WorldWideScience

Sample records for bighorn home improvement

  1. Assessing respiratory pathogen communities in bighorn sheep populations: Sampling realities, challenges, and improvements.

    Directory of Open Access Journals (Sweden)

    Carson J Butler

    at least 30 individuals to reliably detect both Pasteurellaceae and Mycoplasma ovipneumoniae at the population-level. Availability of PCR diagnostic tests to wildlife management agencies would improve the ability to reliably detect Pasteurellaceae in bighorn sheep populations.

  2. Home Improvements Prevent Falls

    Science.gov (United States)

    ... turn JavaScript on. Feature: Falls and Older Adults Home Improvements Prevent Falls Past Issues / Winter 2014 Table ... and ensure your safety. "Safe-ty-fy" Your Home Some Questions for Your Provider Will my medicines ...

  3. Achieving Improvement Through Nursing Home Quality Measurement

    OpenAIRE

    Harris, Yael; Clauser, Steven B.

    2002-01-01

    CMS has initiated the Nursing Home Quality Initiative (NHQI) to improve the quality of nursing home care. Central to the NHQI is the public reporting of nursing home quality measures that serve as the basis for the Initiative's communication and quality improvement program. This article provides an overview of the NHQI, focusing on the role of nursing home quality measures in achieving improvements in nursing home care. We also describe the evolution of quality measurement in nursing homes, a...

  4. ACED Allegheny Home Improvement Loan Program (AHILP)

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Allegheny Home Improvement Loan Program (AHILP) is the most affordable way for eligible Allegheny County residents to rehabilitate and improve their homes....

  5. Kootenai River Wildlife Habitat Enhancement Project : Long-term Bighorn Sheep/Mule Deer Winter and Spring Habitat Improvement Project : Wildlife Mitigation Project, Libby Dam, Montana : Management Plan.

    Energy Technology Data Exchange (ETDEWEB)

    Yde, Chis

    1990-06-01

    The Libby hydroelectric project, located on the Kootenai River in northwestern Montana, resulted in several impacts to the wildlife communities which occupied the habitats inundated by Lake Koocanusa. Montana Department of Fish, Wildlife and Parks, in cooperation with the other management agencies, developed an impact assessment and a wildlife and wildlife habitat mitigation plan for the Libby hydroelectric facility. In response to the mitigation plan, Bonneville Power Administration funded a cooperative project between the Kootenai National Forest and Montana Department of Fish, Wildlife and Parks to develop a long-term habitat enhancement plan for the bighorn sheep and mule deer winter and spring ranges adjacent to Lake Koocanusa. The project goal is to rehabilitate 3372 acres of bighorn sheep and 16,321 acres of mule deer winter and spring ranges on Kootenai National Forest lands adjacent to Lake Koocanusa and to monitor and evaluate the effects of implementing this habitat enhancement work. 2 refs.

  6. Economy Home Improvement, Inc. Information Sheet

    Science.gov (United States)

    Economy Home Improvement, Inc. (the Company) is located in Lexington, Kentucky. The settlement involves renovation activities conducted at a property constructed prior to 1978, located in Lexington, Kentucky.

  7. Housing improvement and home safety Effectiveness Matters

    OpenAIRE

    , Crd; Sphr@, L; , MrcSphsu

    2014-01-01

    The homes we live in impact on health, wellbeing and health inequalities. Treating illnesses directly related to living in cold, damp and dangerous homes costs the NHS £2.5 billion per year. Ensuring affordable warmth through insulation and more efficient heating can improve health and wellbeing. Home safety assessment and modification can reduce falls and risk of falling in older people. Education, promotion of exercise and wearing of appropriate footwear, environmental modifications and tra...

  8. Bighorn sheep (Ovis canadensis) survivorship and habitat studies in Bighorn Canyon National Recreation Area and surrounding lands, Wyoming and Montana, 2000–2003

    Science.gov (United States)

    Schoenecker, Kathryn A.; Singer, Francis J.; Grams, Kayla A.; Roelle, James E.

    2004-01-01

    In the 1850s, bighorn sheep (Ovis canadensis) were numerous and distributed throughout the Bighorn and Pryor Mountains of Montana and Wyoming. After European settlement, bighorn sheep populations declined, and local extinctions occurred in much of their historic range in the western United States. The current bighorn sheep population of Bighorn Canyon National Recreation Area (BICA) is the product of several reintroductions into BICA and surrounding lands. Following a release in 1973 and growth rates near maximum potential of 19.8% per year, the population grew to an estimated peak population of about 211 animals in 1993 and 1994 (Kissell and others, 1996). Recent counts indicate the bighorn sheep population has declined. Kissell and others (1996) reported that the population began to decline rapidly in 1995 and 1996. He noted low ewe:lamb ratios during the decline phase. Bighorn sheep numbers declined to the lowest minimum viable population size of 100 animals recommended by several bighorn sheep experts (Bailey, 1990; Berger, 1990; Smith and others, 1991). National Park Service (NPS) and Bureau of Land Management (BLM) managers were concerned about the decline and requested a study of its causes. In 2000, the U.S. Geological Survey- Biological Resources Division (USGS-BRD) received funding to start a 3-year study of survivorship, condition, and population growth rate of the BICA bighorn sheep population.Several possibilities exist for the bighorn sheep decline. The herd may have experienced a rapid population expansion, followed by a decline to stability at a lower long-term carrying capacity. This pattern of apparently overshooting carrying capacity following an initial release has been reported for a number of ungulates (Caughley, 1976). Disease may have caused the decline; predation and/or competition with wild horses (Equus caballus) may also have been factors. A spatial model of wild horse carrying capacity (Coughenour, 1999) was developed to assist managers

  9. Sears Home Improvement Products, Inc. Information Sheet

    Science.gov (United States)

    Sears Home Improvement Products, Inc. (the Company) is located in Longwood, Florida. The case involves renovation activities conducted at property constructed prior to 1978, located in cities across Minnesota, Wisconsin, California, Georgia, Nevada.

  10. Home Care Nursing Improves Cancer Symptom Management

    Science.gov (United States)

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  11. Pneumonia in bighorn sheep: Risk and resilience

    Science.gov (United States)

    Cassirer, E. Frances; Manlove, Kezia R.; Almberg, Emily S.; Kamath, Pauline; Cox, Mike; Wolff, Peregrine L.; Roug, Annette; Shannon, Justin M.; Robinson, Rusty; Harris, Richard B.; Gonzales, Ben J.; Plowright, Raina K.; Hudson, Peter J.; Cross, Paul C.; Dobson, Andrew; Besser, Thomas E.

    2018-01-01

    Infectious disease was an important driver of historic declines and extirpations of bighorn sheep (Ovis canadensis) in North America and continues to impede population restoration and management. Domestic sheep have long been linked to pneumonia outbreaks in bighorn sheep and this association has now been confirmed in 13 captive commingling experiments. However, ecological and etiological complexities still hinder our understanding and control of the disease. We provide an overview of the current state of knowledge about the biology and management of respiratory disease in bighorn sheep and propose strategies for moving forward. Epizootic pneumonia in bighorn sheep is polymicrobial. Mycoplasma ovipneumoniae, a bacterium host-specific to Caprinae and commonly carried by healthy domestic sheep and goats appears to be a necessary primary agent. All-age epizootics following introduction of M. ovipneumoniae along with other pathogens into bighorn sheep populations are usually severe (median mortality 47%) but fatality rates vary widely, from 15 – 100%. Disease severity may be influenced by the strain of M. ovipneumoniae, by secondary bacterial and viral pathogens, and by factors affecting transmission and host immunity. Once introduced, M. ovipneumoniae can persist in bighorn sheep populations for decades. Carrier dams transmit the pathogen to their susceptible lambs, triggering fatal pneumonia outbreaks in nursery groups, which limits recruitment and slows or prevents population recovery. The result is that demographic costs of pathogen persistence often outweigh the impacts of the initial invasion and die-off. There is currently no effective vaccine or antibiotic for domestic or wild sheep and to date, no management actions have been successful in reducing morbidity, mortality, or disease spread once pathogen invasion has occurred. Molecular-based strain typing suggests that spillover of M. ovipneumoniae into bighorn sheep populations from domestic small ruminants

  12. Haemophilus somnus (Histophilus somni) in bighorn sheep

    Science.gov (United States)

    2006-01-01

    Abstract Respiratory disease and poor lamb recruitment have been identified as limiting factors for bighorn-sheep populations. Haemophilus somnus (recently reclassified as Histophilus somni) is associated with respiratory disease in American bison, domestic sheep, and cattle. It is also harbored in their reproductive tracts and has been associated with reproductive failure in domestic sheep and cattle. Therefore, reproductive tract and lung samples from bighorn sheep were evaluated for the presence of this organism. Organisms identified as H. somnus were isolated from 6 of 62 vaginal but none of 12 preputial swab samples. Antigen specific to H. somnus was detected by immunohistochemical study in 4 of 12 formalin-fixed lung tissue samples of bighorn sheep that died with evidence of pneumonia. Notably, H. somnus was found in alveolar debris in areas of inflammation. The 6 vaginal isolates and 2 H. somnus isolates previously cultured from pneumonic lungs of bighorn sheep were compared with 3 representative isolates from domestic sheep and 2 from cattle. The profiles of major outer membrane proteins and antigens for all of the isolates were predominantly similar, although differences that may be associated with the host–parasite relationship and virulence were detected. The DNA restriction fragment length profiles of the bighorn-sheep isolates had similarities not shared with the other isolates, suggesting distinct phylogenetic lines. All of the isolates had similar antimicrobial profiles, but the isolates from the bighorn sheep produced less pigment than those from the domestic livestock, and growth of the former was not enhanced by CO2. Wildlife biologists and diagnosticians should be aware of the potential of these organisms to cause disease in bighorn sheep and of growth characteristics that may hinder laboratory detection. PMID:16548330

  13. Haemophilus somnus (Histophilus somni) in bighorn sheep.

    Science.gov (United States)

    Ward, Alton C S; Weiser, Glen C; Anderson, Bruce C; Cummings, Patrick J; Arnold, Karen F; Corbeil, Lynette B

    2006-01-01

    Respiratory disease and poor lamb recruitment have been identified as limiting factors for bighorn-sheep populations. Haemophilus somnus (recently reclassified as Histophilus somni) is associated with respiratory disease in American bison, domestic sheep, and cattle. It is also harbored in their reproductive tracts and has been associated with reproductive failure in domestic sheep and cattle. Therefore, reproductive tract and lung samples from bighorn sheep were evaluated for the presence of this organism. Organisms identified as H. somnus were isolated from 6 of 62 vaginal but none of 12 preputial swab samples. Antigen specific to H. somnus was detected by immunohistochemical study in 4 of 12 formalin-fixed lung tissue samples of bighorn sheep that died with evidence of pneumonia. Notably, H. somnus was found in alveolar debris in areas of inflammation. The 6 vaginal isolates and 2 H. somnus isolates previously cultured from pneumonic lungs of bighorn sheep were compared with 3 representative isolates from domestic sheep and 2 from cattle. The profiles of major outer membrane proteins and antigens for all of the isolates were predominantly similar, although differences that may be associated with the host-parasite relationship and virulence were detected. The DNA restriction fragment length profiles of the bighorn-sheep isolates had similarities not shared with the other isolates, suggesting distinct phylogenetic lines. All of the isolates had similar antimicrobial profiles, but the isolates from the bighorn sheep produced less pigment than those from the domestic livestock, and growth of the former was not enhanced by CO2. Wildlife biologists and diagnosticians should be aware of the potential of these organisms to cause disease in bighorn sheep and of growth characteristics that may hinder laboratory detection.

  14. Improving Elderly's Dental Hygiene Through Nursing Home Staff's Dental Health Education at the Nursing Home

    OpenAIRE

    Santoso, Bedjo; Eko Ningtyas, Endah Aryati; Fatmasari, Diyah

    2017-01-01

    Stomatitis often occurs in elderly at nursing home. They need nursing home staff assistance to maintain their dental and oral health. Therefore, nursing home staff need dental health education. Lecture or discussion methods, which are more effective to improve knowledge, attitude and skill of nursing home staff was the purpose of this research. The research design was quasi-experiment research and pretest-posttest with control group. The sample was 42 nursing home staffs and 74 elderlies, div...

  15. Improving care transitions from hospital to home: standardized orders for home health nursing with remote telemonitoring.

    Science.gov (United States)

    Heeke, Sheila; Wood, Felecia; Schuck, Jennifer

    2014-01-01

    A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template.

  16. Helminth parasites of bighorn sheep in Oregon.

    Science.gov (United States)

    Kistner, T P; Matlock, S M; Wyse, D; Mason, G E

    1977-04-01

    The lungs and gastrointestinal tracts from 18 hunter-killed bighorn rams (Ovis canadensis californiana) were examined in total or in part for helminth parasites during a two-year study of three separate herds in Eastern Oregon. Prevalence was 100% with the lungworm Protostrongylus stilesi. The gastrointestinal fauna from 11 rams comprised Cooperia oncophora, Marshallagia marshalli, Nematodirus oiratianus, Oesophagostomum spp., Ostertagia occidentalis, O. ostertagi, Skrjabinema ovis, Trichostrongylus axei and Trichuris spp. Adult Wyominia tetoni and cysticerci of Taenia hydatigena were recovered from two of six livers examined. Additionally, searches for potential molluscan intermediate hosts for P. stilesi were conducted on one bighorn range. Snails identified as belonging to the genera Euconulus, Pupilla and Vallonia were found on both the summer and winter ranges.

  17. Public Choice at the Little Bighorn

    OpenAIRE

    James E. McClure; T. Norman Van Cott

    1993-01-01

    History professors have long portrayed Custer’s stand at the Little Bighorn River in terms of the managerial quirks and personality flaws of the central characters. The discussion in Evan Connell’s (1984) book, Son of the Morning Star, illuminates the Last Stand in terms of economic incentives. In this paper we argue that Custer’s legendary Last Stand offers economics instructors with an extraordinary opportunity to pique students’ interest in the public choice paradigm.

  18. Can we improve the identification of cold homes for targeted home energy-efficiency improvements?

    International Nuclear Information System (INIS)

    Hutchinson, Emma J.; Wilkinson, Paul; Hong, Sung H.; Oreszczyn, Tadj

    2006-01-01

    Objective: To investigate the extent to which homes with low indoor-temperatures can be identified from dwelling and household characteristics. Design: Analysis of data from a national survey of dwellings, occupied by low-income households, scheduled for home energy-efficiency improvements. Setting: Five urban areas of England: Birmingham, Liverpool, Manchester, Newcastle and Southampton. Methods: Half-hourly living-room temperatures were recorded for two to four weeks in dwellings over the winter periods November to April 2001-2002 and 2002-2003. Regression of indoor on outdoor temperatures was used to identify cold-homes in which standardized daytime living-room and/or nighttime bedroom-temperatures were o C (when the outdoor temperature was 5 o C). Tabulation and logistic regression were used to examine the extent to which these cold-homes can be identified from dwelling and household characteristics. Results: Overall, 21.0% of dwellings had standardized daytime living-room temperatures o C, and 46.4% had standardized nighttime bedroom-temperatures below the same temperature. Standardized indoor-temperatures were influenced by a wide range of household and dwelling characteristics, but most strongly by the energy efficiency (SAP) rating and by standardized heating costs. However, even using these variables, along with other dwelling and household characteristics in a multi-variable prediction model, it would be necessary to target more than half of all dwellings in our sample to ensure at least 80% sensitivity for identifying dwellings with cold living-room temperatures. An even higher proportion would have to be targeted to ensure 80% sensitivity for identifying dwellings with cold-bedroom temperatures. Conclusion: Property and household characteristics provide only limited potential for identifying dwellings where winter indoor temperatures are likely to be low, presumably because of the multiple influences on home heating, including personal choice and

  19. Improving care in care homes: a qualitative evaluation of the Croydon care home support team.

    Science.gov (United States)

    Lawrence, Vanessa; Banerjee, Sube

    2010-05-01

    The Croydon care home support team (CHST) was developed in response to reports of patient abuse within long-term care. It presents a novel strategy for improving standards of care within care homes. A qualitative methodology was used to assess the perceived impact of the CHST. In-depth interviews were conducted with 14 care home managers and 24 members of care home staff across 14 care homes. Grounded theory principles guided the collection and analysis of the data. Reports of improved communication between staff, improved staff development and confidence, and improved quality of care point towards the effectiveness of the CHST model. The collaborative approach of the CHST was considered pivotal to its success and presented as an effective method of engaging care home managers and staff. The CHST adopted a systemic approach that placed an equal emphasis on the social, mental health and nursing needs of residents and aimed to address the whole culture of care within the individual homes. The data demonstrate the potential for specialist multi-disciplinary teams to raise standards of care across long-term care settings. Increased awareness of safeguarding issues, improved staff morale and communication and ongoing opportunities for discussion and problem solving promised to sustain improvements. Such services could be instrumental in meeting the government priority of preventing abuse among vulnerable adults.

  20. Techniques for capturing bighorn sheep lambs

    Science.gov (United States)

    Smith, Joshua B.; Walsh, Daniel P.; Goldstein, Elise J.; Parsons, Zachary D.; Karsch, Rebekah C.; Stiver, Julie R.; Cain, James W.; Raedeke, Kenneth J.; Jenks, Jonathan A.

    2014-01-01

    Low lamb recruitment is a major challenge facing managers attempting to mitigate the decline of bighorn sheep (Ovis canadensis), and investigations into the underlying mechanisms are limited because of the inability to readily capture and monitor bighorn sheep lambs. We evaluated 4 capture techniques for bighorn sheep lambs: 1) hand-capture of lambs from radiocollared adult females fitted with vaginal implant transmitters (VITs), 2) hand-capture of lambs of intensively monitored radiocollared adult females, 3) helicopter net-gunning, and 4) hand-capture of lambs from helicopters. During 2010–2012, we successfully captured 90% of lambs from females that retained VITs to ≤1 day of parturition, although we noted differences in capture rates between an area of high road density in the Black Hills (92–100%) of South Dakota, USA, and less accessible areas of New Mexico (71%), USA. Retention of VITs was 78% with pre-partum expulsion the main cause of failure. We were less likely to capture lambs from females that expelled VITs ≥1 day of parturition (range = 80–83%) or females that were collared without VITs (range = 60–78%). We used helicopter net-gunning at several sites in 1999, 2001–2002, and 2011, and it proved a useful technique; however, at one site, attempts to capture lambs led to lamb predation by golden eagles (Aquila chrysaetos). We attempted helicopter hand-captures at one site in 1999, and they also were successful in certain circumstances and avoided risk of physical trauma from net-gunning; however, application was limited. In areas of low accessibility or if personnel lack the ability to monitor females and/or VITs for extended periods, helicopter capture may provide a viable option for lamb capture.

  1. Fatal pneumonia of bighorn sheep following association with domestic sheep.

    Science.gov (United States)

    Foreyt, W J; Jessup, D A

    1982-04-01

    During 1979-1980 acute fibrinopurulent bronchopneumonia resulted in high mortality or total loss of herds of bighorn sheep (Ovis canadensis) in California and Washington. Contact with domestic sheep occurred shortly before the onset of disease in each case. Circumstantial evidence indicated that the apparently healthy domestic sheep transmitted pathogenic bacteria to the bighorns, resulting in mortality. Pasteurella multocida and Corynebacterium pyogenes were isolated from pulmonary tissue of dead bighorns. The presence of domestic sheep may have been an important stress which initiated or compounded the disease.

  2. Improving wound and pressure area care in a nursing home.

    Science.gov (United States)

    Sprakes, Kate; Tyrer, Julie

    Wound and pressure ulcer prevention are key quality indicators of nursing care. This article describes a collaborative project between a community skin care service and a nursing home. The aim of the project was to establish whether the implementation of a wound and pressure ulcer management competency framework within a nursing home would improve patient outcomes and reduce the severity and number of wounds and pressure ulcers. Following the project's implementation, there was a reduction in the number of wounds and pressure ulcers, hospital admissions and district nursing visits. Nursing home staff also reported an increase in their knowledge and skills.

  3. Helping Older Adults Improve Their Medication Experience (HOME) by Addressing Medication Regimen Complexity in Home Healthcare.

    Science.gov (United States)

    Sheehan, Orla C; Kharrazi, Hadi; Carl, Kimberly J; Leff, Bruce; Wolff, Jennifer L; Roth, David L; Gabbard, Jennifer; Boyd, Cynthia M

    In skilled home healthcare (SHHC), communication between nurses and physicians is often inadequate for medication reconciliation and needed changes to the medication regimens are rarely made. Fragmentation of electronic health record (EHR) systems, transitions of care, lack of physician-nurse in-person contact, and poor understanding of medications by patients and their families put patients at risk for serious adverse outcomes. The aim of this study was to develop and test the HOME tool, an informatics tool to improve communication about medication regimens, share the insights of home care nurses with physicians, and highlight to physicians and nurses the complexity of medication schedules. We used human computer interaction design and evaluation principles, automated extraction from standardized forms, and modification of existing EHR fields to highlight key medication-related insights that had arisen during the SHHC visit. Separate versions of the tool were developed for physicians/nurses and patients/caregivers. A pilot of the tool was conducted using 20 SHHC encounters. Home care nurses and physicians found the tool useful for communication. Home care nurses were able to implement the HOME tool into their clinical workflow and reported improved communication with physicians about medications. This simple and largely automated tool improves understanding and communication around medications in SHHC.

  4. Sympatric cattle grazing and desert bighorn sheep foraging

    Science.gov (United States)

    Garrison, Kyle R.; Cain, James W.; Rominger, Eric M.; Goldstein, Elise J.

    2015-01-01

    Foraging behavior affects animal fitness and is largely dictated by the resources available to an animal. Understanding factors that affect forage resources is important for conservation and management of wildlife. Cattle sympatry is proposed to limit desert bighorn population performance, but few studies have quantified the effect of cattle foraging on bighorn forage resources or foraging behavior by desert bighorn. We estimated forage biomass for desert bighorn sheep in 2 mountain ranges: the cattle-grazed Caballo Mountains and the ungrazed San Andres Mountains, New Mexico. We recorded foraging bout efficiency of adult females by recording feeding time/step while foraging, and activity budgets of 3 age-sex classes (i.e., adult males, adult females, yearlings). We also estimated forage biomass at sites where bighorn were observed foraging. We expected lower forage biomass in the cattle-grazed Caballo range than in the ungrazed San Andres range and lower biomass at cattle-accessible versus inaccessible areas within the Caballo range. We predicted bighorn would be less efficient foragers in the Caballo range. Groundcover forage biomass was low in both ranges throughout the study (Jun 2012–Nov 2013). Browse biomass, however, was 4.7 times lower in the Caballo range versus the San Andres range. Bighorn in the Caballo range exhibited greater overall daily travel time, presumably to locate areas of higher forage abundance. By selecting areas with greater forage abundance, adult females in the Caballo range exhibited foraging bout efficiency similar to their San Andres counterparts but lower overall daily browsing time. We did not find a significant reduction in forage biomass at cattle-accessible areas in the Caballo range. Only the most rugged areas in the Caballo range had abundant forage, potentially a result of intensive historical livestock use in less rugged areas. Forage conditions in the Caballo range apparently force bighorn to increase foraging effort by

  5. Prevalence of Mycoplasma ovipneumoniae in desert bighorn sheep in Arizona

    Science.gov (United States)

    Justice-Allen, Anne E.; Luedtke, Clint J.; Overstreet, Matthew; Cain, James W.; Stephenson, Thomas R.

    2011-01-01

    To assess the potential for an epizootic of pneumonia to result from either natural immigration or translocation, we compared the seroprevalence to Mycoplasma ovipneumoniae in several populations of desert bighorn sheep in Arizona. We collected blood samples and nasal or oropharyngeal swabs from 124 desert bighorn sheep (Ovis canadensis nelsoni) from 6 populations in Arizona in 2009 and 2010. M. ovipneumoniae organisms were detected by PCR in 22%, whereas antibodies to M. ovipneumoniae were detected in 47% of tested bighorn sheep. Mycoplasma antibodies were not found in 2 of 6 populations, indicating some bighorn sheep populations in Arizona are naïve to this bacterium. In contrast, others had seroprevalence rates up to 80%. We were able to compare seroprevalence rates and titers over time in 9 individuals (7 individuals included in the 124 bighorn sheep sampled in 2009 and 2010, and 2 individuals originally captured in 2006). Antibody titers persisted for 12 months in individuals from the Kofa National Wildlife Refuge (n = 7) while antibody titers appeared to decline in the Kanab Creek population (n = 2). M. ovipneumoniae is present or has been present in several, but not all, populations of bighorn sheep in Arizona. The results demonstrate the importance of routine health testing for future translocation efforts to reduce disease risk for naive populations.

  6. The ReACH Collaborative--improving quality home care.

    Science.gov (United States)

    Boyce, Patricia Simino; Pace, Karen B; Lauder, Bonnie; Solomon, Debra A

    2007-08-01

    Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71). In summary, home health care is a significant and growing sector of the health care system that provides care to millions of vulnerable patients. There seems little doubt that home health agencies want to focus on quality of care issues and provide optimal care to home-based patients. Furthermore, there is a growing awareness of the value for adapting innovative, effective models for improving the culture of home care practice. This awareness stems from the notion that some agencies see quality improvement activities as a way for them to distinguish themselves not only to regulators and customers, but also to meet the cultural and transformational needs to remain viable in a constantly evolving and competitive health care industry.

  7. Piloting a Statewide Home Visiting Quality Improvement Learning Collaborative.

    Science.gov (United States)

    Goyal, Neera K; Rome, Martha G; Massie, Julie A; Mangeot, Colleen; Ammerman, Robert T; Breckenridge, Jye; Lannon, Carole M

    2017-02-01

    Objective To pilot test a statewide quality improvement (QI) collaborative learning network of home visiting agencies. Methods Project timeline was June 2014-May 2015. Overall objectives of this 8-month initiative were to assess the use of collaborative QI to engage local home visiting agencies and to test the use of statewide home visiting data for QI. Outcome measures were mean time from referral to first home visit, percentage of families with at least three home visits per month, mean duration of participation, and exit rate among infants learning. A statewide data system was used to generate monthly run charts. Results Mean time from referral to first home visit was 16.7 days, and 9.4% of families received ≥3 visits per month. Mean participation was 11.7 months, and the exit rate among infants learning network, agencies tested and measured changes using statewide and internal data. Potential next steps are to develop and test new metrics with current pilot sites and a larger collaborative.

  8. Home visit program improves technique survival in peritoneal dialysis.

    Science.gov (United States)

    Martino, Francesca; Adıbelli, Z; Mason, G; Nayak, A; Ariyanon, W; Rettore, E; Crepaldi, Carlo; Rodighiero, Mariapia; Ronco, Claudio

    2014-01-01

    Peritoneal dialysis (PD) is a home therapy, and technique survival is related to the adherence to PD prescription at home. The presence of a home visit program could improve PD outcomes. We evaluated its effects on clinical outcome during 1 year of follow-up. This was a case-control study. The case group included all 96 patients who performed PD in our center on January 1, 2013, and who attended a home visit program; the control group included all 92 patients who performed PD on January 1, 2008. The home visit program consisted of several additional visits to reinforce patients' confidence in PD management in their own environment. Outcomes were defined as technique failure, peritonitis episode, and hospitalization. Clinical and dialysis features were evaluated for each patient. The case group was significantly older (p = 0.048), with a lower grade of autonomy (p = 0.033), but a better hemoglobin level (p = 0.02) than the control group. During the observational period, we had 11 episodes of technique failure. We found a significant reduction in the rate of technique failure in the case group (p = 0.004). Furthermore, survival analysis showed a significant extension of PD treatment in the patients supported by the home visit program (52 vs. 48.8 weeks, p = 0.018). We did not find any difference between the two groups in terms of peritonitis and hospitalization rate; however, trends toward a reduction of Gram-positive peritonitis rates as well as prevalence and duration of hospitalization related to PD problems were identified in the case group. The retrospective nature of the analysis was a limitation of this study. The home visit program improves the survival of PD patients and could reduce the rate of Gram-positive peritonitis and hospitalization. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=365168.

  9. Ecotypic variation in population dynamics of reintroduced bighorn sheep

    Science.gov (United States)

    Bleich, Vernon C.; Sargeant, Glen A.; Wiedmann, Brett P.

    2018-01-01

    Selection of bighorn sheep (Ovis canadensis) for translocation historically has been motivated by preservation of subspecific purity rather than by adaptation of source stocks to similar environments. Our objective was to estimate cause‐specific, annual, and age‐specific mortality of introduced bighorn sheep that originated at low elevations in southern British Columbia, Canada (BC ecotype), or in the Missouri River Breaks region of central Montana, USA (MT ecotype). In North Dakota, USA, mortality was similar and typically low for adult female bighorn sheep from Montana (0.09 ± 0.029 [SE]) and British Columbia (0.08 ± 0.017) during 2000–2016. Median life expectancy was 11 years for females that reached adulthood (2 yrs old); however, mortality accelerated with age and reached 86% by age 16. Mortalities resulted primarily from low rates of predation, disease, accidents, and unknown natural causes (<0.04 [upper 90% CI]). Similar survival rates of female bighorn sheep from female bighorn sheep from British Columbia and Montana, coupled with greater recruitment of bighorn sheep from Montana, resulted in a greater projected rate of increase for the MT ecotype (λ = 1.21) than for the BC ecotype (1.02), and a more youthful age structure. These results support translocation of bighorn sheep from areas that are environmentally similar to areas that will be stocked. Potential benefits include more rapid population growth, greater resilience to and more rapid recovery from density‐independent losses, an increased possibility that rapidly growing populations will expand into adjacent habitat, increased hunter opportunity, increased connectivity among herds, and a more complete restoration of ecosystem processes.

  10. A model for ageing-home-care service process improvement

    OpenAIRE

    Yu, Shu-Yan; Shie, An-Jin

    2017-01-01

    The purpose of this study was to develop an integrated model to improve service processes in ageing-home-care. According to the literature, existing service processes have potential service failures that affect service quality and efficacy. However, most previous studies have only focused on conceptual model development using New Service Development (NSD) and fail to provide a systematic model to analyse potential service failures and facilitate managers developing solutions to improve the se...

  11. Transfer from planned home birth to hospital: improving interprofessional collaboration.

    Science.gov (United States)

    Vedam, Saraswathi; Leeman, Lawrence; Cheyney, Melissa; Fisher, Timothy J; Myers, Susan; Low, Lisa Kane; Ruhl, Catherine

    2014-01-01

    Women's heightened interest in choice of birthplace and increased rates of planned home birth in the United States have been well documented, yet there remains significant public and professional debate about the ethics of planned home birth in jurisdictions where care is not clearly integrated across birth settings. Simultaneously, the quality of interprofessional interactions is recognized as a predictor of health outcomes during obstetric events. When care is transferred across birth settings, confusion and conflict among providers with respect to roles and responsibilities can adversely affect both outcomes and the experience of care for women and newborns. This article reviews findings of recent North American studies that examine provider attitudes toward planned home birth, differing concepts of safety of birthplace as reported by women and providers, and sources of conflict among maternity care providers during transfer from home to hospital. Emerging evidence and clinical exemplars can inform the development of systems for seamless transfer of women and newborns from planned home births to hospital and improve experience and perceptions of safety among families and providers. Three successful models in the United States that have enhanced multidisciplinary cooperation and coordination of care across birth settings are described. Finally, best practice guidelines for roles, communication, and mutual accommodation among all participating providers when transfer occurs are introduced. Research, health professional education, and policy recommendations for incorporation of key components into existing health care systems in the United States are included. © 2014 by the American College of Nurse-Midwives.

  12. Performance analysis and improvement of WPAN MAC for home networks.

    Science.gov (United States)

    Mehta, Saurabh; Kwak, Kyung Sup

    2010-01-01

    The wireless personal area network (WPAN) is an emerging wireless technology for future short range indoor and outdoor communication applications. The IEEE 802.15.3 medium access control (MAC) is proposed to coordinate the access to the wireless medium among the competing devices, especially for short range and high data rate applications in home networks. In this paper we use analytical modeling to study the performance analysis of WPAN (IEEE 802.15.3) MAC in terms of throughput, efficient bandwidth utilization, and delay with various ACK policies under error channel condition. This allows us to introduce a K-Dly-ACK-AGG policy, payload size adjustment mechanism, and Improved Backoff algorithm to improve the performance of the WPAN MAC. Performance evaluation results demonstrate the impact of our improvements on network capacity. Moreover, these results can be very useful to WPAN application designers and protocol architects to easily and correctly implement WPAN for home networking.

  13. Performance Analysis and Improvement of WPAN MAC for Home Networks

    Directory of Open Access Journals (Sweden)

    Saurabh Mehta

    2010-03-01

    Full Text Available The wireless personal area network (WPAN is an emerging wireless technology for future short range indoor and outdoor communication applications. The IEEE 802.15.3 medium access control (MAC is proposed to coordinate the access to the wireless medium among the competing devices, especially for short range and high data rate applications in home networks. In this paper we use analytical modeling to study the performance analysis of WPAN (IEEE 802.15.3 MAC in terms of throughput, efficient bandwidth utilization, and delay with various ACK policies under error channel condition. This allows us to introduce a K-Dly-ACK-AGG policy, payload size adjustment mechanism, and Improved Backoff algorithm to improve the performance of the WPAN MAC. Performance evaluation results demonstrate the impact of our improvements on network capacity. Moreover, these results can be very useful to WPAN application designers and protocol architects to easily and correctly implement WPAN for home networking.

  14. Fatal Pasteurella haemolytica pneumonia in bighorn sheep after direct contact with clinically normal domestic sheep.

    Science.gov (United States)

    Foreyt, W J

    1989-03-01

    Six Rocky Mountain bighorn sheep were raised in captivity from birth (n = 5) or taken from the wild as a lamb (n = 1). After the bighorn sheep were in captivity for over a year, 6 clinically normal domestic sheep were placed on the 2 ha of pasture on which the bighorn sheep were kept. Nasal swab specimens were obtained from all sheep at the time the domestic sheep were introduced. Pasteurella haemolytica was isolated from swab specimens obtained from 4 of 6 domestic sheep, but not from specimens obtained from the bighorn sheep. All 6 bighorn sheep died of acute hemorrhagic pneumonia after exposure to domestic sheep. Death in the bighorn sheep occurred on days 4, 27, 27, 29, 36, or 71 after initial exposure to domestic sheep. Pasteurella haemolytica was isolated from respiratory tract tissue specimens of all bighorn sheep at the time of death. None of the domestic sheep were clinically ill during the study. At the end of the study, 3 of 6 domestic sheep were euthanatized, and at necropsy, P haemolytica was isolated from 2 of them. The most common serotypes in bighorn and domestic sheep were P haemolytica T-3 and A-2. Other serotypes isolated included P haemolytica A-1, A-9, and A-11 in bighorn sheep and A-1 in domestic sheep. On the basis of results of this study and of other reports, domestic sheep and bighorn sheep should not be managed in proximity to each other because of the potential fatal consequences in bighorn sheep.

  15. Susceptibility of Rocky Mountain bighorn sheep and domestic sheep to pneumonia induced by bighorn and domestic livestock strains of Pasteurella haemolytica.

    OpenAIRE

    Onderka, D K; Rawluk, S A; Wishart, W D

    1988-01-01

    Bighorn sheep were inoculated intratracheally with suspensions of nonhemolytic Pasteurella haemolytica biotype T (10(12) organisms) unique to wild bighorns, with beta-hemolytic P. haemolytica biotype T (10(12) organisms) isolated from clinically normal domestic sheep or intradermally with half a dose of a cattle vaccine containing P. haemolytica biotype A (10(5) organisms). The bighorn strain caused lobar necrotizing bronchopneumonia whereas both domestic livestock strains precipitated fatal ...

  16. Evaluating potential overlap between pack stock and Sierra Nevada bighorn sheep (Ovis canadensis sierrae) in Sequoia and Kings Canyon National Parks, California

    Science.gov (United States)

    Klinger, Robert C.; Few, Alexandra P.; Knox, Kathleen A.; Hatfield, Brian E.; Clark, Jonathan; German, David W.; Stephenson, Thomas R.

    2015-01-01

    Pack stock (horses, mules, burros, llamas, and goats) are frequently assumed to have negative effects on public lands, but there is a general lack of data to be able to quantify the degree to which this is actually the case. Sequoia and Kings Canyon National Parks have received complaints that pack stock may affect Sierra Nevada bighorn sheep (Ovis canadensis sierrae; SNBS), a federally endangered subspecies that occurs in largely disjunct herds in the Sierra Nevada Range of California. The potential effects are thought to be displacement of SNBS from meadows on their summer range (altered habitat use) or, more indirectly, through changes in SNBS habitat or forage quality. Our goals were to conduct an association analysis to quantify the degree of potential spatial overlap in meadow use between SNBS and pack stock and to compare differences in vegetation community composition, structure, and diversity among meadows with different levels of use by bighorn sheep and pack stock. For the association analysis, we used two approaches: (1) we quantified the proportion of meadows that were within the herd home ranges of bighorn sheep and were potentially open to pack stock, and, (2) we used Monte Carlo simulations and use-availability analyses to compare the proportion of meadows used by bighorn sheep relative to the proportional occurrence or area of meadows available to bighorn sheep that were used by pack stock. To evaluate potential effects of pack stock on meadow plant communities and SNBS forage, we sampled vegetation in 2011 and 2012 at 100 plots to generate data that allowed us to compare:

  17. An ecologic study comparing distribution of Pasteurella trehalosi and Mannheimia haemolytica between Sierra Nevada bighorn sheep, White Mountain bighorn sheep, and domestic sheep.

    Science.gov (United States)

    Tomassini, Letizia; Gonzales, Ben; Weiser, Glen C; Sischo, William

    2009-10-01

    The prevalence and phenotypic variability of Pasteurella and Mannheimia isolates from Sierra Nevada bighorn sheep (Ovis canadensis sierrae), White Mountain bighorn sheep (Ovis canadensis nelsoni), and domestic sheep (Ovis aries) from California, USA, were compared. The White Mountain bighorn sheep population had a recent history of pneumonia-associated mortality, whereas the Sierra Nevada bighorn sheep population had no recent history of pneumonia-associated mortality. The domestic sheep flocks were pastured in areas geographically near both populations but were not known to have direct contact with either bighorn sheep population. Oropharyngeal swab samples were collected from healthy domestic and bighorn sheep and cultured to characterize bacterial species, hemolysis, biogroups, and biovariants. Pasteurella trehalosi and Mannheimia haemolytica were detected in all of the study populations, but the relative proportion of each bacterial species differed among sheep populations. Pasteurella trehalosi was more common than M. haemolytica in the bighorn sheep populations, whereas the opposite was true in domestic sheep. Mannheimia haemolytica was separated into 11 biogroups, and P. trehalosi was characterized into two biogroups. Biogroup distributions for M. haemolytica and P. trehalosi differed among the three populations; however, no difference was detected for the distribution of P. trehalosi biogroups between the Sierra Nevada bighorn sheep and domestic sheep. The prevalence odds ratios (pOR) for the distribution of M. haemolytica biogroups suggested little difference between White Mountain bighorn sheep and domestic sheep compared with Sierra Nevada bighorn sheep and domestic sheep, although these comparisons had relatively large confidence intervals for the point estimates. Hemolytic activity of the isolates was not different among the sheep populations for M. haemolytica but was different for P. trehalosi. No clear evidence of association was found in the

  18. Fatal pneumonia following inoculation of healthy bighorn sheep with Pasteurella haemolytica from healthy domestic sheep.

    Science.gov (United States)

    Foreyt, W J; Snipes, K P; Kasten, R W

    1994-04-01

    In a series of three experiments, isolates of Pasteurella haemolytica biotype A, serotype 2, ribotype reference WSU-1, from healthy domestic sheep, were inoculated intratracheally into eight bighorn sheep (Ovis canadensis canadensis) and seven domestic sheep with doses of bacteria ranging from 5.3 x 10(8) to 8.6 x 10(11) colony forming units. Seven of eight inoculated bighorn sheep died from acute pneumonia within 48 hr of inoculation, whereas all seven domestic sheep inoculated with comparable or greater doses of bacteria remained healthy. One contact control bighorn sheep also died 6 days after its penmates received P. haemolytica. Three other noncontact control bighorn sheep remained healthy during the experiments. Pasteurella haemolytica biotype A, serotype 2, ribotype reference WSU-1 in the inocula was recovered from one or more tissues from all bighorns that died; whereas, it was not detected in any bighorn sheep before inoculation. Three different ribotypes of P. haemolytica A2 were recovered from bighorn sheep; however, only the ribotype reference WSU-1 in the domestic sheep-origin inoculum was recovered from all dead bighorn sheep, and was not recovered from bighorn sheep that survived the experiments. Thus, a relatively nonpathogenic and common isolate of P. haemolytica from healthy domestic sheep was lethal in bighorn sheep under experimental conditions.

  19. Ecotypic variation in population dynamics of reintroduced bighorn sheep

    Science.gov (United States)

    Bleich, Vernon C.; Sargeant, Glen A.; Wiedmann, Brett P.

    2018-01-01

    Selection of bighorn sheep (Ovis canadensis) for translocation historically has been motivated by preservation of subspecific purity rather than by adaptation of source stocks to similar environments. Our objective was to estimate cause‐specific, annual, and age‐specific mortality of introduced bighorn sheep that originated at low elevations in southern British Columbia, Canada (BC ecotype), or in the Missouri River Breaks region of central Montana, USA (MT ecotype). In North Dakota, USA, mortality was similar and typically low for adult female bighorn sheep from Montana (0.09 ± 0.029 [SE]) and British Columbia (0.08 ± 0.017) during 2000–2016. Median life expectancy was 11 years for females that reached adulthood (2 yrs old); however, mortality accelerated with age and reached 86% by age 16. Mortalities resulted primarily from low rates of predation, disease, accidents, and unknown natural causes (recruitment of bighorn sheep from Montana, resulted in a greater projected rate of increase for the MT ecotype (λ = 1.21) than for the BC ecotype (1.02), and a more youthful age structure. These results support translocation of bighorn sheep from areas that are environmentally similar to areas that will be stocked. Potential benefits include more rapid population growth, greater resilience to and more rapid recovery from density‐independent losses, an increased possibility that rapidly growing populations will expand into adjacent habitat, increased hunter opportunity, increased connectivity among herds, and a more complete restoration of ecosystem processes.

  20. Care Plan Improvement in Nursing Homes: An Integrative Review.

    Science.gov (United States)

    Mariani, Elena; Chattat, Rabih; Vernooij-Dassen, Myrra; Koopmans, Raymond; Engels, Yvonne

    2017-01-01

    Care planning nowadays is a key activity in the provision of services to nursing home residents. A care plan describes the residents' needs and the actions to address them, providing both individualized and standardized interventions and should be updated as changes in the residents' conditions occur. The aim of this review was to identify the core elements of the implementation of changes in nursing homes' care plans, by providing an overview of the type of stakeholders involved, describing the implementation strategies used, and exploring how care plans changed. An integrative literature review was used to evaluate intervention studies taking place in nursing homes. Data were collected from PubMed, CINHAL-EBSCO, and PsycINFO. English language articles published between 1995 and April 2015 were included. Data analysis followed the strategy of Knafl and Whittemore. Twenty-six articles were included. The stakeholders involved were professionals, family caregivers, and patients. Only a few studies directly involved residents and family caregivers in the quality improvement process. The implementation strategies used were technology implementation, audit, training, feedback, and supervision. The majority of interventions changed the residents' care plans in terms of developing a more standardized care documentation that primarily focuses on its quality. Only some interventions developed more tailored care plans that focus on individualized needs. Care plans generally failed in providing both standardized and personalized interventions. Efforts should be made to directly involve residents in care planning and provide professionals with efficient tools to report care goals and actions in care plans.

  1. Quantifying parental preferences for interventions designed to improve home food preparation and home food environments during early childhood.

    Science.gov (United States)

    Virudachalam, Senbagam; Chung, Paul J; Faerber, Jennifer A; Pian, Timothy M; Thomas, Karen; Feudtner, Chris

    2016-03-01

    Though preparing healthy food at home is a critical health promotion habit, few interventions have aimed to improve parental cooking skills and behaviors. We sought to understand parents' preferences and priorities regarding interventions to improve home food preparation practices and home food environments during early childhood. We administered a discrete choice experiment using maximum difference scaling. Eighty English-speaking parents of healthy 1-4 year-old children rated the relative importance of potential attributes of interventions to improve home food preparation practices and home food environments. We performed latent class analysis to identify subgroups of parents with similar preferences and tested for differences between the subgroups. Participants were mostly white or black 21-45 year-old women whose prevalence of overweight/obesity mirrored the general population. Latent class analysis revealed three distinct groups of parental preferences for intervention content: a healthy cooking group, focused on nutrition and cooking healthier food; a child persuasion group, focused on convincing toddlers to eat home-cooked food; and a creative cooking group, focused on cooking without recipes, meal planning, and time-saving strategies. Younger, lower income, 1-parent households comprised the healthy cooking group, while older, higher income, 2-parent households comprised the creative cooking group (p cooked dinner regularly, unlike the other two groups (p food preparation practices. Such interventions are important for creating healthier home food environments and preventing obesity starting from early childhood. Copyright © 2015 Elsevier Ltd. All rights reserved.

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  3. Improving the Quality of Home Health Care for Children With Medical Complexity.

    Science.gov (United States)

    Nageswaran, Savithri; Golden, Shannon L

    2017-08-01

    The objectives of this study are to describe the quality of home health care services for children with medical complexity, identify barriers to delivering optimal home health care, and discuss potential solutions to improve home health care delivery. In this qualitative study, we conducted 20 semistructured in-depth interviews with primary caregivers of children with medical complexity, and 4 focus groups with 18 home health nurses. During an iterative analysis process, we identified themes related to quality of home health care. There is substantial variability between home health nurses in the delivery of home health care to children. Lack of skills in nurses is common and has serious negative health consequences for children with medical complexity, including hospitalizations, emergency room visits, and need for medical procedures. Inadequate home health care also contributes to caregiver burden. A major barrier to delivering optimal home health care is the lack of training of home health nurses in pediatric care and technology use. Potential solutions for improving care include home health agencies training nurses in the care of children with medical complexity, support for nurses in clinical problem solving, and reimbursement for training nurses in pediatric home care. Caregiver-level interventions includes preparation of caregivers about: providing medical care for their children at home and addressing problems with home health care services. There are problems in the quality of home health care delivered to children with medical complexity. Training nurses in the care of children with medical complexity and preparing caregivers about home care could improve home health care quality. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  4. Logotherapy Counseling to Improve Acceptance of Broken Home Child

    OpenAIRE

    Erlangga, Erwin

    2017-01-01

    This study aims to increase the enrollment of children of a broken home that life has meaning. Subjects are 100 children in Demak whose families experiencing divorce. Research themes include three things: individual counseling, engineering logotherapy, reception, and a child of a broken home. Data obtained based on interviews, observation, and psychological scale showed that of the 100 children of a broken home has a low acceptance that individual counseling with logotherapy techniques were c...

