appealabiliy of population on the subject of diseases is a basic one to determine demand in medical technologies and planning of activities of ambulatory polyclinic section of health care.

  4. 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

  5. Circadian variation of blood pressure in patients with chronic renal failure on continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Clausen, P; Feldt-Rasmussen, B; Ladefoged, Jens

    1995-01-01

    The circadian pattern of blood pressure variation was investigated in 10 patients with advanced chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) and in an age-matched group of controls without renal disease with similar office blood pressure level. Monitoring was done using....... In patients with chronic renal failure undergoing CAPD, an otherwise unnoticed 24-h hypertension and nocturnal blood pressure elevation can be discovered by use of 24-h blood pressure monitoring and this may indicate a need of earlier start of antihypertensive treatment in CAPD patients with borderline...

  6. Scopus’s Source Normalized Impact per Paper (SNIP) versus a Journal Impact Factor based on Fractional Counting of Citations

    NARCIS (Netherlands)

    L. Leydesdorff; T. Opthof

    2010-01-01

    Impact factors (and similar measures such as the Scimago Journal Rankings) suffer from two problems: (a) citation behavior varies among fields of science and, therefore, leads to systematic differences, and (b) there are no statistics to inform us whether differences are significant. The recently in

  7. 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

  8. Crises hipertensivas em portadores de hipertensão arterial em tratamento ambulatorial Crisis hipertensivas en portadores de hipertensión arterial en tratamiento ambulatorio Hypertensive crises in bearers of arterial hypertension in ambulatorial treatment

    Directory of Open Access Journals (Sweden)

    Nirla Gomes Guedes

    2005-06-01

    presión arterial a factores emocionales.This study assessed the socio-demographic characteristics and the characteristics of therapeutic adhesion of 27 bearers of arterial hypertension undergoing ambulatorial treatment who had hypertensive urgencies crises or emergencies in the city of Fortaleza in the period between October of 2002 and May of 2003. The majority were women, between 50 and 60-years old, with little formal education, treatment time shorter than 5 years and time of diagnosis varying from 5 to 10 years. The use of medicine was the treatment that was most mentioned, followed by the reduction of the consumption of salt and attendance to medical appointments. However, attending the appointments and receiving orientation did not seem to change their behavior, since most of the patients that were interviewed practiced no physical exercises and demonstrated little knowledge of the illness, for they attributed the rise of the arterial pressure to emotional factors.

  9. Scopus's Source Normalized Impact per Paper (SNIP) versus a Journal Impact Factor based on Fractional Counting of Citations

    CERN Document Server

    Leydesdorff, Loet

    2010-01-01

    Impact factors (and similar measures such as the Scimago Journal Rankings) suffer from two problems: (i) citation behavior varies among fields of science and therefore leads to systematic differences, and (ii) there are no statistics to inform us whether differences are significant. The recently introduced SNIP indicator of Scopus tries to remedy the first of these two problems, but a number of normalization decisions are involved which makes it impossible to test for significance. Using fractional counting of citations-based on the assumption that impact is proportionate to the number of references in the citing documents-citations can be contextualized at the paper level and aggregated impacts of sets can be tested for their significance. It can be shown that the weighted impact of Annals of Mathematics (0.247) is not so much lower than that of Molecular Cell (0.386) despite a five-fold difference between their impact factors (2.793 and 13.156, respectively).

  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. 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...... stratification based on BP variability. The predictive accuracy of daytime and nighttime BP and the night-to-day BP ratio depended on the disease outcome under study and treatment status, and differed for fatal outcomes compared with the composite of fatal and nonfatal diseases. An exaggerated morning surge...

  12. 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.

  13. 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

  14. 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

  15. 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.

  16. 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.

  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. Improved survival with an ambulatory model of non-invasive ventilation implementation in motor neuron disease.