  5. Transmission of lungworms (Muellerius capillaris) from domestic goats to bighorn sheep on common pasture.

    Science.gov (United States)

    Foreyt, William J; Jenkins, E J; Appleyard, G D

    2009-04-01

    Four domestic goats (Capra hircus) that were passing first-stage dorsal-spined larvae of Muellerius capillaris were copastured on a 0.82-ha pasture for 11 mo from May 2003 to April 2004 with seven Rocky Mountain bighorn sheep (Ovis canadensis) that were not passing dorsal-spined larvae. During the 11-mo experiment, two bighorn sheep died from pneumonia caused by Mannheimia (Pasteurella) haemolytica biotype A, serotype 2. The remaining five bighorn sheep and the four domestic goats remained healthy throughout the experiment. Muellerius larvae were detected from all domestic goats on a monthly basis throughout the experiment and were first detected from all five surviving bighorn sheep approximately 5 mo after the copasturing began. Once the bighorn sheep began passing Muellerius larvae, larvae were detected in low numbers from all bighorn sheep every month thereafter for the 6 mo the goats were still in the enclosure and continued to pass larvae for more than 3 yr after the goats were removed from the experiment. Six bighorn sheep in two similar enclosures that did not contain goats did not pass Muellerius larvae before, during, or after the experimental period. Results of this experiment indicate that M. capillaris from domestic goats is capable of infecting bighorn sheep when animals are copastured together on a common range.

  6. Logotherapy Counseling to Improve Acceptance of Broken Home Child

    Directory of Open Access Journals (Sweden)

    Erwin Erlangga

    2017-08-01

    Full Text Available This study aims to increase the enrollment of children of a broken home that life has meaning. Subjects are 100 children in Demak whose families experiencing divorce. Research themes include three things: individual counseling, engineering logotherapy, reception, and a child of a broken home. Data obtained based on interviews, observation, and psychological scale showed that of the 100 children of a broken home has a low acceptance that individual counseling with logotherapy techniques were considered appropriate to increase the enrollment of children of a broken home. Factors - factors that affect the acceptance of a child of a broken home is self-blame, anger and did not have a purpose in life again. In addition the environment is also a significant effect on the enrollment of children of a broken home. Environmental labeling of families experiencing divorce as a family that failed so that children are increasingly stressed with the stamp of the community. Based on the field test results, the level of acceptance of the child of a broken home increases after the individual is given counseling services with logotherapy techniques. Indicated by changes in the level of acceptance of children of a broken home before being given treatment (initial evaluation and after (final evaluation of 130 points. The results of effectiveness test statistic t test calculations also showed 0,010 <0.05.It was concluded that counseling individuals with logotherapy effective technique to increase the enrollment of children of a broken home

  7. Potential disease agents in domestic goats and relevance to bighorn sheep (Ovis canadensis) management.

    Science.gov (United States)

    Drew, Mark L; Weiser, Glen C

    2017-01-01

    Domestic goats are raised for meat, milk and hair production, in herds for rangeland weed control, and as pack animals. Domestic sheep, goats and wild bighorn sheep are all susceptible to a multifactorial pneumonia. We sampled 43 herd goats from 7 herds and 48 pack goats from 11 herds for viral and bacterial serology, parasitology, and Pasteurellaceae microbiology. The goats in this study were in generally good health, although most goats did harbor various pathogens and parasites including several bacteria, specifically Pasteurellaceae, which have been associated with pneumonia in free-ranging bighorn sheep. It is not known if domestic goats can transmit the Pasteurellaceae or other pathogens found in this study readily to wild bighorn sheep. However, due the possibility of transmission, domestic goats in areas in or near bighorn sheep habitat should be managed to minimize the risk of spreading disease agents to bighorn sheep.

  8. Potential disease agents in domestic goats and relevance to bighorn sheep (Ovis canadensis management.

    Directory of Open Access Journals (Sweden)

    Mark L Drew

    Full Text Available Domestic goats are raised for meat, milk and hair production, in herds for rangeland weed control, and as pack animals. Domestic sheep, goats and wild bighorn sheep are all susceptible to a multifactorial pneumonia. We sampled 43 herd goats from 7 herds and 48 pack goats from 11 herds for viral and bacterial serology, parasitology, and Pasteurellaceae microbiology. The goats in this study were in generally good health, although most goats did harbor various pathogens and parasites including several bacteria, specifically Pasteurellaceae, which have been associated with pneumonia in free-ranging bighorn sheep. It is not known if domestic goats can transmit the Pasteurellaceae or other pathogens found in this study readily to wild bighorn sheep. However, due the possibility of transmission, domestic goats in areas in or near bighorn sheep habitat should be managed to minimize the risk of spreading disease agents to bighorn sheep.

  9. Potential disease agents in domestic goats and relevance to bighorn sheep (Ovis canadensis) management

    Science.gov (United States)

    Weiser, Glen C.

    2017-01-01

    Domestic goats are raised for meat, milk and hair production, in herds for rangeland weed control, and as pack animals. Domestic sheep, goats and wild bighorn sheep are all susceptible to a multifactorial pneumonia. We sampled 43 herd goats from 7 herds and 48 pack goats from 11 herds for viral and bacterial serology, parasitology, and Pasteurellaceae microbiology. The goats in this study were in generally good health, although most goats did harbor various pathogens and parasites including several bacteria, specifically Pasteurellaceae, which have been associated with pneumonia in free-ranging bighorn sheep. It is not known if domestic goats can transmit the Pasteurellaceae or other pathogens found in this study readily to wild bighorn sheep. However, due the possibility of transmission, domestic goats in areas in or near bighorn sheep habitat should be managed to minimize the risk of spreading disease agents to bighorn sheep. PMID:28282407

  10. Improving Nursing Home Staff Knowledge and Attitudes about Pain

    Science.gov (United States)

    Jones, Katherine R.; Fink, Regina; Pepper, Ginny; Hutt, Eveyln; Vojir, Carol P.; Scott, Jill; Clark, Lauren; Mellis, Karen

    2004-01-01

    Purpose: Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain. Design and Methods: Twelve nursing homes participated in this intervention study: six…

  11. Exposure of bighorn sheep to domestic goats colonized with Mycoplasma ovipneumoniae induces sub-lethal pneumonia.

    Directory of Open Access Journals (Sweden)

    Thomas E Besser

    Full Text Available Bronchopneumonia is a population limiting disease of bighorn sheep (Ovis canadensis that has been associated with contact with domestic Caprinae. The disease is polymicrobial but is initiated by Mycoplasma ovipneumoniae, which is commonly carried by both domestic sheep (O. aries and goats (Capra aegagrus hircus. However, while previous bighorn sheep comingling studies with domestic sheep have resulted in nearly 100% pneumonia mortality, only sporadic occurrence of fatal pneumonia was reported from previous comingling studies with domestic goats. Here, we evaluated the ability of domestic goats of defined M. ovipneumoniae carriage status to induce pneumonia in comingled bighorn sheep.In experiment 1, three bighorn sheep naïve to M. ovipneumoniae developed non-fatal respiratory disease (coughing, nasal discharge following comingling with three naturally M. ovipneumoniae-colonized domestic goats. Gross and histological lesions of pneumonia, limited to small areas on the ventral and lateral edges of the anterior and middle lung lobes, were observed at necropsies conducted at the end of the experiment. A control group of three bighorn sheep from the same source housed in isolation during experiment 1 remained free of observed respiratory disease. In experiment 2, three bighorn sheep remained free of observed respiratory disease while comingled with three M. ovipneumoniae-free domestic goats. In experiment 3, introduction of a domestic goat-origin strain of M. ovipneumoniae to the same comingled goats and bighorn sheep used in experiment 2 resulted in clinical signs of respiratory disease (coughing, nasal discharge in both host species. At the end of experiment 3, gross and histological evidence of pneumonia similar to that observed in experiment 1 bighorn sheep was observed in both affected bighorn sheep and domestic goats.M. ovipneumoniae strains carried by domestic goats were transmitted to comingled bighorn sheep, triggering development of

  12. Exposure of bighorn sheep to domestic goats colonized with Mycoplasma ovipneumoniae induces sub-lethal pneumonia.

    Science.gov (United States)

    Besser, Thomas E; Cassirer, E Frances; Potter, Kathleen A; Foreyt, William J

    2017-01-01

    Bronchopneumonia is a population limiting disease of bighorn sheep (Ovis canadensis) that has been associated with contact with domestic Caprinae. The disease is polymicrobial but is initiated by Mycoplasma ovipneumoniae, which is commonly carried by both domestic sheep (O. aries) and goats (Capra aegagrus hircus). However, while previous bighorn sheep comingling studies with domestic sheep have resulted in nearly 100% pneumonia mortality, only sporadic occurrence of fatal pneumonia was reported from previous comingling studies with domestic goats. Here, we evaluated the ability of domestic goats of defined M. ovipneumoniae carriage status to induce pneumonia in comingled bighorn sheep. In experiment 1, three bighorn sheep naïve to M. ovipneumoniae developed non-fatal respiratory disease (coughing, nasal discharge) following comingling with three naturally M. ovipneumoniae-colonized domestic goats. Gross and histological lesions of pneumonia, limited to small areas on the ventral and lateral edges of the anterior and middle lung lobes, were observed at necropsies conducted at the end of the experiment. A control group of three bighorn sheep from the same source housed in isolation during experiment 1 remained free of observed respiratory disease. In experiment 2, three bighorn sheep remained free of observed respiratory disease while comingled with three M. ovipneumoniae-free domestic goats. In experiment 3, introduction of a domestic goat-origin strain of M. ovipneumoniae to the same comingled goats and bighorn sheep used in experiment 2 resulted in clinical signs of respiratory disease (coughing, nasal discharge) in both host species. At the end of experiment 3, gross and histological evidence of pneumonia similar to that observed in experiment 1 bighorn sheep was observed in both affected bighorn sheep and domestic goats. M. ovipneumoniae strains carried by domestic goats were transmitted to comingled bighorn sheep, triggering development of pneumonia. However

  13. Susceptibility of Rocky Mountain bighorn sheep and domestic sheep to pneumonia induced by bighorn and domestic livestock strains of Pasteurella haemolytica.

    Science.gov (United States)

    Onderka, D K; Rawluk, S A; Wishart, W D

    1988-10-01

    Bighorn sheep were inoculated intratracheally with suspensions of nonhemolytic Pasteurella haemolytica biotype T (10(12) organisms) unique to wild bighorns, with beta-hemolytic P. haemolytica biotype T (10(12) organisms) isolated from clinically normal domestic sheep or intradermally with half a dose of a cattle vaccine containing P. haemolytica biotype A (10(5) organisms). The bighorn strain caused lobar necrotizing bronchopneumonia whereas both domestic livestock strains precipitated fatal septicemia and fibrinous bronchopneumonia. The serotypes given were T3, T4, T15 and A1 and these were recovered from lung lesions and other organs. In three trials, domestic sheep were inoculated intratracheally with suspensions of bighorn sheep pneumonic lungs, and two concentrations of the P. haemolytica bighorn strain (10(4) and 10(12) organisms). One of these sheep was inoculated intrabronchially. The domestic sheep experienced a transient fever and elevated white blood cell counts. After six days, none of the sheep had lung lesions and inoculated organisms could not be recovered. It is suggested that bighorn sheep are very susceptible to P. haemolytica from domestic livestock and should not be allowed in contact with sheep or cattle.

  14. Living in cold homes after heating improvements: Evidence from Warm-Front, England's Home Energy Efficiency Scheme

    International Nuclear Information System (INIS)

    Critchley, Roger; Gilbertson, Jan; Grimsley, Michael; Green, Geoff

    2007-01-01

    Objective: To investigate explanatory factors for persistent cold temperatures in homes which have received heating improvements. Design: Analysis of data from a national survey of dwellings and households (in England occupied by low-income residents) that had received heating improvements or repairs under the Warm Front Scheme. Methods: Over the winters of 2001-02 and 2002-03, householders recorded living room and main bedroom temperatures in a diary. Entries were examined for 888 households, which had received high level heating interventions. Two hundred and twenty-two households were identified as occupying cold homes, with mean bedroom temperature below 16 deg. C or mean living room temperatures below 18 deg. C. Binary logistic regression was used to model dwelling and household features and then occupants' behaviour and attitudes in the 'cold homes' sub-set compared with the remainder of the high intervention group. Seventy-nine supplementary, structured telephone interviews explored reasons given for lower temperatures. Using graphical and tabular methods, householders preferring cooler homes were distinguished from those who felt constrained in some way. Results: Cold homes predominate in pre-1930 properties where the householder remains dissatisfied with the heating system despite major improvements funded by Warm Front. Residents of cold homes are less likely to have long-standing illness or disability, but more likely to experience anxiety or depression. A small sample of telephone interviews reveals those preferring lower temperatures for health or other reasons, report less anxiety and depression than those with limited control over their home environment. Their 'thermal resistance' to higher temperatures challenges orthodox definitions of comfort and fuel poverty

  15. Epizootic pneumonia of bighorn sheep following experimental exposure to Mycoplasma ovipneumoniae.

    Science.gov (United States)

    Besser, Thomas E; Cassirer, E Frances; Potter, Kathleen A; Lahmers, Kevin; Oaks, J Lindsay; Shanthalingam, Sudarvili; Srikumaran, Subramaniam; Foreyt, William J

    2014-01-01

    Bronchopneumonia is a population limiting disease of bighorn sheep (Ovis canadensis). The cause of this disease has been a subject of debate. Leukotoxin expressing Mannheimia haemolytica and Bibersteinia trehalosi produce acute pneumonia after experimental challenge but are infrequently isolated from animals in natural outbreaks. Mycoplasma ovipneumoniae, epidemiologically implicated in naturally occurring outbreaks, has received little experimental evaluation as a primary agent of bighorn sheep pneumonia. In two experiments, bighorn sheep housed in multiple pens 7.6 to 12 m apart were exposed to M. ovipneumoniae by introduction of a single infected or challenged animal to a single pen. Respiratory disease was monitored by observation of clinical signs and confirmed by necropsy. Bacterial involvement in the pneumonic lungs was evaluated by conventional aerobic bacteriology and by culture-independent methods. In both experiments the challenge strain of M. ovipneumoniae was transmitted to all animals both within and between pens and all infected bighorn sheep developed bronchopneumonia. In six bighorn sheep in which the disease was allowed to run its course, three died with bronchopneumonia 34, 65, and 109 days after M. ovipneumoniae introduction. Diverse bacterial populations, predominantly including multiple obligate anaerobic species, were present in pneumonic lung tissues at necropsy. Exposure to a single M. ovipneumoniae infected animal resulted in transmission of infection to all bighorn sheep both within the pen and in adjacent pens, and all infected sheep developed bronchopneumonia. The epidemiologic, pathologic and microbiologic findings in these experimental animals resembled those seen in naturally occurring pneumonia outbreaks in free ranging bighorn sheep.

  16. BIGHORN Computational Fluid Dynamics Theory, Methodology, and Code Verification & Validation Benchmark Problems

    Energy Technology Data Exchange (ETDEWEB)

    Xia, Yidong [Idaho National Lab. (INL), Idaho Falls, ID (United States); Andrs, David [Idaho National Lab. (INL), Idaho Falls, ID (United States); Martineau, Richard Charles [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2016-08-01

    This document presents the theoretical background for a hybrid finite-element / finite-volume fluid flow solver, namely BIGHORN, based on the Multiphysics Object Oriented Simulation Environment (MOOSE) computational framework developed at the Idaho National Laboratory (INL). An overview of the numerical methods used in BIGHORN are discussed and followed by a presentation of the formulation details. The document begins with the governing equations for the compressible fluid flow, with an outline of the requisite constitutive relations. A second-order finite volume method used for solving the compressible fluid flow problems is presented next. A Pressure-Corrected Implicit Continuous-fluid Eulerian (PCICE) formulation for time integration is also presented. The multi-fluid formulation is being developed. Although multi-fluid is not fully-developed, BIGHORN has been designed to handle multi-fluid problems. Due to the flexibility in the underlying MOOSE framework, BIGHORN is quite extensible, and can accommodate both multi-species and multi-phase formulations. This document also presents a suite of verification & validation benchmark test problems for BIGHORN. The intent for this suite of problems is to provide baseline comparison data that demonstrates the performance of the BIGHORN solution methods on problems that vary in complexity from laminar to turbulent flows. Wherever possible, some form of solution verification has been attempted to identify sensitivities in the solution methods, and suggest best practices when using BIGHORN.

  17. Desert bighorn sheep lambing habitat: Parturition, nursery, and predation sites

    Science.gov (United States)

    Karsch, Rebekah C.; Cain, James W.; Rominger, Eric M.; Goldstein, Elise J.

    2016-01-01

    Fitness of female ungulates is determined by neonate survival and lifetime reproductive success. Therefore, adult female ungulates should adopt behaviors and habitat selection patterns that enhance survival of neonates during parturition and lactation. Parturition site location may play an important role in neonatal mortality of desert bighorn sheep (Ovis canadensis mexicana) when lambs are especially vulnerable to predation, but parturition sites are rarely documented for this species. Our objectives were to assess environmental characteristics at desert bighorn parturition, lamb nursery, and predation sites and to assess differences in habitat characteristics between parturition sites and nursery group sites, and predation sites and nursery group sites. We used vaginal implant transmitters (VITs) to identify parturition sites and capture neonates. We then compared elevation, slope, terrain ruggedness, and visibility at parturition, nursery, and lamb predation sites with paired random sites and compared characteristics of parturition sites and lamb predation sites to those of nursery sites. When compared to random sites, odds of a site being a parturition site were highest at intermediate slopes and decreased with increasing female visibility. Odds of a site being a predation site increased with decreasing visibility. When compared to nursery group sites, odds of a site being a parturition site had a quadratic relationship with elevation and slope, with odds being highest at intermediate elevations and intermediate slopes. When we compared predation sites to nursery sites, odds of a site being a predation were highest at low elevation areas with high visibility and high elevation areas with low visibility likely because of differences in hunting strategies of coyote (Canis latrans) and puma (Puma concolor). Parturition sites were lower in elevation and slope than nursery sites. Understanding selection of parturition sites by adult females and how habitat

  18. Epidemic pasteurellosis in a bighorn sheep population coinciding with the appearance of a domestic sheep.

    Science.gov (United States)

    George, Janet L; Martin, Daniel J; Lukacs, Paul M; Miller, Michael W

    2008-04-01

    A pneumonia epidemic reduced bighorn sheep (Ovis canadensis) survival and recruitment during 1997-2000 in a population comprised of three interconnected wintering herds (Kenosha Mountains, Sugarloaf Mountain, Twin Eagles) that inhabited the Kenosha and Tarryall Mountain ranges in central Colorado, USA. The onset of this epidemic coincided temporally and spatially with the appearance of a single domestic sheep (Ovis aires) on the Sugarloaf Mountain herd's winter range in December 1997. Although only bighorns in the Sugarloaf Mountain herd were affected in 1997-98, cases also occurred during 1998-99 in the other two wintering herds, likely after the epidemic spread via established seasonal movements of male bighorns. In all, we located 86 bighorn carcasses during 1997-2000. Three species of Pasteurella were isolated in various combinations from affected lung tissues from 20 bighorn carcasses where tissues were available and suitable for diagnostic evaluation; with one exception, beta-hemolytic mannheimia (Pasteurella) haemolytica (primarily reported as biogroup 1(G) or 1(alphaG)) was isolated from lung tissues of cases evaluated during winter 1997-98. The epidemic dramatically lowered adult bighorn monthly survival in all three herds; a model that included an acute epidemic effect, differing between sexes and with vaccination status, that diminished linearly over the next 12 mo best represented field data. In addition to the direct mortality associated with epidemics in these three herds, lamb recruitment in years following the pneumonia epidemic also was depressed as compared to years prior to the epidemic. Based on observations presented here, pasteurellosis epidemics in free-ranging bighorn sheep can arise through incursion of domestic sheep onto native ranges, and thus minimizing contact between domestic and bighorn sheep appears to be a logical principle for bighorn sheep conservation.

  19. Spatio-temporal dynamics of pneumonia in bighorn sheep.

    Science.gov (United States)

    Cassirer, E Frances; Plowright, Raina K; Manlove, Kezia R; Cross, Paul C; Dobson, Andrew P; Potter, Kathleen A; Hudson, Peter J

    2013-05-01

    1. Bighorn sheep mortality related to pneumonia is a primary factor limiting population recovery across western North America, but management has been constrained by an incomplete understanding of the disease. We analysed patterns of pneumonia-caused mortality over 14 years in 16 interconnected bighorn sheep populations to gain insights into underlying disease processes. 2. We observed four age-structured classes of annual pneumonia mortality patterns: all-age, lamb-only, secondary all-age and adult-only. Although there was considerable variability within classes, overall they differed in persistence within and impact on populations. Years with pneumonia-induced mortality occurring simultaneously across age classes (i.e. all-age) appeared to be a consequence of pathogen invasion into a naïve population and resulted in immediate population declines. Subsequently, low recruitment due to frequent high mortality outbreaks in lambs, probably due to association with chronically infected ewes, posed a significant obstacle to population recovery. Secondary all-age events occurred in previously exposed populations when outbreaks in lambs were followed by lower rates of pneumonia-induced mortality in adults. Infrequent pneumonia events restricted to adults were usually of short duration with low mortality. 3. Acute pneumonia-induced mortality in adults was concentrated in fall and early winter around the breeding season when rams are more mobile and the sexes commingle. In contrast, mortality restricted to lambs peaked in summer when ewes and lambs were concentrated in nursery groups. 4. We detected weak synchrony in adult pneumonia between adjacent populations, but found no evidence for landscape-scale extrinsic variables as drivers of disease. 5. We demonstrate that there was a >60% probability of a disease event each year following pneumonia invasion into bighorn sheep populations. Healthy years also occurred periodically, and understanding the factors driving these

  20. Spatio-temporal dynamics of pneumonia in bighorn sheep

    Science.gov (United States)

    Cassirer, E. Frances; Plowright, Raina K.; Manlove, Kezia R.; Cross, Paul C.; Dobson, Andrew P.; Potter, Kathleen A.; Hudson, Peter J.

    2013-01-01

    Bighorn sheep mortality related to pneumonia is a primary factor limiting population recovery across western North America, but management has been constrained by an incomplete understanding of the disease. We analysed patterns of pneumonia-caused mortality over 14 years in 16 interconnected bighorn sheep populations to gain insights into underlying disease processes. 2. We observed four age-structured classes of annual pneumonia mortality patterns: all-age, lamb-only, secondary all-age and adult-only. Although there was considerable variability within classes, overall they differed in persistence within and impact on populations. Years with pneumonia-induced mortality occurring simultaneously across age classes (i.e. all-age) appeared to be a consequence of pathogen invasion into a naïve population and resulted in immediate population declines. Subsequently, low recruitment due to frequent high mortality outbreaks in lambs, probably due to association with chronically infected ewes, posed a significant obstacle to population recovery. Secondary all-age events occurred in previously exposed populations when outbreaks in lambs were followed by lower rates of pneumonia-induced mortality in adults. Infrequent pneumonia events restricted to adults were usually of short duration with low mortality. 3. Acute pneumonia-induced mortality in adults was concentrated in fall and early winter around the breeding season when rams are more mobile and the sexes commingle. In contrast, mortality restricted to lambs peaked in summer when ewes and lambs were concentrated in nursery groups. 4. We detected weak synchrony in adult pneumonia between adjacent populations, but found no evidence for landscape-scale extrinsic variables as drivers of disease. 5. We demonstrate that there was a >60% probability of a disease event each year following pneumonia invasion into bighorn sheep populations. Healthy years also occurred periodically, and understanding the factors driving these

  1. Streaming-aware channel utilization improvement for wireless home networks

    NARCIS (Netherlands)

    Aslam, W.; Lukkien, J.J.

    2012-01-01

    A wireless network of consumer electronic (CE) devices in a modern home, is typically running streaming services with heterogeneous bandwidth demands. Satisfying these demands offers the challenge of mapping them efficiently onto scarce wireless channel bandwidth. This mapping is supported by the

  2. Under surveillance: using cameras to improve care home practice.

    Science.gov (United States)

    Pearce, Lynne

    2017-05-03

    When the owner of Bramley Court in Birmingham mooted the idea of installing surveillance cameras inside the care home, manager and nurse Ann Willey was unenthusiastic. 'It felt like Big Brother was watching you,' she says. But then she considered how cameras might reduce the risk of poor practice and the potential benefits for vulnerable residents.

  3. Quality in home-based childcare : Impact and improvement

    NARCIS (Netherlands)

    Groeneveld, Marilene Gerarda

    2010-01-01

    The thesis ‘Quality in home-based childcare: Impact and improvement’ consists of two studies. The general aim of the first study is to examine children’s stress levels and wellbeing, and the role of caregiver stress and childcare quality. This first study is described in chapters 2, 3, and 4.

  4. Improving patients' home cooking - A case series of participation in a remote culinary coaching program.

    Science.gov (United States)

    Polak, Rani; Pober, David M; Budd, Maggi A; Silver, Julie K; Phillips, Edward M; Abrahamson, Martin J

    2017-08-01

    This case series describes and examines the outcomes of a remote culinary coaching program aimed at improving nutrition through home cooking. Participants (n = 4) improved attitudes about the perceived ease of home cooking (p culinary skills (p = 0.02); and also improved in confidence to continue online learning of culinary skills and consume healthier food. We believe this program might be a viable response to the need for effective and scalable health-related culinary interventions.

  5. Twenty weeks of home-based interactive training of children with cerebral palsy improves functional abilities

    DEFF Research Database (Denmark)

    Lorentzen, Jakob; Greve, Line Z; Kliim-Due, Mette

    2015-01-01

    BACKGROUND: Home-based training is becoming ever more important with increasing demands on the public health systems. We investigated whether individualized and supervised interactive home-based training delivered through the internet improves functional abilities in children with cerebral palsy...

  6. A positive deviance approach to understanding key features to improving diabetes care in the medical home

    NARCIS (Netherlands)

    Gabbay, R.A.; Friedberg, M.W.; Miller-Day, M.; Cronholm, P.F.; Adelman, A.; Schneider, E.C.

    2013-01-01

    PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving

  7. Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

    Directory of Open Access Journals (Sweden)

    Palmer Laura

    2003-05-01

    Full Text Available Abstract Background In November 2002, the Centers for Medicare & Medicaid Services (CMS launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. Methods Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs that led quality improvement efforts in nursing homes from the six pilot states. Results QIOs in the six pilot states found several key outcomes of the Nursing Home Quality Initiative that help to maximize the potential of public reporting to leverage effective improvement in nursing home quality of care. First, public reporting focuses the attention of all stakeholders in the nursing home industry on achieving good quality outcomes on a defined set of measures, and creates an incentive for partnership formation. Second, publicly reported quality measures motivate nursing home providers to improve in certain key clinical areas, and in particular to seek out new ways of changing processes of care, such as engaging physicians and the medical director more directly. Third, the lessons learned by QIOs in the pilot of this Initiative indicate that certain approaches to providing quality improvement assistance are key to guiding nursing home providers' desire and enthusiasm to improve towards a using a systematic approach to quality improvement. Conclusion The Nursing Home Quality Initiative has already demonstrated the potential of public reporting to foster collaboration and coordination among nursing home stakeholders and to heighten interest of nursing homes in quality improvement techniques. The lessons learned from this pilot project have implications for any organizations or individuals planning quality improvement projects in the nursing home setting.

  8. Rehabilitation in home care is associated with functional improvement and preferred discharge.

    Science.gov (United States)

    Cook, Richard J; Berg, Katherine; Lee, Ker-Ai; Poss, Jeffrey W; Hirdes, John P; Stolee, Paul

    2013-06-01

    To investigate the impact of physiotherapy (PT) and occupational therapy (OT) services on long-stay home care patients with musculoskeletal disorders. Observational study. Home care programs. All long-stay home care patients between 2003 and 2008 (N=99,764) with musculoskeletal disorders who received a baseline Resident Assessment Instrument for Home Care assessment, 1 follow-up assessment, and had discharge or death records. PT and OT. The effects of PT and OT services on transitions in functional state, discharge from home care with service plans complete, institutionalization, and death were assessed via multistate Markov models. Home care patients with deficiencies in instrumental activities of daily living and/or activities of daily living at baseline and who received home-based rehabilitation had significantly increased odds of showing functional improvements by their next assessment (for a state 3 to state 2 transition: odds ratio [OR]=1.17; 95% confidence interval [CI], 1.10-1.26; Pfunding for health care services, it is essential to provide the right services at the right time in a cost-effective manner. Long-stay home care patients who receive rehabilitation at home have improved outcomes and lower utilization of costly health services. Our findings suggest that investment in PT and OT services for relatively short periods may provide savings to the health care system over the longer term. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  9. Survival of bighorn sheep (Ovis canadensis) commingled with domestic sheep (Ovis aries) in the absence of Mycoplasma ovipneumoniae.

    Science.gov (United States)

    Besser, Thomas E; Cassirer, E Frances; Yamada, Catherine; Potter, Kathleen A; Herndon, Caroline; Foreyt, William J; Knowles, Donald P; Srikumaran, Subramaniam

    2012-01-01

    To test the hypothesis that Mycoplasma ovipneumoniae is an important agent of the bighorn sheep (Ovis canadensis) pneumonia that has previously inevitably followed experimental commingling with domestic sheep (Ovis aries), we commingled M. ovipneumoniae-free domestic and bighorn sheep (n=4 each). One bighorn sheep died with acute pneumonia 90 days after commingling, but the other three remained healthy for >100 days. This unprecedented survival rate is significantly different (P=0.002) from that of previous bighorn-domestic sheep contact studies but similar to (P>0.05) bighorn sheep survival following commingling with other ungulates. The absence of epizootic respiratory disease in this experiment supports the hypothesized role of M. ovipneumoniae as a key pathogen of epizootic pneumonia in bighorn sheep commingled with domestic sheep.

  10. Water chemistry - Investigation of Methods to Improve Homing by Hatchery Salmon

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Investigate olfactory imprinting techniques that will improve homing by hatchery salmon to their hatchery of origin, and thereby reduce potential risks from these...

  11. Exposure of bighorn sheep to domestic goats colonized with Mycoplasma ovipneumoniae induces sub-lethal pneumonia

    OpenAIRE

    Besser, Thomas E.; Cassirer, E. Frances; Potter, Kathleen A.; Foreyt, William J.

    2017-01-01

    Background Bronchopneumonia is a population limiting disease of bighorn sheep (Ovis canadensis) that has been associated with contact with domestic Caprinae. The disease is polymicrobial but is initiated by Mycoplasma ovipneumoniae, which is commonly carried by both domestic sheep (O. aries) and goats (Capra aegagrus hircus). However, while previous bighorn sheep comingling studies with domestic sheep have resulted in nearly 100% pneumonia mortality, only sporadic occurrence of fatal pneumoni...

  12. Use of Exposure History to Identify Patterns of Immunity to Pneumonia in Bighorn Sheep (Ovis canadensis)

    OpenAIRE

    Plowright, Raina K.; Manlove, Kezia; Cassirer, E. Frances; Cross, Paul C.; Besser, Thomas E.; Hudson, Peter J.

    2013-01-01

    Individual host immune responses to infectious agents drive epidemic behavior and are therefore central to understanding and controlling infectious diseases. However, important features of individual immune responses, such as the strength and longevity of immunity, can be challenging to characterize, particularly if they cannot be replicated or controlled in captive environments. Our research on bighorn sheep pneumonia elucidates how individual bighorn sheep respond to infection with pneumoni...

  13. Home

    Science.gov (United States)

    AF Branding & Trademark Licensing Join the Air Force Home About Us The Air Force Symbol Display Resources Document Library TM Connect Search AF Branding and Trademark Licensing Program: important links Legal Documents 10 U.S.C. § 2260 15 U.S.C. § 167;167; 1114-1125 DODI 5535.12, DoD Branding and

  14. Home

    Science.gov (United States)

    intersect as Attack Wing leaders change roles The 112th COS postured as cyber shield for Pa. infrastructure 111th Attack Wing 111th Attack Wing 21st Century Guard Airmen Home News Photos Art Video Resources - The Balance Search 111th Attack Wing: COMMUNITY/ENVIRO May 16, 2018; Pa. Department of Health update

  15. Development of a platform to combine sensor networks and home robots to improve fall detection in the home environment.

    Science.gov (United States)

    Della Toffola, Luca; Patel, Shyamal; Chen, Bor-rong; Ozsecen, Yalgin M; Puiatti, Alessandro; Bonato, Paolo

    2011-01-01

    Over the last decade, significant progress has been made in the development of wearable sensor systems for continuous health monitoring in the home and community settings. One of the main areas of application for these wearable sensor systems is in detecting emergency events such as falls. Wearable sensors like accelerometers are increasingly being used to monitor daily activities of individuals at a risk of falls, detect emergency events and send alerts to caregivers. However, such systems tend to have a high rate of false alarms, which leads to low compliance levels. Home robots can enable caregivers with the ability to quickly make an assessment and intervene if an emergency event is detected. This can provide an additional layer for detecting false positives, which can lead to improve compliance. In this paper, we present preliminary work on the development of a fall detection system based on a combination sensor networks and home robots. The sensor network architecture comprises of body worn sensors and ambient sensors distributed in the environment. We present the software architecture and conceptual design home robotic platform. We also perform preliminary characterization of the sensor network in terms of latencies and battery lifetime.

  16. Improved parental dietary quality is associated with children's dietary intake through the home environment

    OpenAIRE

    Fl?rez, K. R.; Richardson, A. S.; Ghosh?Dastidar, M. B.; Beckman, R.; Huang, C.; Wagner, L.; Dubowitz, T.

    2017-01-01

    Summary Background Improving access to supermarkets has been shown to improve some dietary outcomes, yet there is little evidence for such effects on children. Relatedly, there is a dearth of research assessing the impact of a structural change (i.e. supermarket in a former food desert) on the home environment and its relationship with children's diet. Objective Assess the relative impact of the home environment on children's diet after the introduction of a new supermarket in a food desert. ...

  17. Home-based nursing interventions improve knowledge of disease and management in patients with heart failure

    Directory of Open Access Journals (Sweden)

    Karina de Oliveira Azzolin

    2015-02-01

    Full Text Available OBJECTIVE: to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire.METHODS: in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered.RESULTS: overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001; and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001. The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01, but weak and non significant at visit 4.CONCLUSION: the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument.

  18. Fifty years after Welles and Welles: Distribution and genetic structure of Desert Bighorn Sheep in Death Valley National Park

    Science.gov (United States)

    Epps, Clinton W.; Wehausen, John D.; Sloan, William B.; Holt, Stacy; Creech, Tyler G.; Crowhurst, Rachel S.; Jaeger, Jef R.; Longshore, Kathleen M.; Monello, Ryan J.

    2013-01-01

    The status of desert bighorn sheep (Ovis canadensis nelsoni) populations in the mountains around Death Valley was first evaluated in 1938, shortly after designation of Death Valley National Monument. However, the most comprehensive evaluation of bighorn sheep in the region was conducted by Ralph and Florence Welles during 1955-1961. They documented patterns of use at water sources and other focal areas around Death Valley and roughly estimated numbers of bighorn sheep from observational data. Data collection on bighorn sheep in the area since that time has

  19. Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

    OpenAIRE

    Kissam, Stephanie; Gifford, David; Parks, Peggy; Patry, Gail; Palmer, Laura; Wilkes, Linda; Fitzgerald, Matthew; Petrulis, Alice Stollenwerk; Barnette, Leslie

    2003-01-01

    Abstract Background In November 2002, the Centers for Medicare & Medicaid Services (CMS) launched a Nursing Home Quality Initiative that included publicly reporting a set of Quality Measures for all nursing homes in the country, and providing quality improvement assistance to nursing homes nationwide. A pilot of this initiative occurred in six states for six months prior to the launch. Methods Review and analysis of the lessons learned from the six Quality Improvement Organizations (QIOs) tha...

  20. Strategies to improve homing of mesenchymal stem cells for greater efficacy in stem cell therapy.

    Science.gov (United States)

    Naderi-Meshkin, Hojjat; Bahrami, Ahmad Reza; Bidkhori, Hamid Reza; Mirahmadi, Mahdi; Ahmadiankia, Naghmeh

    2015-01-01

    Stem/progenitor cell-based therapeutic approach in clinical practice has been an elusive dream in medical sciences, and improvement of stem cell homing is one of major challenges in cell therapy programs. Stem/progenitor cells have a homing response to injured tissues/organs, mediated by interactions of chemokine receptors expressed on the cells and chemokines secreted by the injured tissue. For improvement of directed homing of the cells, many techniques have been developed either to engineer stem/progenitor cells with higher amount of chemokine receptors (stem cell-based strategies) or to modulate the target tissues to release higher level of the corresponding chemokines (target tissue-based strategies). This review discusses both of these strategies involved in the improvement of stem cell homing focusing on mesenchymal stem cells as most frequent studied model in cellular therapies. © 2014 International Federation for Cell Biology.

  1. Epizootic pneumonia of bighorn sheep following experimental exposure to Mycoplasma ovipneumoniae.

    Directory of Open Access Journals (Sweden)

    Thomas E Besser

    Full Text Available Bronchopneumonia is a population limiting disease of bighorn sheep (Ovis canadensis. The cause of this disease has been a subject of debate. Leukotoxin expressing Mannheimia haemolytica and Bibersteinia trehalosi produce acute pneumonia after experimental challenge but are infrequently isolated from animals in natural outbreaks. Mycoplasma ovipneumoniae, epidemiologically implicated in naturally occurring outbreaks, has received little experimental evaluation as a primary agent of bighorn sheep pneumonia.In two experiments, bighorn sheep housed in multiple pens 7.6 to 12 m apart were exposed to M. ovipneumoniae by introduction of a single infected or challenged animal to a single pen. Respiratory disease was monitored by observation of clinical signs and confirmed by necropsy. Bacterial involvement in the pneumonic lungs was evaluated by conventional aerobic bacteriology and by culture-independent methods. In both experiments the challenge strain of M. ovipneumoniae was transmitted to all animals both within and between pens and all infected bighorn sheep developed bronchopneumonia. In six bighorn sheep in which the disease was allowed to run its course, three died with bronchopneumonia 34, 65, and 109 days after M. ovipneumoniae introduction. Diverse bacterial populations, predominantly including multiple obligate anaerobic species, were present in pneumonic lung tissues at necropsy.Exposure to a single M. ovipneumoniae infected animal resulted in transmission of infection to all bighorn sheep both within the pen and in adjacent pens, and all infected sheep developed bronchopneumonia. The epidemiologic, pathologic and microbiologic findings in these experimental animals resembled those seen in naturally occurring pneumonia outbreaks in free ranging bighorn sheep.

  2. Local extinction and unintentional rewilding of bighorn sheep (Ovis canadensis on a desert island.

    Directory of Open Access Journals (Sweden)

    Benjamin T Wilder

    Full Text Available Bighorn sheep (Ovis canadensis were not known to live on Tiburón Island, the largest island in the Gulf of California and Mexico, prior to the surprisingly successful introduction of 20 individuals as a conservation measure in 1975. Today, a stable island population of ∼500 sheep supports limited big game hunting and restocking of depleted areas on the Mexican mainland. We discovered fossil dung morphologically similar to that of bighorn sheep in a dung mat deposit from Mojet Cave, in the mountains of Tiburón Island. To determine the origin of this cave deposit we compared pellet shape to fecal pellets of other large mammals, and extracted DNA to sequence mitochondrial DNA fragments at the 12S ribosomal RNA and control regions. The fossil dung was 14C-dated to 1476-1632 calendar years before present and was confirmed as bighorn sheep by morphological and ancient DNA (aDNA analysis. 12S sequences closely or exactly matched known bighorn sheep sequences; control region sequences exactly matched a haplotype described in desert bighorn sheep populations in southwest Arizona and southern California and showed subtle differentiation from the extant Tiburón population. Native desert bighorn sheep previously colonized this land-bridge island, most likely during the Pleistocene, when lower sea levels connected Tiburón to the mainland. They were extirpated sometime in the last ∼1500 years, probably due to inherent dynamics of isolated populations, prolonged drought, and (or human overkill. The reintroduced population is vulnerable to similar extinction risks. The discovery presented here refutes conventional wisdom that bighorn sheep are not native to Tiburón Island, and establishes its recent introduction as an example of unintentional rewilding, defined here as the introduction of a species without knowledge that it was once native and has since gone locally extinct.

  3. Local extinction and unintentional rewilding of bighorn sheep (Ovis canadensis) on a desert island

    Science.gov (United States)

    Wilder, Benjamin T.; Betancourt, Julio L.; Epps, Clinton W.; Crowhurst, Rachel S.; Mead, Jim I.; Ezcurra, Exequiel

    2014-01-01

    Bighorn sheep (Ovis canadensis) were not known to live on Tiburón Island, the largest island in the Gulf of California and Mexico, prior to the surprisingly successful introduction of 20 individuals as a conservation measure in 1975. Today, a stable island population of ~500 sheep supports limited big game hunting and restocking of depleted areas on the Mexican mainland. We discovered fossil dung morphologically similar to that of bighorn sheep in a dung mat deposit from Mojet Cave, in the mountains of Tiburón Island. To determine the origin of this cave deposit we compared pellet shape to fecal pellets of other large mammals, and extracted DNA to sequence mitochondrial DNA fragments at the 12S ribosomal RNA and control regions. The fossil dung was 14C-dated to 1476–1632 calendar years before present and was confirmed as bighorn sheep by morphological and ancient DNA (aDNA) analysis. 12S sequences closely or exactly matched known bighorn sheep sequences; control region sequences exactly matched a haplotype described in desert bighorn sheep populations in southwest Arizona and southern California and showed subtle differentiation from the extant Tiburón population. Native desert bighorn sheep previously colonized this land-bridge island, most likely during the Pleistocene, when lower sea levels connected Tiburón to the mainland. They were extirpated sometime in the last ~1500 years, probably due to inherent dynamics of isolated populations, prolonged drought, and (or) human overkill. The reintroduced population is vulnerable to similar extinction risks. The discovery presented here refutes conventional wisdom that bighorn sheep are not native to Tiburón Island, and establishes its recent introduction as an example of unintentional rewilding, defined here as the introduction of a species without knowledge that it was once native and has since gone locally extinct.

  4. Local Extinction and Unintentional Rewilding of Bighorn Sheep (Ovis canadensis) on a Desert Island

    Science.gov (United States)

    Wilder, Benjamin T.; Betancourt, Julio L.; Epps, Clinton W.; Crowhurst, Rachel S.; Mead, Jim I.; Ezcurra, Exequiel

    2014-01-01

    Bighorn sheep (Ovis canadensis) were not known to live on Tiburón Island, the largest island in the Gulf of California and Mexico, prior to the surprisingly successful introduction of 20 individuals as a conservation measure in 1975. Today, a stable island population of ∼500 sheep supports limited big game hunting and restocking of depleted areas on the Mexican mainland. We discovered fossil dung morphologically similar to that of bighorn sheep in a dung mat deposit from Mojet Cave, in the mountains of Tiburón Island. To determine the origin of this cave deposit we compared pellet shape to fecal pellets of other large mammals, and extracted DNA to sequence mitochondrial DNA fragments at the 12S ribosomal RNA and control regions. The fossil dung was 14C-dated to 1476–1632 calendar years before present and was confirmed as bighorn sheep by morphological and ancient DNA (aDNA) analysis. 12S sequences closely or exactly matched known bighorn sheep sequences; control region sequences exactly matched a haplotype described in desert bighorn sheep populations in southwest Arizona and southern California and showed subtle differentiation from the extant Tiburón population. Native desert bighorn sheep previously colonized this land-bridge island, most likely during the Pleistocene, when lower sea levels connected Tiburón to the mainland. They were extirpated sometime in the last ∼1500 years, probably due to inherent dynamics of isolated populations, prolonged drought, and (or) human overkill. The reintroduced population is vulnerable to similar extinction risks. The discovery presented here refutes conventional wisdom that bighorn sheep are not native to Tiburón Island, and establishes its recent introduction as an example of unintentional rewilding, defined here as the introduction of a species without knowledge that it was once native and has since gone locally extinct. PMID:24646515

  5. Applying the Advancing Excellence in America's Nursing Homes Circle of Success to improving and sustaining quality.

    Science.gov (United States)

    Bakerjian, Debra; Zisberg, Anna

    2013-01-01

    Looking forward to the Quality Assurance Performance Improvement (QAPI) program to be implemented and required in 2014, and as nursing home staff provide care for residents with increasingly complex health issues, knowledge of how to implement quality improvement (QI) is imperative. The nursing home administrator and director of nursing (DON) provide overall leadership, but it is the primary responsibility of the DON and other registered nurse staff to implement and manage the day to day QI process. This article describes potential roles of nursing leaders and key components of a QI project using a pressure ulcer case study exemplar to illustrate a quality improvement process. The authors suggest specific methods that RN leaders can employ using the Advancing Excellence Campaign Circle of Success as an organizing framework along with evidence-based resources. Nursing home leaders could use this article as a guideline for implementing any clinical quality improvement process. Copyright © 2013 Mosby, Inc. All rights reserved.

  6. Depression improvement and parenting in low-income mothers in home visiting.

    Science.gov (United States)

    Ammerman, Robert T; Altaye, Mekibib; Putnam, Frank W; Teeters, Angelique R; Zou, Yuanshu; Van Ginkel, Judith B

    2015-06-01

    Research on older children and high-resource families demonstrates that maternal improvement in depression often leads to parallel changes in parenting and child adjustment. It is unclear if this association extends to younger children and low-income mothers. This study examined if In-Home Cognitive Behavioral Therapy (IH-CBT), a treatment for depressed mothers participating in home visiting programs, contributes to improvements in parenting and child adjustment. Ninety-three depressed mothers in home visiting between 2 and 10 months postpartum were randomly assigned to IH-CBT (n = 47) plus home visiting or standard home visiting (SHV; n = 46). Mothers were identified via screening and subsequent diagnosis of major depressive disorder (MDD). Measures of depression, parenting stress, nurturing parenting, and child adjustment were administered at pre-treatment, post-treatment, and 3 months follow-up. Results indicated that there were no differences between IH-CBT and controls on parenting and child adjustment. Low levels of depression were associated with decreased parenting stress and increased nurturing parenting. Improvement in depression was related to changes in parenting in low-income mothers participating in home visiting programs. IH-CBT was not independently associated with these improvements, although to the extent that treatment facilitated improvement; there were corresponding benefits to parenting. Child adjustment was not associated with maternal depression, a finding possibly attributed to the benefits of concurrent home visiting or measurement limitations. Future research should focus on longer-term follow-up, implications of relapse, and child adjustment in later years.

  7. Disease and predation: sorting out causes of a bighorn sheep (Ovis canadensis decline.

    Directory of Open Access Journals (Sweden)

    Joshua B Smith

    Full Text Available Estimating survival and documenting causes and timing of mortality events in neonate bighorn sheep (Ovis canadensis improves understanding of population ecology and factors influencing recruitment. During 2010-2012, we captured and radiocollared 74 neonates in the Black Hills, South Dakota, of which 95% (70 died before 52 weeks of age. Pneumonia (36% was the leading cause of mortality followed by predation (30%. We used known fate analysis in Program MARK to estimate weekly survival rates and investigate the influence of intrinsic variables on 52-week survival. Model {S1 wk, 2-8 wks, >8 wks} had the lowest AIC c (Akaike's Information Criterion corrected for small sample size value, indicating that age (3-stage age-interval: 1 week, 2-8 weeks, and >8 weeks best explained survival. Weekly survival estimates for 1 week, 2-8 weeks, and >8 weeks were 0.81 (95% CI = 0.70-0.88, 0.86 (95% CI = 0.81-0.90, and 0.94 (95% CI = 0.91-0.96, respectively. Overall probability of surviving 52 weeks was 0.02 (95% CI = 0.01-0.07. Of 70 documented mortalities, 21% occurred during the first week, 55% during weeks 2-8, and 23% occurred >8 weeks of age. We found pneumonia and predation were temporally heterogeneous with lambs most susceptible to predation during the first 2-3 weeks of life, while the greatest risk from pneumonia occurred from weeks 4-8. Our results indicated pneumonia was the major factor limiting recruitment followed by predation. Mortality from predation may have been partly compensatory to pneumonia and its effects were less pronounced as alternative prey became available. Given the high rates of pneumonia-caused mortality we observed, and the apparent lack of pneumonia-causing pathogens in bighorn populations in the western Black Hills, management activities should be geared towards eliminating contact between diseased and healthy populations.

  8. Disease and predation: Sorting out causes of a bighorn sheep (Ovis canadensis) decline

    Science.gov (United States)

    Smith, Joshua B.; Jenks, Jonathan A.; Grovenburg, Troy W.; Klaver, Robert W.

    2014-01-01

    Estimating survival and documenting causes and timing of mortality events in neonate bighorn sheep (Ovis canadensis) improves understanding of population ecology and factors influencing recruitment. During 2010–2012, we captured and radiocollared 74 neonates in the Black Hills, South Dakota, of which 95% (70) died before 52 weeks of age. Pneumonia (36%) was the leading cause of mortality followed by predation (30%). We used known fate analysis in Program MARK to estimate weekly survival rates and investigate the influence of intrinsic variables on 52-week survival. Model {S1 wk, 2–8 wks, >8 wks} had the lowest AICc (Akaike’s Information Criterion corrected for small sample size) value, indicating that age (3-stage age-interval: 1 week, 2–8 weeks, and >8 weeks) best explained survival. Weekly survival estimates for 1 week, 2–8 weeks, and >8 weeks were 0.81 (95% CI = 0.70–0.88), 0.86 (95% CI = 0.81–0.90), and 0.94 (95% CI = 0.91–0.96), respectively. Overall probability of surviving 52 weeks was 0.02 (95% CI = 0.01–0.07). Of 70 documented mortalities, 21% occurred during the first week, 55% during weeks 2–8, and 23% occurred >8 weeks of age. We found pneumonia and predation were temporally heterogeneous with lambs most susceptible to predation during the first 2–3 weeks of life, while the greatest risk from pneumonia occurred from weeks 4–8. Our results indicated pneumonia was the major factor limiting recruitment followed by predation. Mortality from predation may have been partly compensatory to pneumonia and its effects were less pronounced as alternative prey became available. Given the high rates of pneumonia-caused mortality we observed, and the apparent lack of pneumonia-causing pathogens in bighorn populations in the western Black Hills, management activities should be geared towards eliminating contact between diseased and healthy populations.

  9. Diluting the Cesspool: Families, Home Improvement, and Social Change

    Science.gov (United States)

    Goodsell, Todd L.

    2008-01-01

    In recent years, the process of social change through improvement of residences in decaying neighborhoods--gentrification--has itself changed. Traditional families (married with children) and a broader spectrum of the social class spectrum are more likely to be involved. The present research takes an ethnographic perspective and considers the…

  10. Detecting short-term responses to weekend recreation activity: desert bighorn sheep avoidance of hiking trails

    Science.gov (United States)

    Longshore, Kathleen M.; Lowrey, Chris; Thompson, Daniel B.

    2013-01-01

    To study potential effects of recreation activity on habitat use of desert bighorn sheep (Ovis canadensis nelsoni), we placed Global Positioning System collars on 10 female bighorn sheep within the Wonderland of Rocks–Queen Mountain region of Joshua Tree National Park (JOTR), California, USA, from 2002 to 2004. Recreation use was highest from March to April and during weekends throughout the year. Daily use of recreation trails was highest during midday. By comparing habitat use (slope, ruggedness, distance to water, and distance to recreation trails) of female bighorn sheep on weekdays versus weekends, we were able to detect short-term shifts in behavior in response to recreation. In a logistic regression of bighorn sheep locations versus random locations for March and April, female locations at midday (1200 hours) were significantly more distant from recreation trails on weekends compared with weekdays. Our results indicate that within this region of JOTR, moderate to high levels of human recreation activity may temporarily exclude bighorn females from their preferred habitat. However, the relative proximity of females to recreation trails during the weekdays before and after such habitat shifts indicates that these anthropogenic impacts were short-lived. Our results have implications for management of wildlife on public lands where the co-existence of wildlife and recreational use is a major goal.

  11. Modeling risk of pneumonia epizootics in bighorn sheep

    Science.gov (United States)

    Sells, Sarah N.; Mitchell, Michael S.; Nowak, J. Joshua; Lukacs, Paul M.; Anderson, Neil J.; Ramsey, Jennifer M.; Gude, Justin A.; Krausman, Paul R.

    2015-01-01

    Pneumonia epizootics are a major challenge for management of bighorn sheep (Ovis canadensis) affecting persistence of herds, satisfaction of stakeholders, and allocations of resources by management agencies. Risk factors associated with the disease are poorly understood, making pneumonia epizootics hard to predict; such epizootics are thus managed reactively rather than proactively. We developed a model for herds in Montana that identifies risk factors and addresses biological questions about risk. Using Bayesian logistic regression with repeated measures, we found that private land, weed control using domestic sheep or goats, pneumonia history, and herd density were positively associated with risk of pneumonia epizootics in 43 herds that experienced 22 epizootics out of 637 herd-years from 1979–2013. We defined an area of high risk for pathogen exposure as the area of each herd distribution plus a 14.5-km buffer from that boundary. Within this area, the odds of a pneumonia epizootic increased by >1.5 times per additional unit of private land (unit is the standardized % of private land where global  = 25.58% and SD = 14.53%). Odds were >3.3 times greater if domestic sheep or goats were used for weed control in a herd's area of high risk. If a herd or its neighbors within the area of high risk had a history of a pneumonia epizootic, odds of a subsequent pneumonia epizootic were >10 times greater. Risk greatly increased when herds were at high density, with nearly 15 times greater odds of a pneumonia epizootic compared to when herds were at low density. Odds of a pneumonia epizootic also appeared to decrease following increased spring precipitation (odds = 0.41 per unit increase, global  = 100.18% and SD = 26.97%). Risk was not associated with number of federal sheep and goat allotments, proximity to nearest herds of bighorn sheep, ratio of rams to ewes, percentage of average winter precipitation, or whether herds were of native versus mixed

  12. Causes of Pneumonia Epizootics among Bighorn Sheep, Western United States, 2008–2010

    Science.gov (United States)

    Highland, Margaret A.; Baker, Katherine; Cassirer, E. Frances; Anderson, Neil J.; Ramsey, Jennifer M.; Mansfield, Kristin; Bruning, Darren L.; Wolff, Peregrine; Smith, Joshua B.; Jenks, Jonathan A.

    2012-01-01

    Epizootic pneumonia of bighorn sheep is a devastating disease of uncertain etiology. To help clarify the etiology, we used culture and culture-independent methods to compare the prevalence of the bacterial respiratory pathogens Mannheimia haemolytica, Bibersteinia trehalosi, Pasteurella multocida, and Mycoplasma ovipneumoniae in lung tissue from 44 bighorn sheep from herds affected by 8 outbreaks in the western United States. M. ovipneumoniae, the only agent detected at significantly higher prevalence in animals from outbreaks (95%) than in animals from unaffected healthy populations (0%), was the most consistently detected agent and the only agent that exhibited single strain types within each outbreak. The other respiratory pathogens were frequently but inconsistently detected, as were several obligate anaerobic bacterial species, all of which might represent secondary or opportunistic infections that could contribute to disease severity. These data provide evidence that M. ovipneumoniae plays a primary role in the etiology of epizootic pneumonia of bighorn sheep. PMID:22377321

  13. Causes of pneumonia epizootics among bighorn sheep, Western United States, 2008-2010.

    Science.gov (United States)

    Besser, Thomas E; Highland, Margaret A; Baker, Katherine; Cassirer, E Frances; Anderson, Neil J; Ramsey, Jennifer M; Mansfield, Kristin; Bruning, Darren L; Wolff, Peregrine; Smith, Joshua B; Jenks, Jonathan A

    2012-03-01

    Epizootic pneumonia of bighorn sheep is a devastating disease of uncertain etiology. To help clarify the etiology, we used culture and culture-independent methods to compare the prevalence of the bacterial respiratory pathogens Mannheimia haemolytica, Bibersteinia trehalosi, Pasteurella multocida, and Mycoplasma ovipneumoniae in lung tissue from 44 bighorn sheep from herds affected by 8 outbreaks in the western United States. M. ovipneumoniae, the only agent detected at significantly higher prevalence in animals from outbreaks (95%) than in animals from unaffected healthy populations (0%), was the most consistently detected agent and the only agent that exhibited single strain types within each outbreak. The other respiratory pathogens were frequently but inconsistently detected, as were several obligate anaerobic bacterial species, all of which might represent secondary or opportunistic infections that could contribute to disease severity. These data provide evidence that M. ovipneumoniae plays a primary role in the etiology of epizootic pneumonia of bighorn sheep.

  14. Improving access to home phototherapy for patients with psoriasis: current challenges and future prospects

    Directory of Open Access Journals (Sweden)

    Franken SM

    2016-05-01

    Full Text Available Sylvie M Franken, Carlijn L Vierstra, Thomas RustemeyerDepartment of Dermatology, VU University Medical Centre, Amsterdam, the Netherlands Introduction: Although the treatment burden for phototherapy in the outpatient setting is considerable, prescription of home-based phototherapy has not been instigated. Home-based phototherapy seems more patient friendly in terms of avoiding the thrice-weekly hospital visits. So why are most treatments still given in a hospital setting? Is home-based treatment less effective? Are there financial barriers? Is the treatment not available? To answer these questions, a literature search was done. Methods: A literature search of PubMed, Embase, and Cochrane Library databases was performed, using the search terms “psoriasis” and “phototherapy”. Selection was based on two rounds; the first round involved screening the title and abstract of all records and second involved evaluating the full text of the remaining articles for eligibility according to inclusion and exclusion criteria. Results: In total, 23 publications were included with consensus of both researchers. Overall, the patients reported being very satisfied with home-based phototherapy. Results regarding effectivity in terms of improvement from disease severity and in quality of life were variable but generally positive. Reasons for reluctance varied from medicolegal and social aspects to lack of reimbursement and unfamiliarity on the side of the prescriber. Conclusion: In the treatment for psoriasis, home-based phototherapy is as effective and safe as phototherapy in an outpatient setting. Patients were more satisfied with home-based phototherapy. Factors that negatively influence the prescription of or choice for home-based phototherapy can be summarized in terms of lack of control, lack of knowledge, and lack of a good reimbursement system. Keywords: psoriasis, phototherapy, UVB, home-based, effectiveness, burden, costs, access 

  15. Home

    Science.gov (United States)

    established to aid authorized Alaskan borrowers in financing capital improvement projects such as schools Project, which includes constructing and equipping the expansion of an existing hospital and a new primary in total, no more than 49% of any single project where the other 51% of the project's funding is in

  16. Staff views on how to improve mealtimes for elderly people with dementia living at home.

    Science.gov (United States)

    Johansson, Linda; Björklund, Anita; Sidenvall, Birgitta; Christensson, Lennart

    2017-10-01

    Dementia commonly leads to difficulties in performing daily activities, which can also often affect the ability to prepare and eat meals. As a result, formal support to maintain good nutritional intake might be needed, but there is a lack of knowledge concerning how to support older persons with dementia living at home. The aim of this study was to explore and describe staff views on how to improve mealtimes for persons with dementia who are still living at home. A qualitative descriptive study was performed and data were collected during 2011-2012 through four focus group interviews with staff working in the homes of persons with dementia. Data were analyzed using inductive content analysis. The participants described several ways to improve mealtimes for persons with dementia and advocated adjustments facilitating the preservation of the persons' independence. Finding suitable actions calls for knowledge about the person and his/her individual situation. Proposed actions were enabling meals at home, taking over, and moving meals outside of the home. In addition, it was found that, the types of meals served to these persons should be as familiar to the individual as possible. The results of this study indicate the importance of using a person-centered approach and meeting the individual needs when supporting people with dementia in regards to their meals when living at home. Individualized care in the home may be expensive, however, it is fair to say that people who become malnourished and admitted to hospitals is even more costly. Furthermore, sharing and reflecting experiences and knowledge can assist staff to identify ways to manage complex situations. Therefore, the use of refection should be a part of staff members' everyday work.

  17. Sensor-Based Optimization Model for Air Quality Improvement in Home IoT.

    Science.gov (United States)

    Kim, Jonghyuk; Hwangbo, Hyunwoo

    2018-03-23

    We introduce current home Internet of Things (IoT) technology and present research on its various forms and applications in real life. In addition, we describe IoT marketing strategies as well as specific modeling techniques for improving air quality, a key home IoT service. To this end, we summarize the latest research on sensor-based home IoT, studies on indoor air quality, and technical studies on random data generation. In addition, we develop an air quality improvement model that can be readily applied to the market by acquiring initial analytical data and building infrastructures using spectrum/density analysis and the natural cubic spline method. Accordingly, we generate related data based on user behavioral values. We integrate the logic into the existing home IoT system to enable users to easily access the system through the Web or mobile applications. We expect that the present introduction of a practical marketing application method will contribute to enhancing the expansion of the home IoT market.

  18. Adaptation of a nursing home culture change research instrument for frontline staff quality improvement use.

    Science.gov (United States)

    Hartmann, Christine W; Palmer, Jennifer A; Mills, Whitney L; Pimentel, Camilla B; Allen, Rebecca S; Wewiorski, Nancy J; Dillon, Kristen R; Snow, A Lynn

    2017-08-01

    Enhanced interpersonal relationships and meaningful resident engagement in daily life are central to nursing home cultural transformation, yet these critical components of person-centered care may be difficult for frontline staff to measure using traditional research instruments. To address the need for easy-to-use instruments to help nursing home staff members evaluate and improve person-centered care, the psychometric method of cognitive-based interviewing was used to adapt a structured observation instrument originally developed for researchers and nursing home surveyors. Twenty-eight staff members from 2 Veterans Health Administration (VHA) nursing homes participated in 1 of 3 rounds of cognitive-based interviews, using the instrument in real-life situations. Modifications to the original instrument were guided by a cognitive processing model of instrument refinement. Following 2 rounds of cognitive interviews, pretesting of the revised instrument, and another round of cognitive interviews, the resulting set of 3 short instruments mirrored the concepts of the original longer instrument but were significantly easier for frontline staff to understand and use. Final results indicated frontline staff found the revised instruments feasible to use and clinically relevant in measuring and improving the lived experience of a changing culture. This article provides a framework for developing or adapting other measurement tools for frontline culture change efforts in nursing homes, in addition to reporting on a practical set of instruments to measure aspects of person-centered care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  19. Sensor-Based Optimization Model for Air Quality Improvement in Home IoT

    Directory of Open Access Journals (Sweden)

    Jonghyuk Kim

    2018-03-01

    Full Text Available We introduce current home Internet of Things (IoT technology and present research on its various forms and applications in real life. In addition, we describe IoT marketing strategies as well as specific modeling techniques for improving air quality, a key home IoT service. To this end, we summarize the latest research on sensor-based home IoT, studies on indoor air quality, and technical studies on random data generation. In addition, we develop an air quality improvement model that can be readily applied to the market by acquiring initial analytical data and building infrastructures using spectrum/density analysis and the natural cubic spline method. Accordingly, we generate related data based on user behavioral values. We integrate the logic into the existing home IoT system to enable users to easily access the system through the Web or mobile applications. We expect that the present introduction of a practical marketing application method will contribute to enhancing the expansion of the home IoT market.

  20. 76 FR 78343 - HOME Investment Partnerships Program: Improving Performance and Accountability; and Updating...

    Science.gov (United States)

    2011-12-16

    ... CFR Parts 91 and 92 HOME Investment Partnerships Program: Improving Performance and Accountability... Performance and Accountability; and Updating Property Standards AGENCY: Office of the Assistant Secretary for... regulatory requirements and establish new requirements designed to enhance accountability by States and units...

  1. Staff Assist: A Resource to Improve Nursing Home Quality and Staffing

    Science.gov (United States)

    Castle, Nicholas G.

    2011-01-01

    Purpose: This study describes the creation and use of a web-based resource, designed to help nursing homes implement quality improvements through changes in staffing characteristics. Design and Methods: Information on staffing characteristics (i.e., staffing levels, turnover, stability, and use of agency staff), facility characteristics (e.g.,…

  2. Quality Improvement in Home-Based Child Care Settings: Research Resources to Inform Policy

    Science.gov (United States)

    Lawrence, Sharmila; Stephens, Samuel A.

    2016-01-01

    This "Topic of Interest" provides a comprehensive list of research in the Research Connections collection that was published in 2005 or later addressing issues related to quality improvement specifically in home-based child care. The resources are grouped under the following headings: Overviews, Summaries, and Reviews of Quality…

  3. Efficacy of Adjunct In-Home Coaching to Improve Outcomes in Parent-Child Interaction Therapy

    Science.gov (United States)

    Timmer, Susan G.; Zebell, Nancy M.; Culver, Michelle A.; Urquiza, Anthony J.

    2010-01-01

    Objectives: The purpose of this study is to test whether increasing the exposure to coaching by adding an in-home component to clinic-delivered Parent-Child Interaction Therapy (PCIT) will increase the speed of parenting skill acquisition and show greater improvements in children's behaviors and parental stress. Methods: Seventy-three parent-child…

  4. Fusobacterium necrophorum in North American Bighorn Sheep ( Ovis canadensis ) Pneumonia.

    Science.gov (United States)

    Shanthalingam, Sudarvili; Narayanan, Sanjeevkumar; Batra, Sai Arun; Jegarubee, Bavananthasivam; Srikumaran, Subramaniam

    2016-07-01

    Fusobacterium necrophorum has been detected in pneumonic bighorn sheep (BHS; Ovis canadensis ) lungs, in addition to the aerobic respiratory pathogens Mannheimia haemolytica , Bibersteinia trehalosi , Pasteurella multocida , and Mycoplasma ovipneumoniae . Similar to M. haemolytica , F. necrophorum produces a leukotoxin. Leukotoxin-induced lysis and degranulation of polymorphonuclear leukocytes (PMNs) and macrophages are responsible for acute inflammation and lung tissue damage characteristic of M. haemolytica -caused pneumonia. As one approach in elucidating the role of F. necrophorum in BHS pneumonia, we determined the frequency of the presence of F. necrophorum in archived pneumonic BHS lung tissues, and susceptibility of BHS leukocytes to F. necrophorum leukotoxin. A species-specific PCR assay detected F. necrophorum in 37% of pneumonic BHS lung tissues (total tested n=70). Sequences of PCR amplicons were similar to the less virulent F. necrophorum subsp. funduliforme. Fusobacterium necrophorum leukotoxin exhibited cytotoxicity to BHS PMNs and peripheral blood mononuclear cells. As with the M. haemolytica leukotoxin, F. necrophorum leukotoxin was more toxic to BHS PMNs than domestic sheep PMNs. It is likely that F. necrophorum enters the lungs after M. haemolytica and other aerobic respiratory pathogens enter the lungs and initiate tissue damage, thereby creating a microenvironment that is conducive for anaerobic bacterial growth. In summary, Fusobacterium leukotoxin is highly toxic for BHS leukocytes; however, based on the PCR findings, it is unlikely to play a direct role in the development of BHS pneumonia.

  5. A bighorn sheep die-off in southern Colorado involving a Pasteurellaceae strain that may have originated from syntopic cattle.

    Science.gov (United States)

    Wolfe, Lisa L; Diamond, Brandon; Spraker, Terry R; Sirochman, Michael A; Walsh, Daniel P; Machin, Chandra M; Bade, Donald J; Miller, Michael W

    2010-10-01

    We investigated a pasteurellosis epizootic in free-ranging bighorn sheep (Ovis canadensis) wherein a Pasteurellaceae strain carried by syntopic cattle (Bos taurus) under severe winter conditions appeared to contribute to pneumonia in affected bighorns. Twenty-one moribund or dead bighorn sheep were found on the "Fossil Ridge" herd's winter range, Colorado, USA, between 13 December 2007 and 29 February 2008. Eight carcasses examined showed gross or microscopic evidence of acute to subacute fibrinous bronchopneumonia. All eight carcasses yielded at least one β-hemolytic Mannheimia haemolytica biogroup 1(±(G)) strain, and seven also yielded a β-hemolytic Bibersteinia trehalosi biogroup 4 (CDS) strain; evidence of Pasteurella multocida, Mycoplasma ovipneumoniae, and parainfluenza 3 and bovine respiratory syncytial viruses was also detected. Isolates of β-hemolytic Manneimia haemolytica biogroup 1(G) from a bighorn carcass and a syntopic cow showed 99.5% similarity in genetic fingerprints; B. trehalosi biogroup 4(CDS) isolates were ≥94.9% similar to an isolate from a nearby bighorn herd. Field and laboratory observations suggested that pneumonia in affected bighorns may have been caused by a combination of pathogens including two pathogenic Pasteurellaceae strains--one likely of cattle origin and one likely of bighorn origin--with infections in some cases perhaps exacerbated by other respiratory pathogens and severe weather conditions. Our and others' findings suggest that intimate interactions between wild sheep and cattle should be discouraged as part of a comprehensive approach to health management and conservation of North American wild sheep species.

  6. Development of pneumonia in desert bighorn sheep after exposure to a flock of exotic wild and domestic sheep.

    Science.gov (United States)

    Callan, R J; Bunch, T D; Workman, G W; Mock, R E

    1991-03-15

    From 1986 to 1989, 5 desert bighorn sheep (3 Ovis canadensis mexicana and 2 O c nelsoni), ranging in age from 2 to 3 years, were exposed to a flock of exotic wild and domestic sheep to potentially achieve naturally acquired pneumonia. Pasteurella multocida was isolated from nasal samples from 4 of 6 sheep randomly sampled from the flock. Bighorn sheep were exposed individually and each exposure period was a trial. Treatment before and after exposure varied and included combinations of alpha interferon, antibiotics, anti-inflammatory drugs, and vaccines. Treatments were chosen on the basis of recommendations of others for treating pneumonia in desert bighorn sheep as well as our own experience in sheep and cattle. Regardless of treatment used, bighorn sheep in trials 1 to 4 developed signs of pneumonia within 10 to 14 days of exposure. Bighorn sheep in trials 1 to 3 died within 11 to 17 days of initial exposure. In trial 4, the bighorn sheep was isolated from the carrier sheep for treatment of pneumonia on day 14 and died on day 30. Pasteurella multocida was isolated from lung tissue in 3 of the 4 bighorn sheep. On the basis of results of trials 1 to 4, a more in depth clinical study was conducted in trial 5. Nasal and blood specimens were collected prior to and during trial 5 for bacteriologic culturing and serologic testing for bovine viral diarrhea virus, infectious bovine rhinotracheitis, parainfluenza-3 virus, and respiratory syncytial virus.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Harnessing cross-species alignment to discover SNPs and generate a draft genome sequence of a bighorn sheep (Ovis canadensis).

    Science.gov (United States)

    Miller, Joshua M; Moore, Stephen S; Stothard, Paul; Liao, Xiaoping; Coltman, David W

    2015-05-20

    Whole genome sequences (WGS) have proliferated as sequencing technology continues to improve and costs decline. While many WGS of model or domestic organisms have been produced, a growing number of non-model species are also being sequenced. In the absence of a reference, construction of a genome sequence necessitates de novo assembly which may be beyond the ability of many labs due to the large volumes of raw sequence data and extensive bioinformatics required. In contrast, the presence of a reference WGS allows for alignment which is more tractable than assembly. Recent work has highlighted that the reference need not come from the same species, potentially enabling a wide array of species WGS to be constructed using cross-species alignment. Here we report on the creation a draft WGS from a single bighorn sheep (Ovis canadensis) using alignment to the closely related domestic sheep (Ovis aries). Two sequencing libraries on SOLiD platforms yielded over 865 million reads, and combined alignment to the domestic sheep reference resulted in a nearly complete sequence (95% coverage of the reference) at an average of 12x read depth (104 SD). From this we discovered over 15 million variants and annotated them relative to the domestic sheep reference. We then conducted an enrichment analysis of those SNPs showing fixed differences between the reference and sequenced individual and found significant differences in a number of gene ontology (GO) terms, including those associated with reproduction, muscle properties, and bone deposition. Our results demonstrate that cross-species alignment enables the creation of novel WGS for non-model organisms. The bighorn sheep WGS will provide a resource for future resequencing studies or comparative genomics.

  8. The Sweet-Home project: audio processing and decision making in smart home to improve well-being and reliance.

    Science.gov (United States)

    Vacher, Michel; Chahuara, Pedro; Lecouteux, Benjamin; Istrate, Dan; Portet, Francois; Joubert, Thierry; Sehili, Mohamed; Meillon, Brigitte; Bonnefond, Nicolas; Fabre, Sébastien; Roux, Camille; Caffiau, Sybille

    2013-01-01

    The Sweet-Home project aims at providing audio-based interaction technology that lets the user have full control over their home environment, at detecting distress situations and at easing the social inclusion of the elderly and frail population. This paper presents an overview of the project focusing on the implemented techniques for speech and sound recognition as context-aware decision making with uncertainty. A user experiment in a smart home demonstrates the interest of this audio-based technology.

  9. Supplementary home biofeedback improves quality of life in younger patients with fecal incontinence.

    Science.gov (United States)

    Bartlett, Lynne; Sloots, Kathryn; Nowak, Madeleine; Ho, Yik-Hong

    2015-01-01

    Biofeedback is a scarce, resource-intensive clinical therapy. It is used to treat patients with bowel problems, including fecal incontinence (FI), who fail to respond to simple dietary advice, medication, or pelvic floor exercises. Populations are aging and younger cohorts use technology in managing their health, affording FI self-management opportunities. Does supplementary home-based biofeedback improve FI and quality of life (QOL)? Seventy-five incontinent participants (12 male), mean age 61.1 years, consented to participate. Thirty-nine patients (5 male) were randomized to the standard biofeedback protocol plus daily home use of a Peritron perineometer (intervention) and 36 patients (7 male) to the standard biofeedback protocol (control). On completion of the study each perineometer exercise session was rated for technique by 2 raters, blinded to the patient and order of sessions. With the exception of Fecal Incontinence Quality of Life Scale lifestyle improvement (intervention--9.1% vs. controls--0.3%, P=0.026) and embarrassment improvement (intervention--50.0% vs. controls--18.3%, P=0.026), supplementary home biofeedback did not result in greater clinical improvement for the intervention group as a whole. However, on stratification around the mean age, continence and QOL of younger people in the intervention group were significantly better than those of their control counterparts. Graphed perineometer sessions demonstrated high compliance and improvement in exercise technique. Perineometers provided reassurance, motivation, and an exercise reminder ensuring that confidence was achieved quickly. Home biofeedback was acceptable and well tolerated by all users. Younger participants significantly benefited from using this technology.

  10. Use of exposure history to identify patterns of immunity to pneumonia in bighorn sheep (Ovis canadensis.

    Directory of Open Access Journals (Sweden)

    Raina K Plowright

    Full Text Available Individual host immune responses to infectious agents drive epidemic behavior and are therefore central to understanding and controlling infectious diseases. However, important features of individual immune responses, such as the strength and longevity of immunity, can be challenging to characterize, particularly if they cannot be replicated or controlled in captive environments. Our research on bighorn sheep pneumonia elucidates how individual bighorn sheep respond to infection with pneumonia pathogens by examining the relationship between exposure history and survival in situ. Pneumonia is a poorly understood disease that has impeded the recovery of bighorn sheep (Ovis canadensis following their widespread extirpation in the 1900s. We analyzed the effects of pneumonia-exposure history on survival of 388 radio-collared adults and 753 ewe-lamb pairs. Results from Cox proportional hazards models suggested that surviving ewes develop protective immunity after exposure, but previous exposure in ewes does not protect their lambs during pneumonia outbreaks. Paradoxically, multiple exposures of ewes to pneumonia were associated with diminished survival of their offspring during pneumonia outbreaks. Although there was support for waning and boosting immunity in ewes, models with consistent immunizing exposure were similarly supported. Translocated animals that had not previously been exposed were more likely to die of pneumonia than residents. These results suggest that pneumonia in bighorn sheep can lead to aging populations of immune adults with limited recruitment. Recovery is unlikely to be enhanced by translocating naïve healthy animals into or near populations infected with pneumonia pathogens.

  11. Use of exposure history to identify patterns of immunity to pneumonia in bighorn sheep (Ovis canadensis).

    Science.gov (United States)

    Plowright, Raina K; Manlove, Kezia; Cassirer, E Frances; Cross, Paul C; Besser, Thomas E; Hudson, Peter J

    2013-01-01

    Individual host immune responses to infectious agents drive epidemic behavior and are therefore central to understanding and controlling infectious diseases. However, important features of individual immune responses, such as the strength and longevity of immunity, can be challenging to characterize, particularly if they cannot be replicated or controlled in captive environments. Our research on bighorn sheep pneumonia elucidates how individual bighorn sheep respond to infection with pneumonia pathogens by examining the relationship between exposure history and survival in situ. Pneumonia is a poorly understood disease that has impeded the recovery of bighorn sheep (Ovis canadensis) following their widespread extirpation in the 1900s. We analyzed the effects of pneumonia-exposure history on survival of 388 radio-collared adults and 753 ewe-lamb pairs. Results from Cox proportional hazards models suggested that surviving ewes develop protective immunity after exposure, but previous exposure in ewes does not protect their lambs during pneumonia outbreaks. Paradoxically, multiple exposures of ewes to pneumonia were associated with diminished survival of their offspring during pneumonia outbreaks. Although there was support for waning and boosting immunity in ewes, models with consistent immunizing exposure were similarly supported. Translocated animals that had not previously been exposed were more likely to die of pneumonia than residents. These results suggest that pneumonia in bighorn sheep can lead to aging populations of immune adults with limited recruitment. Recovery is unlikely to be enhanced by translocating naïve healthy animals into or near populations infected with pneumonia pathogens.

  12. Epizootic Pneumonia of Bighorn Sheep following Experimental Exposure to Mycoplasma ovipneumoniae

    OpenAIRE

    Besser, Thomas E.; Cassirer, E. Frances; Potter, Kathleen A.; Lahmers, Kevin; Oaks, J. Lindsay; Shanthalingam, Sudarvili; Srikumaran, Subramaniam; Foreyt, William J.

    2014-01-01

    BACKGROUND: Bronchopneumonia is a population limiting disease of bighorn sheep (Ovis canadensis). The cause of this disease has been a subject of debate. Leukotoxin expressing Mannheimia haemolytica and Bibersteinia trehalosi produce acute pneumonia after experimental challenge but are infrequently isolated from animals in natural outbreaks. Mycoplasma ovipneumoniae, epidemiologically implicated in naturally occurring outbreaks, has received little experimental evaluation as a primary agent o...

  13. Bighorn sheep pneumonia: Sorting out the cause of a polymicrobial disease

    Science.gov (United States)

    Pneumonia of bighorn sheep (Ovis canadensis) is a dramatic disease of high morbidity and mortality first described more than 80 years ago. The etiology of the disease has been debated since its initial discovery, and at various times lungworms, Mannheimia haemolytica and other Pasteurellaceae, and M...

  14. Concordance in diagnostic testing for respiratory pathogens of bighorn sheep

    Science.gov (United States)

    Walsh, Daniel P.; Cassirer, E. Frances; Bonds, Michael D.; Brown, Daniel R.; Edwards, William H.; Weiser, Glen C.; Drew, Mark L.; Briggs, Robert E.; Fox, Karen A.; Miller, Michael W.; Shanthalingam, Sudarvili; Srikumaran, Subramaniam; Besser, Thomas E.

    2016-01-01

    Reliable diagnostic tests are essential for disease investigation and management. This is particularly true for diseases of free-ranging wildlife where sampling is logistically difficult precluding retesting. Clinical assays for wildlife diseases frequently vary among laboratories because of lack of appropriate standardized commercial kits. Results of diagnostic testing may also be called into question when investigators report different etiologies for disease outbreaks, despite similar clinical and pathologic findings. To evaluate reliability of diagnostic testing for respiratory pathogens of bighorn sheep (Ovis canadensis), we conducted a series of ring tests across 6 laboratories routinely involved in detection of Mycoplasma ovipneumoniae, Pasteurellaceae, lktA (the Pasteurellaceae gene encoding leukotoxin), and 3 reference laboratories. Consistency of results for replicate samples within laboratories was high (median agreement = 1.0). Agreement between laboratories was high for polymerase chain reaction (PCR) detection of M. ovipneumoniae and culture isolation of Mannheimia spp. and Bibersteinia trehalosi(median agreement = 0.89–0.95, Kappa = 0.65–0.74), and lower for PCR detection of Mannheimiaspp. lktA (median agreement = 0.58, Kappa = 0.12). Most errors on defined status samples were false negatives, suggesting test sensitivity was a greater problem than specificity. However, tests for M. haemolytica and lktA yielded some false positive results. Despite differences in testing protocols, median agreement among laboratories and correct classification of controls for most agents was ≥0.80, meeting or exceeding the standard required by federal proficiency testing programs. This information is valuable for interpreting test results, laboratory quality assessments, and advancing diagnosis of respiratory disease in wild sheep. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  15. Structured decision making for managing pneumonia epizootics in bighorn sheep

    Science.gov (United States)

    Sells, Sarah N.; Mitchell, Michael S.; Edwards, Victoria L.; Gude, Justin A.; Anderson, Neil J.

    2016-01-01

    Good decision-making is essential to conserving wildlife populations. Although there may be multiple ways to address a problem, perfect solutions rarely exist. Managers are therefore tasked with identifying decisions that will best achieve desired outcomes. Structured decision making (SDM) is a method of decision analysis used to identify the most effective, efficient, and realistic decisions while accounting for values and priorities of the decision maker. The stepwise process includes identifying the management problem, defining objectives for solving the problem, developing alternative approaches to achieve the objectives, and formally evaluating which alternative is most likely to accomplish the objectives. The SDM process can be more effective than informal decision-making because it provides a transparent way to quantitatively evaluate decisions for addressing multiple management objectives while incorporating science, uncertainty, and risk tolerance. To illustrate the application of this process to a management need, we present an SDM-based decision tool developed to identify optimal decisions for proactively managing risk of pneumonia epizootics in bighorn sheep (Ovis canadensis) in Montana. Pneumonia epizootics are a major challenge for managers due to long-term impacts to herds, epistemic uncertainty in timing and location of future epizootics, and consequent difficulty knowing how or when to manage risk. The decision tool facilitates analysis of alternative decisions for how to manage herds based on predictions from a risk model, herd-specific objectives, and predicted costs and benefits of each alternative. Decision analyses for 2 example herds revealed that meeting management objectives necessitates specific approaches unique to each herd. The analyses showed how and under what circumstances the alternatives are optimal compared to other approaches and current management. Managers can be confident that these decisions are effective, efficient, and

  16. Improving quality and safety in nursing homes and home care: the study protocol of a mixed-methods research design to implement a leadership intervention

    Science.gov (United States)

    Wiig, Siri; Ree, Eline; Johannessen, Terese; Strømme, Torunn; Storm, Marianne; Aase, Ingunn; Ullebust, Berit; Holen-Rabbersvik, Elisabeth; Hurup Thomsen, Line; Sandvik Pedersen, Anne Torhild; van de Bovenkamp, Hester; Bal, Roland; Aase, Karina

    2018-01-01

    Introduction Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context. Methods and analysis The aim of the ‘Improving Quality and Safety in Primary Care—Implementing a Leadership Intervention in Nursing Homes and Homecare’ (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers’ and staffs’ knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention. Ethics and dissemination The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care. PMID:29599394

  17. Improving quality and safety in nursing homes and home care: the study protocol of a mixed-methods research design to implement a leadership intervention.

    Science.gov (United States)

    Wiig, Siri; Ree, Eline; Johannessen, Terese; Strømme, Torunn; Storm, Marianne; Aase, Ingunn; Ullebust, Berit; Holen-Rabbersvik, Elisabeth; Hurup Thomsen, Line; Sandvik Pedersen, Anne Torhild; van de Bovenkamp, Hester; Bal, Roland; Aase, Karina

    2018-03-28

    Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context. The aim of the 'Improving Quality and Safety in Primary Care-Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers' and staffs' knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention. The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. An individual-based modelling approach to estimate landscape connectivity for bighorn sheep (Ovis canadensis

    Directory of Open Access Journals (Sweden)

    Corrie H. Allen

    2016-05-01

    Full Text Available Background. Preserving connectivity, or the ability of a landscape to support species movement, is among the most commonly recommended strategies to reduce the negative effects of climate change and human land use development on species. Connectivity analyses have traditionally used a corridor-based approach and rely heavily on least cost path modeling and circuit theory to delineate corridors. Individual-based models are gaining popularity as a potentially more ecologically realistic method of estimating landscape connectivity. However, this remains a relatively unexplored approach. We sought to explore the utility of a simple, individual-based model as a land-use management support tool in identifying and implementing landscape connectivity. Methods. We created an individual-based model of bighorn sheep (Ovis canadensis that simulates a bighorn sheep traversing a landscape by following simple movement rules. The model was calibrated for bighorn sheep in the Okanagan Valley, British Columbia, Canada, a region containing isolated herds that are vital to conservation of the species in its northern range. Simulations were run to determine baseline connectivity between subpopulations in the study area. We then applied the model to explore two land management scenarios on simulated connectivity: restoring natural fire regimes and identifying appropriate sites for interventions that would increase road permeability for bighorn sheep. Results. This model suggests there are no continuous areas of good habitat between current subpopulations of sheep in the study area; however, a series of stepping-stones or circuitous routes could facilitate movement between subpopulations and into currently unoccupied, yet suitable, bighorn habitat. Restoring natural fire regimes or mimicking fire with prescribed burns and tree removal could considerably increase bighorn connectivity in this area. Moreover, several key road crossing sites that could benefit from

  19. Use of the Home Safety Self-Assessment Tool (HSSAT) within Community Health Education to Improve Home Safety.

    Science.gov (United States)

    Horowitz, Beverly P; Almonte, Tiffany; Vasil, Andrea

    2016-10-01

    This exploratory research examined the benefits of a health education program utilizing the Home Safety Self-Assessment Tool (HSSAT) to increase perceived knowledge of home safety, recognition of unsafe activities, ability to safely perform activities, and develop home safety plans of 47 older adults. Focus groups in two senior centers explored social workers' perspectives on use of the HSSAT in community practice. Results for the health education program found significant differences between reported knowledge of home safety (p = .02), ability to recognize unsafe activities (p = .01), safely perform activities (p = .04), and develop a safety plan (p = .002). Social workers identified home safety as a major concern and the HSSAT a promising assessment tool. Research has implications for reducing environmental fall risks.

  20. Targeting Nursing Homes Under the Quality Improvement Organization Program’s 9th Statement of Work

    OpenAIRE

    Stevenson, David G.; Mor, Vincent

    2009-01-01

    In the Quality Improvement Organization (QIO) program’s latest Statement of Work, the Centers for Medicare and Medicaid Services (CMS) is targeting its nursing home activities toward facilities that perform poorly on two quality measures—pressure ulcers and restraint use. The designation of target facilities is a shift in strategy for CMS and a direct response to criticism that QIO program resources were not being targeted effectively to facilities or clinical areas that most needed improveme...

  1. SmartNursing - a mobile application to improve communication in home care

    DEFF Research Database (Denmark)

    Nyborg, Mads; Bashir, Khurram; Maknickaite, Asta

    2013-01-01

    This paper presents SmartNursing system and discusses how increasing capabilities of smartphone could benefit employees in working environment. A SmartNursing system is developed for home nurses working environment to fulfil their needs. The solution helps to improve communication among nurses......, provide customized information and increase work efficiency. Developed system consists of mobile application, web based server and database. This article discusses the solution SmartNursing from design to implementation....

  2. Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs.

    Science.gov (United States)

    Konetzka, R Tamara; Skira, Meghan M; Werner, Rachel M

    2018-01-01

    Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement.

  3. Bighorn sheep pneumonia: sorting out the cause of a polymicrobial disease.

    Science.gov (United States)

    Besser, Thomas E; Frances Cassirer, E; Highland, Margaret A; Wolff, Peregrine; Justice-Allen, Anne; Mansfield, Kristin; Davis, Margaret A; Foreyt, William

    2013-02-01

    Pneumonia of bighorn sheep (Ovis canadensis) is a dramatic disease of high morbidity and mortality first described more than 80 years ago. The etiology of the disease has been debated since its initial discovery, and at various times lungworms, Mannheimia haemolytica and other Pasteurellaceae, and Mycoplasma ovipneumoniae have been proposed as primary causal agents. A multi-factorial "respiratory disease complex" has also been proposed as confirmation of causation has eluded investigators. In this paper we review the evidence for each of the candidate primary agents with regard to causal criteria including strength of association, temporality, plausibility, experimental evidence, and analogy. While we find some degree of biological plausibility for all agents and strong experimental evidence for M. haemolytica, we demonstrate that of the alternatives considered, M. ovipneumoniae is the best supported by all criteria and is therefore the most parsimonious explanation for the disease. The strong but somewhat controversial experimental evidence implicating disease transmission from domestic sheep is consistent with this finding. Based on epidemiologic and microbiologic data, we propose that healthy bighorn sheep populations are naïve to M. ovipneumoniae, and that its introduction to susceptible bighorn sheep populations results in epizootic polymicrobial bacterial pneumonia often followed by chronic infection in recovered adults. If this hypothesized model is correct, efforts to control this disease by development or application of vectored vaccines to Pasteurellaceae are unlikely to provide significant benefits, whereas efforts to ensure segregation of healthy bighorn sheep populations from M. ovipneumoniae-infected reservoir hosts are crucial to prevention of new disease epizootics. It may also be possible to develop M. ovipneumoniae vaccines or other management strategies that could reduce the impact of this devastating disease in bighorn sheep. Copyright © 2012

  4. Quality of Life and Nutrition Condition of Patients Improve Under Home Parenteral Nutrition: An Exploratory Study.

    Science.gov (United States)

    Girke, Jutta; Seipt, Claudia; Markowski, Andrea; Luettig, Birgit; Schettler, Anika; Momma, Michael; Schneider, Andrea S

    2016-10-01

    Patients with end-stage cancer and advanced chronic bowel disease are often malnourished, which has a negative effect on patients' outcome, well-being, and activity. It is inconclusive whether these patients benefit from home parenteral nutrition. This prospective exploratory study investigates its influence on nutrition state, muscle strength, mobility, and quality of life. Patients ≥18 years old with an indication for home parenteral nutrition were included and followed for 2-24 months. Nutrition parameters, activity, and quality of life were assessed. Forty-eight patients participated (mean age 11.5 years), and 85% were severely malnourished (subjective global assessment score, class C). Four weeks after parenteral nutrition, patients with tumors demonstrated a deterioration in phase angle (from 3.9 to 3.4) and extracellular mass:body cell mass ratio (from 1.6 to 2.1), while patients with bowel disease improved (from 3.4 to 4.0 and 2.1 to 1.6, respectively); grip strength remained constant in both groups (difference: 1.11 and -2.11, respectively). Activity improved in patients with bowel disease but stayed the same in the tumor group (P = .02 and P = .33, respectively). When the groups were pooled, emotional and social functioning domain scores (P parenteral nutrition. Both groups seem to benefit from home parenteral nutrition without harmful side effects. If the indication is determined early, the patients' disease course could perhaps be improved. © 2016 American Society for Parenteral and Enteral Nutrition.

  5. Improving activities of daily living for nursing home elder persons in Taiwan.

    Science.gov (United States)

    Chang, Su-Hsien; Wung, Shu-Fen; Crogan, Neva L

    2008-01-01

    Excess disability among nursing home elder persons can be prevented or remediated. Because of self-selected disuse and caregiver support of dependency, nursing home residents are likely to develop excess disability. No study was found to test a theory-based program aimed at improving elder persons' self-care abilities for Taiwanese nursing home elder persons who are at risk for developing excess disability. The purpose of this study was to test the effectiveness of a theory-based intervention program on self-care, specifically on activities of daily living (ADLs) performance among nursing home elder persons in Taiwan. A secondary aim was to determine the correlation between ADLs performance and three bliss concepts: life satisfaction, self-esteem, and motivation in health behavior. This study used a quasi-experimental, two-group, pretest-posttest design. Forty-two qualified participants were recruited from two nursing homes located in southern Taiwan and assigned to either the experimental group (n = 21) or the comparison group (n = 21). Participants in the experimental group received the Self-Care Self-Efficacy Enhancement Program (SCSEEP), and those in the comparison group received biweekly social visits for 6 weeks. Levels of ADLs performance were measured by Tappen's Refined ADL Assessment Scale. Life satisfaction was measured by Adams' Life Satisfaction Index A. Self-esteem was measured by Rosenberg's Self-Esteem Scale. Motivation in health behavior was measured by Cox's Health Self-Determinism Index. Elder persons receiving the SCSEEP had significant improvement in feeding, dressing, grooming, and washing activities. Self-esteem (p = .011) and life satisfaction (p = .033) but not motivation in health behavior (p = .282) were positively correlated with levels of ADLs performance. The SCSEEP provides a theory-based intervention model for Taiwanese nursing home elder persons aimed at improving ADLs performance. Further research with a larger sample size is

  6. Transmission of Mannheimia haemolytica from domestic sheep (Ovis aries) to bighorn sheep (Ovis canadensis): unequivocal demonstration with green fluorescent protein-tagged organisms.

    Science.gov (United States)

    Lawrence, Paulraj K; Shanthalingam, Sudarvili; Dassanayake, Rohana P; Subramaniam, Renuka; Herndon, Caroline N; Knowles, Donald P; Rurangirwa, Fred R; Foreyt, William J; Wayman, Gary; Marciel, Ann Marie; Highlander, Sarah K; Srikumaran, Subramaniam

    2010-07-01

    Previous studies demonstrated that bighorn sheep (Ovis canadensis) died of pneumonia when commingled with domestic sheep (Ovis aries) but did not conclusively prove that the responsible pathogens were transmitted from domestic to bighorn sheep. The objective of this study was to determine, unambiguously, whether Mannheimia haemolytica can be transmitted from domestic to bighorn sheep when they commingle. Four isolates of M. haemolytica were obtained from the pharynx of two of four domestic sheep and tagged with a plasmid carrying the genes for green fluorescent protein (GFP) and ampicillin resistance (AP(R)). Four domestic sheep, colonized with the tagged bacteria, were kept about 10 m apart from four bighorn sheep for 1 mo with no clinical signs of pneumonia observed in the bighorn sheep during that period. The domestic and bighorn sheep were then allowed to have fence-line contact for 2 mo. During that period, three bighorn sheep acquired the tagged bacteria from the domestic sheep. At the end of the 2 mo of fence-line contact, the animals were allowed to commingle. All four bighorn sheep died 2 days to 9 days following commingling. The lungs from all four bighorn sheep showed gross and histopathologic lesions characteristic of M. haemolytica pneumonia. Tagged M. haemolytica were isolated from all four bighorn sheep, as confirmed by growth in ampicillin-containing culture medium, PCR-amplification of genes encoding GFP and Ap(R), and immunofluorescent staining of GFP. These results unequivocally demonstrate transmission of M. haemolytica from domestic to bighorn sheep, resulting in pneumonia and death of bighorn sheep.