    Science.gov (United States)

    Sheers, Nicole; Berlowitz, David J; Rautela, Linda; Batchelder, Ian; Hopkinson, Kim; Howard, Mark E

    2014-06-01

    Non-invasive ventilation (NIV) increases survival and quality of life in motor neuron disease (MND). NIV implementation historically occurred during a multi-day inpatient admission at this institution; however, increased demand led to prolonged waiting times. The aim of this study was to evaluate the introduction of an ambulatory model of NIV implementation. A prospective cohort study was performed. Inclusion criteria were referral for NIV implementation six months pre- or post-commencement of the Day Admission model. This model involved a 4-h stay to commence ventilation with follow-up in-laboratory polysomnography titration and outpatient attendance. Outcome measures included waiting time, hospital length of stay, adverse events and polysomnography data. Results indicated that after changing to the Day Admission model the median waiting time fell from 30 to 13.5 days (p Survival was also prolonged (median (IQR) 278 (51-512) days pre- vs 580 (306-1355) days post-introduction of the Day Admission model; hazard ratio 0.41, p = 0.04). Daytime PaCO2 was no different. In conclusion, reduced waiting time to commence ventilation and improved survival were observed following introduction of an ambulatory model of NIV implementation in people with MND, with no change in the effectiveness of ventilation.

  19. 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.

  20. 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.

  1. 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.

  2. Automatic detection of respiration rate from ambulatory single-lead ECG.

    Science.gov (United States)

    Boyle, Justin; Bidargaddi, Niranjan; Sarela, Antti; Karunanithi, Mohan

    2009-11-01

    Ambulatory electrocardiography is increasingly being used in clinical practice to detect abnormal electrical behavior of the heart during ordinary daily activities. The utility of this monitoring can be improved by deriving respiration, which previously has been based on overnight apnea studies where patients are stationary, or the use of multilead ECG systems for stress testing. We compared six respiratory measures derived from a single-lead portable ECG monitor with simultaneously measured respiration air flow obtained from an ambulatory nasal cannula respiratory monitor. Ten controlled 1-h recordings were performed covering activities of daily living (lying, sitting, standing, walking, jogging, running, and stair climbing) and six overnight studies. The best method was an average of a 0.2-0.8 Hz bandpass filter and RR technique based on lengthening and shortening of the RR interval. Mean error rates with the reference gold standard were +/-4 breaths per minute (bpm) (all activities), +/-2 bpm (lying and sitting), and +/-1 breath per minute (overnight studies). Statistically similar results were obtained using heart rate information alone (RR technique) compared to the best technique derived from the full ECG waveform that simplifies data collection procedures. The study shows that respiration can be derived under dynamic activities from a single-lead ECG without significant differences from traditional methods. PMID:19775978

  3. Medicare beneficiaries more likely to receive appropriate ambulatory services in HMOs than in traditional medicare.

    Science.gov (United States)

    Ayanian, John Z; Landon, Bruce E; Zaslavsky, Alan M; Saunders, Robert C; Pawlson, L Gregory; Newhouse, Joseph P

    2013-07-01

    With quality-of-care bonus payments now available for Medicare Advantage health maintenance organizations (HMOs) and for accountable care organizations in traditional Medicare, the need to understand the relative quality of care delivered to Medicare enrollees has increased. We compared the quality of ambulatory care from 2003 through 2009 between beneficiaries enrolled in Medicare Advantage HMOs and those enrolled in traditional Medicare, and we assessed how the performance of various types of Medicare HMOs differed from that of traditional Medicare for these same measures. We found that beneficiaries in Medicare HMOs were consistently more likely than those in traditional Medicare to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardiovascular disease. We also found that Medicare HMO physicians were rated less favorably by their patients than were physicians in traditional Medicare in 2003; however, by 2009 the opposite was true. Not-for-profit, larger, and older Medicare HMOs performed consistently more favorably on clinical measures and ratings of care than for-profit, smaller, and newer HMOs. Our results suggest that the positive effects of more-integrated delivery systems on the quality of ambulatory care in Medicare HMOs may outweigh the potential incentives to restrict care under capitated payments.