  7. Pioneering a Nursing Home Quality Improvement Learning Collaborative: A Case Study of Method and Lessons Learned.

    Science.gov (United States)

    Gillespie, Suzanne M; Olsan, Tobie; Liebel, Dianne; Cai, Xueya; Stewart, Reginald; Katz, Paul R; Karuza, Jurgis

    2016-02-01

    To describe the development of a nursing home (NH) quality improvement learning collaborative (QILC) that provides Lean Six Sigma (LSS) training and infrastructure support for quality assurance performance improvement change efforts. Case report. Twenty-seven NHs located in the Greater Rochester, NY area. The learning collaborative approach in which interprofessional teams from different NHs work together to improve common clinical and organizational processes by sharing experiences and evidence-based practices to achieve measurable changes in resident outcomes and system efficiencies. NH participation, curriculum design, LSS projects. Over 6 years, 27 NHs from urban and rural settings joined the QILC as organizational members and sponsored 47 interprofessional teams to learn LSS techniques and tools, and to implement quality improvement projects. NHs, in both urban and rural settings, can benefit from participation in QILCs and are able to learn and apply LSS tools in their team-based quality improvement efforts. Published by Elsevier Inc.

  8. Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality.

    Science.gov (United States)

    Bowblis, John R; Roberts, Amy Restorick

    2018-06-01

    Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

  9. Capacity and readiness for quality improvement among home and community-based service providers.

    Science.gov (United States)

    Abrahamson, Kathleen; Myers, Jaclyn; Arling, Greg; Davila, Heather; Mueller, Christine; Abery, Brian; Cai, Yun

    2016-01-01

    The objective of this study was to explore home and community-based service (HCBS) providers' perspectives of organizational readiness for quality improvement (QI). Data were obtained from a survey of participants (N = 56) in a state-sponsored HCBS QI initiative. Quality improvement challenges included lack of time and resources, staff apprehension or resistance, resistance from consumers and families, and project sustainability. Support from leadership was viewed as an important factor in participating organizations' decision to engage in QI. Internal resources available to support QI varied widely between participating organizations, with differences observed between smaller and larger agencies, as well as between provider types and populations served.

  10. Improving palliative care through teamwork (IMPACTT) in nursing homes: Study design and baseline findings.

    Science.gov (United States)

    Temkin-Greener, Helena; Ladwig, Susan; Ye, Zhiqiu; Norton, Sally A; Mukamel, Dana B

    2017-05-01

    The 2014 Institute of Medicine report recommended that healthcare providers caring for individuals with advanced illness have basic palliative care competencies in communication, inter-professional collaboration, and symptom management. Nursing homes, where one in three American decedents live and die, have fallen short of these competency goals. We implemented an intervention study to examine the efficacy of nursing home-based integrated palliative care teams in improving the quality of care processes and outcomes for residents at the end of life. This paper describes the design, rationale, and challenges of a two-arm randomized controlled trial of nursing home-based palliative care teams in 31 facilities. The impact of the intervention on residents' outcomes is measured with four risk-adjusted quality indicators: place of death (nursing home or hospital), number of hospitalizations, and self-reported pain and depression in the last 90-days of life. The effect of the intervention is also evaluated with regard to staff satisfaction and impact on care processes (e.g. palliative care competency, communication, coordination). Both secondary (e.g. the Minimum Data Set) and primary (e.g. staff surveys) data are employed to examine the effect of the intervention. Several challenges in conducting a complex, nursing home-based intervention have been identified. While sustainability of the intervention without research funding is not clear, we surmise that without changes to the payment model that put palliative care services in this care setting on par with the more "skilled" care, it will not be reasonable to expect any widespread efforts to implement facility-based palliative care services. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. The sweet-home project: audio technology in smart homes to improve well-being and reliance.

    Science.gov (United States)

    Vacher, Michel; Istrate, Dan; Portet, François; Joubert, Thierry; Chevalier, Thierry; Smidtas, Serge; Meillon, Brigitte; Lecouteux, Benjamin; Sehili, Mohamed; Chahuara, Pedro; Méniard, Sylvain

    2011-01-01

    The Sweet-Home project aims at providing audio-based interaction technology that lets the user have full control over their home environment, at detecting distress situations and at easing the social inclusion of the elderly and frail population. This paper presents an overview of the project focusing on the multimodal sound corpus acquisition and labelling and on the investigated techniques for speech and sound recognition. The user study and the recognition performances show the interest of this audio technology.

  12. Improving socially constructed cross-cultural communication in aged care homes: A critical perspective.

    Science.gov (United States)

    Xiao, Lily Dongxia; Willis, Eileen; Harrington, Ann; Gillham, David; De Bellis, Anita; Morey, Wendy; Jeffers, Lesley

    2018-01-01

    Cultural diversity between residents and staff is significant in aged care homes in many developed nations in the context of international migration. This diversity can be a challenge to achieving effective cross-cultural communication. The aim of this study was to critically examine how staff and residents initiated effective cross-cultural communication and social cohesion that enabled positive changes to occur. A critical hermeneutic analysis underpinned by Giddens' Structuration Theory was applied to the study. Data were collected by interviews with residents or their family and by focus groups with staff in four aged care homes in Australia. Findings reveal that residents and staff are capable of restructuring communication via a partnership approach. They can also work in collaboration to develop communication resources. When staff demonstrate cultural humility, they empower residents from culturally and linguistically diverse backgrounds to engage in effective communication. Findings also suggest that workforce interventions are required to improve residents' experiences in cross-cultural care. This study challenges aged care homes to establish policies, criteria and procedures in cross-cultural communication. There is also the challenge to provide ongoing education and training for staff to improve their cross-cultural communication capabilities. © 2017 John Wiley & Sons Ltd.

  13. Does empowering resident families or nursing home employees in decision making improve service quality?

    Science.gov (United States)

    Hamann, Darla J

    2014-08-01

    This research examines how the empowerment of residents' family members and nursing home employees in managerial decision making is related to service quality. The study was conducted using data from 33 nursing homes in the United States. Surveys were administered to more than 1,000 employees on-site and mailed to the primary-contact family member of each resident. The resulting multilevel data were analyzed using hierarchical linear modeling. The empowerment of families in decision making was positively associated with their perceptions of service quality. The empowerment of nursing staff in decision making was more strongly related to service quality than the empowerment of nonnursing staff. Among nursing staff, the empowerment of nursing assistants improved service quality more than the empowerment of nurses. © The Author(s) 2013.

  14. Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Østergaard, Ann; Kjær, Pia

    2016-01-01

    part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients. MAIN MEASURES: Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome...... score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2-4; P=0.04). EuroQol-5D™ quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66-0.79; Control median = 0.66, IQR = 0.56 - 0.72; P=0.03). The total amount of home-based training...... and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective....

  15. The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement.

    Science.gov (United States)

    Chimento, George F; Thomas, Leslie C

    2017-09-01

    The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH. The PSH model guides the patient throughout the pre and perioperative process and into the postoperative phase. It has been shown in multiple studies to decrease length of stay, improve functional outcomes, allow more home discharges, and lower costs. There is no increase in complications or readmission rates. The PSH pathway is a safe and effective method of providing value-based care to patients undergoing hip and knee arthroplasty.

  16. Affecting culture change and performance improvement in Medicaid nursing homes: the Promote Understanding, Leadership, and Learning (PULL) Program.

    Science.gov (United States)

    Eliopoulos, Charlotte

    2013-01-01

    A growing number of nursing homes are implementing culture change programming to create a more homelike environment in which residents and direct care staff are empowered with greater participation in care activities. Although nursing homes that have adopted culture change practices have brought about positive transformation in their settings that have improved quality of care and life, as well as increased resident and staff satisfaction, they represent a minority of all nursing homes. Nursing homes that serve primarily a Medicaid population without supplemental sources of funding have been limited in the resources to support such change processes. The purpose of this project was to gain insight into effective strategies to provide culture change and quality improvement programming to low-performing, under-resourced nursing homes that represent the population of nursing homes least likely to have implemented this programming. Factors that interfered with transformation were identified and insights were gained into factors that need to be considered before transformational processes can be initiated. Effective educational strategies and processes that facilitate change in these types of nursing homes were identified. Despite limitations to the study, there was evidence that the experiences and findings can be of value to other low-performing, under-resourced nursing homes. Ongoing clinical work and research are needed to refine the implementation process and increase the ability to help these settings utilize resources and implement high quality cost effective care to nursing home residents. Copyright © 2013 Mosby, Inc. All rights reserved.

  17. Specific Physician Orders Improve Pain Detection and Pain Reports in Nursing Home Residents: Preliminary Data.

    Science.gov (United States)

    Monroe, Todd B; Misra, Sumathi; Habermann, Ralf C; Dietrich, Mary S; Bruehl, Stephen P; Cowan, Ronald L; Newhouse, Paul A; Simmons, Sandra F

    2015-10-01

    Despite evidence that many nursing home residents' pain is poorly managed, reasons for this poor management remain unanswered. The aim of this study was to determine if specific order sets related to pain assessment would improve pain management in nursing home (NH) residents. Outcomes included observed nurse pain assessment queries and resident reports of pain. The pretest/post-test study was performed in a 240-bed for-profit nursing home in the mid-southern region of the United States and participants were 43 nursing home residents capable of self-consent. Medical chart abstraction was performed during a 2-week (14-day) period before the implementation of specific order sets for pain assessment (intervention) and a 2-week (14-day) period after the intervention. Trained research assistants observed medication administration passes and performed participant interviews after each medication pass. One month after intervention implementation, 1 additional day of observations was conducted to determine data reliability. Nurses were observed to ask residents about pain more frequently, and nurses continued to ask about pain at higher rates 1 month after the intervention was discontinued. The proportion of residents who reported pain also significantly increased in response to increased nurse queries (e.g., "Do you have any pain right now?"), which underscores the importance of nurses directly asking residents about pain. Notably 70% of this long-stay NH population only told the nurses about their pain symptoms when asked directly. Findings uncover that using specific pain order sets seems to improve the detection of pain, which should be a routine part of nursing assessment. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  18. Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda

    Directory of Open Access Journals (Sweden)

    Deborah Sitrin

    2015-03-01

    Full Text Available Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design: Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW during pregnancy (0, 1–2, 3+ – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results: There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion: Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of

  19. Improved Clinical Efficacy with Wound Support Network Between Hospital and Home Care Service.

    Science.gov (United States)

    Bergersen, Tone Kristin; Storheim, Elisabeth; Gundersen, Stina; Kleven, Linn; Johnson, Maria; Sandvik, Leiv; Kvaerner, Kari Jorunn; Ørjasæter, Nils-Otto

    2016-11-01

    The aim of this study was to test the efficacy of a wound support network model between the primary home care service and the hospital. The impact on wound healing rate, cost benefit, and transfer of knowledge was investigated. The intervention group was exposed to a wound support network (n = 32), and the control group continued standard organization of treatment (n = 21). Nonrandomized controlled study; observations were made before (baseline) and after the implementation of the intervention (12 weeks). Patients with chronic wounds (lasting >6 weeks and with wound area >1 cm) in Oslo, Norway. Closure of the observation wound; wound size; total number of wounds; presence of eczema, edema, and pain; number of dressings per week; time spent per dressing; and number of control appointments at the hospital. The economic impact is calculated for the hospital and for the community of Oslo, Norway. The number of control appointments (t = 3.80, P home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital.

  20. The SUSTAIN Project: A European Study on Improving Integrated Care for Older People Living at Home

    Science.gov (United States)

    Stoop, Annerieke; Billings, Jenny; Leichsenring, Kai; Ruppe, Georg; Tram, Nhu; Barbaglia, María Gabriela; Ambugo, Eliva A.; Zonneveld, Nick; Paat-Ahi, Gerli; Hoffmann, Henrik; Khan, Usman; Stein, Viktoria; Wistow, Gerald; Lette, Manon; Jansen, Aaltje P.D.; Nijpels, Giel; Baan, Caroline A.

    2018-01-01

    Introduction: Integrated care programmes are increasingly being put in place to provide care to older people who live at home. Knowledge of how to further develop integrated care and how to transfer successful initiatives to other contexts is still limited. Therefore, a cross-European research project, called Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN), has been initiated with a twofold objective: 1. to collaborate with local stakeholders to support and monitor improvements to established integrated care initiatives for older people with multiple health and social care needs. Improvements focus on person-centredness, prevention orientation, safety and efficiency; 2. to make these improvements applicable and adaptable to other health and social care systems, and regions in Europe. This paper presents the overall structure and approach of the SUSTAIN project. Methods: SUSTAIN uses a multiple embedded case study design. In three phases, SUSTAIN partners: (i) conduct interviews and workshops with stakeholders from fourteen established integrated care initiatives to understand where they would prefer improvements to existing ways of working; (ii) collaborate with local stakeholders to support the design and implementation of improvement plans, evaluate implementation progress and outcomes per initiative, and carry out overarching analyses to compare the different initiatives, and; (iii) translate knowledge and experience to an online roadmap. Discussion: SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home. PMID:29632456

  1. Did professional attendance at home births improve early neonatal survival in Indonesia?

    Science.gov (United States)

    Hatt, Laurel; Stanton, Cynthia; Ronsmans, Carine; Makowiecka, Krystyna; Adisasmita, Asri

    2009-07-01

    BACKGROUND Early neonatal mortality has been persistently high in developing countries. Indonesia, with its national policy of home-based, midwife-assisted birth, is an apt context for assessing the effect of home-based professional birth attendance on early neonatal survival. METHODS We pooled four Indonesian Demographic and Health Surveys and used multivariate logistic regression to analyse trends in first-day and early neonatal mortality. We measured the effect of the context of delivery, including place and type of provider, and tested for changes in trend when the 'Midwife in the Village' programme was initiated. RESULTS Reported first-day mortality did not decrease significantly between 1986 and 2002, whereas early neonatal mortality decreased by an average of 3.2% annually. The rate of the decline did not change over the time period, either in 1989 when the Midwife in the Village programme was initiated, or in any year following when uptake of professional care increased. In simple and multivariate analyses, there were no significant differences in first-day or early neonatal death rates comparing home-based births with or without a professional midwife. Early neonatal mortality was higher in public facilities, likely due to selection. Biological determinants (twin births, male sex, short birth interval, previous early neonatal loss) were important for both outcomes. CONCLUSIONS Decreasing newborn death rates in Indonesia are encouraging, but it is not clear that these decreases are associated with greater uptake of professional delivery care at home or in health facilities. This may suggest a need for improved training in immediate newborn care, strengthened emergency referral, and continued support for family planning policies.

  2. Home-based nursing interventions improve knowledge of disease and management in patients with heart failure 1

    Science.gov (United States)

    Azzolin, Karina de Oliveira; Lemos, Dayanna Machado; Lucena, Amália de Fátima; Rabelo-Silva, Eneida Rejane

    2015-01-01

    OBJECTIVE: to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire. METHODS: in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered. RESULTS: overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001); and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001). The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01), but weak and non significant at visit 4. CONCLUSION: the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument. PMID:25806630

  3. A prototype home robot with an ambient facial interface to improve drug compliance.

    Science.gov (United States)

    Takacs, Barnabas; Hanak, David

    2008-01-01

    We have developed a prototype home robot to improve drug compliance. The robot is a small mobile device, capable of autonomous behaviour, as well as remotely controlled operation via a wireless datalink. The robot is capable of face detection and also has a display screen to provide facial feedback to help motivate patients and thus increase their level of compliance. An RFID reader can identify tags attached to different objects, such as bottles, for fluid intake monitoring. A tablet dispenser allows drug compliance monitoring. Despite some limitations, experience with the prototype suggests that simple and low-cost robots may soon become feasible for care of people living alone or in isolation.

  4. Home grocery delivery improves the household food environments of behavioral weight loss participants: results of an 8-week pilot study.

    Science.gov (United States)

    Gorin, Amy A; Raynor, Hollie A; Niemeier, Heather M; Wing, Rena R

    2007-11-14

    Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service. Overweight participants (N = 28; BMI = 31.7 +/- 3.6 kg/m2; 89.3% women, 47.9 +/- 9.5 years) were randomly assigned to 8-weeks of standard behavioral weight loss (SBT) or to SBT plus home food delivery (SBT+Home). SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges. Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01) and number of foods that were high in fat (p = .002). While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08). Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study. Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes.

  5. Home grocery delivery improves the household food environments of behavioral weight loss participants: Results of an 8-week pilot study

    Directory of Open Access Journals (Sweden)

    Niemeier Heather M

    2007-11-01

    Full Text Available Abstract Background Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service. Methods Overweight participants (N = 28; BMI = 31.7 ± 3.6 kg/m2; 89.3% women, 47.9 ± 9.5 years were randomly assigned to 8-weeks of standard behavioral weight loss (SBT or to SBT plus home food delivery (SBT+Home. SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges. Results Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01 and number of foods that were high in fat (p = .002. While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08. Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study. Conclusion Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes.

  6. Impact of Intervention to Improve Nursing Home Resident-Staff Interactions and Engagement.

    Science.gov (United States)

    Hartmann, Christine W; Mills, Whitney L; Pimentel, Camilla B; Palmer, Jennifer A; Allen, Rebecca S; Zhao, Shibei; Wewiorski, Nancy J; Sullivan, Jennifer L; Dillon, Kristen; Clark, Valerie; Berlowitz, Dan R; Snow, Andrea Lynn

    2018-04-30

    For nursing home residents, positive interactions with staff and engagement in daily life contribute meaningfully to quality of life. We sought to improve these aspects of person-centered care in an opportunistic snowball sample of six Veterans Health Administration nursing homes (e.g., Community Living Centers-CLCs) using an intervention that targeted staff behavior change, focusing on improving interactions between residents and staff and thereby ultimately aiming to improve resident engagement. We grounded this mixed-methods study in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change. We implemented the intervention by (a) using a set of evidence-based practices for implementing quality improvement and (b) combining primarily CLC-based staff facilitation with some researcher-led facilitation. Validated resident and staff surveys and structured observations collected pre and post intervention, as well as semi-structured staff interviews conducted post intervention, helped assess intervention success. Sixty-two CLC residents and 308 staff members responded to the surveys. Researchers conducted 1,490 discrete observations. Intervention implementation was associated with increased staff communication with residents during the provision of direct care and decreased negative staff interactions with residents. In the 66 interviews, staff consistently credited the intervention with helping them (a) develop awareness of the importance of identifying opportunities for engagement and (b) act to improve the quality of interactions between residents and staff. The intervention proved feasible and influenced staff to make simple enhancements to their behaviors that improved resident-staff interactions and staff-assessed resident engagement.

  7. Potential disease agents in domestic goats and relevance to bighorn sheep (Ovis canadensis) management

    OpenAIRE

    Drew, Mark L.; Weiser, Glen C.

    2017-01-01

    Domestic goats are raised for meat, milk and hair production, in herds for rangeland weed control, and as pack animals. Domestic sheep, goats and wild bighorn sheep are all susceptible to a multifactorial pneumonia. We sampled 43 herd goats from 7 herds and 48 pack goats from 11 herds for viral and bacterial serology, parasitology, and Pasteurellaceae microbiology. The goats in this study were in generally good health, although most goats did harbor various pathogens and parasites including s...

  8. Role of carriers in the transmission of pneumonia in bighorn sheep (Ovis canadensis)

    OpenAIRE

    Raghavan, Bindu; Erickson, Kayla; Kugadas, Abirami; Batra, Sai A.; Call, Douglas R.; Davis, Margaret A.; Foreyt, William J.; Srikumaran, Subramaniam

    2016-01-01

    ABSTRACT In the absence of livestock contact, recurring lamb mortality in bighorn sheep (Ovis canadensis) populations previously exposed to pneumonia indicates the likely presence of carriers of pneumonia-causing pathogens, and possibly inadequate maternally derived immunity. To investigate this problem we commingled na?ve, pregnant ewes (n=3) with previously exposed rams (n=2). Post-commingling, all ewes and lambs born to them acquired pneumonia-causing pathogens (leukotoxin-producing Pasteu...

  9. A Smart Gateway Architecture for Improving Efficiency of Home Network Applications

    OpenAIRE

    Ding, Fei; Song, Aiguo; Tong, En; Li, Jianqing

    2016-01-01

    A smart home gateway plays an important role in the Internet of Things (IoT) system that takes responsibility for the connection between the network layer and the ubiquitous sensor network (USN) layer. Even though the home network application is developing rapidly, researches on the home gateway based open development architecture are less. This makes it difficult to extend the home network to support new applications, share service, and interoperate with other home network systems. An integr...

  10. Cold homes, fuel poverty and energy efficiency improvements: A longitudinal focus group approach.

    Science.gov (United States)

    Grey, Charlotte N B; Schmieder-Gaite, Tina; Jiang, Shiyu; Nascimento, Christina; Poortinga, Wouter

    2017-08-01

    Cold homes and fuel poverty have been identified as factors in health and social inequalities that could be alleviated through energy efficiency interventions. Research on fuel poverty and the health impacts of affordable warmth initiatives have to date primarily been conducted using quantitative and statistical methods, limiting the way how fuel poverty is understood. This study took a longitudinal focus group approach that allowed exploration of lived experiences of fuel poverty before and after an energy efficiency intervention. Focus group discussions were held with residents from three low-income communities before (n = 28) and after (n = 22) they received energy efficiency measures funded through a government-led scheme. The results show that improving the energy efficiency of homes at risk of fuel poverty has a profound impact on wellbeing and quality of life, financial stress, thermal comfort, social interactions and indoor space use. However, the process of receiving the intervention was experienced by some as stressful. There is a need for better community engagement and communication to improve the benefits delivered by fuel poverty programmes, as well as further qualitative exploration to better understand the wider impacts of fuel poverty and policy-led intervention schemes.

  11. Improving prediction of fall risk among nursing home residents using electronic medical records.

    Science.gov (United States)

    Marier, Allison; Olsho, Lauren E W; Rhodes, William; Spector, William D

    2016-03-01

    Falls are physically and financially costly, but may be preventable with targeted intervention. The Minimum Data Set (MDS) is one potential source of information on fall risk factors among nursing home residents, but its limited breadth and relatively infrequent updates may limit its practical utility. Richer, more frequently updated data from electronic medical records (EMRs) may improve ability to identify individuals at highest risk for falls. The authors applied a repeated events survival model to analyze MDS 3.0 and EMR data for 5129 residents in 13 nursing homes within a single large California chain that uses a centralized EMR system from a leading vendor. Estimated regression parameters were used to project resident fall probability. The authors examined the proportion of observed falls within each projected fall risk decile to assess improvements in predictive power from including EMR data. In a model incorporating fall risk factors from the MDS only, 28.6% of observed falls occurred among residents in the highest projected risk decile. In an alternative specification incorporating more frequently updated measures for the same risk factors from the EMR data, 32.3% of observed falls occurred among residents in the highest projected risk decile, a 13% increase over the base MDS-only specification. Incorporating EMR data improves ability to identify those at highest risk for falls relative to prediction using MDS data alone. These improvements stem chiefly from the greater frequency with which EMR data are updated, with minimal additional gains from availability of additional risk factor variables. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Improving Chronic Disease Self-Management by Older Home Health Patients through Community Health Coaching

    Directory of Open Access Journals (Sweden)

    Cheryl Dye

    2018-04-01

    Full Text Available The purpose of the study was to pilot test a model to reduce hospital readmissions and emergency department use of rural, older adults with chronic diseases discharged from home health services (HHS through the use of volunteers. The study’s priority population consistently experiences poorer health outcomes than their urban counterparts due in part to lower socioeconomic status, reduced access to health services, and incidence of chronic diseases. When they are hospitalized for complications due to poorly managed chronic diseases, they are frequently readmitted for the same conditions. This pilot study examines the use of volunteer community members who were trained as Health Coaches to mentor discharged HHS patients in following the self-care plan developed by their HHS RN; improving chronic disease self-management behaviors; reducing risk of falls, pneumonia, and flu; and accessing community resources. Program participants increased their ability to monitor and track their chronic health conditions, make positive lifestyle changes, and reduce incidents of falls, pneumonia and flu. Although differences in the ED and hospital admission rates after discharge from HHS between the treatment and comparison group (matched for gender, age, and chronic condition were not statistically significant, the treatment group’s rate was less than the comparison group thus suggesting a promising impact of the HC program (90 day: 263 comparison vs. 129 treatment; p = 0.65; 180 day 666.67 vs. 290.32; p = 0.19. The community health coach model offers a potential approach for improving the ability of discharged older home health patients to manage chronic conditions and ultimately reduce emergent care.

  13. The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes.

    Science.gov (United States)

    Nakanishi, Miharu; Tei-Tominaga, Maki

    2018-05-08

    Background : Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods : A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional), presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results : Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions : Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.

  14. The Association between Quality Improvement Initiatives in Dementia Care and Supportive Psychosocial Work Environments in Nursing Homes

    Directory of Open Access Journals (Sweden)

    Miharu Nakanishi

    2018-05-01

    Full Text Available Background: Quality improvement initiatives can help nursing homes strengthen psychosocial work environments. The aim of the present study was to examine the association between supportive psychosocial work environment, and professional and organizational characteristics regarding quality improvement initiatives in dementia care. Methods: A paper questionnaire survey was administered to a convenience sample of 365 professional caregivers in 12 special nursing homes in Japan. Psychosocial work environment was assessed using the Social Capital and Ethical Climate at the Workplace Scale to calculate a score of social capital in the workplace, ethical leadership, and exclusive workplace climate. Variables for quality improvement initiatives included type of home (unit-type or traditional, presence of additional benefit for dementia care, and professionalism in dementia care among caregivers evaluated using the Japanese version of the Sense of Competence in Dementia Care Staff Scale. Results: Elevated professionalism and unit-type home were significantly associated with high social capital, strong ethical leadership, and low exclusive workplace climate. The presence of dementia care benefit was not associated with any subscale of psychosocial work environment. Conclusions: Quality improvement initiatives to foster supportive psychosocial work environment should enhance professionalism in dementia care with unit-based team building of professional caregivers in special nursing homes.

  15. Precipitation, density, and population dynamics of desert bighorn sheep on San Andres National Wildlife Refuge, New Mexico

    Science.gov (United States)

    Bender, L.C.; Weisenberger, M.E.

    2005-01-01

    Understanding the determinants of population size and performance for desert bighorn sheep (Ovis canadensis mexicana) is critical to develop effective recovery and management strategies. In arid environments, plant communities and consequently herbivore populations are strongly dependent upon precipitation, which is highly variable seasonally and annually. We conducted a retrospective exploratory analysis of desert bighorn sheep population dynamics on San Andres National Wildlife Refuge (SANWR), New Mexico, 1941-1976, by modeling sheep population size as a function of previous population sizes and precipitation. Population size and trend of desert bighorn were best and well described (R 2=0.89) by a model that included only total annual precipitation as a covariate. Models incorporating density-dependence, delayed density-dependence, and combinations of density and precipitation were less informative than the model containing precipitation alone (??AlCc=8.5-22.5). Lamb:female ratios were positively related to precipitation (current year: F1,34=7.09, P=0.012; previous year: F1,33=3.37, P=0.075) but were unrelated to population size (current year. F1,34=0.04, P=0.843; previous year: F1,33 =0.14, P=0.715). Instantaneous population rate of increase (r) was related to population size (F1,33=5.55; P=0.025). Precipitation limited populations of desert bighorn sheep on SANWR primarily in a density-independent manner by affecting production or survival of lambs, likely through influences on forage quantity and quality. Habitat evaluations and recovery plans for desert bighorn sheep need to consider fundamental influences on desert bighorn populations such as precipitation and food, rather than focus solely on proximate issues such as security cover, predation, and disease. Moreover, the concept of carrying capacity for desert bighorn sheep may need re-evaluation in respect to highly variable (CV =35.6%) localized precipitation patterns. On SANWR carrying capacity for desert

  16. Characteristics of Quality Improvement Champions in Nursing Homes: A Systematic Review With Implications for Evidence-Based Practice.

    Science.gov (United States)

    Woo, Kyungmi; Milworm, Gvira; Dowding, Dawn

    2017-12-01

    Improving care quality while reducing cost has always been a focus of nursing homes. Certified nursing assistants comprise the largest proportion of the workforce in nursing homes and have the potential to contribute to the quality of care provided. Quality improvement (QI) initiatives using certified nursing assistants as champions have the potential to improve job satisfaction, which has been associated with care quality. To identify the role, use and preparation of champions in a nursing home setting as a way of informing future QI strategies in nursing homes. A systematic literature review. Medical Subject Headings and text words for "quality improvement" were combined with those for "champion*" to search Medline, CINAHL, Joanna Briggs Institute, MedLine In-Process, and other Nonindexed Citations. After duplicates were removed, a total of 337 potential articles were identified for further review. After full text review, seven articles from five original studies met inclusion criteria and were included in the synthesis. Various types of QI initiatives and implementation strategies were used together with champions. Champions were identified by study authors as one of the single most effective strategies employed in all studies. The majority of studies described the champion role as that of a leader, who fosters and reinforces changes for improvement. Although all the included studies suggested that implementing nurse or aid champions in their QI initiatives were important facilitators of success, how the champions were selected and trained in their role is either missing or not described in any detail in the studies included in the review. Utilizing certified nursing assistants as QI champions can increase participation in QI projects and has the potential to improve job satisfaction and contribute to improve quality of care and improved patient outcomes in nursing homes. © 2017 Sigma Theta Tau International.

  17. Collaboration between Hospital and Community Pharmacists to Improve Medication Management from Hospital to Home

    Directory of Open Access Journals (Sweden)

    Judith Kristeller

    2017-05-01

    Full Text Available Objective: The objective of this study is to determine if a model for patient-centered care that integrates medication management between hospital and community pharmacists is feasible and can improve medication adherence. Design: This was a randomized, non-blinded, interventional study of 69 patients discharged from a hospital to home. Process measures include the number and type of medication-related discrepancies or problems identified, patient willingness to participate, the quality and quantity of interactions with community pharmacists, hospital readmissions, and medication adherence. Setting: A 214-bed acute care hospital in Northeastern Pennsylvania and seventeen regional community pharmacies. Patients: Enrolled patients were hospitalized with a primary or secondary diagnosis of heart failure or COPD, had a planned discharge to home, and agreed to speak to one of seventeen community pharmacists within the study network (i.e., a network community pharmacist following hospital discharge. Intervention: Information about a comprehensive medication review completed by the hospital pharmacist was communicated with the network community pharmacist to assist with providing medication therapy management following hospital discharge. Results: Of 180 patients eligible for the study, 111 declined to participate. Many patients were reluctant to talk to an additional pharmacist, however if the patient’s pharmacist was already within the network of 17 pharmacies, they usually agreed to participate. The study enrolled 35 patients in the intervention group and 34 in the control group. An average of 6 medication-related problems per patient were communicated to the patient’s network community pharmacist after discharge. In the treatment group, 44% of patients had at least one conversation with the network community pharmacist following hospital discharge. There was no difference in post-discharge adherence between the groups (Proportion of Days

  18. Improvement of home composting process of food waste using different minerals.

    Science.gov (United States)

    Margaritis, M; Psarras, K; Panaretou, V; Thanos, A G; Malamis, D; Sotiropoulos, A

    2018-03-01

    This article presents the experimental study of the process of composting in a prototype home-scale system with a special focus on process improvement by using different additives (i.e. woodchips, perlite, vermiculite and zeolite). The interventions with different bulking agents were realized through composting cycles using substrates with 10% additives in specific mixtures of kitchen waste materials. The pre-selected proportion of the mixtures examined was 3:1:1 in cellulosic:proteins:carbohydrates, in order to achieve an initial C/N ratio equal to 30. The control of the initial properties of the examined substrates aimed at the consequent improvement of the properties of the final product (compost). The results indicated that composting process was enhanced with the use of additives and especially the case of zeolite and perlite provided the best results, in terms of efficient temperature evolution (>55 °C for 4 consecutive days). Carbon to nitrogen ratios decreased by 40% from the initial values for the reactors were minerals were added, while for the bioreactor tested with woodchips the reduction was slight, showing slowest degradation rate. Moisture content of produced compost varied within the range of 55-64% d.m., while nutrient content (K, Na, Ca, Mg) was in accordance with the limit values reported in literature. Finally, the composts obtained, exhibited a satisfactory degree of maturity, fulfilling the criterion related to the absence of phytotoxic compounds. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Home cooking and ingredient synergism improve lycopene isomer production in Sofrito.

    Science.gov (United States)

    Rinaldi de Alvarenga, José Fernando; Tran, Camilla; Hurtado-Barroso, Sara; Martinez-Huélamo, Miriam; Illan, Montserrat; Lamuela-Raventos, Rosa M

    2017-09-01

    There has been increasing interest in tomato products rich in lycopene Z-isomers since these carotenoids present greater bioavailability and antioxidant capacity than the all-E lycopene form. Intrinsic food properties as well as processing and the interaction between dietary components can all influence the content, type and bioavailability of carotenoids. The aim of this study was to evaluate whether carotenoid content and isomerization in tomato-based Mediterranean sofrito is affected by the process of home cooking and the presence of other ingredients such as extra virgin olive oil, onion and garlic. We used a full factorial design to clarify the contribution of each ingredient to the carotenoid composition of sofrito and to determine whether this can be improved by the cooking time and ingredient synergism. Cooking time and onion content were associated with a higher production of 5-Z-lycopene, 9-Z-lycopene and 13-Z-lycopene in sofrito. Onion proved to be the most interesting ingredient in the sofrito formulation due to their enhancing effect on lycopene isomerization. The use of onion combined with an adequate processing time may improve the bioavailability of lycopene in tomato products. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Differential Susceptibility of Bighorn Sheep (Ovis canadensis) and Domestic Sheep (Ovis aries) Neutrophils to Mannheimia haemolytica Leukotoxin is not due to Differential Expression of Cell Surface CD18.

    Science.gov (United States)

    Dassanayake, Rohana P; Shanthalingam, Sudarvili; Liu, Weiguo; Casas, Eduardo; Srikumaran, Subramaniam

    2017-07-01

    Bighornsheep ( Ovis canadensis ) are more susceptible to pneumonia caused by Mannheimia haemolytica than are domestic sheep ( Ovis aries ). Leukotoxin produced by M. haemolytica is the principal virulence factor involved in pneumonia pathogenesis. Although leukotoxin is cytolytic to all subsets of ruminant leukocytes, neutrophils are the most susceptible subset. Bighorn sheep neutrophils are four- to eightfold more susceptible to leukotoxin-induced cytolysis than are domestic sheep neutrophils. We hypothesized that the higher susceptibility of bighorn sheep neutrophils, in comparison to domestic sheep neutrophils, is due to higher expression of CD18, the receptor for leukotoxin on leukocytes. Our objective was to quantify CD18 expression on neutrophils of bighorn sheep and domestic sheep. Cell-surface CD18 expression on bighorn sheep and domestic sheep neutrophils was measured as antibody binding capacity of cells by flow cytometric analysis with two fluorochrome-conjugated anti-CD18 monoclonal antibodies (BAQ30A and HUH82A) and microspheres. Contrary to our expectations, CD18 expression was higher (Psheep neutrophils in comparison to bighorn sheep neutrophils. These findings suggest that the higher in vitro susceptibility to leukotoxin of bighorn sheep neutrophils compared to domestic sheep neutrophils is not due to higher expression of the leukotoxin receptor CD18 on bighorn sheep neutrophils.

  1. Adoption of Lean Thinking and Service Improvement for Care Home Service

    OpenAIRE

    Chuang-Chun Chiou

    2014-01-01

    Ageing population is a global trend; therefore the need of care service has been increasing dramatically. There are three basic forms of service delivered to the elderly: institution, community, and home. Particularly, the institutional service can be seen as an extension of medical service. The nursing home or so-called care home which is equipped with professional staff and facilities can provide a variety of service including rehabilitation service, short-term care, and long term care. Sim...

  2. Energy Storage System Control Algorithm by Operating Target Power to Improve Energy Sustainability of Smart Home

    OpenAIRE

    Byeongkwan Kang; Kyuhee Jang; Sounghoan Park; Myeong-in Choi; Sehyun Park

    2018-01-01

    As energy issues are emerging around the world, a variety of smart home technologies aimed at realizing zero energy houses are being introduced. Energy storage system (ESS) for smart home energy independence is increasingly gaining interest. However, limitations exist in that most of them are controlled according to time schedules or used in conjunction with photovoltaic (PV) generation systems. In consideration of load usage patterns and PV generation of smart home, this study proposes an ES...

  3. Contact and contagion: Probability of transmission given contact varies with demographic state in bighorn sheep.

    Science.gov (United States)

    Manlove, Kezia R; Cassirer, E Frances; Plowright, Raina K; Cross, Paul C; Hudson, Peter J

    2017-07-01

    Understanding both contact and probability of transmission given contact are key to managing wildlife disease. However, wildlife disease research tends to focus on contact heterogeneity, in part because the probability of transmission given contact is notoriously difficult to measure. Here, we present a first step towards empirically investigating the probability of transmission given contact in free-ranging wildlife. We used measured contact networks to test whether bighorn sheep demographic states vary systematically in infectiousness or susceptibility to Mycoplasma ovipneumoniae, an agent responsible for bighorn sheep pneumonia. We built covariates using contact network metrics, demographic information and infection status, and used logistic regression to relate those covariates to lamb survival. The covariate set contained degree, a classic network metric describing node centrality, but also included covariates breaking the network metrics into subsets that differentiated between contacts with yearlings, ewes with lambs, and ewes without lambs, and animals with and without active infections. Yearlings, ewes with lambs, and ewes without lambs showed similar group membership patterns, but direct interactions involving touch occurred at a rate two orders of magnitude higher between lambs and reproductive ewes than between any classes of adults or yearlings, and one order of magnitude higher than direct interactions between multiple lambs. Although yearlings and non-reproductive bighorn ewes regularly carried M. ovipneumoniae, our models suggest that a contact with an infected reproductive ewe had approximately five times the odds of producing a lamb mortality event of an identical contact with an infected dry ewe or yearling. Consequently, management actions targeting infected animals might lead to unnecessary removal of young animals that carry pathogens but rarely transmit. This analysis demonstrates a simple logistic regression approach for testing a priori

  4. Tailored mental health care after nursing home admission: improving transfers of people with dementia with behavioral problems. An explorative study.

    Science.gov (United States)

    Van Mierlo, L D; Bootsma-Van der Wiel, A; Meiland, F J M; Van Hout, H P J; Stek, M L; Dröes, R M

    2015-01-01

    In the Netherlands, many community-dwelling people with dementia and behavioral disturbances and their family caregivers receive mental health care from a community psychiatric nurse (CPN). To promote continuity of care for these persons after moving to a nursing home, a transfer intervention was developed. The aim of this explorative study was to evaluate this intervention and its implementation. A qualitative explorative study design was used. CPNs visited professional nursing home carers, people with dementia and family caregivers six weeks after moving, advised on how to manage behavioral problems of their former clients and provided support to family caregivers. Twenty-two interviews were conducted with participants exposed to the intervention (5 CPNs, 5 family and 12 nursing home carers) and with 11 stakeholders (i.e., nursing home and mental health care managers, professional caregivers) to identify facilitators and barriers to the implementation. Data were collected in 2012 and 2013. The follow-up visit at six weeks met the need for background information of new admitted patients and helped family caregivers close off the period prior to the move. It did not meet the original purpose of providing nursing home staff with advice about problem behaviors on time: six weeks after the move was experienced as too late. The transfer intervention increased the awareness of nursing home staff about personal and behavioral characteristics of residents with dementia and supported caregivers in coping with the new situation. The timing of the intervention could be improved by scheduling it immediately after the move.

  5. Improving Maternal Healthcare Access and Neonatal Survival through a Birthing Home Model in Rural Haiti

    Directory of Open Access Journals (Sweden)

    Elizabeth Wickstrom

    2007-10-01

    Full Text Available High neonatal mortality in Haiti is sustained by limited access to essential maternity services, particularly for Haiti’s rural population. We investigated the feasibility of a rural birthing home model to provide basic prenatal, delivery, and neonatal services for women with uncomplicated pregnancies while simultaneously providing triage and transport of women with pregnancy related complications. The model included consideration of the local context, including women’s perceptions of barriers to healthcare access and available resources to implement change. Evaluation methods included the performance of a baseline community census and collection of pregnancy histories from 791 women living in a defined area of rural Haiti. These retrospective data were compared with pregnancy outcome for 668 women subsequently receiving services at the birthing home. Of 764 reported most recent pregnancies in the baseline survey, 663(87% occurred at home with no assistance from skilled health staff. Of 668 women followed after opening of the birthing home, 514 (77% subsequently gave birth at the birthing home, 94 (14% were referred to a regional hospital for delivery, and only 60 (9% delivered at home or on the way to the birthing home. Other measures of clinical volume and patient satisfaction also indicated positive changes in health care seeking. After introduction of the birthing home, fewer neonates died than predicted by historical information or national statistics. The present experience points out the feasibility of a rural birthing home model to increase access to essential maternity services.

  6. A Smart Gateway Architecture for Improving Efficiency of Home Network Applications

    Directory of Open Access Journals (Sweden)

    Fei Ding

    2016-01-01

    Full Text Available A smart home gateway plays an important role in the Internet of Things (IoT system that takes responsibility for the connection between the network layer and the ubiquitous sensor network (USN layer. Even though the home network application is developing rapidly, researches on the home gateway based open development architecture are less. This makes it difficult to extend the home network to support new applications, share service, and interoperate with other home network systems. An integrated access gateway (IAGW is proposed in this paper which upward connects with the operator machine-to-machine platform (M2M P/F. In this home network scheme, the gateway provides standard interfaces for supporting various applications in home environments, ranging from on-site configuration to node and service access. In addition, communication management ability is also provided by M2M P/F. A testbed of a simple home network application system that includes the IAGW prototype is created to test its user interaction capabilities. Experimental results show that the proposed gateway provides significant flexibility for users to configure and deploy a home automation network; it can be applied to other monitoring areas and simultaneously supports a multi-ubiquitous sensor network.

  7. Home blood pressure monitoring, secure electronic messaging and medication intensification for improving hypertension control: a mediation analysis.

    Science.gov (United States)

    Ralston, J D; Cook, A J; Anderson, M L; Catz, S L; Fishman, P A; Carlson, J; Johnson, R; Green, B B

    2014-01-01

    We evaluated the role of home monitoring, communication with pharmacists, medication intensification, medication adherence and lifestyle factors in contributing to the effectiveness of an intervention to improve blood pressure control in patients with uncontrolled essential hypertension. We performed a mediation analysis of a published randomized trial based on the Chronic Care Model delivered over a secure patient website from June 2005 to December 2007. Study arms analyzed included usual care with a home blood pressure monitor and usual care with home blood pressure monitor and web-based pharmacist care. Mediator measures included secure messaging and telephone encounters; home blood pressure monitoring; medications intensification and adherence and lifestyle factors. Overall fidelity to the Chronic Care Model was assessed with the Patient Assessment of Chronic Care (PACIC) instrument. The primary outcome was percent of participants with blood pressure (BP) <140/90 mm Hg. At 12 months follow-up, patients in the web-based pharmacist care group were more likely to have BP <140/90 mm Hg (55%) compared to patients in the group with home blood pressure monitors only (37%) (p = 0.001). Home blood pressure monitoring accounted for 30.3% of the intervention effect, secure electronic messaging accounted for 96%, and medication intensification for 29.3%. Medication adherence and self-report of fruit and vegetable intake and weight change were not different between the two study groups. The PACIC score accounted for 22.0 % of the main intervention effect. The effect of web-based pharmacist care on improved blood pressure control was explained in part through a combination of home blood pressure monitoring, secure messaging, and antihypertensive medication intensification.

  8. Caring for the Elderly at Work and Home: Can a Randomized Organizational Intervention Improve Psychological Health?

    Science.gov (United States)

    Kossek, Ellen Ernst; Thompson, Rebecca J; Lawson, Katie M; Bodner, Todd; Perrigino, Matthew B; Hammer, Leslie B; Buxton, Orfeu M; Almeida, David M; Moen, Phyllis; Hurtado, David A; Wipfli, Brad; Berkman, Lisa F; Bray, Jeremy W

    2017-12-07

    Although job stress models suggest that changing the work social environment to increase job resources improves psychological health, many intervention studies have weak designs and overlook influences of family caregiving demands. We tested the effects of an organizational intervention designed to increase supervisor social support for work and nonwork roles, and job control in a results-oriented work environment on the stress and psychological distress of health care employees who care for the elderly, while simultaneously considering their own family caregiving responsibilities. Using a group-randomized organizational field trial with an intent-to-treat design, 420 caregivers in 15 intervention extended-care nursing facilities were compared with 511 caregivers in 15 control facilities at 4 measurement times: preintervention and 6, 12, and 18 months. There were no main intervention effects showing improvements in stress and psychological distress when comparing intervention with control sites. Moderation analyses indicate that the intervention was more effective in reducing stress and psychological distress for caregivers who were also caring for other family members off the job (those with elders and those "sandwiched" with both child and elder caregiving responsibilities) compared with employees without caregiving demands. These findings extend previous studies by showing that the effect of organizational interventions designed to increase job resources to improve psychological health varies according to differences in nonwork caregiving demands. This research suggests that caregivers, especially those with "double-duty" elder caregiving at home and work and "triple-duty" responsibilities, including child care, may benefit from interventions designed to increase work-nonwork social support and job control. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  9. Passive transfer in domestic and bighorn lambs Total IgG in ewe sera and colostrum and serum IgG kinetics in lambs following colostrum ingestion are similar in domestic sheep and bighorn sheep (ovis aries and ovis canadensis)

    Science.gov (United States)

    Pneumonia is a population-limiting disease of bighorn sheep (BHS; Ovis canadensis) and a recognized disease entity in domestic sheep (DS; Ovis aries) worldwide. Respiratory disease in BHS lambs can persist for years after all-age outbreaks, resulting in suppressed lamb recruitment. It has been sugge...

  10. Linking Structure, Process, and Outcome to Improve Group Home Services for Foster Youth in California

    Science.gov (United States)

    Green, Rex S.; Ellis, Peter T.

    2007-01-01

    The California Youth Connection obtained funding from two foundations to evaluate the performance of group homes serving foster youth in Alameda County, California, in order to inform state policy-making. The evaluation team initially included 14 foster youth that personally experienced group home living. Three inter-related aspects of service…

  11. Project CHERISH (Children in Home Environments: Regulation To Improve Safety and Health). Final Report.

    Science.gov (United States)

    Grubb, Paul Dallas

    In 1990, Project CHERISH (Children in Home Environments: Regulation to Increase Safety and Health) enabled the Texas Department of Human Services to implement and evaluate several innovative strategies to strengthen regulation of family day care homes. This report contains descriptions of those strategies, an evaluation of their efficacy, and…

  12. The Pew Home Visiting Campaign: Helping States Improve Quality, Evaluation, and Accountability

    Science.gov (United States)

    Schlitt, John

    2010-01-01

    The Pew Home Visiting Campaign was launched in 2009 by the Pew Center on the States to guide state policymakers toward smart investments in quality, voluntary home-based programs for new and expectant families. In light of the federal development and pressing needs of states, the campaign will assist states in several ways, including policy…

  13. Improving Older Adults' Functional Ability through Service Use in a Home Care Program in Hong Kong

    Science.gov (United States)

    Cheung, Chau-kiu; Ngan, Raymond Man-hung

    2005-01-01

    Objective: Despite past findings about the contribution of home care services to older users' functional ability, the effective processes and components of the services are not transparent. Such processes appear to rely on the actual use of component services of the home care program. Method: The study gathered 116 observations during 2 years…

  14. Transforming Data into Practical Information: Using Consumer Input to Improve Home-Care Services

    Science.gov (United States)

    Applebaum, Robert; Kunkel, Suzanne; Wilson, Ken

    2007-01-01

    Purpose: As funds have increased for the provision of in-home care, so too have concerns about the quality of services. In response, care management agencies and home-care providers have developed an array of monitoring activities designed to ensure the quality of services. In this article, we show how an area agency on aging both collected and…

  15. Evidence-Based Health Promotion in Nursing Homes: A Pilot Intervention to Improve Oral Health

    Science.gov (United States)

    Cadet, Tamara J.; Berrett-Abebe, Julie; Burke, Shanna L.; Bakk, Louanne; Kalenderian, Elsbeth; Maramaldi, Peter

    2016-01-01

    Nursing home residents over the age of 65 years are at high risk for poor oral health and related complications such as pneumonia and adverse diabetes outcomes. A preliminary study found that Massachusetts' nursing homes generally lack the training and resources needed to provide adequate oral health care to residents. In this study, an…

  16. Effects of improved home heating on asthma in community dwelling children: randomised controlled trial.

    Science.gov (United States)

    Howden-Chapman, Philippa; Pierse, Nevil; Nicholls, Sarah; Gillespie-Bennett, Julie; Viggers, Helen; Cunningham, Malcolm; Phipps, Robyn; Boulic, Mikael; Fjällström, Pär; Free, Sarah; Chapman, Ralph; Lloyd, Bob; Wickens, Kristin; Shields, David; Baker, Michael; Cunningham, Chris; Woodward, Alistair; Bullen, Chris; Crane, Julian

    2008-09-23

    To assess whether non-polluting, more effective home heating (heat pump, wood pellet burner, flued gas) has a positive effect on the health of children with asthma. Randomised controlled trial. Households in five communities in New Zealand. 409 children aged 6-12 years with doctor diagnosed asthma. Installation of a non-polluting, more effective home heater before winter. The control group received a replacement heater at the end of the trial. The primary outcome was change in lung function (peak expiratory flow rate and forced expiratory volume in one second, FEV(1)). Secondary outcomes were child reported respiratory tract symptoms and daily use of preventer and reliever drugs. At the end of winter 2005 (baseline) and winter 2006 (follow-up) parents reported their child's general health, use of health services, overall respiratory health, and housing conditions. Nitrogen dioxide levels were measured monthly for four months and temperatures in the living room and child's bedroom were recorded hourly. Improvements in lung function were not significant (difference in mean FEV(1) 130.7 ml, 95% confidence interval -20.3 to 281.7). Compared with children in the control group, however, children in the intervention group had 1.80 fewer days off school (95% confidence interval 0.11 to 3.13), 0.40 fewer visits to a doctor for asthma (0.11 to 0.62), and 0.25 fewer visits to a pharmacist for asthma (0.09 to 0.32). Children in the intervention group also had fewer reports of poor health (adjusted odds ratio 0.48, 95% confidence interval 0.31 to 0.74), less sleep disturbed by wheezing (0.55, 0.35 to 0.85), less dry cough at night (0.52, 0.32 to 0.83), and reduced scores for lower respiratory tract symptoms (0.77, 0.73 to 0.81) than children in the control group. The intervention was associated with a mean temperature rise in the living room of 1.10 degrees C (95% confidence interval 0.54 degrees C to 1.64 degrees C) and in the child's bedroom of 0.57 degrees C (0.05 degrees C

  17. 'right@home': a randomised controlled trial of sustained nurse home visiting from pregnancy to child age 2 years, versus usual care, to improve parent care, parent responsivity and the home learning environment at 2 years.

    Science.gov (United States)

    Goldfeld, Sharon; Price, Anna; Bryson, Hannah; Bruce, Tracey; Mensah, Fiona; Orsini, Francesca; Gold, Lisa; Hiscock, Harriet; Smith, Charlene; Bishop, Lara; Jackson, Dianne; Kemp, Lynn

    2017-03-20

    By the time children start school, inequities in learning, development and health outcomes are already evident. Sustained nurse home visiting (SNHV) offers a potential platform for families experiencing adversity, who often have limited access to services. While SNHV programmes have been growing in popularity in Australia and internationally, it is not known whether they can improve children's learning and development when offered via the Australian service system. The right@home trial aims to investigate the effectiveness of an SNHV programme, offered to women from pregnancy to child age 2 years, in improving parent care of and responsivity to the child, and the home learning environment. Pregnant Australian women (n=722) are identified after completing a screening survey of 10 factors known to predict children's learning and development (eg, young pregnancy, poor mental or physical health, lack of support). Consenting women-surveyed while attending clinics at 10 hospitals in Victoria and Tasmania-are enrolled if they report having 2 or more risk factors. The intervention comprises 25 home visits from pregnancy to 2 years, focusing on parent care of the child, responsivity to the child and providing a good quality home learning environment. The standard, universal, Australian child and family health service provides the comparator (control). Primary outcome measures include a combination of parent-reported and objective assessments of children's sleep, safety, nutrition, parenting styles and the home learning environment, including the Home Observation of the Environment Inventory and items adapted from the Longitudinal Study of Australian Children. This study is approved by the Royal Children's Hospital Human Research Ethics Committees (HREC 32296) and site-specific HRECs. The investigators and sponsor will communicate the trial results to stakeholders, participants, healthcare professionals, the public and other relevant groups via presentations and

  18. Does Person-Centered Care Improve Residents' Satisfaction With Nursing Home Quality?

    Science.gov (United States)

    Poey, Judith L; Hermer, Linda; Cornelison, Laci; Kaup, Migette L; Drake, Patrick; Stone, Robyn I; Doll, Gayle

    2017-11-01

    Person-centered care (PCC) is meant to enhance nursing home residents' quality of life (QOL). Including residents' perspectives is critical to determining whether PCC is meeting residents' needs and desires. This study examines whether PCC practices promote satisfaction with QOL and quality of care and services (QOC and QOS) among nursing home residents. A longitudinal, retrospective cohort study using an in-person survey. Three hundred twenty nursing homes in Kansas enrolled or not enrolled in a pay-for-performance program, Promoting Excellent Alternatives in Kansas (PEAK 2.0), to promote PCC in nursing homes. A total of 6214 nursing home residents in 2013-2014 and 5538 residents in 2014-2015, with a Brief Interview for Mental Status score ≥8, participated in face-to-face interviews. Results were aggregated to the nursing home level. My InnerView developed a Resident Satisfaction Survey for Kansas composed of 32 questions divided into QOL, QOC, QOS, and global satisfaction subdomains. After controlling for facility characteristics, satisfaction with overall QOL and QOC was higher in homes that had fully implemented PCC. Although some individual measures in the QOS domain (eg, food) showed greater satisfaction at earlier levels of implementation, high satisfaction was observed primarily in homes that had fully implemented PCC. These findings provide evidence for the effectiveness of PCC implementation on nursing home resident satisfaction. The PEAK 2.0 program may provide replicable methods for nursing homes and states to implement PCC systematically. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  19. Patient-centered medical homes improve care for adults with chronic conditions.

    Science.gov (United States)

    Pourat, Nadereh; Lavarreda, Shana Alex; Snyder, Sophie

    2013-05-01

    The success of health care reform implementation in 2014 partly depends on more efficient delivery of care to the millions of California residents eligible to gain insurance. Emerging evidence supports the effectiveness of the patient-centered medical home (PCMH) as a potential model of care delivery, which improves health outcomes and reduces costs. Among other principles, PCMH entails receipt of care from a personal doctor, who coordinates the patient's care and develops an individualized treatment plan for the patient. These principles are particularly essential in delivery of care to those with chronic conditions who require more intensive care management. Using the 2009 California Health Interview Survey (CHIS 2009), this policy brief indicates that patients who reported meeting these fundamental PCMH principles were more likely to have visited the doctor and to have received flu shots, and they also had better communication with providers than those who did not report meeting these PCMH principles. The data also showed that uninsured individuals, Medi-Cal beneficiaries, those at or below 133% of the federal poverty level, Latinos, and Asian-Americans were less likely to report meeting all three PCMH principles. These findings highlight the population groups that would most benefit from the PCMH care delivery model, particularly Medi-Cal beneficiaries and those eligible for Covered California, the California health benefits exchange.

  20. Does the Texas First Dental Home Program Improve Parental Oral Care Knowledge and Practices?

    Science.gov (United States)

    Thompson, Charmaine L; McCann, Ann L; Schneiderman, Emet D

    2017-03-15

    This study evaluated the effectiveness of the Texas Medicaid First Dental Home (FDH) by comparing the oral health knowledge, practices, and opinions of participating vs. non-participating parents. A 29-question survey (English & Spanish) was developed and administered to 165 parents of children under three years old (FDH=49, Non-FDH=116) who visited qualifying Medicaid clinics in Texas. Mann Whitney U tests showed that FDH parents scored higher on overall knowledge (P=0.001) and practice scores (Pparents responded correctly more often than non-FDH about the recommended amount of toothpaste for toddlers (Pparents knew tap water was a potential source of fluoride (Pparents scored marginally higher about when a child should have the first dental visit (P=0.051). More Non-FDH parents let their child go to sleep with a bottle, sippy cup or pacifier (Pparents by increasing their oral healthcare knowledge and practices. This is the first step towards improving the oral health of children.

  1. Improving children?s health and development in British Columbia through nurse home visiting: a randomized controlled trial protocol

    OpenAIRE

    Catherine, Nicole L. A.; Gonzalez, Andrea; Boyle, Michael; Sheehan, Debbie; Jack, Susan M.; Hougham, Kaitlyn A.; McCandless, Lawrence; MacMillan, Harriet L.; Waddell, Charlotte

    2016-01-01

    Background Nurse-Family Partnership is a nurse home visitation program that aims to improve the lives of young mothers and their children. The program focuses on women who are parenting for the first time and experiencing socioeconomic disadvantage. Nurse visits start as early in pregnancy as possible and continue until the child reaches age two years. The program has proven effective in the United States ? improving children?s mental health and development and maternal wellbeing, and showing...

  2. Book Review: And then there were none: The demise of Desert Bighorn Sheep in the Pusch Ridge Wilderness

    Science.gov (United States)

    Cain, James W.

    2018-01-01

    And Then There Were None: The Demise of Desert Bighorn Sheep in the Pusch Ridge Wilderness. Paul R.Krausman. 2017. The University of New Mexico Press, Albuquerque, New Mexico, USA. 248 pp. $65.00 hardcover. ISBN 978‐0‐8263‐5785‐4.

  3. Bighorn sheep (Ovis canadensis) sinus tumors are associated with coinfections by potentially pathogenic bacteria in the upper respiratory tract.

    Science.gov (United States)

    Fox, Karen A; Rouse, Natalie M; Huyvaert, Kathryn P; Griffin, Karen A; Killion, Halcyon J; Jennings-Gaines, Jessica; Edwards, William H; Quackenbush, Sandra L; Miller, Michael W

    2015-01-01

    Bighorn sheep (Ovis canadensis) sinus tumors are hyperplastic to neoplastic, predominantly stromal masses of the paranasal sinuses that expand the sinus lining and obstruct the sinus cavities. Obstruction of the sinus cavities and disruption of normal sinus lining anatomy may interfere with clearance of bacterial pathogens from the upper respiratory tract. To examine this possibility, we explored whether the presence of sinus tumor features (tumor score) affected the likelihood of detecting potentially pathogenic bacteria from upper respiratory sinus lining tissues in bighorn sheep. We developed or used existing PCR assays for the detection of leukotoxigenic Pasteurellaceae and Mycoplasma ovipneumoniae in sinus lining tissues collected from 97 bighorn sheep in Colorado, US from 2009 to 2012. With the use of logistic regression analyses we found that tumor score was a good predictor of the probability of detecting potentially pathogenic bacteria in sinus lining tissues; we were more likely to detect potentially pathogenic bacteria from samples with high tumor scores. These findings add to our understanding of possible mechanisms for the maintenance and shedding of bacterial agents from the upper respiratory tracts of bighorn sheep.

  4. Experimental contact transmission of Pasteurella haemolytica from clinically normal domestic sheep causing pneumonia in Rocky Mountain bighorn sheep.

    Science.gov (United States)

    Onderka, D K; Wishart, W D

    1988-10-01

    Two Rocky Mountain bighorn lambs (Ovis canadensis canadensis) were held in captivity for 120 days before being housed with two domestic sheep. The lambs were clinically normal and had no Pasteurella spp. on nasal swab cultures. The domestic sheep were known to carry Pasteurella haemolytica biotype A in the nasal passages. After being in close contact for 19 days. P. haemolytica biotype A was cultured from nasal swabs of one of the bighorn lambs. By 26 days, both bighorn sheep developed coughs, were anorectic and became lethargic and nasal swabs yielded P. haemolytica biotype T, serotype 10. Twenty-nine days after contact, the lambs were necropsied and found to have extensive fibrinous bronchopneumonia. From affected tissues pure cultures of beta-hemolytic P. haemolytica biotype T, serotype 10 were grown. Both domestic sheep remained clinically normal and had no gross or microscopic lesions, but they carried the same P. haemolytica serotype in their tonsils. Behavioural observations gave no indication of stress in the bighorn lambs.

  5. Preliminary study of uranium favorability of upper cretaceous, paleocene, and lower eocene rocks of the Bighorn Basin, Wyoming and Montana

    International Nuclear Information System (INIS)

    Hesse, S.L.; Dunagan, J.F. Jr.

    1978-02-01

    This report presents an evaluation of the uranium favorability of continental sediments of the Upper Cretaceous Lance, Paleocene Polecat Bench, and lower Eocene Willwood Formations in the Bighorn Basin of Wyoming and Montana, an intermontane structural basin of Laramide age. Previous work dealing with the Bighorn Basin was reviewed, and field investigations were carried out in the spring and summer of 1976. Subsurface data were collected and results of surface and subsurface investigations were evaluated with respect to uranium favorability. Precambrian plutonic and metamorphic rocks and Tertiary tuffaceous rocks in the Bighorn Basin and bordering uplifts are considered insignificant as source rocks, although the Wiggins Formation (White River equivalent) cannot be evaluated as a possible source because of a lack of data. Potential host rocks locally show only limited favorability. Lithology of strata exposed along the western and southern basin margins is more favorable than that of rocks in the central and eastern parts of the basin, but there is little organic material, pyrite, or other reducing agents in these rocks. Strata of the Lance, Polecat Bench, and Willwood Formations in the Bighorn Basin are considered generally unfavorable for sandstone uranium deposits

  6. Estimating bighorn sheep (Ovis Canadensis) abundance using noninvasive sampling at a mineral lick within a national park wilderness area

    Science.gov (United States)

    Kathryn A. Schoenecker; Mary Kay Watry; Laura E. Ellison; Michael K. Schwartz; Gordon L. Luikart

    2015-01-01

    Conservation of species requires accurate population estimates. We used genetic markers from feces to determine bighorn sheep abundance for a herd that was hypothesized to be declining and in need of population status monitoring. We sampled from a small but accessible portion of the population’s range where animals naturally congregate at a natural mineral lick to test...

  7. 75 FR 28642 - Limiting Mountain Lion Predation on Desert Bighorn Sheep on Kofa National Wildlife Refuge, Yuma...

    Science.gov (United States)

    2010-05-21

    ... DEPARTMENT OF THE INTERIOR Fish and Wildlife Service [FWS-R2-R-2009-N274] [22570-1261-0000-K2] Limiting Mountain Lion Predation on Desert Bighorn Sheep on Kofa National Wildlife Refuge, Yuma and La Paz Counties, AZ AGENCY: Fish and Wildlife Service, Interior. ACTION: Notice of availability of the final...

  8. Virtual Telemedicine Visits in Pediatric Home Parenteral Nutrition Patients: A Quality Improvement Initiative.

    Science.gov (United States)

    Raphael, Bram P; Schumann, Caitlin; Garrity-Gentille, Sara; McClelland, Jennifer; Rosa, Carolyn; Tascione, Christina; Gallotto, Mary; Takvorian-Bené, Melissa; Carey, Alexandra N; McCarthy, Patrick; Duggan, Christopher; Ozonoff, Al

    2018-05-04

    Despite being less costly than prolonged hospitalization, home parenteral nutrition (HPN) is associated with high rates of post-discharge complications, including frequent readmissions and central line-associated bloodstream infections (CLABSIs). Telemedicine has been associated with improved outcomes and reduced healthcare utilization in other high-risk populations, but no studies to date have supported effectiveness of telemedicine in pediatric HPN. We prospectively collected data on pediatric patients managed at a single HPN program who participated in postdischarge telemedicine visits from March 1, 2014 to March 30, 2016. We excluded patients with a history of HPN and strictly palliative care goals. Univariate analysis was performed for primary outcomes: Community-acquired CLABSI and 30-day readmission rate. Twenty-six families participated in the pilot initiative with median (interquartile range) patient age 1.5 (5.7) years old, diagnosis of short bowel syndrome in 16 (62%), and in-state residence in 17 (55%). Ishikawa (fishbone) diagram identified causes of post-discharge HPN complications. Areas of focus during telemedicine visit included central venous catheter care methods, materials, clinical concerns, and equipment. Compared to historical comparison group, the telemedicine group experienced CLABSI rates of 1.0 versus 2.7 per 1,000 line days and readmission rates of 38% versus 17% (p = 0.03, 0.02, respectively). Telemedicine visits identified opportunities for improvement for families newly discharged on HPN. In a small cohort of patients who experienced telemedicine visits, we found lower CLABSI rates alongside higher readmission rates compared with a historical comparison group. Further studies are needed to optimize telemedicine in delivering care to this high-risk population.

  9. An Improved Optimization Function for Maximizing User Comfort with Minimum Energy Consumption in Smart Homes

    Directory of Open Access Journals (Sweden)

    Israr Ullah

    2017-11-01

    Full Text Available In the smart home environment, efficient energy management is a challenging task. Solutions are needed to achieve a high occupant comfort level with minimum energy consumption. User comfort is measured in terms of three fundamental parameters: (a thermal comfort, (b visual comfort and (c air quality. Temperature, illumination and CO 2 sensors are used to collect indoor contextual information. In this paper, we have proposed an improved optimization function to achieve maximum user comfort in the building environment with minimum energy consumption. A comprehensive formulation is done for energy optimization with detailed analysis. The Kalman filter algorithm is used to remove noise in sensor readings by predicting actual parameter values. For optimization, we have used genetic algorithm (GA and particle swarm optimization (PSO algorithms and performed comparative analysis with a baseline scheme on real data collected for a one-month duration in our lab’s indoor environment. Experimental results show that the proposed optimization function has achieved a 27 . 32 % and a 31 . 42 % reduction in energy consumption with PSO and GA, respectively. The user comfort index was also improved by 10 % i.e., from 0 . 86 to 0 . 96 . GA-based optimization results were better than PSO, as it has achieved almost the same user comfort with 4 . 19 % reduced energy consumption. Results show that the proposed optimization function gives better results than the baseline scheme in terms of user comfort and the amount of consumed energy. The proposed system can help with collecting the data about user preferences and energy consumption for long-term analysis and better decision making in the future for efficient resource utilization and overall profit maximization.

  10. Role of carriers in the transmission of pneumonia in bighorn sheep (Ovis canadensis).

    Science.gov (United States)

    Raghavan, Bindu; Erickson, Kayla; Kugadas, Abirami; Batra, Sai A; Call, Douglas R; Davis, Margaret A; Foreyt, William J; Srikumaran, Subramaniam

    2016-06-15

    In the absence of livestock contact, recurring lamb mortality in bighorn sheep (Ovis canadensis) populations previously exposed to pneumonia indicates the likely presence of carriers of pneumonia-causing pathogens, and possibly inadequate maternally derived immunity. To investigate this problem we commingled naïve, pregnant ewes (n=3) with previously exposed rams (n=2). Post-commingling, all ewes and lambs born to them acquired pneumonia-causing pathogens (leukotoxin-producing Pasteurellaceae and Mycoplasma ovipneumoniae), with subsequent lamb mortality between 4-9 weeks of age. Infected ewes became carriers for two subsequent years and lambs born to them succumbed to pneumonia. In another experiment, we attempted to suppress the carriage of leukotoxin-producing Pasteurellaceae by administering an antibiotic to carrier ewes, and evaluated lamb survival. Lambs born to both treatment and control ewes (n=4 each) acquired pneumonia and died. Antibody titers against leukotoxin-producing Pasteurellaceae in all eight ewes were 'protective' (>1:800 and no apparent respiratory disease); however their lambs were either born with comparatively low titers, or with high (but non-protective) titers that declined rapidly within 2-8 weeks of age, rendering them susceptible to fatal disease. Thus, exposure to pneumonia-causing pathogens from carrier ewes, and inadequate titers of maternally derived protective antibodies, are likely to render bighorn lambs susceptible to fatal pneumonia. © 2016. Published by The Company of Biologists Ltd.

  11. Food habits and radionuclide tissue concentrations of Nevada desert bighorn sheep, 1972--1973

    International Nuclear Information System (INIS)

    Brown, K.W.; Smith, D.D.; Bernhardt, D.E.; Giles, K.R.; Helvie, J.B.

    1976-06-01

    The botanical composition of the diet and radionuclide content of selected tissues of desert bighorn sheep (Ovis canadensis nelsoni) collected during the 1972 and 1973 hunting seasons were determined by analyzing rumen contents, and lung, liver, kidney, and bone tissues. Botanical examination of the rumen contents showed that grass exceeded 50 percent of the diet of 10 to 14 animals collected in 1972 and 12 of 18 animals collected in 1973. Desert needlegrass (Stipa speciosa), Indian rice grass (Oryzopsis hymenoides), and squirrel tail (Sitanion hystrix) were the major grasses utilized. The dominant shrub species consumed included the joint firs (Ephedra viridis) and (Ephedra nevadensis), Mohave yucca (Yucca schidigera), and cliff rose (Cowania mexicana). With the exception of potassium-40, gamma-emitting radionuclides were not detected in desert bighorn sheep tissue. The tritium levels reported were within environmental levels. Strontium-90 levels averaged 4.9 and 4.1 pCi/gram of bone ash for 1972 and 1973, respectively, continuing the downward trend observed in recent years. Uranium levels were similar to those reported from cattle grazing the same general geographic areas. The daily consumption for one year of 500 grams of liver containing the highest levels of plutonium and uranium would result in a dose to the human bone, the tissue expected to receive the highest dose, of approximately 1 mrem/year. This is less than 1% of the radiation protection guides for the general population

  12. Role of carriers in the transmission of pneumonia in bighorn sheep (Ovis canadensis

    Directory of Open Access Journals (Sweden)

    Bindu Raghavan

    2016-06-01

    Full Text Available In the absence of livestock contact, recurring lamb mortality in bighorn sheep (Ovis canadensis populations previously exposed to pneumonia indicates the likely presence of carriers of pneumonia-causing pathogens, and possibly inadequate maternally derived immunity. To investigate this problem we commingled naïve, pregnant ewes (n=3 with previously exposed rams (n=2. Post-commingling, all ewes and lambs born to them acquired pneumonia-causing pathogens (leukotoxin-producing Pasteurellaceae and Mycoplasma ovipneumoniae, with subsequent lamb mortality between 4-9 weeks of age. Infected ewes became carriers for two subsequent years and lambs born to them succumbed to pneumonia. In another experiment, we attempted to suppress the carriage of leukotoxin-producing Pasteurellaceae by administering an antibiotic to carrier ewes, and evaluated lamb survival. Lambs born to both treatment and control ewes (n=4 each acquired pneumonia and died. Antibody titers against leukotoxin-producing Pasteurellaceae in all eight ewes were ‘protective’ (>1:800 and no apparent respiratory disease; however their lambs were either born with comparatively low titers, or with high (but non-protective titers that declined rapidly within 2-8 weeks of age, rendering them susceptible to fatal disease. Thus, exposure to pneumonia-causing pathogens from carrier ewes, and inadequate titers of maternally derived protective antibodies, are likely to render bighorn lambs susceptible to fatal pneumonia.

  13. Ural-Tweed Bighorn Sheep Wildlife Mitigation Project, 1986 Annual Report.

    Energy Technology Data Exchange (ETDEWEB)

    Yde, Chris A. (Montana Department of Fish, Wildlife and Parks, Helena, MT); Summerfield, Bob; Young, Lewis (Kootenai National Forest, Libby, MT)

    1987-02-01

    This report summarizes the results of the project activities from September 1, 1984 to December 31, 1986. To date, habitat treatments have been initiated on eight areas. The treatments include selective slash and burn, prescribed fire and fertilization. Inclement weather precluded the completion of the prescribed burns scheduled during fall 1985 and fall 1986. The lower Stonehill prescribed fire was rescheduled from fall 1985 to spring 1986 with the burn accomplished, producing varied results. Extensive pretreatment vegetative information has been collected from all units scheduled for habitat manipulations. Additionally, future projects have been delineated for other areas frequented by bighorn sheep. Ten adult bighorn sheep (5 ewes and 5 rams) have been fitted with radio transmitters. Systematic aerial and ground surveys were utilized to monitor the movements and seasonal habitat preferences of the instrumented sheep. Age and sex information was gathered whenever possible to aid in the development of a population model, Monthly pallet group collections were initiated in May 1985 to provide samples for 2.6 diaminopimetic acid (DAPA), food habits and lungworm larvae analysis. The majority of the data analysis is ongoing and will be presented in later reports.

  14. Phylogeographic and population genetic structure of bighorn sheep ( Ovis canadensis ) in North American deserts.

    Science.gov (United States)

    Buchalski, Michael R; Sacks, Benjamin N; Gille, Daphne A; Penedo, Maria Cecilia T; Ernest, Holly B; Morrison, Scott A; Boyce, Walter M

    2016-06-09

    Fossil data are ambiguous regarding the evolutionary origin of contemporary desert bighorn sheep ( Ovis canadensis subspecies). To address this uncertainty, we conducted phylogeographic and population genetic analyses on bighorn sheep subspecies found in southwestern North America. We analyzed 515 base pairs of mtDNA control region sequence and 39 microsatellites in 804 individuals from 58 locations. Phylogenetic analyses revealed 2 highly divergent clades concordant with Sierra Nevada ( O. c. sierrae ) and Rocky Mountain ( O. c. canadensis ) bighorn and showed that these 2 subspecies both diverged from desert bighorn prior to or during the Illinoian glaciation (~315-94 thousand years ago [kya]). Desert bighorn comprised several more recently diverged haplogroups concordant with the putative Nelson ( O. c. nelsoni ), Mexican ( O. c. mexicana ), and Peninsular ( O. c. cremnobates ) subspecies. Corresponding estimates of effective splitting times (~17-3 kya), and haplogroup ages (~85-72 kya) placed the most likely timeframe for divergence among desert bighorn subspecies somewhere within the last glacial maximum. Median-joining haplotype network and Bayesian skyline analyses both indicated that desert bighorn collectively comprised a historically large and haplotype-diverse population, which subsequently lost much of its diversity through demographic decline. Using microsatellite data, discriminant analysis of principle components (DAPC) and Bayesian clustering analyses both indicated genetic structure concordant with the geographic distribution of 3 desert subspecies. Likewise, microsatellite and mitochondrial-based F ST comparisons revealed significant fixation indices among the desert bighorn genetic clusters. We conclude these desert subspecies represent ancient lineages likely descended from separate Pleistocene refugial populations and should therefore be managed as distinct taxa to preserve maximal biodiversity. Los datos de fósiles sobre el origen evolutivo

  15. Influences on wood load in mountain streams of the Bighorn National Forest, Wyoming, USA.

    Science.gov (United States)

    Nowakowski, Amy L; Wohl, Ellen

    2008-10-01

    We documented valley and channel characteristics and wood loads in 19 reaches of forested headwater mountain streams in the Bighorn National Forest of northern Wyoming. Ten of these reaches were in the Upper Tongue River watershed, which has a history of management including timber harvest, tie floating, and road construction. Nine reaches were in the North Rock Creek watershed, which has little history of management activities. We used these data to test hypotheses that (i) valley geometry correlates with wood load, (ii) stream gradient correlates with wood load, and (iii) wood loads are significantly lower in managed watersheds than in otherwise similar unmanaged watersheds. Statistical analyses of the data support the first and third hypotheses. Stream reaches with steeper valley side slopes tend to have higher wood loads, and reaches in managed watersheds tend to have lower wood loads than reaches in unmanaged watersheds. Results do not support the second hypothesis. Shear stress correlated more strongly with wood load than did stream gradient, but statistical models with valley-scale variables had greater explanatory power than statistical models with channel-scale variables. Wood loads in stream reaches within managed watersheds in the Bighorn National Forest tend to be two to three times lower than wood loads in unmanaged watersheds.

  16. Midwife-assisted planned home birth: an essential component of improving the safety of childbirth in Sub-Saharan Africa.

    Science.gov (United States)

    Dayyabu, Aliyu Labaran; Murtala, Yusuf; Grünebaum, Amos; McCullough, Laurence B; Arabin, Birgit; Levene, Malcolm I; Brent, Robert L; Monni, Giovanni; Sen, Cihat; Makatsariya, Alexander; Chervenak, Frank A

    2018-05-29

    Hospital births, when compared to out-of-hospital births, have generally led to not only a significantly reduced maternal and perinatal mortality and morbidity but also an increase in certain interventions. A trend seems to be emerging, especially in the US where some women are requesting home births, which creates ethical challenges for obstetricians and the health care organizations and policy makers. In the developing world, a completely different reality exists. Home births constitute the majority of deliveries in the developing world. There are severe limitations in terms of facilities, health personnel and deeply entrenched cultural and socio-economic conditions militating against hospital births. As a consequence, maternal and perinatal mortality and morbidity remain the highest, especially in Sub-Saharan Africa (SSA). Midwife-assisted planned home birth therefore has a major role to play in increasing the safety of childbirth in SSA. The objective of this paper is to propose a model that can be used to improve the safety of childbirth in low resource countries and to outline why midwife assisted planned home birth with coordination of hospitals is the preferred alternative to unassisted or inadequately assisted planned home birth in SSA.

  17. Shared Bacterial and Viral Respiratory Agents in Bighorn Sheep (Ovis canadensis, Domestic Sheep (Ovis aries, and Goats (Capra hircus in Montana

    Directory of Open Access Journals (Sweden)

    David S. Miller

    2011-01-01

    Full Text Available Transmission of infectious agents from livestock reservoirs has been hypothesized to cause respiratory disease outbreaks in bighorn sheep (Ovis canadensis, and land management policies intended to limit this transmission have proven controversial. This cross-sectional study compares the infectious agents present in multiple populations of bighorn sheep near to and distant from their interface with domestic sheep (O. aries and domestic goat (Capra hircus and provides critical baseline information needed for interpretations of cross-species transmission risks. Bighorn sheep and livestock shared exposure to Pasteurellaceae, viral, and endoparasite agents. In contrast, although the impact is uncertain, Mycoplasma sp. was isolated from livestock but not bighorn sheep. These results may be the result of historic cross-species transmission of agents that has resulted in a mosaic of endemic and exotic agents. Future work using longitudinal and multiple population comparisons is needed to rigorously establish the risk of outbreaks from cross-species transmission of infectious agents.

  18. Shared bacterial and viral respiratory agents in bighorn sheep (Ovis canadensis), domestic sheep (Ovis aries), and goats (Capra hircus) in Montana

    Science.gov (United States)

    Miller, David S.; Weiser, Glen C.; Aune, Keith; Roeder, Brent; Atkinson, Mark; Anderson, Neil; Roffe, Thomas J.; Keating, Kim A.; Chapman, Phillip L.; Kimberling, Cleon; Rhyan, Jack C.; Clarke, P. Ryan

    2011-01-01

    Transmission of infectious agents from livestock reservoirs has been hypothesized to cause respiratory disease outbreaks in bighorn sheep (Ovis canadensis), and land management policies intended to limit this transmission have proven controversial. This cross-sectional study compares the infectious agents present in multiple populations of bighorn sheep near to and distant from their interface with domestic sheep (O. aries) and domestic goat (Capra hircus) and provides critical baseline information needed for interpretations of cross-species transmission risks. Bighorn sheep and livestock shared exposure to Pasteurellaceae, viral, and endoparasite agents. In contrast, although the impact is uncertain, Mycoplasma sp. was isolated from livestock but not bighorn sheep. These results may be the result of historic cross-species transmission of agents that has resulted in a mosaic of endemic and exotic agents. Future work using longitudinal and multiple population comparisons is needed to rigorously establish the risk of outbreaks from cross-species transmission of infectious agents.

  19. Energy Storage System Control Algorithm by Operating Target Power to Improve Energy Sustainability of Smart Home

    Directory of Open Access Journals (Sweden)

    Byeongkwan Kang

    2018-01-01

    Full Text Available As energy issues are emerging around the world, a variety of smart home technologies aimed at realizing zero energy houses are being introduced. Energy storage system (ESS for smart home energy independence is increasingly gaining interest. However, limitations exist in that most of them are controlled according to time schedules or used in conjunction with photovoltaic (PV generation systems. In consideration of load usage patterns and PV generation of smart home, this study proposes an ESS control algorithm that uses constant energy of energy network while making maximum use of ESS. Constant energy means that the load consumes a certain amount of power under all conditions, which translates to low variability. The proposed algorithm makes a smart home a load of energy network with low uncertainty and complexity. The simulation results show that the optimal ESS operating target power not only makes the smart home use power constantly from the energy network, but also maximizes utilization of the ESS. In addition, since the smart home is a load that uses constant energy, it has the advantage of being able to operate an efficient energy network from the viewpoint of energy providers.

  20. Data for improvement and clinical excellence: protocol for an audit with feedback intervention in home care and supportive living.

    Science.gov (United States)

    Fraser, Kimberly D; Sales, Anne E; O'Rourke, Hannah M; Schalm, Corinne

    2012-01-18

    Although considerable evidence exists about the effectiveness of audit coupled with feedback, very few audit-with-feedback interventions have been done in either home care or supportive living settings to date. With little history of audit and feedback in home care or supportive living there is potential for greater effects, at least initially. This study extends the work of an earlier study designed to assess the effects of an audit-with-feedback intervention. It will be delivered quarterly over a one-year period in seven home care offices and 11 supportive living sites. The research questions are the same as in the first study but in a different environment. They are as follows: 1. What effects do feedback reports have on processes and outcomes over time? 2. How do different provider groups in home care and supportive living sites respond to feedback reports based on quality indicator data? The research team conducting this study includes researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of quarterly feedback reports in 19 home care offices and supportive living sites across Alberta. Data for the feedback reports are based on the Resident Assessment Instrument Home Care tool, a standardized instrument mandated for use in home care and supportive living environments throughout Alberta. The feedback reports consist of one page, printed front and back, presenting both graphic and textual information. Reports are delivered to all employees working in each site. The primary evaluation uses a controlled interrupted time-series design, both adjusted and unadjusted for covariates. The concurrent process evaluation includes observation, focus groups, and self-reports to assess uptake of the feedback reports. The project described in this protocol follows a similar intervention conducted in our previous study, Data for Improvement and Clinical Excellence--Long-Term Care. We will offer dissemination strategies

  1. Data for improvement and clinical excellence: protocol for an audit with feedback intervention in home care and supportive living

    Directory of Open Access Journals (Sweden)

    Fraser Kimberly D

    2012-01-01

    Full Text Available Abstract Background Although considerable evidence exists about the effectiveness of audit coupled with feedback, very few audit-with-feedback interventions have been done in either home care or supportive living settings to date. With little history of audit and feedback in home care or supportive living there is potential for greater effects, at least initially. This study extends the work of an earlier study designed to assess the effects of an audit-with-feedback intervention. It will be delivered quarterly over a one-year period in seven home care offices and 11 supportive living sites. The research questions are the same as in the first study but in a different environment. They are as follows: 1. What effects do feedback reports have on processes and outcomes over time? 2. How do different provider groups in home care and supportive living sites respond to feedback reports based on quality indicator data? Methods The research team conducting this study includes researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of quarterly feedback reports in 19 home care offices and supportive living sites across Alberta. Data for the feedback reports are based on the Resident Assessment Instrument Home Care tool, a standardized instrument mandated for use in home care and supportive living environments throughout Alberta. The feedback reports consist of one page, printed front and back, presenting both graphic and textual information. Reports are delivered to all employees working in each site. The primary evaluation uses a controlled interrupted time-series design, both adjusted and unadjusted for covariates. The concurrent process evaluation includes observation, focus groups, and self-reports to assess uptake of the feedback reports. The project described in this protocol follows a similar intervention conducted in our previous study, Data for Improvement and Clinical Excellence

  2. Improving access to care through the patient-centered medical home.

    Science.gov (United States)

    North, Stephen W; McElligot, James; Douglas, Gaye; Martin, Amanda

    2014-02-01

    School-based health centers (SBHCs) serve an essential role in providing access to high-quality, comprehensive care to underserved children and adolescents in more than 2,000 schools across the United States. SBHCs are an essential component of the health care safety net, and their role in the patient-centered medical home (PCMH) continues to evolve as both collaborating partners and, when fully functioning, independent PCMHs. The American Academy of Pediatrics (AAP) supports the use of SBHCs, citing the proven benefits and exciting potential as justification, but also offers caution and recommends a focus on communication within the community. Traditional "brick and mortar" SBHCs are more likely to be located in urban communities (54.2% urban versus 18.0% rural) and be in schools with more students, allowing for a greater return on investment. Current SBHCs are located in schools with an average population of 997 students. The need for a large school population to help an SBHC approach financial viability excludes children in rural communities who are more likely to attend a school with fewer than 500 students, be poor, and have difficulty accessing health care.2 The expansion of telehealth technologies allows the creation of solutions to decrease geographic barriers that have limited the growth of SBHCs in rural communities. Telehealth school-based health centers (tSBHCs) that exclusively provide services through telemedicine are operating and developing in communities where geographic barriers and financial challenges have prevented the establishment of brick and mortar SBHCs. TSBHCs are beginning to increase the number and variety of services they provide through the use of telehealth to include behavioral health, nutrition services, and pediatric specialists. Understanding the role of tSBHCs in the growth of the PCMH model is critical for using these tools to continue to improve child and adolescent health. Copyright 2014, SLACK Incorporated.

  3. Internet-based home training is capable to improve balance in multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Frevel, D; Mäurer, M

    2015-02-01

    Balance disorders are common in multiple sclerosis. Aim of the study is to investigate the effectiveness of an Internet-based home training program (e-Training) to improve balance in patients with multiple sclerosis. A randomized, controlled study. Academic teaching hospital in cooperation with the therapeutic riding center Gut Üttingshof, Bad Mergentheim. Eighteen multiple sclerosis patients (mean EDSS 3,5) took part in the trial. Outcome of patients using e-Training (N.=9) was compared to the outcome of patients receiving hippotherapy (N.=9), which can be considered as an advanced concept for the improvement of balance and postural control in multiple sclerosis. After simple random allocation patients received hippotherapy or Internet-based home training (balance, postural control and strength training) twice a week for 12 weeks. Assessments were done before and after the intervention and included static and dynamic balance (primary outcome). Isometric muscle strength of the knee and trunk extension/flexion (dynamometer), walking capacity, fatigue and quality of life served as secondary outcome parameters. Both intervention groups showed comparable and highly significant improvement in static and dynamic balance capacity, no difference was seen between the both intervention groups. However looking at fatigue and quality of life only the group receiving hippotherapy improved significantly. Since e-Training shows even comparable effects to hippotherapy to improve balance, we believe that the established Internet-based home training program, specialized on balance and postural control training, is feasible for a balance and strength training in persons with multiple sclerosis. We demonstrated that Internet-based home training is possible in patients with multiple sclerosis.

  4. Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study.

    Science.gov (United States)

    Kwong, Enid Wy; Hung, Maria Sy; Woo, Kevin

    2016-11-25

    A need exits to develop a protocol for preventing pressure ulcers (PUs) in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning), changing (action), and refreezing (results) were carried out. During each cycle, focus group interviews, field observations of the care staff's practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the revised risk assessment method, the timely and appropriate

  5. Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study

    Directory of Open Access Journals (Sweden)

    Enid WY Kwong

    2016-11-01

    Full Text Available Abstract Background A need exits to develop a protocol for preventing pressure ulcers (PUs in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. Methods A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning, changing (action, and refreezing (results were carried out. During each cycle, focus group interviews, field observations of the care staff’s practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. Results The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the

  6. Assessment of a treatment guideline to improve home management of malaria in children in rural south-west Nigeria

    Directory of Open Access Journals (Sweden)

    Oduola Ayo MJ

    2008-01-01

    Full Text Available Abstract Background Many Nigerian children with malaria are treated at home. Treatments are mostly incorrect, due to caregivers' poor knowledge of appropriate and correct dose of drugs. A comparative study was carried out in two rural health districts in southwest Nigeria to determine the effectiveness of a guideline targeted at caregivers, in the treatment of febrile children using chloroquine. Methods Baseline and post intervention knowledge, attitude and practice household surveys were conducted. The intervention strategy consisted of training a core group of mothers ("mother trainers" in selected communities on the correct treatment of malaria and distributing a newly developed treatment guideline to each household. "Mother trainers" disseminated the educational messages about malaria and the use of the guideline to their communities. Results Knowledge of cause, prevention and treatment of malaria increased with the one-year intervention. Many, (70.4% of the respondents stated that they used the guideline each time a child was treated for malaria. There was a significant increase in the correct use of chloroquine from 2.6% at baseline to 52.3% after intervention among those who treated children at home in the intervention arm compared with 4.2% to 12.7% in the control arm. The correctness of use was significantly associated with use of the guideline. The timeliness of commencing treatment was significantly earlier in those who treated febrile children at home using chloroquine than those who took their children to the chemist or health facility (p Conclusion The use of the guideline with adequate training significantly improved correctness of malaria treatment with chloroquine at home. Adoption of this mode of intervention is recommended to improve compliance with drug use at home. The applicability for deploying artemisinin-based combination therapy at the community level needs to be investigated.

  7. Performance Improvement Strategic Home Based Manufacturer Tahu And Tempe Groups Based In The District Of Jember

    Directory of Open Access Journals (Sweden)

    Istatuk Budi Yuswanto

    2017-04-01

    Full Text Available Tahu dan tempe is a product of the soybean meal that has been known since long in Indonesia. Tahu is a Chinese food products in contrast to tempe an authentic Indonesian food . As tempe tahu also favored by the people of Indonesia because it has a taste that delicious nutritious and affordable price.Industries that produce tahu dan tempe are generally small-scale home-based businesses with the number of workers a little less than 2-6 people and investments that are not too large. The use of technology in small business home-based producer of tahu dan tempe quite simple and easy to learn so it can be run by anyone. The success of small business home-based manufacturers to survive and evolve toward more advanced by knowing their strengths weaknesses opportunities that can be taken by small business home-based and threat or better known as the SWOT Strength Weakness Opportunity Threath that can be retrieved strategies that affect the success and development of small business home-based manufacturer of tahu dan tempe.Constraints faced by small businesses and home-based manufacturers know that the soybean Tepe that include budget constraints limited access to banking limited human resources marketing only the scope of Jember and lack of good management. No group or cooperative does not have a good recording making it difficult to make financial reports manufacturing planning and operational supervision and finances into this industry employers group lemah.Pembentukan help solve problems and maximize its potential.

  8. Can we do better? Economic analysis of human resource investment to improve home care service for the elderly in Serbia.

    Science.gov (United States)

    Mihic, Marko M; Todorovic, Marija Lj; Obradovic, Vladimir Lj; Mitrovic, Zorica M

    2016-01-01

    Social services aimed at the elderly are facing great challenges caused by progressive aging of the global population but also by the constant pressure to spend funds in a rational manner. This paper focuses on analyzing the investments into human resources aimed at enhancing home care for the elderly since many countries have recorded progress in the area over the past years. The goal of this paper is to stress the significance of performing an economic analysis of the investment. This paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method. The economic analysis of investing in human resources for home care service in Serbia showed that the both scenarios of investing in either additional home care hours or more beneficiaries are cost-efficient. However, the optimal solution with the positive (and the highest) value of economic net present value criterion is to invest in human resources to boost the number of home care hours from 6 to 8 hours per week and increase the number of the beneficiaries to 33%. This paper shows how the statistical and economic analysis results can be used to evaluate different scenarios and enable quality decision-making based on exact data in order to improve health and quality of life of the elderly and spend funds in a rational manner.

  9. 78 FR 69614 - Home Improvements and Structural Alterations (HISA) Benefits Program

    Science.gov (United States)

    2013-11-20

    ... more than one kitchen, we interpret the statutory reference to ``essential lavatory and sanitary... single kitchen facility is a reasonable interpretation of ``essential'' lavatory and sanitary facilities... continuation of treatment for the veteran's disability or to provide access to the home or to essential...

  10. Evolving an empowering approach to continuous quality improvement in home care.

    Science.gov (United States)

    McWilliam, C L; Desai, K L; Sweetland, D

    1995-01-01

    Theory suggests that in an "empowering" organization all individuals assume genuine decision-making roles and control over their work. Unfortunately, many organizations actually stifle empowerment through creating new bureaucratic barriers as they implement structures to deploy quality management principles. The Oxford County Home Care Program describes how it redesigned its organizational structure to facilitate empowerment.

  11. Cueing training in the home improves gait-related mobility in Parkinson's disease : The RESCUE trial

    NARCIS (Netherlands)

    Nieuwboer, A.; Kwakkel, G.; Rochester, L.; Jones, D.; Van Wegen, E.; Willems, A. M.; Chavret, F.; Hetherington, V.; Baker, K.; Lim, I.

    2007-01-01

    Objectives: Gait and mobility problems are difficult to treat in people with Parkinson's disease. The Rehabilitation in Parkinson's Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity.

  12. Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial.

    NARCIS (Netherlands)

    Nieuwboer, A.; Kwakkel, G.; Rochester, L.; Jones, D.; Wegen, E. van; Willems, A.M.; Chavret, F.; Hetherington, V.; Baker, K.; Lim, I.

    2007-01-01

    OBJECTIVES: Gait and mobility problems are difficult to treat in people with Parkinson's disease. The Rehabilitation in Parkinson's Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity.

  13. Age-specific infectious period shapes dynamics of pneumonia in bighorn sheep.

    Science.gov (United States)

    Plowright, Raina K; Manlove, Kezia R; Besser, Thomas E; Páez, David J; Andrews, Kimberly R; Matthews, Patrick E; Waits, Lisette P; Hudson, Peter J; Cassirer, E Frances

    2017-10-01

    Superspreading, the phenomenon where a small proportion of individuals contribute disproportionately to new infections, has profound effects on disease dynamics. Superspreading can arise through variation in contacts, infectiousness or infectious periods. The latter has received little attention, yet it drives the dynamics of many diseases of critical public health, livestock health and conservation concern. Here, we present rare evidence of variation in infectious periods underlying a superspreading phenomenon in a free-ranging wildlife system. We detected persistent infections of Mycoplasma ovipneumoniae, the primary causative agent of pneumonia in bighorn sheep (Ovis canadensis), in a small number of older individuals that were homozygous at an immunologically relevant genetic locus. Interactions among age-structure, genetic composition and infectious periods may drive feedbacks in disease dynamics that determine the magnitude of population response to infection. Accordingly, variation in initial conditions may explain divergent population responses to infection that range from recovery to catastrophic decline and extirpation. © 2017 John Wiley & Sons Ltd/CNRS.