  4. Accuracy of patient's turnover time prediction using RFID technology in an academic ambulatory surgery center.

    Science.gov (United States)

    Marchand-Maillet, Florence; Debes, Claire; Garnier, Fanny; Dufeu, Nicolas; Sciard, Didier; Beaussier, Marc

    2015-02-01

    Patients flow in outpatient surgical unit is a major issue with regards to resource utilization, overall case load and patient satisfaction. An electronic Radio Frequency Identification Device (RFID) was used to document the overall time spent by the patients between their admission and discharge from the unit. The objective of this study was to evaluate how a RFID-based data collection system could provide an accurate prediction of the actual time for the patient to be discharged from the ambulatory surgical unit after surgery. This is an observational prospective evaluation carried out in an academic ambulatory surgery center (ASC). Data on length of stay at each step of the patient care, from admission to discharge, were recorded by a RFID device and analyzed according to the type of surgical procedure, the surgeon and the anesthetic technique. Based on these initial data (n = 1520), patients were scheduled in a sequential manner according to the expected duration of the previous case. The primary endpoint was the difference between actual and predicted time of discharge from the unit. A total of 414 consecutive patients were prospectively evaluated. One hundred seventy four patients (42%) were discharged at the predicted time ± 30 min. Only 24% were discharged behind predicted schedule. Using an automatic record of patient's length of stay would allow an accurate prediction of the discharge time according to the type of surgery, the surgeon and the anesthetic procedure.

  5. 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

  6. 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.

  7. Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study

    Directory of Open Access Journals (Sweden)

    Ann Scheck McAlearney

    2013-01-01

    Full Text Available Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR system implementation and to synthesize the key informants' perspectives about successful implementation practices. Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system. Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success.

  8. 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

  9. 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.

  10. 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

  11. Evaluation of the Possible Sources and Controlling Factors of Toxic Metals/Metalloids in the Florida Everglades and Their Potential Risk of Exposure.

    Science.gov (United States)

    Li, Yanbin; Duan, Zhiwei; Liu, Guangliang; Kalla, Peter; Scheidt, Daniel; Cai, Yong

    2015-08-18

    The Florida Everglades is an environmentally sensitive wetland ecosystem with a number of threatened and endangered fauna species susceptible to the deterioration of water quality. Several potential toxic metal sources exist in the Everglades, including farming, atmospheric deposition, and human activities in urban areas, causing concerns of potential metal exposure risks. However, little is known about the pollution status of toxic metals/metalloids of potential concern, except for Hg. In this study, eight toxic metals/metalloids (Cd, Cr, Pb, Ni, Cu, Zn, As, and Hg) in Everglades soils were investigated in both dry and wet seasons. Pb, Cr, As, Cu, Cd, and Ni were identified to be above Florida SQGs (sediment quality guidelines) at a number of sampling sites, particularly Pb, which had a level of potential risk to organisms similar to that of Hg. In addition, a method was developed for quantitative source identification and controlling factor elucidation of toxic metals/metalloids by introducing an index, enrichment factor (EF), in the conventional multiple regression analysis. EFs represent the effects of anthropogenic sources on metals/metalloids in soils. Multiple regression analysis showed that Cr and Ni were mainly controlled by anthropogenic loading, whereas soil characteristics, in particular natural organic matter (NOM), played a more important role for Hg, As, Cd, and Zn. NOM may control the distribution of these toxic metals/metalloids by affecting their mobility in soils. For Cu and Pb, the effects of EFs and environmental factors are comparable, suggesting combined effects of loading and soil characteristics. This study is the first comprehensive research with a vast amount of sampling sites on the distribution and potential risks of toxic metals/metalloids in the Everglades. The finding suggests that in addition to Hg other metals/metalloids could also potentially be an environmental problem in this wetland ecosystem. PMID:26197026

  12. Evaluation of the Possible Sources and Controlling Factors of Toxic Metals/Metalloids in the Florida Everglades and Their Potential Risk of Exposure.

    Science.gov (United States)

    Li, Yanbin; Duan, Zhiwei; Liu, Guangliang; Kalla, Peter; Scheidt, Daniel; Cai, Yong

    2015-08-18

    The Florida Everglades is an environmentally sensitive wetland ecosystem with a number of threatened and endangered fauna species susceptible to the deterioration of water quality. Several potential toxic metal sources exist in the Everglades, including farming, atmospheric deposition, and human activities in urban areas, causing concerns of potential metal exposure risks. However, little is known about the pollution status of toxic metals/metalloids of potential concern, except for Hg. In this study, eight toxic metals/metalloids (Cd, Cr, Pb, Ni, Cu, Zn, As, and Hg) in Everglades soils were investigated in both dry and wet seasons. Pb, Cr, As, Cu, Cd, and Ni were identified to be above Florida SQGs (sediment quality guidelines) at a number of sampling sites, particularly Pb, which had a level of potential risk to organisms similar to that of Hg. In addition, a method was developed for quantitative source identification and controlling factor elucidation of toxic metals/metalloids by introducing an index, enrichment factor (EF), in the conventional multiple regression analysis. EFs represent the effects of anthropogenic sources on metals/metalloids in soils. Multiple regression analysis showed that Cr and Ni were mainly controlled by anthropogenic loading, whereas soil characteristics, in particular natural organic matter (NOM), played a more important role for Hg, As, Cd, and Zn. NOM may control the distribution of these toxic metals/metalloids by affecting their mobility in soils. For Cu and Pb, the effects of EFs and environmental factors are comparable, suggesting combined effects of loading and soil characteristics. This study is the first comprehensive research with a vast amount of sampling sites on the distribution and potential risks of toxic metals/metalloids in the Everglades. The finding suggests that in addition to Hg other metals/metalloids could also potentially be an environmental problem in this wetland ecosystem.

  13. An application of the theory of planned behaviour to study the influencing factors of participation in source separation of food waste

    Energy Technology Data Exchange (ETDEWEB)

    Karim Ghani, Wan Azlina Wan Ab., E-mail: wanaz@eng.upm.edu.my [Department of Chemical and Environmental Engineering, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan (Malaysia); Rusli, Iffah Farizan, E-mail: iffahrusli@yahoo.com [Department of Chemical and Environmental Engineering, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan (Malaysia); Biak, Dayang Radiah Awang, E-mail: dayang@eng.upm.edu.my [Department of Chemical and Environmental Engineering, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan (Malaysia); Idris, Azni, E-mail: azni@eng.upm.edu.my [Department of Chemical and Environmental Engineering, Faculty of Engineering, University Putra Malaysia, 43400 Serdang, Selangor Darul Ehsan (Malaysia)

    2013-05-15

    Highlights: ► Theory of planned behaviour (TPB) has been conducted to identify the influencing factors for participation in source separation of food waste using self administered questionnaires. ► The findings suggested several implications for the development and implementation of waste separation at home programme. ► The analysis indicates that the attitude towards waste separation is determined as the main predictors where this in turn could be a significant predictor of the repondent’s actual food waste separation behaviour. ► To date, none of similar have been reported elsewhere and this finding will be beneficial to local Authorities as indicator in designing campaigns to promote the use of waste separation programmes to reinforce the positive attitudes. - Abstract: Tremendous increases in biodegradable (food waste) generation significantly impact the local authorities, who are responsible to manage, treat and dispose of this waste. The process of separation of food waste at its generation source is identified as effective means in reducing the amount food waste sent to landfill and can be reused as feedstock to downstream treatment processes namely composting or anaerobic digestion. However, these efforts will only succeed with positive attitudes and highly participations rate by the public towards the scheme. Thus, the social survey (using questionnaires) to analyse public’s view and influencing factors towards participation in source separation of food waste in households based on the theory of planned behaviour technique (TPB) was performed in June and July 2011 among selected staff in Universiti Putra Malaysia, Serdang, Selangor. The survey demonstrates that the public has positive intention in participating provided the opportunities, facilities and knowledge on waste separation at source are adequately prepared by the respective local authorities. Furthermore, good moral values and situational factors such as storage convenience and