  14. A Review of Hypothesized Determinants Associated with Bighorn Sheep (Ovis canadensis Die-Offs

    Directory of Open Access Journals (Sweden)

    David S. Miller

    2012-01-01

    Full Text Available Multiple determinants have been hypothesized to cause or favor disease outbreaks among free-ranging bighorn sheep (Ovis canadensis populations. This paper considered direct and indirect causes of mortality, as well as potential interactions among proposed environmental, host, and agent determinants of disease. A clear, invariant relationship between a single agent and field outbreaks has not yet been documented, in part due to methodological limitations and practical challenges associated with developing rigorous study designs. Therefore, although there is a need to develop predictive models for outbreaks and validated mitigation strategies, uncertainty remains as to whether outbreaks are due to endemic or recently introduced agents. Consequently, absence of established and universal explanations for outbreaks contributes to conflict among wildlife and livestock stakeholders over land use and management practices. This example illustrates the challenge of developing comprehensive models for understanding and managing wildlife diseases in complex biological and sociological environments.

  15. Can we do better? Economic analysis of human resource investment to improve home care service for the elderly in Serbia

    Directory of Open Access Journals (Sweden)

    Mihic MM

    2016-01-01

    Full Text Available Marko M Mihic, Marija Lj Todorovic, Vladimir Lj Obradovic, Zorica M Mitrovic Department for Management and Specialised Management Disciplines, Faculty of Organisational Sciences, University of Belgrade, Belgrade, Serbia Background: Social services aimed at the elderly are facing great challenges caused by progressive aging of the global population but also by the constant pressure to spend funds in a rational manner.Purpose: This paper focuses on analyzing the investments into human resources aimed at enhancing home care for the elderly since many countries have recorded progress in the area over the past years. The goal of this paper is to stress the significance of performing an economic analysis of the investment.Methods: This paper combines statistical analysis methods such as correlation and regression analysis, methods of economic analysis, and scenario method.Results: The economic analysis of investing in human resources for home care service in Serbia showed that the both scenarios of investing in either additional home care hours or more beneficiaries are cost-efficient. However, the optimal solution with the positive (and the highest value of economic net present value criterion is to invest in human resources to boost the number of home care hours from 6 to 8 hours per week and increase the number of the beneficiaries to 33%.Conclusion: This paper shows how the statistical and economic analysis results can be used to evaluate different scenarios and enable quality decision-making based on exact data in order to improve health and quality of life of the elderly and spend funds in a rational manner. Keywords: home care, social investment, human resources, economic analysis, elderly

  16. Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: A pilot randomized controlled trial

    NARCIS (Netherlands)

    Oosting, E.; Jans, M.P.; Dronkers, J.J.; Naber, R.H.; Dronkers-Landman, C.M.; Appelman-De Vries, S.M.; Meeteren, N.L. van

    2012-01-01

    Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise

  17. Improvements in the quality of co-ordination of nursing care following implementation of the Resident Assessment Instrument in Dutch nursing homes.

    NARCIS (Netherlands)

    Achterberg, W.P.; Holtkamp, C.C.M.; Kerkstra, A.; Pot, A.M.; Ooms, M.E.; Ribbe, M.W.

    2001-01-01

    Aim: To study the effect of implementation of the Resident Assessment Instrument (RAI) on the quality of co-ordination of nursing care in Dutch nursing homes. Background: The Resident Assessment Instrument (RAI) was designed to improve the quality of care and quality of life in nursing homes. Until

  18. Improving the outcome of infants born at <30 weeks' gestation - a randomized controlled trial of preventative care at home

    Directory of Open Access Journals (Sweden)

    Orton Jane

    2009-12-01

    Full Text Available Abstract Background Early developmental interventions to prevent the high rate of neurodevelopmental problems in very preterm children, including cognitive, motor and behavioral impairments, are urgently needed. These interventions should be multi-faceted and include modules for caregivers given their high rates of mental health problems. Methods/Design We have designed a randomized controlled trial to assess the effectiveness of a preventative care program delivered at home over the first 12 months of life for infants born very preterm ( Discussion This paper presents the background, study design and protocol for a randomized controlled trial in very preterm infants utilizing a preventative care program in the first year after discharge home designed to improve cognitive, motor and behavioral outcomes of very preterm children and caregiver mental health at two-years' corrected age. Clinical Trial Registration Number ACTRN12605000492651

  19. Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial.

    Science.gov (United States)

    Rasmussen, Rune Skovgaard; Østergaard, Ann; Kjær, Pia; Skerris, Anja; Skou, Christina; Christoffersen, Jane; Seest, Line Skou; Poulsen, Mai Bang; Rønholt, Finn; Overgaard, Karsten

    2016-03-01

    To evaluate if home-based rehabilitation of inpatients improved outcome compared to standard care. Interventional, randomised, safety/efficacy open-label trial. University hospital stroke unit in collaboration with three municipalities. Seventy-one eligible stroke patients (41 women) with focal neurological deficits hospitalised in a stroke unit for more than three days and in need of rehabilitation. Thirty-eight patients were randomised to home-based rehabilitation during hospitalization and for up to four weeks after discharge to replace part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients. Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome measures were the modified Barthel-100 Index, Motor Assessment Scale, CT-50 Cognitive Test, EuroQol-5D, Body Mass Index and treatment-associated economy. Thirty-one intervention and 30 control patients completed the study. Patients in the intervention group achieved better modified Rankin Scale score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2-4; P=0.04). EuroQol-5D quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66-0.79; Control median = 0.66, IQR = 0.56 - 0.72; P=0.03). The total amount of home-based training in minutes highly correlated with mRS, Barthel, Motor Assessment Scale and EuroQol-5D™ scores (P-values ranging from Prehabilitation reduced disability and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective. © The Author(s) 2015.

  20. An Integrated Pest Management Intervention Improves Knowledge, Pest Control, and Practices in Family Child Care Homes.

    Science.gov (United States)

    Stephens, Michelle; Hazard, Kimberly; Moser, Debra; Cox, Dana; Rose, Roberta; Alkon, Abbey

    2017-10-26

    To reduce young children's exposure to pesticides when attending family child care homes (FCCHs), we developed an integrated pest management (IPM) intervention for FCCH directors. First, we developed IPM educational materials and resources to provide the foundation for an IPM educational intervention for FCCHs. Next, we conducted and evaluated a six-month nurse child care health consultant (CCHC)-led education and consultation IPM intervention to increase IPM knowledge, IPM practices, IPM policies, and decrease the presence or evidence of pests. The pilot intervention study was conducted by three CCHCs in 20 FCCHs in three counties in California. Pre- and post-intervention measures were completed by the FCCH directors and observation measures were completed by the CCHCs. Results indicated significant increases in IPM knowledge, ( t -statistic (degrees of freedom), ( t (df) = 2.55(10), p child care homes to harmful chemicals.

  1. Effectiveness of Home Visits in Pregnancy as a Public Health Measure to Improve Birth Outcomes.

    Directory of Open Access Journals (Sweden)

    Kayoko Ichikawa

    Full Text Available Birth outcomes, such as preterm birth, low birth weight (LBW, and small for gestational age (SGA, are crucial indicators of child development and health.To evaluate whether home visits from public health nurses for high-risk pregnant women prevent adverse birth outcomes.In this quasi-experimental cohort study in Kyoto city, Japan, high-risk pregnant women were defined as teenage girls (range 14-19 years old, women with a twin pregnancy, women who registered their pregnancy late, had a physical or mental illness, were of single marital status, non-Japanese women who were not fluent in Japanese, or elderly primiparas. We collected data from all high-risk pregnant women at pregnancy registration interviews held at a public health centers between 1 July 2011 and 30 June 2012, as well as birth outcomes when delivered from the Maternal and Child Health Handbook (N = 964, which is a record of prenatal check-ups, delivery, child development and vaccinations. Of these women, 622 women were selected based on the home-visit program propensity score-matched sample (pair of N = 311 and included in the analysis. Data were analyzed between January and June 2014.In the propensity score-matched sample, women who received the home-visit program had lower odds of preterm birth (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.39 to 0.98 and showed a 0.55-week difference in gestational age (95% CI: 0.18 to 0.92 compared to the matched controlled sample. Although the program did not prevent LBW and SGA, children born to mothers who received the program showed an increase in birth weight by 107.8 g (95% CI: 27.0 to 188.5.Home visits by public health nurses for high-risk pregnant women in Japan might be effective in preventing preterm birth, but not SGA.

  2. Project (inverted exclamation mark)EXITO!: success through diversity and universality for outcomes improvement among Hispanic home care patients.

    Science.gov (United States)

    Woerner, Louise; Espinosa, Javier; Bourne, Susan; O'Toole, Marie; Ingersoll, Gail L

    2009-01-01

    The National Health Disparities Report notes that Hispanics have poorer quality of care in 23 of 38 core measures. The result of this disparity is great personal and health system costs, which could be reduced. Prior studies have focused on access and language. We studied outcomes improvement. The purpose of this project was to develop a replicable theory-based outcomes improvement model for delivery of nursing care to Hispanic patients. The Leininger Sunrise Enabler approach was used to design a program specific to the cultural needs of a home care population. Outcome and Assessment Information Set (OASIS) data from 125 unduplicated home care patients were tracked. Nursing care delivery was analyzed using ethnographic research techniques. Delivery of nursing care using a culturally congruent approach reduced acute hospitalization and emergent care visits. Medication management and customer and nursing satisfaction also improved. National standards for culturally and linguistically appropriate services in health care help reduce healthcare disparities, but improving Hispanic outcomes requires moving beyond symptoms and symptom management to transcultural care. The estimated savings to the health care system are significant.

  3. Tree-ring-based reconstruction of precipitation in the Bighorn Basin, Wyoming, since 1260 A.D

    Science.gov (United States)

    Gray, S.T.; Fastie, C.L.; Jackson, S.T.; Betancourt, J.L.

    2004-01-01

    Cores and cross sections from 79 Douglas fir (Pseudotsuga menziesii) and limber pine (Pinus flexilis) trees at four sites in the Bighorn Basin of north-central Wyoming and south-central Montana were used to develop a proxy for annual (June-June) precipitation spanning 1260-1998 A.D. The reconstruction exhibits considerable nonstationarity, and the instrumental era (post-1900) in particular fails to capture the full range of precipitation variability experienced in the past ???750 years. Both single-year and decadal-scale dry events were more severe before 1900. Dry spells in the late thirteenth and sixteenth centuries surpass both magnitude and duration of any droughts in the Bighorn Basin after 1900. Precipitation variability appears to shift to a higher-frequency mode after 1750, with 15-20-yr droughts becoming rare. Comparisons between instrumental and reconstructed values of precipitation and indices of Pacific basin variability reveal that precipitation in the Bighorn Basin generally responds to Pacific forcing in a manner similar to that of the southwestern United States (drier during La Nin??a events), but high country precipitation in areas surrounding the basin displays the opposite response (drier during El Nin??o events). ?? 2004 American Meteorological Society.

  4. Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care.

    Science.gov (United States)

    Stockdale, Susan E; Zuchowski, Jessica; Rubenstein, Lisa V; Sapir, Negar; Yano, Elizabeth M; Altman, Lisa; Fickel, Jacqueline J; McDougall, Skye; Dresselhaus, Timothy; Hamilton, Alison B

    Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation. Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread. We analyzed administrative records and conducted interviews with 85 organizational leaders. We developed and applied criteria for assessing design element implementation using hybrid deductive/inductive analytic techniques. All quality councils implemented interdisciplinary leadership and a structured quality improvement process, and all but one completed at least one quality improvement project and a toolkit for spreading improvements. Quality councils were perceived as most effective when service line leaders had well-functioning interdisciplinary communication. Matching positions within leadership hierarchies with appropriate supportive roles facilitated frontline quality improvement efforts. Two key resources were (a) a dedicated internal facilitator with project management, data collection, and presentation skills and (b) support for preparing customized data reports for identifying and addressing practice level quality issues. Overall, quality councils successfully cultivated interdisciplinary, multilevel primary care quality improvement leadership with accountability mechanisms and generated frontline innovations suitable for spread. Practice level performance data and quality improvement project management support

  5. A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes.

    Directory of Open Access Journals (Sweden)

    Lee-Fay Low

    Full Text Available We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes.Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure.Sixty-three unique studies were broadly grouped according to clinical domain-oral health (3 studies, hygiene and infection control (3 studies, nutrition (2 studies, nursing home acquired pneumonia (2 studies, depression (2 studies appropriate prescribing (7 studies, reduction of physical restraints (3 studies, management of behavioral and psychological symptoms of dementia (6 studies, falls reduction and prevention (11 studies, quality improvement (9 studies, philosophy of care (10 studies and other (5 studies. No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy. Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes or organizational factors (e.g. funding, resources, logistics.Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and

  6. Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

    Science.gov (United States)

    Akinci, Fevzi; Patel, Poonam M

    2014-01-01

    Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

  7. Feasibility of modified remotely monitored in-home gaming technology for improving hand function in adolescents with cerebral palsy.

    Science.gov (United States)

    Huber, Meghan; Rabin, Bryan; Docan, Ciprian; Burdea, Grigore C; AbdelBaky, Moustafa; Golomb, Meredith R

    2010-03-01

    The convergence of game technology, the Internet, and rehabilitation science forms the second-generation virtual rehabilitation framework. This paper presents the first pilot study designed to look at the feasibility of at-home use of gaming technology adapted to address hand impairments in adolescents with hemiplegia due to perinatal stroke or intraventricular hemorrhage. Three participants trained at home for approximately 30 min/day, several days a week, for six to ten months. During therapy, they wore a fifths dimension technologies ultra sensing glove and played custom-developed Java 3D games on a modified PlayStation 3. The games were designed to accommodate the participants' limited range of motion, and to improve finger range and speed of motion. Trials took place in Indiana, while monitoFring/data storage took place at Rutgers Tele-Rehabilitation Institute (New Jersey). Significant improvements in finger range of motion (as measured by the sensing glove) were associated with self- and family-reported improvements in activities of daily living. In online subjective evaluations, participants indicated that they liked the system ease of use, clarity of instructions, and appropriate length of exercising. Other telerehabilitation studies are compared to this study and its technology challenges. Directions for future research are included.

  8. Quality and use of consumer information provided with home test kits: room for improvement.

    Science.gov (United States)

    Grispen, Janaica E J; Ickenroth, Martine H P; de Vries, Nanne K; van der Weijden, Trudy; Ronda, Gaby

    2014-10-01

    Diagnostic self-tests (tests on body materials that are initiated by consumers with the aim of diagnosing a disorder or risk factor) are becoming increasingly available. Although the pros and cons of self-testing are currently not clear, it is an existing phenomenon that is likely to gain further popularity. To examine consumers' use of and needs for information about self-testing, and to assess the quality of consumer information provided with home test kits, as perceived by consumers and as assessed using a checklist of quality criteria. A cross-sectional Internet survey among 305 self-testers assessed their use of and needs for information and their perception of the quality of consumer information provided with self-test kits. A meta-search engine was used to identify Dutch and English consumer information for home diagnostic tests available online at the time of the study. The quality of this consumer information was evaluated using a checklist of quality criteria. The consumers' information needs were in line with the most frequently used information, and the information was perceived as being of moderate to good quality. The information was mostly in agreement with clinical practice guidelines, although information on reliability and follow-up behaviour was limited. Approximately half of the instruction leaflets did not include information on the target group of the test. Although generally of moderate to good quality, some aspects of the information provided were in many cases insufficient. European legislation concerning self-tests and accompanying information needs to be adapted and adhered to more closely. © 2012 John Wiley & Sons Ltd.

  9. Possible Involvement of Permian Phosphoria Formation Oil as a Source of REE and Other Metals Associated with Complex U-V Mineralization in the Northern Bighorn Basin?

    Directory of Open Access Journals (Sweden)

    Anita L. Moore-Nall

    2017-11-01

    Full Text Available The origin of V, U, REE and other metals in the Permian Phosphoria Formation have been speculated and studied by numerous scientists. The exceptionally high concentrations of metals have been interpreted to reflect fundamental transitions from anoxic to oxic marine conditions. Much of the oil in the Bighorn Basin, is sourced by the Phosphoria Formation. Two of the top 10 producing oil fields in Wyoming are located approximately 50 km west of two abandoned U-V mining districts in the northern portion of the basin. These fields produce from basin margin anticlinal structures from Mississippian age reservoir rock. Samples collected from abandoned U-V mines and prospects hosted in Mississippian aged paleokarst in Montana and Wyoming have hydrocarbon residue present and contain anomalous high concentrations of many metals that are found in similar concentrations in the Phosphoria Formation. As, Hg, Mo, Pb, Tl, U, V and Zn, often metals of environmental concern occur in high concentrations in Phosphoria Formation samples and had values ranging from 30–1295 ppm As, 0.179–12.8 ppm Hg, 2–791 ppm Mo, <2–146 ppm Pb, 10–490 ppm Tl, 907–86,800 ppm U, 1240–18,900 ppm V, and 7–2230 ppm Zn, in mineralized samples from this study. The REE plus Y composition of Madison Limestone- and limestone breccia hosted-bitumen reflect similar patterns to both mineralized samples from this study and to U.S. Geological Survey rock samples from studies of the Phosphoria Formation. Geochemical, mineralogical and field data were used to investigate past theories for mineralization of these deposits to determine if U present in home wells and Hg content of fish from rivers on the proximal Crow Indian Reservation may have been derived from these deposits or related to their mode of mineralization.

  10. Long-Term Improvements in Knowledge and Psychosocial Factors of a Teen Pregnancy Prevention Intervention Implemented in Group Homes.

    Science.gov (United States)

    Green, Jennifer; Oman, Roy F; Lu, Minggen; Clements-Nolle, Kristen D

    2017-06-01

    Youth in out-of-home care have higher rates of sexual risk behaviors and pregnancy than youth nationally. This study aimed to determine if Power Through Choices (PTC), a teen pregnancy prevention program developed for youth in out-of-home care, significantly improves knowledge and psychosocial outcomes regarding HIV and sexually transmitted infections (STIs), sexual activity and contraception methods, long term. A cluster randomized controlled trial was conducted with 1,036 ethnically diverse youths (aged 13-18 years) recruited from 44 residential group homes in three states. Intervention participants received the 10-session PTC intervention; control participants received usual care. Participants were administered self-report surveys at baseline, after intervention, 6 and 12 months after the intervention. Survey items assessed knowledge, attitudes, self-efficacy, and behavioral intentions regarding HIV and STIs, sexual activity and contraception methods. Random intercept logistic regression analyses were used to assess differences between the intervention and control groups. Compared with youth in the control group, youth in the PTC intervention demonstrated significant improvements in knowledge about anatomy and fertility (adjusted odds ratio [AOR] = 1.07, 95% confidence interval [CI] = 1.03-1.11), HIV and STIs (AOR = 1.03, 95% CI = 1.002-1.07), and methods of protection (AOR = 1.06, 95% CI = 1.03-1.09), as well as self-efficacy regarding self-efficacy to communicate with a partner (AOR = 1.14, 95% CI = 1.04-1.26), plan for protected sex and avoid unprotected sex (AOR = 1.16, 95% CI = 1.04-1.28), and where to get methods of birth control (AOR = 1.13, 95% CI = 1.01-1.26) 12 months after the intervention. Findings suggest that the PTC intervention can have positive long-term knowledge and psychosocial effects regarding contraception methods on youth in out-of-home care. Copyright © 2017 Society for Adolescent Health and Medicine. Published by

  11. Home-based pulmonary rehabilitation improves clinical features and systemic inflammation in chronic obstructive pulmonary disease patients

    Directory of Open Access Journals (Sweden)

    Nascimento ESP

    2015-03-01

    Full Text Available Eloisa Sanches Pereira do Nascimento,1 Luciana Maria Malosá Sampaio,1 Fabiana Sobral Peixoto-Souza,1 Fernanda Dultra Dias,1 Evelim Leal Freitas Dantas Gomes,1 Flavia Regina Greiffo,2 Ana Paula Ligeiro de Oliveira,2 Roberto Stirbulov,3 Rodolfo Paula Vieira,2 Dirceu Costa11Laboratory of Functional Respiratory Evaluation (LARESP, 2Laboratory of Pulmonary and Exercise Immunology (LABPEI, Nove de Julho University (UNINOVE, São Paulo, SP, Brazil; 3Department of Pneumology, Santa Casa University Hospital, São Paulo, SP, BrazilAbstract: Chronic obstructive pulmonary disease (COPD is a respiratory disease characterized by chronic airflow limitation that leads beyond the pulmonary changes to important systemic effects. COPD is characterized by pulmonary and systemic inflammation. However, increases in the levels of inflammatory cytokines in plasma are found even when the disease is stable. Pulmonary rehabilitation improves physical exercise capacity and quality of life and decreases dyspnea. The aim of this study was to evaluate whether a home-based pulmonary rehabilitation (HBPR program improves exercise tolerance in COPD patients, as well as health-related quality of life and systemic inflammation. This prospective study was conducted at the Laboratory of Functional Respiratory Evaluation, Nove de Julho University, São Paulo, Brazil. After anamnesis, patients were subjected to evaluations of health-related quality of life and dyspnea, spirometry, respiratory muscle strength, upper limbs incremental test, incremental shuttle walk test, and blood test for quantification of systemic inflammatory markers (interleukin [IL]-6 and IL-8. At the end of the evaluations, patients received a booklet containing the physical exercises to be performed at home, three times per week for 8 consecutive weeks. Around 25 patients were enrolled, and 14 completed the pre- and post-HBPR ratings. There was a significant increase in the walked distance and the maximal

  12. Achieving quality improvement in the nursing home: influence of nursing leadership on communication and teamwork.

    Science.gov (United States)

    Vogelsmeier, Amy; Scott-Cawiezell, Jill

    2011-01-01

    Leadership, communication, and teamwork are essential elements of organizational capacity and are linked to organizational performance. How those organizations actually achieve improved performance, however, is not clearly understood. In this comparative case study, nursing leadership who facilitated open communication and teamwork achieved improvement while nursing leadership who impeded open communication and teamwork did not.

  13. Palliative home care intervention to improve the quality of life of women with advanced breast cancer

    International Nuclear Information System (INIS)

    Figueredo Villa, Katiuska

    2013-01-01

    The quality of life is affected frequently observed in women with advanced breast cancer and is considered a leading indicator of effectiveness of palliative care. A descriptive, quasi-experimental study is presented ex-ante / ex-post, by applying open-ended interviews to explore the effects on the processes of adaptation of each patient and a self-administrable scale identified specific dimensions of quality of life, satisfaction with care and overall quality of life. The intervention was performed palliative home care to 52 women, according to the damages identified in the baseline diagnosis. The overall strategy included four steps: clinical and socio-demographic characterization of women; identification of the effects on the processes of adaptation by the theoretical model of Roy and dimensions of quality of life frequently affected, to design individually oriented actions on the drive shaft of Nursing Interventions Classification and evaluation of results intervention. The dimensions achieved higher frequency of involvement were: behavior, physical symptoms, pain interference and leisure activities, social life and family. Data were analyzed with qualitative methodologies and uni and multivariate statistical processing. After the intervention favorable changes in adaptive processes and dimensions of quality of life were observed; well as in the assessment of overall satisfaction with life. It was interesting that the dimensions of satisfaction assessed at the end of the intervention obtained an unfavorable assessment, outcome associated with sociodemographic variables. (author)

  14. Disease introduction is associated with a phase transition in bighorn sheep demographics

    Science.gov (United States)

    Manlove, Kezia; Cassirer, E. Frances; Cross, Paul C.; Plowright, Raina K.; Hudson, Peter J.

    2016-01-01

    Ecological theory suggests that pathogens are capable of regulating or limiting host population dynamics, and this relationship has been empirically established in several settings. However, although studies of childhood diseases were integral to the development of disease ecology, few studies show population limitation by a disease affecting juveniles. Here, we present empirical evidence that disease in lambs constrains population growth in bighorn sheep (Ovis canadensis) based on 45 years of population-level and 18 years of individual-level monitoring across 12 populations. While populations generally increased (λ = 1.11) prior to disease introduction, most of these same populations experienced an abrupt change in trajectory at the time of disease invasion, usually followed by stagnant-to-declining growth rates (λ = 0.98) over the next 20 years. Disease-induced juvenile mortality imposed strong constraints on population growth that were not observed prior to disease introduction, even as adult survival returned to pre-invasion levels. Simulations suggested that models including persistent disease-induced mortality in juveniles qualitatively matched observed population trajectories, whereas models that only incorporated all-age disease events did not. We use these results to argue that pathogen persistence may pose a lasting, but under-recognized, threat to host populations, particularly in cases where clinical disease manifests primarily in juveniles.

  15. How Respiratory Pathogens Contribute to Lamb Mortality in a Poorly Performing Bighorn Sheep ( Ovis canadensis ) Herd.

    Science.gov (United States)

    Wood, Mary E; Fox, Karen A; Jennings-Gaines, Jessica; Killion, Halcyon J; Amundson, Sierra; Miller, Michael W; Edwards, William H

    2017-01-01

    We evaluated bighorn sheep ( Ovis canadensis ) ewes and their lambs in captivity to examine the sources and roles of respiratory pathogens causing lamb mortality in a poorly performing herd. After seven consecutive years of observed December recruitments of sheep from the remnant Gribbles Park herd in Colorado, US were captured and transported to the Thorne-Williams Wildlife Research Center in Wyoming in March 2013. Ewes were sampled repeatedly over 16 mo. In April 2014, ewes were separated into individual pens prior to lambing. Upon death, lambs were necropsied and tested for respiratory pathogens. Six lambs developed clinical respiratory disease and one lamb was abandoned. Pathology from an additional six lambs born in 2013 was also evaluated. Mycoplasma ovipneumoniae , leukotoxigenic Mannheimia spp., leukotoxigenic Bibersteinia trehalosi , and Pasteurella multocida all contributed to lamb pneumonia. Histopathology suggested a continuum of disease, with lesions typical of pasteurellosis predominating in younger lambs and lesions typical of mycoplasmosis predominating in older lambs. Mixed pathology was observed in lambs dying between these timeframes. We suspected that all the ewes in our study were persistently infected and chronically shedding the bacteria that contributed to summer lamb mortality.

  16. A run-around heat exchanger system to improve the energy efficiency of a home appliance using hot water

    International Nuclear Information System (INIS)

    Park, Jae Sung; Jacobi, Anthony M.

    2009-01-01

    A significant portion of the energy consumed by many home appliances using hot water is used to heat cold supply water. Such home appliances generally are supplied water at a temperature lower than the ambient temperature, and the supply water is normally heated to its maximum operating temperature, often using natural gas or an electrical heater. In some cases, it is possible to pre-heat the supply water and save energy that would normally be consumed by the natural gas or electrical heater. In order to save the energy consumed by an appliance using water heater, a run-around heat exchanger system is used to transfer heat from the ambient to the water before an electrical heater is energized. A simple model to predict the performance of this system is developed and validated, and the model is used to explore design and operating issues relevant to the run-around heat exchanger system. Despite the additional power consumption by the fan and pump of the run-around heat exchanger system, the experimental data and analysis show that for some systems the overall energy efficiency of the appliance can be improved, saving about 6% of the energy used by the baseline machine.

  17. Home-based walking improves cardiopulmonary function and health-related QOL in community-dwelling adults.

    Science.gov (United States)

    Okamoto, N; Nakatani, T; Morita, N; Saeki, K; Kurumatani, N

    2007-12-01

    The objective of our study was to investigate the effects of a home-based walking program on physical fitness and QOL among community residents. Subjects (n = 200, mean age: 64.2 years, range: 42 - 75 years) who participated in the 32-week trial were randomly allocated to one of two groups: an exercise (E) group and a control (C) group. The E group was instructed to increase the number of steps a day that they walked and to perform aerobic walking at a target heart rate for 20 minutes or more daily, 2 or more days a week. The C group was told to continue their normal level of activity. Outcome measures were the 3-minute shuttle stamina walk test (SSWT), 30-second chair-stand test (CS-30), and SF-36. Increases in SSWT values were significantly greater in the E group than in the C group (men 24.1 m vs. 6.3 m; women 8.8 m vs. 2.4 m), as were increases in CS-30 values (men 5.9 vs. 2.6; women 4.5 vs. - 0.1). On the SF-36, the scores in the E group for vitality and mental health increased significantly. Home-based walking is considered to be an effective and feasible method to improve physical fitness and QOL among community residents.

  18. A facility specialist model for improving retention of nursing home staff: results from a randomized, controlled study.

    Science.gov (United States)

    Pillemer, Karl; Meador, Rhoda; Henderson, Charles; Robison, Julie; Hegeman, Carol; Graham, Edwin; Schultz, Leslie

    2008-07-01

    This article reports on a randomized, controlled intervention study designed to reduce employee turnover by creating a retention specialist position in nursing homes. We collected data three times over a 1-year period in 30 nursing homes, sampled in stratified random manner from facilities in New York State and Connecticut and randomly assigned to treatment and control conditions. Staff outcomes were measured through certified nursing assistant interviews, and turnover rates were measured over the course of the year. In the intervention condition, a staff member was selected to be the facility retention specialist, who would advocate for and implement programs to improve staff retention and commitment throughout the facility. Retention specialists received an intensive 3-day training in retention leadership and in a number of evidence-based retention programs. Ongoing support was provided throughout the project. Treatment facilities experienced significant declines in turnover rates compared to control facilities. As predicted, we found positive effects on certified nursing assistant assessments of the quality of retention efforts and of care provided in the facility; we did not find effects for job satisfaction or stress. The study provides evidence for the effectiveness of the retention specialist model. Findings from a detailed process evaluation suggest modifications of the program that may increase program effects.

  19. Using a Standardized Patient to Improve Collaboration and Problem Solving Skills With CPAP Usage in the Home.

    Science.gov (United States)

    Williams, Margaret G; Ruhs, Joan

    2017-06-01

    A review of literature revealed a lack of research pertaining to nurses' or student nurses' knowledge of continuous positive airway pressure (CPAP) and the ability to troubleshoot CPAP malfunction. This study sought to answer the following questions: What are associate degree nursing (ADN) students' knowledge, interdisciplinary communication, and problem-solving skills regarding patients' home use of CPAP? Is there a change after participation in a simulation with a patient on CPAP in home setting? Twenty-one ADN students enrolled in small Midwest college participated. A preexperimental design of one group pretest posttest was used. Each student completed a demographic questionnaire, Mayo High Performance Teamwork Scale, Interprofessional collaborative simulation experience survey, and a CPAP knowledge base survey before and upon completion of the simulation. There were no changes in students' comfort, baseline knowledge, and basic understanding regarding CPAP. However, after the simulation, students described more detailed problem-solving skills, which included using respiratory therapists, durable medical equipment providers, and community resources. On the Mayo High Performance Teamwork Scale, all 16 items demonstrated improved scores (baseline mean = 21.65 and postsimulation mean = 25.6).

  20. Improving management and effectiveness of home blood pressure monitoring: a qualitative UK primary care study.

    Science.gov (United States)

    Grant, Sabrina; Greenfield, Sheila M; Nouwen, Arie; McManus, Richard J

    2015-11-01

    Self-monitoring blood pressure (SMBP) is becoming an increasingly prevalent practice in UK primary care, yet there remains little conceptual understanding of why patients with hypertension engage in self-monitoring. To identify psychological factors or processes prompting the decision to self-monitor blood pressure. A qualitative study of patients previously participating in a survey study about SMBP from four general practices in the West Midlands. Taped and transcribed in-depth interviews with 16 patients (6 currently monitoring, 2 used to self-monitor, and 8 had never self-monitored). Thematic analysis was undertaken. Three main themes emerged: 'self' and 'living with hypertension' described the emotional element of living with an asymptomatic condition; 'self-monitoring behaviour and medication' described overall views about self-monitoring, current practice, reasons for monitoring, and the impact on medication adherence; and 'the GP-patient transaction' described the power relations affecting decisions to self-monitor. Self-monitoring was performed by some as a protective tool against the fears of a silent but serious condition, whereas others self-monitor simply out of curiosity. People who self-monitored tended not to discuss this with their nurse or GP, partly due to perceiving minimal or no interest from their clinician about home monitoring, and partly due to fear of being prescribed additional medication. The decision to self-monitor appeared often to be an individual choice with no schedule or systems to integrate it with other medical care. Better recognition by clinicians that patients are self-monitoring, perhaps utilising the results in shared decision-making, might help integrate it into daily practice. © British Journal of General Practice 2015.

  1. [Physical improvements and rising motivation following the "school style" technique in the residents of a nursing home].

    Science.gov (United States)

    Shiota, Kozue; Goto, Shinichi; Tanenaga, Satoshi; Koyama, Keiko

    2014-01-01

    After five years of using our unique "school style" technique, we were able to increase the number of home discharges and decrease the number of days spent in the facility. In order to identify the factors underlying these results, a survey was conducted regarding changes of the physical and cognitive function while in the facility. The subjects included 41 patients who newly began using our facility. All subjects participated in both group and individual programs and were evaluated using the Mini Mental State Examination (MMSE), Frontal Assessment Battery at the bedside (FAB), Vitality Index and Functional Independence Measure (FIM) determined monthly starting the first day of entry into our facility. We compared the results using the Friedman test. The rate of participation in the group program was 81.9%. The average duration of participation in functional training as an individual program was 5.94 days, while that for Kumon learning therapy was 3.27 days. Effective improvements were noted in all four evaluation measurements: MMSE・FAB・Vitality Index・FIM. Improvements in the physical and cognitive function were obtained despite the status of the subjects as elderly individuals with chronic disease. Against this background, we applied interventions with rehabilitation using an intensive program for individuals and noted a pleasant experience during all activities in our unique "school style" protocol, which seeks to improve the subject's motivation. These factors are therefore important for improving the physical and cognitive function.

  2. Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study

    Directory of Open Access Journals (Sweden)

    Johnson David W

    2011-10-01

    Full Text Available Abstract Background Nightly extended hours hemodialysis may improve left ventricular hypertrophy and function and endothelial function but presents problems of sustainability and increased cost. The effect of alternate nightly home hemodialysis (NHD on cardiovascular structure and function is not known. Methods Sixty-three patients on standard hemodialysis (SHD: 3.5-6 hours/session, 3-5 sessions weekly converted to NHD (6-10 hours/session overnight for 3-5 sessions weekly. 2Dimensional transthoracic echocardiography and ultrasound measures of brachial artery reactivity (BAR, carotid intima-media thickness (CIMT, total arterial compliance (TAC and augmentation index (AIX were performed post dialysis at baseline and 18-24 months following conversion to NHD. In 37 patients, indices of oxidative stress: plasma malonyldialdehyde (MDA and anti-oxidant enzymes: catalase (CAT, glutathione peroxidase (GPX and superoxide dismutase (SOD activity and total antioxidant status (TAS were measured at baseline, 3 and 6 months. Results Left ventricular mass index (LVMI remained stable. Despite significant derangement at baseline, there were no changes in diastolic function measures, CIMT, BAR and TAC. AIX increased. Conversion to NHD improved bone mineral metabolism parameters and blood pressure control. Interdialytic weight gains increased. No definite improvements in measures of oxidative stress were demonstrated. Conclusions Despite improvement in uremic toxin levels and some cardiovascular risk factors, conversion to an alternate nightly NHD regimen did not improve cardiovascular structure and function. Continuing suboptimal control of uremic toxins and interdialytic weight gains may be a possible explanation. This study adds to the increasing uncertainty about the nature of improvement in cardiovascular parameters with conversion to intensive hemodialysis regimens. Future randomized controlled trials will be important to determine whether increases in

  3. Is nutritional quality of food-at-home purchases improving? 1969-2010: 40 years of household consumption surveys in France.

    Science.gov (United States)

    Caillavet, France; Darmon, Nicole; Létoile, Flavie; Nichèle, Véronique

    2018-02-01

    The rise of nutrition-related diseases in developed countries prompts investigation into the role played by changing food patterns. Our aim was to observe changes in food-at-home purchases by French households and their impacts on nutritional quality over the past 40 years (1969-2010). Time-series of food-at-home purchases from representative samples of French households were built based on two sources of data: the INSEE National Food Survey (1969-1991) and the Kantar Food Consumption Panel (1989-2010). Food-at-home purchases were converted into energy and nutrients using the French CIQUAL food composition table. The nutritional quality of food-at-home purchases was estimated using the mean adequacy ratio (MAR) for 15 key nutrients. MAR was expressed per 2000 kcal to assess the nutrient density of food-at-home purchases. Between 1969 and 2010, food-at-home purchases showed dramatic changes in many food groups, with increasing processed vs raw products. The purchase of calories increased (+6.7%) and nutrient density improved (MAR per 2000 kcal + 12.9 points). However, this overall trend harbors heterogeneous patterns: food-at-home calories decreased and nutrient density improved up to 2002, but then calories increased while nutrient density stabilized. The nutritional quality of French households' food-at-home purchases improved over the last 40 years, as shown by increasing nutrient density. However, during the last decade, nutrient density ceased to increase and the purchase of calories increased, advocating a need for public action to promote healthier food purchasing patterns.

  4. In hip osteoarthritis, Nordic Walking is superior to strength training and home based exercise for improving function

    DEFF Research Database (Denmark)

    Bieler, T.; Siersma, Volkert; Magnusson, S. P.

    2017-01-01

    in 60+-year-old persons (n = 152) with hip osteoarthritis (OA) not awaiting hip replacement. Functional performance [i.e., 30-s chair stand test (primary outcome), timed stair climbing, and 6-min walk test] and self-reported outcomes (i.e., physical function, pain, physical activity level, self-efficacy......This observer-blinded, randomized controlled trial compared the short- and long-term effects of 4 months of supervised strength training (ST) in a local fitness center, supervised Nordic Walking (NW) in a local park, and unsupervised home-based exercise (HBE, control) on functional performance...... activity and to both ST and HBE for improving (P exercise modality compared with ST and HBE....

  5. Magnetostratigraphy of the Willwood Formation, Bighorn Basin, Wyoming: new constraints on the location of Paleocene/Eocene boundary

    Science.gov (United States)

    Tauxe, L.; Gee, J.; Gallet, Y.; Pick, T.; Bown, T.

    1994-01-01

    The lower Eocene Willwood Formation in the Bighorn Basin of Wyoming preserves a rich and diverse mammalian and floral record. The paleomagnetic behavior of the sequence of floodplain paleosols of varying degrees of maturation ranges from excellent to poor. We present a magnetostratigraphic section for a composite section near Worland, Wyoming, by using a set of strict criteria for interpreting the step-wise alternating field and thermal demagnetization data of 266 samples from 90 sites throughout the composite section. Correlation to the geomagnetic reversal time scale was achieved by combining magnetostratigraphic and biostratigraphic data from this section, from a section in the Clark's Fork Basin in northern Wyoming, and from DSDP Site 550, with the isotopic data determined on a tuff near the top of our section. Our correlation suggests that the Bighorn Basin composite section in the Worland area spans from within Chron C24r to near the top of Chron C24n, or from approximately 55 to 52 Ma. This correlation places the Paleocene/Eocene boundary within the vicinity of the base of the section. Cryptochron C24r.6 of Cande and Kent is tentatively identified some 100 m above the base of the section. The temporal framework provided here enables correlation of the mammalian biostratigraphy of the Bighorn Basin to other continental sequences as well as to marine records. It also provides independent chronological information for the calculation of sediment accumulation rates to constrain soil maturation rates. We exclude an age as young as 53 Ma for the Paleocene/Eocene boundary and support older ages, as recommended in recent time scales. The location of a tuff dated at 52.8 ?? 0.3 Ma at the older boundary C24n.1 is consistent with the age of 52.5 Ma estimated by Cande and Kent and inconsistent with that of 53.7 Ma, from Harland et al. ?? 1994.

  6. Effect of vaccination against pneumonia on the survival of bighorn sheep (Ovis canadensis) commingled with carrier animals.

    Science.gov (United States)

    Raghavan, Bindu; Bavananthasivam, Jegarubee; Kugadas, Abirami; Haldorson, Gary J; Srikumaran, Subramaniam

    2017-05-01

    Leukotoxin producing (lkt+) members of Pasteurellaceae, particularly Mannheimia haemolytica and Bibersteinia trehalosi are important pathogens of pneumonia in bighorn sheep (BHS; Ovis canadensis), causing fatal disease. Predisposing or concurrent infection with Mycoplasma ovipneumoniae enhances the severity of the disease, resulting in increased morbidity and mortality. Several studies have investigated the effectiveness of vaccines against lkt+ members of Pasteurellaceae in preventing fatal pneumonia in BHS. In all of these studies, however, vaccinated animals were challenged experimentally, by direct inoculation of the pathogens, rather than by natural challenge. Moreover, none has investigated the efficacy of the vaccines under conditions of concurrent infection with M. ovipneumoniae. We immunized three bighorn rams and one pregnant ewe with an experimental multivalent vaccine along with a commercial vaccine. The immunized animals were then commingled with two bighorn ewes known to be carriers of lkt+ members of Pasteurellaceae, to simulate natural infection or disease transmission. All vaccinated animals remained healthy. We then inoculated the two carrier ewes with nasal washings from domestic sheep containing M. ovipneumoniae. Within a week, all animals developed mild to moderate signs of pneumonia. While the rams died within two-three months post-inoculation (p.i.), the vaccinated ewe and her lamb died five and eight months p.i., respectively. Taken together, these results suggest that vaccination of BHS against lkt+ members of Pasteurellaceae alone can protect them from natural challenge by these pathogens. However, it may not be adequate to protect them against pneumonia compounded by concurrent infection with M. ovipneumoniae. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Meals in nursing homes

    DEFF Research Database (Denmark)

    Kofod, Jens Erik; Birkemose, A.

    2004-01-01

    Undernutrition is present among 33% of nursing home residents in Denmark. Hence, it is relevant to examine the meal situation at nursing homes to single out factors that may increase or reduce the residents' food intake. in the ongoing Danish nursing home debate it is claimed that a new type...... of nursing home improves the residents' meal situation with a positive effect on nutrition. The aim of this work is to test the general hypothesis that (i) residents appreciate the meal situation in these nursing homes and (ii) nutritional status of the residents is improved in this type of nursing home....... This study was carried out in four Danish nursing homes at various locations in Denmark. The methods used are qualitative interviews and observations at four nursing homes in combination with measurement of body mass index (BMI) at two of the four nursing homes. Undernutrition is defined as a BMI below 20...

  8. Time-limited home-care reablement services for maintaining and improving the functional independence of older adults.

    Science.gov (United States)

    Cochrane, Andy; Furlong, Mairead; McGilloway, Sinead; Molloy, David W; Stevenson, Michael; Donnelly, Michael

    2016-10-11

    Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field. We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed. Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years).We are very uncertain as to

  9. Computerised clinical decision support systems to improve medication safety in long-term care homes: a systematic review.

    Science.gov (United States)

    Marasinghe, Keshini Madara

    2015-05-12

    Computerised clinical decision support systems (CCDSS) are used to improve the quality of care in various healthcare settings. This systematic review evaluated the impact of CCDSS on improving medication safety in long-term care homes (LTC). Medication safety in older populations is an important health concern as inappropriate medication use can elevate the risk of potentially severe outcomes (ie, adverse drug reactions, ADR). With an increasing ageing population, greater use of LTC by the growing ageing population and increasing number of medication-related health issues in LTC, strategies to improve medication safety are essential. Databases searched included MEDLINE, EMBASE, Scopus and Cochrane Library. Three groups of keywords were combined: those relating to LTC, medication safety and CCDSS. One reviewer undertook screening and quality assessment. Overall findings suggest that CCDSS in LTC improved the quality of prescribing decisions (ie, appropriate medication orders), detected ADR, triggered warning messages (ie, related to central nervous system side effects, drug-associated constipation, renal insufficiency) and reduced injury risk among older adults. CCDSS have received little attention in LTC, as attested by the limited published literature. With an increasing ageing population, greater use of LTC by the ageing population and increased workload for health professionals, merely relying on physicians' judgement on medication safety would not be sufficient. CCDSS to improve medication safety and enhance the quality of prescribing decisions are essential. Analysis of review findings indicates that CCDSS are beneficial, effective and have potential to improve medication safety in LTC; however, the use of CCDSS in LTC is scarce. Careful assessment on the impact of CCDSS on medication safety and further modifications to existing CCDSS are recommended for wider acceptance. Due to scant evidence in the current literature, further research on implementation and

  10. Drainage and Landscape Evolution in the Bighorn Basin Accompanying Advection of the Yellowstone Hotspot Swell Through North America

    Science.gov (United States)

    Guerrero, E. F.; Meigs, A.

    2012-12-01

    Mantle plumes have been recognized to express themselves on the surface as long wavelength and low amplitude topographic swells. These swells are measured as positive geoid anomalies and include shorter wavelength topographic features such as volcanic edifices and pre-exisitng topography. Advection of the topographic swell is expected as the lithosphere passes over the plume uplift source. The hot spot swell occurs in the landscape as transient signal that is expressed with waxing and waning topography. Waxing topography occurs at the leading edge of the swell and is expressed as an increase in rock uplift that is preserved by rivers and landscapes. Advection of topography predicts a shift in a basin from deposition to incision, an increase in convexity of a transverse river's long profile and a lateral river migration in the direction of advection. The Yellowstone region has a strong positive geoid anomaly and the volcanic signal, which have been interpreted as the longer and shorter wavelength topographic expressions of the hot spot. These expressions of the hot spot developed in a part of North America with a compounded deformation and topographic history. Previous studies of the Yellowstone topographic swell have concentrated on the waning or trailing signal preserved in the Snake River Plain. Our project revisits the classic geomorphology study area in the Bighorn Basin of Wyoming and Montana, which is in leading edge of the swell. Present models identify the swell as having a 400 km in diameter and that it is centered on the Yellowstone caldera. If we assume advection to occur in concert with the caldera eruptive track, the Yellowstone swell has migrated to the northeast at a rate of 3 cm yr-1 and began acting on the Bighorn Basin's landscape between 3 and 2 Ma. The Bighorn Basin has an established history of a basin-wide switch from deposition to incision during the late Pliocene, yet the age control on the erosional evolution of the region is relative. This

  11. Intensive educational efforts combined with external quality assessment improve the preanalytical phase in general practitioner offices and nursing homes.

    Science.gov (United States)

    Sølvik, Una Ørvim; Bjelkarøy, Wenche Iren; Berg, Kari van den; Saga, Anne Lise; Hager, Helle Borgstrøm; Sandberg, Sverre

    2017-10-26

    Errors in the preanalytical phase in clinical laboratories affect patient safety. The aim of this study was to evaluate the effect of intensive educational efforts together with external quality assessment (EQA) of the preanalytical phase from 2013 to 2015 to improve patient identification in primary health care in Norway. In addition, routines for venous and capillary blood sampling were investigated. A preanalytical EQA was circulated in 2013 by the Norwegian Quality Improvement of Laboratory Examinations (Noklus) to general practitioner offices and nursing homes (n=2000) to obtain information about important issues to focus on before launching an intensive educational program with courses, posters and visits in 2013-2015. Preanalytical EQA surveys were further circulated in 2014 and 2015. The response rate varied between 42% and 55%. The percentages of participants asking for the patients' name and the Norwegian identification number increased from about 8% in 2013 to about 35% in 2015. The increase was similar for those participating in only one EQA survey and for those who participated in EQA surveys both in 2013 and 2015. Guidelines for venous and capillary blood sampling were not always followed. Educational efforts more than the preanalytical EQA influenced the actions and resulted in an increase in the percentages of participants that followed the guidelines for patient identification. Some aspects of blood sampling routines need improvement.