  14. An application of the theory of planned behaviour to study the influencing factors of participation in source separation of food waste

    International Nuclear Information System (INIS)

    Highlights: ► Theory of planned behaviour (TPB) has been conducted to identify the influencing factors for participation in source separation of food waste using self administered questionnaires. ► The findings suggested several implications for the development and implementation of waste separation at home programme. ► The analysis indicates that the attitude towards waste separation is determined as the main predictors where this in turn could be a significant predictor of the repondent’s actual food waste separation behaviour. ► To date, none of similar have been reported elsewhere and this finding will be beneficial to local Authorities as indicator in designing campaigns to promote the use of waste separation programmes to reinforce the positive attitudes. - Abstract: Tremendous increases in biodegradable (food waste) generation significantly impact the local authorities, who are responsible to manage, treat and dispose of this waste. The process of separation of food waste at its generation source is identified as effective means in reducing the amount food waste sent to landfill and can be reused as feedstock to downstream treatment processes namely composting or anaerobic digestion. However, these efforts will only succeed with positive attitudes and highly participations rate by the public towards the scheme. Thus, the social survey (using questionnaires) to analyse public’s view and influencing factors towards participation in source separation of food waste in households based on the theory of planned behaviour technique (TPB) was performed in June and July 2011 among selected staff in Universiti Putra Malaysia, Serdang, Selangor. The survey demonstrates that the public has positive intention in participating provided the opportunities, facilities and knowledge on waste separation at source are adequately prepared by the respective local authorities. Furthermore, good moral values and situational factors such as storage convenience and

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

    Directory of Open Access Journals (Sweden)

    Tran Thi Tuyet-Hanh

    2016-02-01

    Full Text Available Background: Despite progress made by the Millennium Development Goal (MDG number 7.C, Vietnam still faces challenges with regard to the provision of access to safe drinking water and basic sanitation. Objective: This paper describes household trends in access to improved water sources and sanitation facilities separately, and analyses factors associated with access to improved water sources and sanitation facilities in combination. Design: Secondary data from the Vietnam Multiple Indicator Cluster Survey in 2000, 2006, and 2011 were analyzed. Descriptive statistics and tests of significance describe trends over time in access to water and sanitation by location, demographic and socio-economic factors. Binary logistic regressions (2000, 2006, and 2011 describe associations between access to water and sanitation, and geographic, demographic, and socio-economic factors. Results: There have been some outstanding developments in access to improved water sources and sanitation facilities from 2000 to 2011. In 2011, the proportion of households with access to improved water sources and sanitation facilities reached 90% and 77%, respectively, meeting the 2015 MDG targets for safe drinking water and basic sanitation set at 88% and 75%, respectively. However, despite these achievements, in 2011, only 74% of households overall had access to combined improved drinking water and sanitation facilities. There were also stark differences between regions. In 2011, only 47% of households had access to both improved water and sanitation facilities in the Mekong River Delta compared with 94% in the Red River Delta. In 2011, households in urban compared to rural areas were more than twice as likely (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.9–2.5 to have access to improved water and sanitation facilities in combination, and households in the highest compared with the lowest wealth quintile were over 40 times more likely (OR: 42.3; 95% CI: 29.8–60

  16. Biosafety issues of eutropicated sources of drinking-water supply in relation to the risk of mass development of toxic cyanobacteria: model of stability factors of zooplankton

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    Konstantin Nosov

    2013-06-01

    Full Text Available The main issues of biosafety of eutrophicated water reservoirs, which are used as drinking-water sources, are related with the risk of mass development of toxic cyanobacteria. The factor of this risk is, in particular, a character of feedbacks in zooplankton, some species of which in the course of their nutrition eliminate repre-sentatives of phytoplankton. In turn, these representatives are the competitors to cyanobacteria and saturate water with the products of their metabolism – nutrients for phytoplankton. The authors describe the relations for these species, which open the new approaches to the prediction of the risk of mass development of cyanobacteria in eutrophicated hydrobiocoenoses.