  12. Home parenteral nutrition improves quality of life and nutritional status in patients with cancer: a French observational multicentre study.

    Science.gov (United States)

    Culine, S; Chambrier, C; Tadmouri, A; Senesse, P; Seys, P; Radji, A; Rotarski, M; Balian, A; Dufour, P

    2014-07-01

    Malnutrition is a predictor of poor outcomes in patients with cancer. Little is known about the benefit of nutritional support in these patients. The purpose of this study was to assess the impact of home parenteral nutrition (HPN) on quality of life (Qol) in cancer patients. We performed an observational prospective study to determine the impact of HPN on Qol in a population of patients with heterogeneous cancer. Physicians, patients and family members had to complete a questionnaire before HPN administration and 28 days after the course of HPN. Qol was evaluated using the self-administered questionnaire FACT-G. We included 767 patients with cancer of whom 437 ended the study. Mean patient age was 63±11.4 years and 60.5% were men. Primary gastrointestinal cancer was reported in 50% of patients and 65.3% were presenting metastases. Malnutrition was reported in 98.3%. After 28 days of HPN intake, significant improvement was observed in the Qol (49.95±5.82 vs. 48.35±5.01 at baseline, pnutrition risk index had also improved significantly. Most patients (78%) had perceived a positive impact of the HPN. A significant improvement in patient's well-being was perceived also by family members and physicians. Our data suggest that preventing and correcting malnutrition using HPN in patients with cancer might have a significant benefit on their well-being. Randomized controlled studies are required to confirm this finding.

  13. Use of CAHPS® patient experience survey data as part of a patient-centered medical home quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Quigley DD

    2015-07-01

    Full Text Available Denise D Quigley,1 Peter J Mendel,1 Zachary S Predmore,2 Alex Y Chen,3 Ron D Hays41RAND Corporation, Santa Monica, CA, 2RAND Corporation, Boston, MA, 3AltaMed Health Services Corporation, 4Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USAObjective: To describe how practice leaders used Consumer Assessment of Healthcare Providers and Systems (CAHPS® Clinician and Group (CG-CAHPS data in transitioning toward a patient-centered medical home (PCMH.Study design: Interviews conducted at 14 primary care practices within a large urban Federally Qualified Health Center in California.Participants: Thirty-eight interviews were conducted with lead physicians (n=13, site clinic administrators (n=13, nurse supervisors (n=10, and executive leadership (n=2.Results: Seven themes were identified on how practice leaders used CG-CAHPS data for PCMH transformation. CAHPS® was used: 1 for quality improvement (QI and focusing changes for PCMH transformation; 2 to maintain focus on patient experience; 3 alongside other data; 4 for monitoring site-level trends and changes; 5 to identify, analyze, and monitor areas for improvement; 6 for provider-level performance monitoring and individual coaching within a transparent environment of accountability; and 7 for PCMH transformation, but changes to instrument length, reading level, and the wording of specific items were suggested.Conclusion: Practice leaders used CG-CAHPS data to implement QI, develop a shared vision, and coach providers and staff on performance. They described how CAHPS® helped to improve the patient experience in the PCMH model, including access to routine and urgent care, wait times, provider spending enough time and listening carefully, and courteousness of staff. Regular reporting, reviewing, and discussing of patient-experience data alongside other clinical quality and productivity measures at multilevels of the organization was critical in maximizing the

  14. Healthy Habits, Happy Homes: randomized trial to improve household routines for obesity prevention among preschool-aged children.

    Science.gov (United States)

    Haines, Jess; McDonald, Julia; O'Brien, Ashley; Sherry, Bettylou; Bottino, Clement J; Schmidt, Marie Evans; Taveras, Elsie M

    2013-11-01

    Racial/ethnic and socioeconomic disparities exist across risk factors for childhood obesity. To examine the effectiveness of a home-based intervention to improve household routines known to be associated with childhood obesity among a sample of low-income, racial/ethnic minority families with young children. Randomized trial. The intervention was delivered in the families' homes. The study involved 121 families with children aged 2 to 5 years who had a television (TV) in the room where he or she slept; 111 (92%) had 6-month outcome data (55 intervention and 56 control). The mean (SD) age of the children was 4.0 (1.1) years; 45% were overweight/obese. Fifty-two percent of the children were Hispanic, 34% were black, and 14% were white/other. Nearly 60% of the families had household incomes of $20,000 or less. The 6-month intervention promoted 4 household routines, family meals, adequate sleep, limiting TV time, and removing the TV from the child's bedroom, using (1) motivational coaching at home and by phone, (2) mailed educational materials, and (3) text messages. Control subjects were mailed materials focused on child development. Change in parent report of frequency of family meals (times/wk), child sleep duration (hours/d), child weekday and weekend day TV viewing (hours/d), and the presence of a TV in the room where the child slept from baseline to 6 months. A secondary outcome was change in age- and sex-adjusted body mass index (calculated as weight in kilograms divided by height in meters squared). Compared with control subjects, intervention participants had increased sleep duration (0.75 hours/d; 95% CI, 0.06 to 1.44; P = .03), greater decreases in TV viewing on weekend days (-1.06 hours/d; 95% CI, -1.97 to -0.15; P = .02), and decreased body mass index (-0.40; 95% CI, -0.79 to 0.00; P = .05). No significant intervention effect was found for the presence of a TV in the room where the child slept or family meal frequency. Our results suggest that promoting

  15. Organizational learning and continuous quality improvement: examining the impact on nursing home performance.

    Science.gov (United States)

    Rondeau, Kent V; Wagar, Terry H

    2002-01-01

    Interest is growing in learning more about the ability of total quality management and continuous quality improvement (TQM/CQI) initiatives to contribute to the performance of healthcare organizations. A major factor in the successful implementation of TQM/CQI is the seminal contribution of an organization's culture. Many implementation efforts have not succeeded because of a corporate culture that failed to stress broader organizational learning. This may help to explain why some TQM/CQI programs have been unsuccessful in improving healthcare organization performance. Organizational performance variables and organizational learning orientation were assessed in a sample of 181 Canadian long-term care organizations that had implemented a formal TQM/CQI program. Categorical regression analysis shows that, in the absence of a strong corporAte culture that stresses organizational learning and employee development, few performance enhancements are reported. The results of the assessment suggest that a TQM/CQI program without the backing of a strong organizational learning culture may be insufficient to achieve augmented organizational performance.

  16. A Home-Based Educational Intervention Improves Patient Activation Measures and Diabetes Health Indicators among Zuni Indians.

    Directory of Open Access Journals (Sweden)

    Vallabh O Shah

    Full Text Available One in three people will be diagnosed with diabetes by 2050, and the proportion will likely be higher among Native Americans. Diabetes control is currently suboptimal in underserved populations despite a plethora of new therapies. Patient empowerment is a key determinant of diabetes control, but such empowerment can be difficult to achieve due to resource limitation and cultural, language and health literacy barriers. We describe a home-based educational intervention using Community Health Representatives (CHRs, leading to improvement in Patient Activation Measures scores and clinical indicators of diabetes control.Sixty participants with type 2 diabetes (T2D completed a baseline evaluation including physical exam, Point of Care (POC testing, and the Patient Activation Measure (PAM survey. Participants then underwent a one hour group didactic session led by Community Health Representatives (CHRs who subsequently carried out monthly home-based educational interventions to encourage healthy lifestyles, including diet, exercise, and alcohol and cigarette avoidance until follow up at 6 months, when clinical phenotyping and the PAM survey were repeated.PAM scores were increased by at least one level in 35 (58% participants, while 24 participants who started at higher baseline score did not change. Six months after intervention, mean levels of A1C decreased by 0.7 ± 1.2%; fasting blood glucose decreased by 24.0 ± 38.0 mg/dl; BMI decreased by 1.5 ± 2.1 kg/m2; total cholesterol decreased by 12.0 ± 28.0 mg/dl; and triglycerides decreased by 52.0 ± 71.0 mg/dl. All of these changes were statistically significant (p < 0.05.This six month, CHR led and community-oriented educational intervention helps inform standards of practice for the management of diabetes, engages diabetic populations in their own care, and reduces health disparities for the underserved population of Zuni Indians.ClinicalTrials.gov NCT02339311.

  17. A multivalent Mannheimia-Bibersteinia vaccine protects bighorn sheep against Mannheimia haemolytica challenge.

    Science.gov (United States)

    Subramaniam, Renuka; Shanthalingam, Sudarvili; Bavananthasivam, Jegarubee; Kugadas, Abirami; Potter, Kathleen A; Foreyt, William J; Hodgins, Douglas C; Shewen, Patricia E; Barrington, George M; Knowles, Donald P; Srikumaran, Subramaniam

    2011-10-01

    Bighorn sheep (BHS) are more susceptible than domestic sheep (DS) to Mannheimia haemolytica pneumonia. Although both species carry M. haemolytica as a commensal bacterium in the nasopharynx, DS carry mostly leukotoxin (Lkt)-positive strains while BHS carry Lkt-negative strains. Consequently, antibodies to surface antigens and Lkt are present at much higher titers in DS than in BHS. The objective of this study was to determine whether repeated immunization of BHS with multivalent Mannheimia-Bibersteinia vaccine will protect them upon M. haemolytica challenge. Four BHS were vaccinated with a culture supernatant vaccine prepared from M. haemolytica serotypes A1 and A2 and Bibersteinia trehalosi serotype T10 on days 0, 21, 35, 49, and 77. Four other BHS were used as nonvaccinated controls. On the day of challenge, 12 days after the last immunization, the mean serum titers of Lkt-neutralizing antibodies and antibodies to surface antigens against M. haemolytica were 1:160 and 1:4,000, respectively. Following intranasal challenge with M. haemolytica A2 (1 × 10(5) CFU), all four control BHS died within 48 h. Necropsy revealed acute fibrinonecrotic pneumonia characteristic of M. haemolytica infection. None of the vaccinated BHS died during the 8 weeks postchallenge observation period. Radiography at 3 weeks postchallenge revealed no lung lesions in two vaccinated BHS and mild lesions in the other two, which resolved by 8 weeks postchallenge. These results indicate that if BHS can be induced to develop high titers of Lkt-neutralizing antibodies and antibodies to surface antigens, they are likely to survive M. haemolytica challenge which is likely to reduce the BHS population decline due to pneumonia.

  18. Bighorn sheep × domestic sheep hybrids survive Mannheimia haemolytica challenge in the absence of vaccination.

    Science.gov (United States)

    Subramaniam, R; Shanthalingam, S; Bavananthasivam, J; Kugadas, A; Raghavan, B; Batra, S A; Herndon, C N; Rodriguez, J; Tibary, A; Nelson, D; Potter, K A; Foreyt, W J; Srikumaran, S

    2014-06-04

    Bighorn sheep (BHS, Ovis canadensis) are much more susceptible than domestic sheep (DS, Ovis aries) to pneumonia caused by leukotoxin (Lkt)-producing members of the Family Pasteurellaceae, particularly Mannheimia haemolytica and Bibersteinia trehalosi. Leukotoxin is widely accepted as the critical virulence factor of these bacteria since Lkt-negative mutants do not cause death of BHS. Typically, DS carry Lkt-positive M. haemolytica and/or B. trehalosi as commensal bacteria in their nasopharynx. In contrast, most BHS do not carry Lkt-positive M. haemolytica or B. trehalosi, or carry Lkt-negative strains in their nasopharynx. In previous studies, we demonstrated that unimmunized DS resist M. haemolytica challenge while BHS succumb to it. We hypothesized that Lkt-neutralizing antibodies, induced by Lkt-positive M. haemolytica and/or B. trehalosi innately carried by DS in their nasopharynx, render them less susceptible to infection by these bacteria. In this study we developed BHS×DS F1 hybrids by artificial insemination of domestic ewes with BHS semen. F1 hybrids were fertile, and produced F2 hybrids and back-crosses. The F1, F2, and back-crosses were raised together with domestic ewes. All these animals acquired Lkt-positive M. haemolytica and/or B. trehalosi, and developed high titers of Lkt-neutralizing antibodies in the absence of vaccination. Furthermore, all of these animals resisted challenge with lethal dose of M. haemolytica. These results suggest that lack of previous exposure to Lkt is at least partially responsible for fatal pneumonia in BHS when they acquire Lkt-positive M. haemolytica and/or B. trehalosi from DS when the two species commingle. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. A Multivalent Mannheimia-Bibersteinia Vaccine Protects Bighorn Sheep against Mannheimia haemolytica Challenge ▿

    Science.gov (United States)

    Subramaniam, Renuka; Shanthalingam, Sudarvili; Bavananthasivam, Jegarubee; Kugadas, Abirami; Potter, Kathleen A.; Foreyt, William J.; Hodgins, Douglas C.; Shewen, Patricia E.; Barrington, George M.; Knowles, Donald P.; Srikumaran, Subramaniam

    2011-01-01

    Bighorn sheep (BHS) are more susceptible than domestic sheep (DS) to Mannheimia haemolytica pneumonia. Although both species carry M. haemolytica as a commensal bacterium in the nasopharynx, DS carry mostly leukotoxin (Lkt)-positive strains while BHS carry Lkt-negative strains. Consequently, antibodies to surface antigens and Lkt are present at much higher titers in DS than in BHS. The objective of this study was to determine whether repeated immunization of BHS with multivalent Mannheimia-Bibersteinia vaccine will protect them upon M. haemolytica challenge. Four BHS were vaccinated with a culture supernatant vaccine prepared from M. haemolytica serotypes A1 and A2 and Bibersteinia trehalosi serotype T10 on days 0, 21, 35, 49, and 77. Four other BHS were used as nonvaccinated controls. On the day of challenge, 12 days after the last immunization, the mean serum titers of Lkt-neutralizing antibodies and antibodies to surface antigens against M. haemolytica were 1:160 and 1:4,000, respectively. Following intranasal challenge with M. haemolytica A2 (1 × 105 CFU), all four control BHS died within 48 h. Necropsy revealed acute fibrinonecrotic pneumonia characteristic of M. haemolytica infection. None of the vaccinated BHS died during the 8 weeks postchallenge observation period. Radiography at 3 weeks postchallenge revealed no lung lesions in two vaccinated BHS and mild lesions in the other two, which resolved by 8 weeks postchallenge. These results indicate that if BHS can be induced to develop high titers of Lkt-neutralizing antibodies and antibodies to surface antigens, they are likely to survive M. haemolytica challenge which is likely to reduce the BHS population decline due to pneumonia. PMID:21832104

  20. Role of Bibersteinia trehalosi, respiratory syncytial virus, and parainfluenza-3 virus in bighorn sheep pneumonia.

    Science.gov (United States)

    Dassanayake, Rohana P; Shanthalingam, Sudarvili; Subramaniam, Renuka; Herndon, Caroline N; Bavananthasivam, Jegarubee; Haldorson, Gary J; Foreyt, William J; Evermann, James F; Herrmann-Hoesing, Lynn M; Knowles, Donald P; Srikumaran, Subramaniam

    2013-02-22

    Pneumonic bighorn sheep (BHS) have been found to be culture- and/or sero-positive for Bibersteinia trehalosi, respiratory syncytial virus (RSV), and parainfluenza-3 virus (PI-3). The objective of this study was to determine whether these pathogens can cause fatal pneumonia in BHS. In the first study, two groups of four BHS each were intra-tracheally administered with leukotoxin-positive (Group I) or leukotoxin-negative (Group II) B. trehalosi. All four animals in Group I developed severe pneumonia, and two of them died within 3 days. The other two animals showed severe pneumonic lesions on euthanasia and necropsy. Animals in Group II neither died nor showed gross pneumonic lesions on necropsy, suggesting that leukotoxin-positive, but not leukotoxin-negative, B. trehalosi can cause fatal pneumonia in BHS. In the second study, two other groups of four BHS (Groups III and IV) were intra-nasally administered with a mixture of RSV and PI-3. Four days later, RSV/PI-3-inoculated Group IV and another group of four BHS (Group V, positive control) were intra-nasally administered with Mannheimia haemolytica, the pathogen that consistently causes fatal pneumonia in BHS. All four animals in group III developed pneumonia, but did not die during the study period. However all four animals in Group IV, and three animals in Group V developed severe pneumonia and died within two days of M. haemolytica inoculation. The fourth animal in Group V showed severe pneumonic lesions on euthanasia and necropsy. These findings suggest that RSV/PI-3 can cause non-fatal pneumonia, but are not necessary predisposing agents for M. haemolytica-caused pneumonia of BHS. Copyright © 2012 Elsevier B.V. All rights reserved.

  1. Mycoplasma ovipneumoniae can predispose bighorn sheep to fatal Mannheimia haemolytica pneumonia.

    Science.gov (United States)

    Dassanayake, Rohana P; Shanthalingam, Sudarvili; Herndon, Caroline N; Subramaniam, Renuka; Lawrence, Paulraj K; Bavananthasivam, Jegarubee; Cassirer, E Frances; Haldorson, Gary J; Foreyt, William J; Rurangirwa, Fred R; Knowles, Donald P; Besser, Thomas E; Srikumaran, Subramaniam

    2010-10-26

    Mycoplasma ovipneumoniae has been isolated from the lungs of pneumonic bighorn sheep (BHS). However experimental reproduction of fatal pneumonia in BHS with M. ovipneumoniae was not successful. Therefore the specific role, if any, of M. ovipneumoniae in BHS pneumonia is unclear. The objective of this study was to determine whether M. ovipneumoniae alone causes fatal pneumonia in BHS, or predisposes them to infection by Mannheimia haemolytica. We chose M. haemolytica for this study because of its isolation from pneumonic BHS, and its consistent ability to cause fatal pneumonia under experimental conditions. Since in vitro culture could attenuate virulence of M. ovipneumoniae, we used ceftiofur-treated lung homogenates from pneumonic BHS lambs or nasopharyngeal washings from M. ovipneumoniae-positive domestic sheep (DS) as the source of M. ovipneumoniae. Two adult BHS were inoculated intranasally with lung homogenates while two others received nasopharyngeal washings from DS. All BHS developed clinical signs of respiratory infection, but only one BHS died. The dead BHS had carried leukotoxin-positive M. haemolytica in the nasopharynx before the onset of this study. It is likely that M. ovipneumoniae colonization predisposed this BHS to fatal infection with the M. haemolytica already present in this animal. The remaining three BHS developed pneumonia and died 1-5 days following intranasal inoculation with M. haemolytica. On necropsy, lungs of all four BHS showed lesions characteristic of bronchopneumonia. M. haemolytica and M. ovipneumoniae were isolated from the lungs. These results suggest that M. ovipneumoniae alone may not cause fatal pneumonia in BHS, but can predispose them to fatal pneumonia due to M. haemolytica infection. Copyright © 2010 Elsevier B.V. All rights reserved.

  2. Home- and Community-Based Occupational Therapy Improves Functioning in Frail Older People: A Systematic Review.

    Science.gov (United States)

    De Coninck, Leen; Bekkering, Geertruida E; Bouckaert, Leen; Declercq, Anja; Graff, Maud J L; Aertgeerts, Bert

    2017-08-01

    The objective is to assess the effectiveness of occupational therapy to improve performance in daily living activities in community-dwelling physically frail older people. We conducted a systematic review and meta-analysis. We included randomized controlled trials reporting on occupational therapy as intervention, or as part of a multidisciplinary approach. This systematic review was carried out in accordance with the Cochrane methods of systematic reviews of interventions. Meta-analyses were performed to pool results across studies using the standardized mean difference. The primary outcome measures were mobility, functioning in daily living activities, and social participation. Secondary outcome measures were fear of falling, cognition, disability, and number of falling persons. Nine studies met the inclusion criteria. Overall, the studies were of reasonable quality with low risk of bias. There was a significant increase in all primary outcomes. The pooled result for functioning in daily living activities was a standardized mean difference of -0.30 (95% CI -0.50 to -0.11; P = .002), for social participation -0.44 (95% CI -0.69, -0.19; P = .0007) and for mobility -0.45 (95% CI -0.78 to -0.12; P = .007). All secondary outcomes showed positive trends, with fear of falling being significant. No adverse effects of occupational therapy were found. There is strong evidence that occupational therapy improves functioning in community-dwelling physically frail older people. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  3. Using comprehensive geriatric assessment for quality improvements in healthcare of older people in UK care homes: protocol for realist review within Proactive Healthcare of Older People in Care Homes (PEACH) study.

    Science.gov (United States)

    Zubair, Maria; Chadborn, Neil H; Gladman, John R F; Dening, Tom; Gordon, Adam L; Goodman, Claire

    2017-10-10

    Care home residents are relatively high users of healthcare resources and may have complex needs. Comprehensive geriatric assessment (CGA) may benefit care home residents and improve efficiency of care delivery. This is an approach to care in which there is a thorough multidisciplinary assessment (physical and mental health, functioning and physical and social environments) and a care plan based on this assessment, usually delivered by a multidisciplinary team. The CGA process is known to improve outcomes for community-dwelling older people and those in receipt of hospital care, but less is known about its efficacy in care home residents. Realist review was selected as the most appropriate method to explore the complex nature of the care home setting and multidisciplinary delivery of care. The aim of the realist review is to identify and characterise a programme theory that underpins the CGA intervention. The realist review will extract data from research articles which describe the causal mechanisms through which the practice of CGA generates outcomes. The focus of the intervention is care homes, and the outcomes of interest are health-related quality of life and satisfaction with services; for both residents and staff. Further outcomes may include appropriate use of National Health Service services and resources of older care home residents. The review will proceed through three stages: (1) identifying the candidate programme theories that underpin CGA through interviews with key stakeholders, systematic search of the peer-reviewed and non-peer-reviewed evidence, (2) identifying the evidence relevant to CGA in UK care homes and refining the programme theories through refining and iterating the systematic search, lateral searches and seeking further information from study authors and (3) analysis and synthesis of evidence, involving the testing of the programme theories. The PEACH project was identified as service development following submission to the UK Health

  4. Ultrasound-Targeted Microbubble Destruction Improves the Migration and Homing of Mesenchymal Stem Cells after Myocardial Infarction by Upregulating SDF-1/CXCR4: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Lu Li

    2015-01-01

    Full Text Available Mesenchymal stem cell (MSC therapy shows considerable promise for the treatment of myocardial infarction (MI. However, the inefficient migration and homing of MSCs after systemic infusion have limited their therapeutic applications. Ultrasound-targeted microbubble destruction (UTMD has proven to be promising to improve the homing of MSCs to the ischemic myocardium, but the concrete mechanism remains unclear. We hypothesize that UTMD promotes MSC homing by upregulating SDF-1/CXCR4, and this study was aimed at exploring this potential mechanism. We analyzed SDF-1/CXCR4 expression after UTMD treatment in vitro and in vivo and counted the number of homing MSCs in MI areas. The in vitro results demonstrated that UTMD not only led to elevated secretion of SDF-1 but also resulted in an increased proportion of MSCs that expressed surface CXCR4. The in vivo findings show an increase in the number of homing MSCs and higher expression of SDF-1/CXCR4 in the UTMD combined with MSCs infusion group compared to other groups. In conclusion, UTMD can increase SDF-1 expression in the ischemic myocardium and upregulate the expression of surface CXCR4 on MSCs, which provides a molecular mechanism for the homing of MSCs assisted by UTMD via SDF-1/CXCR4 axis.

  5. Costs and benefits of group living with disease: a case study of pneumonia in bighorn lambs (Ovis canadensis).

    Science.gov (United States)

    Manlove, Kezia R; Cassirer, E Frances; Cross, Paul C; Plowright, Raina K; Hudson, Peter J

    2014-12-22

    Group living facilitates pathogen transmission among social hosts, yet temporally stable host social organizations can actually limit transmission of some pathogens. When there are few between-subpopulation contacts for the duration of a disease event, transmission becomes localized to subpopulations. The number of per capita infectious contacts approaches the subpopulation size as pathogen infectiousness increases. Here, we illustrate that this is the case during epidemics of highly infectious pneumonia in bighorn lambs (Ovis canadensis). We classified individually marked bighorn ewes into disjoint seasonal subpopulations, and decomposed the variance in lamb survival to weaning into components associated with individual ewes, subpopulations, populations and years. During epidemics, lamb survival varied substantially more between ewe-subpopulations than across populations or years, suggesting localized pathogen transmission. This pattern of lamb survival was not observed during years when disease was absent. Additionally, group sizes in ewe-subpopulations were independent of population size, but the number of ewe-subpopulations increased with population size. Consequently, although one might reasonably assume that force of infection for this highly communicable disease scales with population size, in fact, host social behaviour modulates transmission such that disease is frequency-dependent within populations, and some groups remain protected during epidemic events. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  6. Costs and benefits of group living with disease: a case study of pneumonia in bighorn lambs (Ovis canadensis)

    Science.gov (United States)

    Manlove, Kezia R.; Cassirer, E. Frances; Cross, Paul C.; Plowright, Raina K.; Hudson, Peter J.

    2014-01-01

    Group living facilitates pathogen transmission among social hosts, yet temporally stable host social organizations can actually limit transmission of some pathogens. When there are few between-subpopulation contacts for the duration of a disease event, transmission becomes localized to subpopulations. The number of per capita infectious contacts approaches the subpopulation size as pathogen infectiousness increases. Here, we illustrate that this is the case during epidemics of highly infectious pneumonia in bighorn lambs (Ovis canadensis). We classified individually marked bighorn ewes into disjoint seasonal subpopulations, and decomposed the variance in lamb survival to weaning into components associated with individual ewes, subpopulations, populations and years. During epidemics, lamb survival varied substantially more between ewe-subpopulations than across populations or years, suggesting localized pathogen transmission. This pattern of lamb survival was not observed during years when disease was absent. Additionally, group sizes in ewe-subpopulations were independent of population size, but the number of ewe-subpopulations increased with population size. Consequently, although one might reasonably assume that force of infection for this highly communicable disease scales with population size, in fact, host social behaviour modulates transmission such that disease is frequency-dependent within populations, and some groups remain protected during epidemic events.

  7. Reduction in food away from home is associated with improved child relative weight and body composition outcomes and this relation is mediated by changes in diet quality.

    Science.gov (United States)

    Altman, Myra; Cahill Holland, Jodi; Lundeen, Delaney; Kolko, Rachel P; Stein, Richard I; Saelens, Brian E; Welch, R Robinson; Perri, Michael G; Schechtman, Kenneth B; Epstein, Leonard H; Wilfley, Denise E

    2015-09-01

    Reducing consumption of food away from home is often targeted during pediatric obesity treatment, given the associations with weight status and gain. However, the effects of this dietary change on weight loss are unknown. Our aim was to evaluate associations between changes in dietary factors and child anthropometric outcomes after treatment. It is hypothesized that reduced consumption of food away from home will be associated with improved dietary intake and greater reductions in anthropometric outcomes (standardized body mass index [BMI] and percent body fat), and the relationship between food away from home and anthropometric outcomes will be mediated by improved child dietary intake. We conducted a longitudinal evaluation of associations between dietary changes and child anthropometric outcomes. Child diet (three 24-hour recalls) and anthropometric data were collected at baseline and 16 weeks. Participants were 170 overweight and obese children ages 7 to 11 years who completed a 16-week family-based behavioral weight-loss treatment as part of a larger multi-site randomized controlled trial conducted in two cohorts between 2010 and 2011 (clinical research trial). Dietary treatment targets during family-based behavioral weight-loss treatment included improving diet quality and reducing food away from home. The main outcome measures in this study were child relative weight (standardized BMI) and body composition (percent body fat). We performed t tests and bootstrapped single-mediation analyses adjusting for relevant covariates. As hypothesized, decreased food away from home was associated with improved diet quality and greater reductions in standardized BMI (Paway from home and anthropometric outcomes were mediated by changes in diet quality. Specifically, change in total energy intake and added sugars mediated the association between change in food away from home and standardized BMI, and change in overall diet quality, fiber, added sugars, and added fats

  8. [Home births].

    Science.gov (United States)

    Welffens, K; Kirkpatrick, C; Daelemans, C; Derisbourg, S

    In Belgium, very few women give birth outside the delivery room. In the United Kingdom and in the Netherlands, they are more numerous. Several studies evaluated obstetric and neonatal outcomes of home births compared with hospital births. We selected seven recent and large studies (with cohorts of more than 5.000 women) using PubMed, Science Direct and Cochrane Database of Systematic Reviews. Several questions were examined. Is there any difference in maternal and neonatal outcomes depending on the intended place of birth? Does parity affect outcomes ? What are the characteristics of women who choose to deliver at home ? We conclude that giving birth at home improves obstetric outcomes but is riskier for the baby, especially for the first one. The women delivering at home are mainly white Europeans, between 25 and 35 years old, in a relationship, multiparous and wealthier. In order to avoid this increased risk for the baby while preserving the obstetric advantages, alongside birth centers offer an intermediate solution. They combine the reassuring home-like atmosphere with the safety of the hospital. In Belgium, the first alongside birth center " Le Cocon " (a low technicity unit distinct from the delivery room) offers now this type of alternative place of birth for women in Hôpital Erasme in Brussels.

  9. COSMOS--improving the quality of life in nursing home patients: protocol for an effectiveness-implementation cluster randomized clinical hybrid trial.

    Science.gov (United States)

    Husebo, Bettina S; Flo, Elisabeth; Aarsland, Dag; Selbaek, Geir; Testad, Ingelin; Gulla, Christine; Aasmul, Irene; Ballard, Clive

    2015-09-15

    Nursing home patients have complex mental and physical health problems, disabilities and social needs, combined with widespread prescription of psychotropic drugs. Preservation of their quality of life is an important goal. This can only be achieved within nursing homes that offer competent clinical conditions of treatment and care. COmmunication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, Safety (COSMOS) is an effectiveness-implementation hybrid trial that combines and implements organization of activities evidence-based interventions to improve staff competence and thereby the patients' quality of life, mental health and safety. The aim of this paper is to describe the development, content and implementation process of the COSMOS trial. COSMOS includes a 2-month pilot study with 128 participants distributed among nine Norwegian nursing homes, and a 4-month multicenter, cluster randomized effectiveness-implementation clinical hybrid trial with follow-up at month 9, including 571 patients from 67 nursing home units (one unit defined as one cluster). Clusters are randomized to COSMOS intervention or current best practice (control group). The intervention group will receive a 2-day education program including written guidelines, repeated theoretical and practical training (credited education of caregivers, physicians and nursing home managers), case discussions and role play. The 1-day midway evaluation, information and interviews of nursing staff and a telephone hotline all support the implementation process. Outcome measures include quality of life in late-stage dementia, neuropsychiatric symptoms, activities of daily living, pain, depression, sleep, medication, cost-utility analysis, hospital admission and mortality. Despite complex medical and psychosocial challenges, nursing home patients are often treated by staff possessing low level skills, lacking education and in facilities with a high staff turnover

  10. Functional measures show improvements after a home exercise program following supervised balance training in older adults with elevated fall risk.

    Science.gov (United States)

    Tisher, Kristen; Mann, Kimberly; VanDyke, Sarah; Johansson, Charity; Vallabhajosula, Srikant

    2018-03-05

    Supervised balance training shows immediate benefit for older adults at fall risk. The long-term effectiveness of such training can be enhanced by implementing a safe and simple home exercise program (HEP). We investigated the effects of a12-week unsupervised HEP following supervised clinic-based balance training on functional mobility, balance, fall risk, and gait. Six older adults with an elevated fall risk obtained an HEP and comprised the HEP group (HEPG) and five older adults who were not given an HEP comprised the no HEP group (NoHEPG). The HEP consisted of three static balance exercises: feet-together, single-leg stance, and tandem. Each exercise was to be performed twice for 30-60 s, once per day, 3 days per week for 12 weeks. Participants were educated on proper form, safety, and progression of exercises. Pre- and post-HEP testing included Berg Balance Scale (BBS), Timed Up and Go, Short Physical Performance Battery (SPPB) assessments, Activities-Balance Confidence, Late-Life Functional Disability Instrument and instrumented assessments of balance and gait (Limits of Stability, modified Clinical Test of Sensory Interaction on Balance, Gait). A healthy control group (HCG; n = 11) was also tested. For most of the measures, the HEPG improved to the level of HCG. Though task-specific improvements like BBS and SPPB components were seen, the results did not carry over to more dynamic assessments. Results provide proof of concept that a simple HEP can be independently implemented and effective for sustaining and/or improving balance in older adults at elevated fall-risk after they have undergone a clinic-based balance intervention.

  11. A needs assessment of health information technology for improving care coordination in three leading patient-centered medical homes.

    Science.gov (United States)

    Richardson, Joshua E; Vest, Joshua R; Green, Cori M; Kern, Lisa M; Kaushal, Rainu

    2015-07-01

    We investigated ways that patient-centered medical homes (PCMHs) are currently using health information technology (IT) for care coordination and what types of health IT are needed to improve care coordination. A multi-disciplinary team of researchers conducted semi-structured telephone interviews with 28 participants from 3 PCMHs in the United States. Participants included administrators and clinicians from PCMHs, electronic health record (EHR) and health information exchange (HIE) representatives, and policy makers. Participants identified multiple barriers to care coordination using current health IT tools. We identified five areas in which health IT can improve care coordination in PCMHs: 1) monitoring patient populations, 2) notifying clinicians and other staff when specific patients move across care settings, 3) collaborating around patients, 4) reporting activities, and 5) interoperability. To accomplish these tasks, many participants described using homegrown care coordination systems separate from EHRs. The participants in this study have resources, experience, and expertise with using health IT for care coordination, yet they still identified multiple areas for improvement. We hypothesize that focusing health IT development in the five areas we identified can enable more effective care coordination. Key findings from this work are that homegrown systems apart from EHRs are currently used to support care coordination and, also, that reporting tools are key components of care coordination. New health IT that enables monitoring, notifying, collaborating, reporting, and interoperability would enhance care coordination within PCMHs beyond what current health IT enables. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. Improvement of a questionnaire measuring activity limitations in rising and sitting down in patients with lower-extremity disorders living at home

    NARCIS (Netherlands)

    Roorda, LD; Molenaar, IW; Lankhorst, GJ; Bouter, LM

    2005-01-01

    Objective: To improve a self-administered questionnaire that includes 42 dichotomous items and measures activity limitations in rising and sitting down (R&S) in patients with lower-extremity disorders who live at home. Design: Cross-sectional study. Setting: Outpatient clinics of secondary and

  13. Improving the appearance of all textile products from clothing to home textile using laser technology

    Science.gov (United States)

    Ondogan, Ziynet; Pamuk, Oktay; Ondogan, Ece Nuket; Ozguney, Arif

    2005-11-01

    Denim trousers, commonly known as "blue jeans", have maintained their popularity for many years. For the purpose of supporting customers' purchasing behaviour and to address their aesthetic taste, companies have been trying in recent years to develop various techniques to improve the visual aspects of denim fabrics. These techniques mainly include printing on fabrics, embroidery and washing the final product. Especially, fraying certain areas of the fabric by sanding and stone washing to create designs is a popular technique. However, due to certain inconveniences caused by these procedures and in response to growing demands, research is underway to obtain a similar appearance by creating better quality and more advantageous manufacturing conditions. As is known, the laser is a source of energy which can be directed on desired objects and whose power and intensity can be easily controlled. Use of the laser enables us to cut a great variety of material from metal to fabric. Starting off from this point, we thought it would be possible to transfer certain designs onto the surface of textile material by changing the dye molecules in the fabric and creating alterations in its colour quality values by directing the laser to the material at reduced intensity. This study mainly deals with a machine specially designed for making use of laser beams to transfer pictures, figures as well as graphics of desired variety, size and intensity on all kinds of surfaces in textile manufacturing such as knitted—woven fabrics, leather, etc. at desired precision and without damaging the texture of the material. In the designed system, computer-controlled laser beams are used to change the colour of the dye material on the textile surface by directing the laser beams at a desired wavelength and intensity onto various textile surfaces selected for application. For this purpose, a laser beam source that can reach the initial level of power and that can be controlled by means of a

  14. Evolution of Home Automation Technology

    OpenAIRE

    Mohd. Rihan; M. Salim Beg

    2009-01-01

    In modern society home and office automation has becomeincreasingly important, providing ways to interconnectvarious home appliances. This interconnection results infaster transfer of information within home/offices leading tobetter home management and improved user experience.Home Automation, in essence, is a technology thatintegrates various electrical systems of a home to provideenhanced comfort and security. Users are grantedconvenient and complete control over all the electrical homeappl...

  15. Interactions between Rocky Mountain Bighorn Sheep Ovis canadensis canadensis and Domestic Sheep Ovis aries and the Biological, Social, Economic, and Legal Implications of these Interactions on USDA Forest Service Lands in the Evanston/Mt. View Ranger District

    OpenAIRE

    Herrera, Ashly Nicole

    2012-01-01

    Strong evidence exists indicating domestic sheep (Ovis aries) can infect Rocky Mountain bighorn sheep (Ovis canadensis canadensis), a United States Forest Service (USFS) Region 4 sensitive species, with pneumonia (Callan 1991; Foreyt 1989, 1992, 1994; Foreyt and Lagerquist 1996; George et al 2008; Wehausen et al. 2011). Since the transmission of the pneumonic bacteria between the domestic and wild sheep is a result of bighorn sheep coming into contact with the bacteria carried in the mucous m...

  16. Improving communication with palliative care cancer patients at home - A pilot study of SAGE & THYME communication skills model.

    Science.gov (United States)

    Griffiths, Jane; Wilson, Charlotte; Ewing, Gail; Connolly, Michael; Grande, Gunn

    2015-10-01

    To pilot an evidence-based communication skills model (SAGE & THYME) with UK District Nurses (DNs) who visit patients with advanced cancer early in the dying trajectory. Evidence suggests that DNs lack confidence in communication skills and in assessing cancer patients' psycho-social needs; also that they lack time. SAGE & THYME is a highly structured model for teaching patient centred interactions. It addresses concerns about confidence and time. Mixed methods. 33 DNs were trained in SAGE & THYME in a three hour workshop and interviewed in focus groups on three occasions: pre-training, immediately post-training and two months post-training. Questionnaires measuring perceived outcomes of communication, confidence in communication and motivation to use SAGE & THYME were administered at the focus groups. SAGE & THYME provided a structure for conversations and facilitated opening and closing of interactions. The main principle of patient centeredness was reportedly used by all. Knowledge about communication behaviours helpful to patients improved and was sustained two months after training. Increased confidence in communication skills was also sustained. Motivation to use SAGE & THYME was high and remained so at two months, and some said the model saved them time. Challenges with using the model included controlling the home environment and a change in style of communication which was so marked some DNs preferred to use it with new patients. Training DNs in SAGE & THYME in a three hour workshop appears to be a promising model for improving communication skills when working with cancer patients. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  17. Improving Smart Home Concept with the Internet of Things Concept Using RaspberryPi and NodeMCU

    Science.gov (United States)

    Amri, Yasirli; Andri Setiawan, Mukhammad

    2018-03-01

    The Internet of things (IoT) is getting more tractions in recent years. One of the usage scenario of IoT is smart home. Smart home basically provides home automation for installed devices at home such as thermostat, lighting, air conditioning, etc and allows devices connected to the Internet to be monitored and controlled remotely by user. However many studies on smart home concept focusing only on few main features. They still lack of important usage of IoT i.e. providing energy efficiency, energy monitoring, dealing with security, and managing privacy. This paper proposes a smart home system with RaspberryPi and NodeMCU as the backend that not only serves as home automation and merely a switch replacement, but to also record and report important things to the owner of the house e.g. when someone trespasses the house (security perimeter), or to report the calculation of how much money has been spent in consuming the electrical appliances. We successfully examine our proposed system in a real life working scenario. The communication between user and the system is done using Telegram Bot.

  18. Improving children's health and development in British Columbia through nurse home visiting: a randomized controlled trial protocol.

    Science.gov (United States)

    Catherine, Nicole L A; Gonzalez, Andrea; Boyle, Michael; Sheehan, Debbie; Jack, Susan M; Hougham, Kaitlyn A; McCandless, Lawrence; MacMillan, Harriet L; Waddell, Charlotte

    2016-08-04

    Nurse-Family Partnership is a nurse home visitation program that aims to improve the lives of young mothers and their children. The program focuses on women who are parenting for the first time and experiencing socioeconomic disadvantage. Nurse visits start as early in pregnancy as possible and continue until the child reaches age two years. The program has proven effective in the United States - improving children's mental health and development and maternal wellbeing, and showing long-term cost-effectiveness. But it is not known whether the same benefits will be obtained in Canada, where public services differ. The British Columbia Healthy Connections Project therefore involves a randomized controlled trial evaluating Nurse-Family Partnership's effectiveness compared with existing (usual) services in improving children's mental health and early development and mother's life circumstances. The trial's main aims are to: reduce childhood injuries by age two years (primary outcome indicator); reduce prenatal nicotine and alcohol use; improve child cognitive and language development and behaviour at age two years; and reduce subsequent pregnancies by 24 months postpartum. Potential explanatory factors such as maternal mental health (including self-efficacy) are also being assessed, as is the program's impact on exposure to intimate-partner violence. To inform future economic evaluation, data are also being collected on health and social service access and use. Eligible and consenting participants (N = 1040) are being recruited prior to 28 weeks gestation then individually randomized to receive existing services (comparison group) or Nurse-Family Partnership plus existing services (intervention group). Nurse-Family Partnership is being delivered following fidelity guidelines. Data are being collected during in person and telephone interviews at: baseline; 34-36 weeks gestation; and two, 10, 18 and 24 months postpartum. Additional data will be obtained via

  19. In vitro prion protein conversion suggests risk of bighorn sheep (Ovis canadensis) to transmissible spongiform encephalopathies

    Science.gov (United States)

    Johnson, Christopher J.; Morawski, A.R.; Carlson, C.M.; Chang, H.

    2013-01-01

    Background: Transmissible spongiform encephalopathies (TSEs) affect both domestic sheep (scrapie) and captive and free-ranging cervids (chronic wasting disease; CWD). The geographical range of bighorn sheep (Ovis canadensis; BHS) overlaps with states or provinces that have contained scrapie-positive sheep or goats and areas with present epizootics of CWD in cervids. No TSEs have been documented in BHS, but the susceptibility of this species to TSEs remains unknown. Results: We acquired a library of BHS tissues and found no evidence of preexisting TSEs in these animals. The prion protein gene (Prnp) in all BHS in our library was identical to scrapie-susceptible domestic sheep (A136R 154Q171). Using an in vitro prion protein conversion assay, which has been previously used to assess TSE species barriers and, in our study appears to recollect known species barriers in mice, we assessed the potential transmissibility of TSEs to BHS. As expected based upon Prnp genotype, we observed BHS prion protein conversion by classical scrapie agent and evidence for a species barrier between transmissible mink encephalopathy (TME) and BHS. Interestingly, our data suggest that the species barrier of BHS to white-tailed deer or wapiti CWD agents is likely low. We also used protein misfolding cyclic amplification to confirm that CWD, but not TME, can template prion protein misfolding in A136R 154Q171genotype sheep. Conclusions: Our results indicate the in vitro conversion assay used in our study does mimic the species barrier of mice to the TSE agents that we tested. Based on Prnp genotype and results from conversion assays, BHS are likely to be susceptible to infection by classical scrapie. Despite mismatches in amino acids thought to modulate prion protein conversion, our data indicate that A136R154Q171 genotype sheep prion protein is misfolded by CWD agent, suggesting that these animals could be susceptible to CWD. Further investigation of TSE transmissibility to BHS, including

  20. The longitudinal prevalence of MRSA in care home residents and the effectiveness of improving infection prevention knowledge and practice on colonisation using a stepped wedge study design

    Science.gov (United States)

    Horner, C; Barr, B; Hall, D; Hodgson, G; Parnell, P; Tompkins, D

    2012-01-01

    Objectives To determine the prevalence and health outcomes of meticillin-resistant Staphylococcus aureus (MRSA) colonisation in elderly care home residents. To measure the effectiveness of improving infection prevention knowledge and practice on MRSA prevalence. Setting Care homes for elderly residents in Leeds, UK. Participants Residents able to give informed consent. Design A controlled intervention study, using a stepped wedge design, comprising 65 homes divided into three groups. Baseline MRSA prevalence was determined by screening the nares of residents (n=2492). An intervention based upon staff education and training on hand hygiene was delivered at three different times according to group number. Scores for three assessment methods, an audit of hand hygiene facilities, staff hand hygiene observations and an educational questionnaire, were collected before and after the intervention. After each group of homes received the intervention, all participants were screened for MRSA nasal colonisation. In total, four surveys took place between November 2006 and February 2009. Results MRSA prevalence was 20%, 19%, 22% and 21% in each survey, respectively. There was a significant improvement in scores for all three assessment methods post-intervention (p≤0.001). The intervention was associated with a small but significant increase in MRSA prevalence (p=0.023). MRSA colonisation was associated with previous and subsequent MRSA infection but was not significantly associated with subsequent hospitalisation or mortality. Conclusions The intervention did not result in a decrease in the prevalence of MRSA colonisation in care home residents. Additional measures will be required to reduce endemic MRSA colonisation in care homes. PMID:22240647

  1. Improving psychotropic drug prescription in nursing home patients with dementia : design of a cluster randomized controlled trial

    NARCIS (Netherlands)

    Smeets, Claudia H. W.; Smalbrugge, Martin; Gerritsen, Debby L.; Nelissen-Vrancken, Marjorie H. J. M. G.; Wetzels, Roland B.; van der Spek, Klaas; Zuidema, Sytse U.; Koopmans, Raymond T. C. M.

    2013-01-01

    Background: Neuropsychiatric symptoms are highly prevalent in nursing home patients with dementia. Despite modest effectiveness and considerable side effects, psychotropic drugs are frequently prescribed for these neuropsychiatric symptoms. This raises questions whether psychotropic drugs are

  2. The Community Intervention Team as a means of Improving the transition from hospital to home for patients

    OpenAIRE

    Kearns, Michelle; Curran, Margaret; Collier, Dorcas; Burke, Mary; Lawler, Michelle

    2017-01-01

    Introduction: Too frequently patients are discharged from hospital to their home without local support from healthcare professionals. Without this support patients are often readmitted to hospital unnecessarily.Short description of practice change implemented: Networked Community intervention team (CIT) services make a unique contribution in facilitating the transition between hospital and home.Aim and theory of change: The aim is to facilitate early discharge from an acute setting, providing...

  3. A multicomponent exercise program improves physical function in long-term nursing home residents: A randomized controlled trial.

    Science.gov (United States)

    Arrieta, Haritz; Rezola-Pardo, Chloe; Zarrazquin, Idoia; Echeverria, Iñaki; Yanguas, Jose Javier; Iturburu, Miren; Gil, Susana Maria; Rodriguez-Larrad, Ana; Irazusta, Jon

    2018-03-01

    To investigate the impact of a multicomponent exercise program on anthropometry, physical function, and physical activity on older adults living in long-term nursing homes (LTNH), we conducted a randomized controlled trial involving 112 participants aged 84.9 ± 6.9 years. Participants were randomly assigned to an intervention (IG) or control group (CG). The IG participated in a 3-month multicomponent exercise intervention focused on strength, balance, stretching exercises, and walking recommendations. Subjects in the CG participated in routine activities. Analyses of outcome parameters were performed in the entire sample and in two subgroups, classified according to participants' physical function score at baseline. The group-by-time interaction, favoring the IG, was significant for the entire sample and for the participants in the low physical function subgroup for the following parameters: waist circumference, 30-s chair-stand, arm-curl, 8-ft timed up-and-go, SPPB score, gait speed, and Berg scale (p < .05). In participants with higher physical function at baseline, significant group-by-time interaction was observed in the SPPB score and Berg scale (p < .05). When differences were analyzed within groups, the IG maintained or improved in all assessed parameters, while participants in the CG showed a marked decline. Our study showed that a multicomponent exercise program is effective for older people living in LTNH. This is especially relevant in those with lower physical function scores. The lower efficacy of the program in participants with better function might be due to the insufficient exercise demands of our intervention for more fit residents. Future studies should analyze the effects of programs with higher intensities in older people with intermediate to high physical function. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Nutritional support teams: the cooperation among physicians and pharmacists helps improve cost-effectiveness of home parenteral nutrition (HPN).