  17. Application of positive matrix factorization to on-road measurements for source apportionment of diesel- and gasoline-powered vehicle emissions in Mexico City

    Directory of Open Access Journals (Sweden)

    D. A. Thornhill

    2009-12-01

    Full Text Available The goal of this research is to quantify diesel- and gasoline-powered motor vehicle emissions within the Mexico City Metropolitan Area (MCMA using on-road measurements captured by a mobile laboratory combined with positive matrix factorization (PMF receptor modeling. During the MCMA-2006 ground-based component of the MILAGRO field campaign, the Aerodyne Mobile Laboratory (AML measured many gaseous and particulate pollutants, including carbon dioxide, carbon monoxide (CO, nitrogen oxides (NOx, benzene, toluene, alkylated aromatics, formaldehyde, acetaldehyde, acetone, ammonia, particle number, fine particulate mass (PM2.5, and black carbon (BC. These serve as inputs to the receptor model, which is able to resolve three factors corresponding to gasoline engine exhaust, diesel engine exhaust, and the urban background. Using the source profiles, we calculate fuel-based emission factors for each type of exhaust. The MCMA's gasoline-powered vehicles are considerably dirtier, on average, than those in the US with respect to CO and aldehydes. Its diesel-powered vehicles have similar emission factors of NOx and higher emission factors of aldehydes, particle number, and BC. In the fleet sampled during AML driving, gasoline-powered vehicles are responsible for 97% of mobile source emissions of CO, 22% of NOx, 95–97% of aromatics, 72–85% of carbonyls, 74% of ammonia, negligible amounts of particle number, 26% of PM2.5, and 2% of BC; diesel-powered vehicles account for the balance. Because the mobile lab spent 17% of its time waiting at stoplights, the results may overemphasize idling conditions, possibly resulting in an underestimate of NOx and overestimate of CO emissions. On the other hand, estimates of the inventory that do not correctly account for emissions during idling are likely to produce bias in the opposite direction. Nevertheless, the fuel-based inventory suggests that mobile

  18. Influence of air pressure, humidity, solar radiation, temperature, and wind speed on ambulatory visits due to chronic obstructive pulmonary disease in Bavaria, Germany

    Science.gov (United States)

    Ferrari, Uta; Exner, Teresa; Wanka, Eva R.; Bergemann, Christoph; Meyer-Arnek, Julian; Hildenbrand, Beate; Tufman, Amanda; Heumann, Christian; Huber, Rudolf M.; Bittner, Michael; Fischer, Rainald

    2012-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the most important causes of morbidity and mortality in the world. The disease is often aggravated by periods of increased symptoms requiring medical attention. Among the possible triggers for these exacerbations, meteorological factors are under consideration. The objective of this study was to assess the influence of various meteorological factors on the health status of patients with COPD. For this purpose, the daily number of ambulatory care visits due to COPD was analysed in Bavaria, Germany, for the years 2006 and 2007. The meteorological factors were provided by the model at the European Centre for Medium Range Weather Forecast (ECMWF). For the multivariate analysis, a generalised linear model was used. In Bavaria, an increase of 1% of daily consultations (about 103 visits per day) was found to be associated with a change of 0.72 K temperature, 209.55 of log air surface pressure in Pa, and a decrease of 1% of daily consultations with 1,453,763 Ws m2 of solar radiation. There also seem to be regional differences between north and south Bavaria; for instance, the effect of wind speed and specific humidity with a lag of 1 day were only significant in the north. This study could contribute to a tool for the prevention of exacerbations. It also serves as a model for the further evaluation of the impact of meteorological factors on health, and could easily be applied to other diseases or other regions.

  19. Quantification of vehicle fleet PM10 particulate matter emission factors from exhaust and non-exhaust sources using tunnel measurement techniques.

    Science.gov (United States)

    Lawrence, Samantha; Sokhi, Ranjeet; Ravindra, Khaiwal

    2016-03-01

    Road tunnels act like large laboratories; they provide an excellent environment to quantify atmospheric particles emission factors from exhaust and non-exhaust sources due to their known boundary conditions. Current work compares the High Volume, Dichotomous Stacked Filter Unit and Partisol Air Sampler for coarse, PM10 and PM2.5 particle concentration measurement and found that they do not differ significantly (p = 95%). PM2.5 fraction contributes 66% of PM10 proportions and significantly influenced by traffic (turbulence) and meteorological conditions. Mass emission factors for PM10 varies from 21.3 ± 1.9 to 28.8 ± 3.4 mg/vkm and composed of Motorcycle (0.0003-0.001 mg/vkm), Cars (26.1-33.4 mg/vkm), LDVs (2.4-3.0 mg/vkm), HDVs (2.2-2.8 mg/vkm) and Buses (0.1 mg/vkm). Based on Lawrence et al. (2013), source apportionment modelling, the PM10 emission of brake wear (3.8-4.4 mg/vkm), petrol exhaust (3.9-4.5 mg/vkm), diesel exhaust (7.2-8.3 mg/vkm), re-suspension (9-10.4 mg/vkm), road surface wear (3.9-4.5 mg/vkm), and unexplained (7.2 mg/vkm) were also calculated. The current study determined that the combined non-exhaust fleet PM10 emission factor (16.7-19.3 mg/vkm) are higher than the combined exhaust emission factor (11.1-12.8 mg/vkm). Thus, highlight the significance of non-exhaust emissions and the need for legislation and abatement strategies to reduce their contributions to ambient PM concentrations. PMID:26844787

  20. Quantification of vehicle fleet PM10 particulate matter emission factors from exhaust and non-exhaust sources using tunnel measurement techniques.

    Science.gov (United States)

    Lawrence, Samantha; Sokhi, Ranjeet; Ravindra, Khaiwal

    2016-03-01

    Road tunnels act like large laboratories; they provide an excellent environment to quantify atmospheric particles emission factors from exhaust and non-exhaust sources due to their known boundary conditions. Current work compares the High Volume, Dichotomous Stacked Filter Unit and Partisol Air Sampler for coarse, PM10 and PM2.5 particle concentration measurement and found that they do not differ significantly (p = 95%). PM2.5 fraction contributes 66% of PM10 proportions and significantly influenced by traffic (turbulence) and meteorological conditions. Mass emission factors for PM10 varies from 21.3 ± 1.9 to 28.8 ± 3.4 mg/vkm and composed of Motorcycle (0.0003-0.001 mg/vkm), Cars (26.1-33.4 mg/vkm), LDVs (2.4-3.0 mg/vkm), HDVs (2.2-2.8 mg/vkm) and Buses (0.1 mg/vkm). Based on Lawrence et al. (2013), source apportionment modelling, the PM10 emission of brake wear (3.8-4.4 mg/vkm), petrol exhaust (3.9-4.5 mg/vkm), diesel exhaust (7.2-8.3 mg/vkm), re-suspension (9-10.4 mg/vkm), road surface wear (3.9-4.5 mg/vkm), and unexplained (7.2 mg/vkm) were also calculated. The current study determined that the combined non-exhaust fleet PM10 emission factor (16.7-19.3 mg/vkm) are higher than the combined exhaust emission factor (11.1-12.8 mg/vkm). Thus, highlight the significance of non-exhaust emissions and the need for legislation and abatement strategies to reduce their contributions to ambient PM concentrations.