    Science.gov (United States)

    Pietka, Magdalena; Watrobska-Swietlikowska, Dorota; Szczepanek, Kinga; Szybinski, Piotr; Sznitowska, Małgorzata; Kłęk, Stanisław

    2014-09-12

    Modern home parenteral nutrition (HPN) requires the preparation of tailored admixtures. The physicians' demands for their composition are often at the variance with pharmaceutical principles, which causes the necessity of either the preparation of ex tempore admixtures or stability testing ensuring long shelf life. Both approaches are not cost-effective. The aim of the study was to use the cooperation among physicians and pharmacists to assure both: cost-effectiveness and patient-tailored HPN admixtures. The first part of the study consisted of the thorough analysis of prescriptions for the most demanding 47 HPN patients (27 females and 20 males, mean age 53.1 year) treated at one HPN center to create few as possible long-shelf life admixtures. The second part of the study consisted of stability testing and modifications. The analysis showed over 137 variations needed to cover all macro- and micronutrients requirements. Their cost as ex-tempore solutions was extremely high (over 110 000 EURO/month) due to logistics and similarly high if stability test for variation were to be performed (68 500 EURO). Therefore prescription was prepared de novo within team of physicians and pharmacists and four base models were designed. Water and electrolytes, particularly magnesium and calcium showed to be the major issues. Stability tests failed in one admixture due to high electrolytes concentration. It was corrected, and the new formula passes the test. Five basic models were then used for creation of new bags. Cost of such an activity were 3 700 EURO (pcooperation within the members of nutritional support team could improve the cost-effectiveness and quality of HPN. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  5. Preliminary Geologic/spectral Analysis of LANDSAT-4 Thematic Mapper Data, Wind River/bighorn Basin Area, Wyoming

    Science.gov (United States)

    Lang, H. R.; Conel, J. E.; Paylor, E. D.

    1984-01-01

    A LIDQA evaluation for geologic applications of a LANDSAT TM scene covering the Wind River/Bighorn Basin area, Wyoming, is examined. This involves a quantitative assessment of data quality including spatial and spectral characteristics. Analysis is concentrated on the 6 visible, near infrared, and short wavelength infrared bands. Preliminary analysis demonstrates that: (1) principal component images derived from the correlation matrix provide the most useful geologic information. To extract surface spectral reflectance, the TM radiance data must be calibrated. Scatterplots demonstrate that TM data can be calibrated and sensor response is essentially linear. Low instrumental offset and gain settings result in spectral data that do not utilize the full dynamic range of the TM system.

  6. Protocol for a home-based integrated physical therapy program to reduce falls and improve mobility in people with Parkinson’s disease

    Directory of Open Access Journals (Sweden)

    Morris Meg E

    2012-07-01

    Full Text Available Abstract Background The high incidence of falls associated with Parkinson’s disease (PD increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson’s has not been convincingly demonstrated. Methods/design 180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education or a home-based life skills program (control intervention. Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined. Discussion This study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD. Trial registration The trial is registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12608000390381.

  7. Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh.

    Science.gov (United States)

    Nahar, Baitun; Hossain, Md Iqbal; Hamadani, Jena D; Ahmed, Tahmeed; Grantham-McGregor, Sally; Persson, Lars-Ake

    2012-08-07

    Parenting programmes are effective in enhancing parenting practices and child development. This study evaluated the effects of a intervention with psychosocial stimulation (PS) on the quality of the home environment and mothers' child-rearing practices in a community-based trial with severely malnourished Bangladeshi children. Severely underweight children (n = 507), 6-24 months of age, were randomly assigned to five groups: PS; food supplementation (FS); PS + FS; clinic-control (CC); and, hospital-control (CH). PS included fortnightly follow-up visits for six months at community clinics where a play leader demonstrated play activities and gave education on child development and child rearing practices. FS comprised cereal-based supplements (150-300 kcal/day) for three months. All groups received medical care, micronutrient supplements and growth monitoring. Mothers were given the Home Observation for Measurement of the Environment (HOME) inventory and a questionnaire on parenting at baseline and after six months to assess the outcome. 322 children completed the study. After six months of intervention the PS + FS and PS groups benefitted in the total HOME score (depending on the comparison group, effect sizes varied from 0.66 to 0.33 SD) The PS + FS and PS groups also benefitted in two HOME subscales: maternal involvement (effect sizes: 0.8 to 0.55 SD) and play materials, (effect sizes: 0.46 to 0.6 SD), and child-rearing practices scores (effect size: 1.5 to 1.1 SD). The PS + FS group benefitted 4.0 points in total HOME score compared with CH, 4.8 points compared with CC and 4.5 points compared with FS (p Child-rearing practice scores of the PS + FS group improved 7.7, 6.4 and 6.6 points and the PS group improved 8.5, 7.2 and 7.4 points more than CH, CC and FS, respectively (p Child-rearing practices of mothers of severely malnourished children and the quality of their home environment can be improved through community

  8. European Home Energy

    DEFF Research Database (Denmark)

    Tommerup, Henrik M.

    2009-01-01

    An important aim of the european energy performance of buildings directive is to improve the overall energy efficiency of new homes......An important aim of the european energy performance of buildings directive is to improve the overall energy efficiency of new homes...

  9. Synchronizing early Eocene deep-sea and continental records - cyclostratigraphic age models for the Bighorn Basin Coring Project drill cores

    Science.gov (United States)

    Westerhold, Thomas; Röhl, Ursula; Wilkens, Roy H.; Gingerich, Philip D.; Clyde, William C.; Wing, Scott L.; Bowen, Gabriel J.; Kraus, Mary J.

    2018-03-01

    A consistent chronostratigraphic framework is required to understand the effect of major paleoclimate perturbations on both marine and terrestrial ecosystems. Transient global warming events in the early Eocene, at 56-54 Ma, show the impact of large-scale carbon input into the ocean-atmosphere system. Here we provide the first timescale synchronization of continental and marine deposits spanning the Paleocene-Eocene Thermal Maximum (PETM) and the interval just prior to the Eocene Thermal Maximum 2 (ETM-2). Cyclic variations in geochemical data come from continental drill cores of the Bighorn Basin Coring Project (BBCP, Wyoming, USA) and from marine deep-sea drilling deposits retrieved by the Ocean Drilling Program (ODP). Both are dominated by eccentricity-modulated precession cycles used to construct a common cyclostratigraphic framework. Integration of age models results in a revised astrochronology for the PETM in deep-sea records that is now generally consistent with independent 3He age models. The duration of the PETM is estimated at ˜ 200 kyr for the carbon isotope excursion and ˜ 120 kyr for the associated pelagic clay layer. A common terrestrial and marine age model shows a concurrent major change in marine and terrestrial biota ˜ 200 kyr before ETM-2. In the Bighorn Basin, the change is referred to as Biohorizon B and represents a period of significant mammalian turnover and immigration, separating the upper Haplomylus-Ectocion Range Zone from the Bunophorus Interval Zone and approximating the Wa-4-Wa-5 land mammal zone boundary. In sediments from ODP Site 1262 (Walvis Ridge), major changes in the biota at this time are documented by the radiation of a second generation of apical spine-bearing sphenolith species (e.g., S. radians and S. editus), the emergence of T. orthostylus, and the marked decline of D. multiradiatus.

  10. A New Model for Designing Cost Effective Zero Carbon Homes: Minimizing Commercial Viability Issues and Improving the Economics for Both the Developer and Purchaser

    Directory of Open Access Journals (Sweden)

    Rehan Khodabuccus

    2016-02-01

    Full Text Available There is a limited penetration of housing which offsets all operational carbon emissions within UK housing developer portfolios. This paper develops a balanced approach to zero carbon housing design from both architectural and national house builder perspectives. The paper discusses the techniques which can be used to reduce build costs, simplify designs and simplify renewable energy systems, resulting in more cost effective homes. The paper develops a technical and economic linked model to optimise a zero carbon design and then develops a home using this technique. It acknowledges that extra costs are inevitable but minimises them and details a lifecycle costing approach to provide economic justification. The paper then focuses on how the building designed can function more efficiently and economically than a Part L 2013 Building Regulation compliant building. Improved functionality is demonstrated both with and without the use of feed in tariffs. A key finding from this research is that zero carbon homes can benefit the consumer without impacting the developer. The results also demonstrate that homes could be better marketed on economic rather than environmental or technical attributes.

  11. Nursing Homes

    Science.gov (United States)

    ... Home › Aging & Health A to Z › Nursing Homes Font size A A A Print Share Glossary Basic ... Reason For Living in A Nursing Home Some type of disability with activities of daily living (ADLs) ...

  12. Home Care

    Science.gov (United States)

    ... are part of home healthcare agencies. You may benefit from home care if you are dealing with ... it will trigger an emergency response or checkup phone call. Newer technologies ... or mobile testing technology (home diagnostics), including x-rays and ...

  13. A difference between day and night : protein intake improves after the transition from conventional to frequent nocturnal home hemodialysis

    NARCIS (Netherlands)

    Ipema, Karin J. R.; van der Schans, Cees P.; Vonk, Noortje; de Vries, Jorien M.; Westerhuis, Ralf; Duym, Ellen; Franssen, Casper F. M.

    Background: Malnutrition is an important cause of the excessive morbidity and mortality rate of dialysis patients. Frequent nocturnal home hemodialysis (NHHD) has many benefits compared with conventional thrice-weekly hemodialysis (CHD), due to the virtual absence of dietary restrictions and a much

  14. Improved Cost-effectiveness for Management of Chronic Heart Failure by Combined Home-based Intervention with Clinical Nursing Specialists

    Directory of Open Access Journals (Sweden)

    Yi-Lwun Ho

    2007-01-01

    Conclusion: The home- and clinic-based caring system is capable of decreasing adverse outcomes, most notably hospitalization and length of stay, and could trigger significant cost savings in the management of heart failure. [J Formos Med Assoc 2007;106(4:313-319

  15. Medicines administration for residents with dysphagia in care homes: A small scale observational study to improve practice.

    Science.gov (United States)

    Serrano Santos, Jose Manuel; Poland, Fiona; Wright, David; Longmore, Timothy

    2016-10-30

    In the UK, 69.5% of residents in care homes are exposed to one or more medication errors and 50% have some form of dysphagia. Hospital research identified that nurses frequently crush tablets to facilitate swallowing but this has not been explored in care homes. This project aimed to observe the administration of medicines to patients with dysphagia (PWD) and without in care homes. A convenient sample of general practitioners in North Yorkshire invited care homes with nursing, to participate in the study. A pharmacist specialised in dysphagia observed nurses during drug rounds and compared these practices with national guidelines. Deviations were classified as types of medication administration errors (MAEs). Overall, 738 administrations were observed from 166 patients of which 38 patients (22.9%) had dysphagia. MAE rates were 57.3% and 30.8% for PWD and those without respectively (pdysphagia and need to communicate its presence to the resident's GP. Further research should explore the design of an effective training for nurses. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Tailored mental health care after nursing home admission: improving transfers of people with dementia with behavioral problems. An explorative study

    NARCIS (Netherlands)

    van Mierlo, L.D.; van der Wiel, A.; Meiland, F.J.M.; van Hout, H.P.J.; Stek, M.L.; Dröes, R.M.

    2015-01-01

    Objectives: In the Netherlands, many community-dwelling people with dementia and behavioral disturbances and their family caregivers receive mental health care from a community psychiatric nurse (CPN). To promote continuity of care for these persons after moving to a nursing home, a transfer

  17. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial

    Science.gov (United States)

    2012-01-01

    -centred approach to dementia care in nursing homes. The major strengths of the study design are the large sample size, the cluster-randomisation, and the one-year follow-up. The generalisability of the implementation strategies may be questionable because the motivation for person-centred care in both the intervention and control nursing homes is above average. The results of this study may be useful in improving the quality of care and are relevant for policymakers. Trial registration The trial is registered in the Netherlands National Trial Register: NTR2314. PMID:22214264

  18. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    van de Ven Geertje

    2012-01-01

    integral person-centred approach to dementia care in nursing homes. The major strengths of the study design are the large sample size, the cluster-randomisation, and the one-year follow-up. The generalisability of the implementation strategies may be questionable because the motivation for person-centred care in both the intervention and control nursing homes is above average. The results of this study may be useful in improving the quality of care and are relevant for policymakers. Trial registration The trial is registered in the Netherlands National Trial Register: NTR2314.

  19. Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh

    Directory of Open Access Journals (Sweden)

    Nahar Baitun

    2012-08-01

    Full Text Available Abstract Background Parenting programmes are effective in enhancing parenting practices and child development. This study evaluated the effects of a intervention with psychosocial stimulation (PS on the quality of the home environment and mothers’ child-rearing practices in a community-based trial with severely malnourished Bangladeshi children. Method Severely underweight children (n = 507, 6–24 months of age, were randomly assigned to five groups: PS; food supplementation (FS; PS + FS; clinic-control (CC; and, hospital-control (CH. PS included fortnightly follow-up visits for six months at community clinics where a play leader demonstrated play activities and gave education on child development and child rearing practices. FS comprised cereal-based supplements (150–300 kcal/day for three months. All groups received medical care, micronutrient supplements and growth monitoring. Mothers were given the Home Observation for Measurement of the Environment (HOME inventory and a questionnaire on parenting at baseline and after six months to assess the outcome. Results 322 children completed the study. After six months of intervention the PS + FS and PS groups benefitted in the total HOME score (depending on the comparison group, effect sizes varied from 0.66 to 0.33 SD The PS + FS and PS groups also benefitted in two HOME subscales: maternal involvement (effect sizes: 0.8 to 0.55 SD and play materials, (effect sizes: 0.46 to 0.6 SD, and child-rearing practices scores (effect size: 1.5 to 1.1 SD. The PS + FS group benefitted 4.0 points in total HOME score compared with CH, 4.8 points compared with CC and 4.5 points compared with FS (p  Conclusions Child-rearing practices of mothers of severely malnourished children and the quality of their home environment can be improved through community-based psychosocial stimulation with or without food supplementation. This may be of importance to promote child development.

  20. Driving Demand for Home Energy Improvements: Motivating residential customers to invest in comprehensive upgrades that eliminate energy waste, avoid high utility bills, and spur the economy

    Energy Technology Data Exchange (ETDEWEB)

    Fuller, Merrian C.

    2010-09-20

    Policy makers and program designers in the U.S. and abroad are deeply concerned with the question of how to scale up energy efficiency to a level that is commensurate both to the scale of the energy and climate challenges we face, and to the potential for energy savings that has been touted for decades. When policy makers ask what energy efficiency can do, the answers usually revolve around the technical and economic potential of energy efficiency - they rarely hone in on the element of energy demand that matters most for changing energy usage in existing homes: the consumer. A growing literature is concerned with the behavioral underpinnings of energy consumption. We examine a narrower, related subject: How can millions of Americans be persuaded to divert valued time and resources into upgrading their homes to eliminate energy waste, avoid high utility bills, and spur the economy? With hundreds of millions of public dollars flowing into incentives, workforce training, and other initiatives to support comprehensive home energy improvements, it makes sense to review the history of these programs and begin gleaning best practices for encouraging comprehensive home energy improvements. Looking across 30 years of energy efficiency programs that targeted the residential market, many of the same issues that confronted past program administrators are relevant today: How do we cost-effectively motivate customers to take action? Who can we partner with to increase program participation? How do we get residential efficiency programs to scale? While there is no proven formula - and only limited success to date with reliably motivating large numbers of Americans to invest in comprehensive home energy improvements, especially if they are being asked to pay for a majority of the improvement costs - there is a rich and varied history of experiences that new programs can draw upon. Our primary audiences are policy makers and program designers - especially those that are relatively

  1. Assessment of the effectiveness of biofeedback in children with dyssynergic defecation and recalcitrant constipation/encopresis: does home biofeedback improve long-term outcomes.

    Science.gov (United States)

    Croffie, Joseph M; Ammar, M Samer; Pfefferkorn, Marian D; Horn, Debra; Klipsch, Ann; Fitzgerald, Joseph F; Gupta, Sandeep K; Molleston, Jean P; Corkins, Mark R

    2005-01-01

    The purpose of this study was to determine whether biofeedback benefits children with dyssynergic defecation and constipation/encopresis, and whether home biofeedback improves long-term outcomes. Thirty-six patients with chronic constipation who had failed at least 6 months of conventional treatment and demonstrated dyssynergic defecation at anorectal manometry were randomized to biofeedback in the laboratory alone (group 1, n=24) or in the laboratory and at home (group 2, n=12) and followed up at 2, 4, and a mean of 44 months. Thirty patients were available for long-term follow-up. Bowel movements increased in all from a mean of 1.4/week to 5.1, 5.8, and 5.1 per week at 2 months, 4 months, and long-term, respectively (p < or = 0.001). Soiling decreased in all from a mean of 5.5/week to 0.6, 0.1, and 1 per week at 2 months, 4 months, and long-term, respectively (p < or = 0.001). Laxative use decreased from a mean of 4.1 days/week to 0.6, 0.3, and 0.7 per week at 2 months, 4 months, and long-term, respectively (p < or = 0.001). Twenty-seven of 30 parents ranked their satisfaction a mean of 2.2 (range 1-excellent to 3-good). There were no significant differences in outcomes between the laboratory alone group and the laboratory plus home group. Biofeedback is beneficial for some children with chronic constipation and dyssynergic defecation. Supplemental home biofeedback does not improve long-term outcomes.

  2. Homing oneself

    DEFF Research Database (Denmark)

    Winther, Ida Wentzel

    2009-01-01

    What is home? A building, a physical and mental phenomenon, or a concept?  There are many homes and ways `to home oneself´. Many of us quite often dwell in other places than at home (as professional commuters between two places, as travellers staying in hotels, as children of divorced parents...

  3. Designing Recreational Virtual Environments for Older Adult Nursing Home Residents - How Nature And Content Matter For Improving Augmented Exercise Experiences

    DEFF Research Database (Denmark)

    Bruun-Pedersen, Jon Ram; Serafin, Stefania; Maculewicz, Justyna

    2016-01-01

    In this paper, we discuss the design for restorative virtual environments (RVEs), specifically developed to augment rehabilitation exercise for older adult users living at nursing homes, in order to increase exercise motivation. User evaluations on these RVE designs suggest that the soundscapes did...... not have a noticeable role for user experience. Moreover, soundscapes might simply be perceived congruent with the visuals, and thus seamlessly accepted by users as an inherent part of the augmented exercise experience....

  4. A dual-task home-based rehabilitation programme for improving balance control in patients with acquired brain injury: a single-blind, randomized controlled pilot study.

    Science.gov (United States)

    Peirone, Eliana; Goria, Paolo Filiberto; Anselmino, Arianna

    2014-04-01

    To evaluate the safety, feasibility and effectiveness of a dual-task home-based rehabilitation programme on balance impairments among adult patients with acquired brain injury. Single-blind, randomized controlled pilot study. Single rehabilitation centre. Sixteen participants between 12 and 18 months post-acquired brain injury with balance impairments and a score task home-based programme six days a week for seven weeks. The primary outcome measure was the Balance Evaluation System Test; secondary measures were the Activities-specific Balance Confidence Scale and Goal Attainment Scaling. At the end of the pilot study, the intervention group showed significantly greater improvement in Balance Evaluation System Test scores (17.87, SD 6.05) vs. the control group (5.5, SD 3.53; P = 0.008, r = 0.63). There was no significant difference in improvement in Activities-specific Balance Confidence Scale scores between the intervention group (25.25, SD 25.51) and the control group (7.00, SD 14.73; P = 0.11, r = 0.63). There was no significant improvement in Goal Attainment Scaling scores in the intervention (19.37, SD 9.03) vs. the control group (16.28, SD 6.58; P = 0.093, r = 0.63). This pilot study shows the safety, feasibility and short-term benefit of a dual-task home-based rehabilitation programme to improve balance control in patients with acquired brain injury. A sample size of 26 participants is required for a definitive study.

  5. Home, Smart Home

    DEFF Research Database (Denmark)

    Hansen, Ellen Kathrine; Olesen, Gitte Gylling Hammershøj; Mullins, Michael

    2013-01-01

    The article places focus on how smart technologies integrated in a one family- home and particular the window offer unique challenges and opportunities for designing buildings with the best possible environments for people and nature. Toward an interdisciplinary approach, we address the interaction...... between daylight defined in technical terms and daylight defined in aesthetic, architectural terms. Through field-tests of a Danish carbon-neutral home and an analysis of five key design parameters, we explore the contradictions and potentials in smart buildings, using the smart window as example of how...... to the energy design is central. The study illuminates an approach of the design of smart houses as living organisms by connecting technology with the needs of the occupants with the power and beauty of daylight....

  6. Improvement in Obstructive Sleep Apnea Diagnosis and Management Wait Times: A Retrospective Analysis of a Home Management Pathway for Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Samuel Alan Stewart

    2015-01-01

    Full Text Available Obstructive sleep apnea is a common condition within the Canadian population. The current gold standard for diagnosis and management of patients is in-laboratory (in-lab polysomnography; however, the limited availability of testing options for patients has led to long wait times and increased disease burden within the population. The Sleep Research Laboratory in Saskatoon (Saskatchewan implemented a home management program to run in parallel with the in-lab system several years ago in an effort to increase their capacity and reduce wait times. The present study was a retrospective analysis of all patients referred to the program between 2009 and 2012. The home management system has improved wait times by diagnosing and managing up to one-half of the referred patient population, reducing the wait for in-lab treatment from a median of 152 days in 2009 to 92 days in 2012 (P<0.0001. Moving forward, home management can provide a viable alternative to in-lab testing for patients who meet strict entry criteria, reducing the in-lab workload and, ultimately, reducing wait times.

  7. To evaluate if increased supervision and support of South African Government health workers' home visits improves maternal and child outcomes: study protocol for a randomized control trial.

    Science.gov (United States)

    Rotheram-Borus, Mary Jane; Le Roux, Karl; Le Roux, Ingrid M; Christodoulou, Joan; Laurenzi, Christina; Mbewu, Nokwanele; Tomlinson, Mark

    2017-08-07

    Concurrent epidemics of HIV, depression, alcohol abuse, and partner violence threaten maternal and child health (MCH) in South Africa. Although home visiting has been repeatedly demonstrated efficacious in research evaluations, efficacy disappears when programs are scaled broadly. In this cluster randomized controlled trial (RCT), we examine whether the benefits of ongoing accountability and supervision within an existing government funded and implemented community health workers (CHW) home visiting program ensure the effectiveness of home visiting. In the deeply rural, Eastern Cape of South Africa, CHW will be hired by the government and will be initially trained by the Philani Programme to conduct home visits with all pregnant mothers and their children until the children are 2 years old. Eight clinics will be randomized to receive either (1) the Accountable Care Condition in which additional monitoring and accountability systems that Philani routinely uses are implemented (4 clinics, 16 CHW, 450 households); or (2) a Standard Care Condition of initial Philani training, but with supervision and monitoring being delivered by local government structures and systems (4 clinics, 21 CHW, 450 households). In the Accountable Care Condition areas, the CHW's mobile phone reports, which are time-location stamped, will be monitored and data-informed supervision will be provided, as well as monitoring growth, medical adherence, mental health, and alcohol use outcomes. Interviewers will independently assess outcomes at pregnancy at 3, 6, 15, and 24 months post-birth. The primary outcome will be a composite score of documenting maternal HIV/TB testing, linkage to care, treatment adherence and retention, as well as child physical growth, cognitive functioning, and child behavior and developmental milestones. The proposed cluster RCT will evaluate whether routinely implementing supervision and accountability procedures and monitoring CHWs' over time will improve MCH outcomes

  8. Overexpression of c-Met in bone marrow mesenchymal stem cells improves their effectiveness in homing and repair of acute liver failure.

    Science.gov (United States)

    Wang, Kun; Li, Yuwen; Zhu, Tiantian; Zhang, Yongting; Li, Wenting; Lin, Wenyu; Li, Jun; Zhu, Chuanlong

    2017-07-05

    Transplantation of bone marrow-derived mesenchymal stem cells (BMSCs) has emerged as a novel therapy for acute liver failure (ALF). However, the homing efficiency of BMSCs to the injured liver sites appears to be poor. In this study, we aimed to determine if overexpression of c-Met in BMSCs could promote the homing ability of BMSCs to rat livers affected by ALF. Overexpression of c-Met in BMSCs (c-Met-BMSCs) was attained by transfection of naive BMSCs with the lenti-c-Met-GFP. The impact of transplanted c-Met-BMSCs on both homing and repair of ALF was evaluated and compared with lenti-GFP empty vector transfected BMSCs (control BMSCs). After cells were transfected with the lenti-c-Met-GFP vector, the BMSCs displayed very high expression of c-Met protein as demonstrated by Western blot. In addition, in vitro transwell migration assays showed that the migration ability of c-Met-BMSCs was significantly increased in comparison with that of control BMSCs (P liver; this was accompanied by elevated survival rates and liver function in the ALF rats. Parallel pathological examination further confirmed that transplantation of c-Met-BMSCs ameliorated liver injury with reduced hepatic activity index (HAI) scores, and that the effects of c-Met-BMSCs were more profound than those of control BMSCs. Overexpression of c-Met promotes the homing of BMSCs to injured hepatic sites in a rat model of ALF, thereby improving the efficacy of BMSC therapy for ALF repair.

  9. Health Sensors, Smart Home Devices, and the Internet of Medical Things: An Opportunity for Dramatic Improvement in Care for the Lower Extremity Complications of Diabetes.

    Science.gov (United States)

    Basatneh, Rami; Najafi, Bijan; Armstrong, David G

    2018-05-01

    The prevalent and long-neglected diabetic foot ulcer (DFU) and its related complications rank among the most debilitating and costly sequelae of diabetes. With the rise of the Internet of medical things (IoMT), along with smart devices, the med-tech industry is on the cusp of a home-care revolution, which could also create opportunity for developing effective solutions with significant potential to reduce DFU-associated costs and saving limbs. This article discusses potential applications of IoMT to the DFU patient population and beyond. To better understand potential opportunities and challenges associated with implementing IoMT for management of DFU, the authors reviewed recent relevant literatures and included their own expert opinions from a multidisciplinary point of view including podiatry, engineering, and data security. The IoMT has opened digital transformation of home-based diabetic foot care, as it enables promoting patient engagement, personalized care and smart management of chronic and noncommunicable diseases through individual data-driven treatment regimens, telecommunication, data mining, and comprehensive feedback tailored to individual requirements. In particular, with recent advances in voice-activated commands technology and its integration as a part of IoMT, new opportunities have emerged to improve the patient's central role and responsibility in enabling an optimized health care ecosystem. The IoMT has opened new opportunities in health care from remote monitoring to smart sensors and medical device integration. While it is at its early stage of development, ultimately we envisage a connected home that, using voice-controlled technology and Bluetooth-radio-connected add-ons, may augment much of what home health does today.

  10. Home-based Nintendo Wii training to improve upper-limb function in children ages 7 to 12 with spastic hemiplegic cerebral palsy.

    Science.gov (United States)

    Kassee, Caroline; Hunt, Carolyn; Holmes, Michael W R; Lloyd, Meghann

    2017-05-17

    This pilot study compared a Nintendo Wii intervention to single-joint resistance training for the upper limb in children ages 7 to 12 with spastic hemiplegic cerebral palsy (CP). Children were randomized to Wii training (n= 3), or resistance training (n= 3) and trained at home for 6 weeks. Pre, post and 4-week follow-up measures were collected. Outcome measures were the Melbourne Assessment (MA2), and ABILHAND-Kids, and grip strength. Compliance, motivation and feasibility of each intervention was explored using daily logbook responses and questionnaires. Descriptive statistics were used. Three children improved in the MA2, two of which were in the Wii training group. Improvements in the ABILHAND-Kids were minimal for all participants. Grip strength improvements were observed in 3 participants, two of which were in the resistance training group. The Wii training group reported higher compliance and more consistently positive responses to motivation and feasibility questions. Therefore, Wii training may be an effective home-based rehabilitation strategy, and is worth exploring in a larger trial. Implications of Wii training in the context of motivation theory are discussed.

  11. A pilot test of a self-guided, home-based intervention to improve condom-related sexual experiences, attitudes, and behaviors among young women.

    Science.gov (United States)

    Yarber, William L; Milhausen, Robin R; Beavers, Karly A; Ryan, Rebecca; Sullivan, Margaret J; Vanterpool, Karen B; Sanders, Stephanie A; Graham, Cynthia A; Crosby, Richard A

    2018-03-01

    To conduct a pilot test of a brief, self-guided, home-based program designed to improve male condom use attitudes and behaviors among young women. Women aged 18-24 years from a large Midwestern University reporting having had penile-vaginal sex with two or more partners in the past 3 months. Sixty-seven enrolled; 91.0% completed the study. A repeated measures design was used, with assessments occurring at baseline, immediately  post intervention (T2), and 30 days subsequent (T3). Condom use errors and problems decreased, condom-related attitudes and self-efficacy improved, and experiences of condom-protected sex were rated more positively when comparing baseline with T2 and T3 scores. Further, the proportion of condom-protected episodes more than doubled between T1 and T3 for those in the lowest quartile for condom use at baseline. This low-resource, home-based program improved condom-related attitudes and promoted the correct and consistent use of condoms.

  12. The Adolescent "Expanded Medical Home": School-Based Health Centers Partner with a Primary Care Clinic to Improve Population Health and Mitigate Social Determinants of Health.

    Science.gov (United States)

    Riley, Margaret; Laurie, Anna R; Plegue, Melissa A; Richarson, Caroline R

    2016-01-01

    Access to high-quality health care is a crucial social determinant of health. We describe the implementation of an "expanded medical home" partnering a primary care practice (the Ypsilanti Health Center [YHC]) with local school-based health centers (the Regional Alliance for Healthy Schools [RAHS]), and to assess whether this model improves access to and quality of care for shared patients. Using the Consolidated Framework for Implementation Research, we define the steps in, barriers to, and facilitating factors in implementing the expanded medical home model. Visits and quality measures were assessed for patients seen by YHC only versus YHC/RAHS at baseline and during the intervention. At baseline, patients seen at YHC/RAHS had higher compliance with most quality metrics compared with those seen at YHC only. The proportion of shared patients significantly increased because of the intervention (P partnership between primary care physicians and school-based health centers increases the number of shared high-risk adolescent patients. Shared patients have improved compliance with quality measures, which may lead to long-term improved health equity. © Copyright 2016 by the American Board of Family Medicine.

  13. Payment reform to finance a medical home: comment on "Achieving cost control, care coordination, and quality improvement through incremental payment system reform".

    Science.gov (United States)

    McGuire, Thomas G

    2010-01-01

    This commentary on R. F. Averill et al. (2010) addresses their idea of risk and quality adjusting fee-for-service payments to primary care physicians in order to improve the efficiency of primary care and take a step toward financing a "medical home"for patients. I show how their idea can create incentives for efficient practice styles. Pairing this with an active beneficiary choice of primary care physician with an enrollment fee would make the idea easier to implement and provide an incentive and the financing for elements of service not covered by procedure-based fees.

  14. The use of data for process and quality improvement in long term care and home care: a systematic review of the literature.

    Science.gov (United States)

    Sales, Anne E; Bostrom, Anne-Marie; Bucknall, Tracey; Draper, Kellie; Fraser, Kimberly; Schalm, Corinne; Warren, Sharon

    2012-02-01

    Standardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data. To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes? Searches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention. After reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education

  15. Staff Distress Improves by Treating Pain in Nursing Home Patients With Dementia: Results From a Cluster-Randomized Controlled Trial.

    Science.gov (United States)

    Aasmul, Irene; Husebo, Bettina Sandgathe; Flo, Elisabeth

    2016-12-01

    Most people with dementia develop neuropsychiatric symptoms (NPSs), which are distressing for their carers. Untreated pain may increase the prevalence and severity of NPSs and thereby staff burden. We investigated the association between NPSs and the impact of individual pain treatment on distress in nursing home staff. Nursing home (NH) units were cluster-randomized to an intervention group (33 NH units; n = 175) or control group (27 NH units; n = 177). Patients in the intervention group received individual pain treatment for eight weeks, followed by a four-week washout period; control groups received care as usual. Staff informants (n = 138) used the Neuropsychiatric Inventory-NH version (including caregiver distress) as primary outcome to assess their own distress. Other outcomes were pain (Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale) and cognitive functioning (Mini-Mental State Examination). Using hierarchical regression analysis, all NPS items at baseline were associated with staff distress (P pain treatment reduced staff distress in the intervention group compared to control group especially in regard to agitation-related symptoms and apathy. Furthermore, our results indicated a multifactorial model of staff distress, in which enhanced knowledge and understanding of NPSs and pain in people with advanced dementia may play an important role. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  16. Healthy Habits, Happy Homes: methods and baseline data of a randomized controlled trial to improve household routines for obesity prevention.

    Science.gov (United States)

    Taveras, Elsie M; McDonald, Julia; O'Brien, Ashley; Haines, Jess; Sherry, Bettylou; Bottino, Clement J; Troncoso, Karen; Schmidt, Marie Evans; Koziol, Renata

    2012-11-01

    To develop a home-based intervention for parents of 2-5 year old children to promote household routines to prevent overweight/obesity. We recruited 121 children from health centers in Boston between 2011 and 2012 and randomized 62 to intervention and 59 to the control condition. The 6-month intervention included 1) motivational coaching at home and by phone with a health educator, 2) mailed educational materials, and 3) weekly text messages. The intervention promoted three household routines: eating meals as a family, obtaining adequate sleep, and limiting screen time. Of the 121 children, mean (SD) age was 4.0 (1.1) years; 52% were Hispanic, 34% Black, and 14% White/Other. Nearly 60% of the sample had annual household incomes ≤ $20,000. Approximately 64% of families reported eating together ≥ 7 times per week, however, many meals were eaten in front of a TV. Over half of the children slept less than the recommended 11h/night and 78% viewed ≥ 2 h/day of screen time. Household routines that increase obesity risk were prevalent among low-income families in this study. If proven to be effective, promotion of household routines related to family meals, sleep, and screen time may prevent young children from becoming overweight/obese. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... for Hospitals Ostomy Home Skills Hospital Quality Improvement Package The standardized interactive program has been developed by the American College of Surgeons ... and Associates Medical Students International Surgeons ...

  18. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... login or create account first) Skills Kits Broadcast Rights for Hospitals Ostomy Home Skills Hospital Quality Improvement Package The standardized interactive program has been developed by the ...

  19. Home-Based Virtual Reality-Augmented Training Improves Lower Limb Muscle Strength, Balance, and Functional Mobility following Chronic Incomplete Spinal Cord Injury.

    Science.gov (United States)

    Villiger, Michael; Liviero, Jasmin; Awai, Lea; Stoop, Rahel; Pyk, Pawel; Clijsen, Ron; Curt, Armin; Eng, Kynan; Bolliger, Marc

    2017-01-01

    Key factors positively influencing rehabilitation and functional recovery after spinal cord injury (SCI) include training variety, intensive movement repetition, and motivating training tasks. Systems supporting these aspects may provide profound gains in rehabilitation, independent of the subject's treatment location. In the present study, we test the hypotheses that virtual reality (VR)-augmented training at home (i.e., unsupervised) is feasible with subjects with an incomplete SCI (iSCI) and that it improves motor functions such as lower limb muscle strength, balance, and functional mobility. In the study, 12 chronic iSCI subjects used a home-based, mobile version of a lower limb VR training system. The system included motivating training scenarios and combined action observation and execution. Virtual representations of the legs and feet were controlled via movement sensors. The subjects performed home-based training over 4 weeks, with 16-20 sessions of 30-45 min each. The outcome measures assessed were the Lower Extremity Motor Score (LEMS), Berg Balance Scale (BBS), Timed Up and Go (TUG), Spinal Cord Independence Measure mobility, Walking Index for Spinal Cord Injury II, and 10 m and 6 min walking tests. Two pre-treatment assessment time points were chosen for outcome stability: 4 weeks before treatment and immediately before treatment. At post-assessment (i.e., immediately after treatment), high motivation and positive changes were reported by the subjects (adapted Patients' Global Impression of Change). Significant improvements were shown in lower limb muscle strength (LEMS, P  = 0.008), balance (BBS, P  = 0.008), and functional mobility (TUG, P  = 0.007). At follow-up assessment (i.e., 2-3 months after treatment), functional mobility (TUG) remained significantly improved ( P  = 0.005) in contrast to the other outcome measures. In summary, unsupervised exercises at home with the VR training system led to beneficial functional

  20. Home-Based Virtual Reality-Augmented Training Improves Lower Limb Muscle Strength, Balance, and Functional Mobility following Chronic Incomplete Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Michael Villiger

    2017-11-01

    Full Text Available Key factors positively influencing rehabilitation and functional recovery after spinal cord injury (SCI include training variety, intensive movement repetition, and motivating training tasks. Systems supporting these aspects may provide profound gains in rehabilitation, independent of the subject’s treatment location. In the present study, we test the hypotheses that virtual reality (VR-augmented training at home (i.e., unsupervised is feasible with subjects with an incomplete SCI (iSCI and that it improves motor functions such as lower limb muscle strength, balance, and functional mobility. In the study, 12 chronic iSCI subjects used a home-based, mobile version of a lower limb VR training system. The system included motivating training scenarios and combined action observation and execution. Virtual representations of the legs and feet were controlled via movement sensors. The subjects performed home-based training over 4 weeks, with 16–20 sessions of 30–45 min each. The outcome measures assessed were the Lower Extremity Motor Score (LEMS, Berg Balance Scale (BBS, Timed Up and Go (TUG, Spinal Cord Independence Measure mobility, Walking Index for Spinal Cord Injury II, and 10 m and 6 min walking tests. Two pre-treatment assessment time points were chosen for outcome stability: 4 weeks before treatment and immediately before treatment. At post-assessment (i.e., immediately after treatment, high motivation and positive changes were reported by the subjects (adapted Patients’ Global Impression of Change. Significant improvements were shown in lower limb muscle strength (LEMS, P = 0.008, balance (BBS, P = 0.008, and functional mobility (TUG, P = 0.007. At follow-up assessment (i.e., 2–3 months after treatment, functional mobility (TUG remained significantly improved (P = 0.005 in contrast to the other outcome measures. In summary, unsupervised exercises at home with the VR training system led to beneficial

  1. Home hemodialysis

    DEFF Research Database (Denmark)

    Agar, John W; Perkins, Anthony; Heaf, James G

    2015-01-01

    We describe the infrastructure that is necessary for hemodialysis in the home focusing on physical requirements, the organization of plumbing and water, and the key features that should guide the selection of machines that are suitable for home use.......We describe the infrastructure that is necessary for hemodialysis in the home focusing on physical requirements, the organization of plumbing and water, and the key features that should guide the selection of machines that are suitable for home use....

  2. Reflexology versus Swedish Massage to Reduce Physiologic Stress and Pain and Improve Mood in Nursing Home Residents with Cancer: A Pilot Trial

    Directory of Open Access Journals (Sweden)

    Nancy A. Hodgson

    2012-01-01

    Full Text Available Objective. The purpose of this pilot study was to investigate and compare the effects of reflexology and Swedish massage therapy on physiologic stress, pain, and mood in older cancer survivors residing in nursing homes. Methods. An experimental, repeated-measures, crossover design study of 18 nursing home residents aged 75 or over and diagnosed with solid tumor in the past 5 years and following completion of cancer treatments. The intervention tested was 20 minutes of Swedish Massage Therapy to the lower extremities, versus 20 minute Reflexology, using highly specified protocols. Pre- and post-intervention levels of salivary cortisol, observed affect, and pain were compared in the Swedish Massage Therapy and Reflexology conditions. Results. Both Reflexology and Swedish Massage resulted in significant declines in salivary cortisol and pain and improvements in mood. Conclusions. Preliminary data suggest that studies of Swedish Massage Therapy and Reflexology are feasible in this population of cancer survivors typically excluded from trials. Both interventions were well tolerated and produced measurable improvements in outcomes. Further research is needed to explore the mechanisms underlying the potential benefits of these CAM modalities in this patient population.

  3. Improving the accessibility at home: implementation of a domotic application using a p300-based brain computer interface system

    Directory of Open Access Journals (Sweden)

    Rebeca Corralejo Palacios

    2012-05-01

    Full Text Available The aim of this study was to develop a Brain Computer Interface (BCI application to control domotic devices usually present at home. Previous studies have shown that people with severe disabilities, both physical and cognitive ones, do not achieve high accuracy results using motor imagery-based BCIs. To overcome this limitation, we propose the implementation of a BCI application using P300 evoked potentials, because neither extensive training nor extremely high concentration level are required for this kind of BCIs. The implemented BCI application allows to control several devices as TV, DVD player, mini Hi-Fi system, multimedia hard drive, telephone, heater, fan and lights. Our aim is that potential users, i.e. people with severe disabilities, are able to achieve high accuracy. Therefore, this domotic BCI application is useful to increase

  4. Intensive client-centred occupational therapy in the home improves older adults' occupational performance. Results from a Danish randomized controlled trial

    DEFF Research Database (Denmark)

    Nielsen, Tove Lise; Andersen, Niels Trolle; Petersen, Kirsten Schultz

    2018-01-01

    Abstract Background: There is growing interest in enabling older adults’ occupational performance. We tested whether 11 weeks of intensive client-centred occupational therapy (ICC-OT) was superior to usual practice in improving the occupational performance of home-dwelling older adults. Methods...... randomised to receive either a maximum 22 sessions of occupation-based ICC-OT (N = 59) or to receive usual practice with a maximum three sessions of occupational therapy (N = 60). The primary outcome was self-rated occupational performance assessed with the Canadian Occupational Performance Measure (COPM...... significant (95% confidence interval 0.50 to 2.02), t-test: p = 0.001. Conclusions: ICC-OT improved older adults’ occupational performance more effectively than usual practice. This result may benefit older adults and support programmatic changes....

  5. Morning Versus Evening Bright Light Treatment at Home to Improve Function and Pain Sensitivity for Women with Fibromyalgia: A Pilot Study.

    Science.gov (United States)

    Burgess, Helen J; Park, Margaret; Ong, Jason C; Shakoor, Najia; Williams, David A; Burns, John

    2017-01-01

    To test the feasibility, acceptability, and effects of a home-based morning versus evening bright light treatment on function and pain sensitivity in women with fibromyalgia. A single blind randomized study with two treatment arms: 6 days of a 1 hour morning light treatment or 6 days of a 1 hour evening light treatment. Function, pain sensitivity, and circadian timing were assessed before and after treatment. Participants slept at home, except for two nights in Sleep Center. Ten women meeting the American College of Rheumatology's diagnostic criteria for fibromyalgia, including normal blood test results. Self-reported function was assessed with the Fibromyalgia Impact Questionnaire (FIQ). Pain sensitivity was assessed using a heat stimulus that gave measures of threshold and tolerance. Circadian timing was assessed with the dim light melatonin onset. Both morning and evening light treatments led to improvements in function and pain sensitivity. However, only the morning light treatment led to a clinically meaningful improvement in function (>14% reduction from baseline FIQ) and morning light significantly increased pain threshold more than evening light ( P  treatment appears to be a feasible and acceptable adjunctive treatment to women with fibromyalgia. Those who undergo morning light treatment may show improvements in function and pain sensitivity. Advances in circadian timing may be one mechanism by which morning light improves pain sensitivity. Findings can inform the design of a randomized controlled trial. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  6. Effectiveness and feasibility of virtual reality and gaming system use at home by older adults for enabling physical activity to improve health-related domains: a systematic review.

    Science.gov (United States)

    Miller, Kimberly J; Adair, Brooke S; Pearce, Alan J; Said, Catherine M; Ozanne, Elizabeth; Morris, Meg M

    2014-03-01

    use of virtual reality and commercial gaming systems (VR/gaming) at home by older adults is receiving attention as a means of enabling physical activity. to summarise evidence for the effectiveness and feasibility of VR/gaming system utilisation by older adults at home for enabling physical activity to improve impairments, activity limitations or participation. a systematic review searching 12 electronic databases from 1 January 2000-10 July 2012 using key search terms. Two independent reviewers screened yield articles using pre-determined selection criteria, extracted data using customised forms and applied the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist to rate study quality. fourteen studies investigating the effects of VR/gaming system use by healthy older adults and people with neurological conditions on activity limitations, body functions and physical impairments and cognitive and emotional well-being met the selection criteria. Study quality ratings were low and, therefore, evidence was not strong enough to conclude that interventions were effective. Feasibility was inconsistently reported in studies. Where feasibility was discussed, strong retention (≥70%) and adherence (≥64%) was reported. Initial assistance to use the technologies, and the need for monitoring exertion, aggravation of musculoskeletal symptoms and falls risk were reported. existing evidence to support the feasibility and effectiveness VR/gaming systems use by older adults at home to enable physical activity to address impairments, activity limitations and participation is weak with a high risk of bias. The findings of this review may inform future, more rigorous research.

  7. Impact of Case Mix Severity on Quality Improvement in a Patient-centered Medical Home (PCMH) in the Maryland Multi-Payor Program.

    Science.gov (United States)

    Khanna, Niharika; Shaya, Fadia T; Chirikov, Viktor V; Sharp, David; Steffen, Ben

    2016-01-01

    We present data on quality of care (QC) improvement in 35 of 45 National Quality Forum metrics reported annually by 52 primary care practices recognized as patient-centered medical homes (PCMHs) that participated in the Maryland Multi-Payor Program from 2011 to 2013. We assigned QC metrics to (1) chronic, (2) preventive, and (3) mental health care domains. The study used a panel data design with no control group. Using longitudinal fixed-effects regressions, we modeled QC and case mix severity in a PCMH. Overall, 35 of 45 quality metrics reported by 52 PCMHs demonstrated improvement over 3 years, and case mix severity did not affect the achievement of quality improvement. From 2011 to 2012, QC increased by 0.14 (P case mix severity did not correlate with QC. In multivariate analyses, higher QC correlated with larger practices, greater proportion of older patients, and readmission visits. Rural practices had higher proportions of Medicaid patients, lower QC, and higher QC improvement in interaction analyses with time. The gains in QC in the chronic disease domain, the preventive care domain, and, most significantly, the mental health care domain were observed over time regardless of patient case mix severity. QC improvement was generally not modified by practice characteristics, except for rurality. © Copyright 2016 by the American Board of Family Medicine.

  8. Transitional Home Care program utilizing the Integrated Practice Unit concept (THC-IPU: Effectiveness in improving acute hospital utilization

    Directory of Open Access Journals (Sweden)

    Lian Leng Low

    2017-08-01

    Full Text Available Background: Organizing care into integrated practice units (IPUs around conditions and patient segments has been proposed to increase value. We organized transitional care into an IPU (THC-IPU for a patient segment of functionally dependent patients with limited community ambulation. Methods: 1,166 eligible patients were approached for enrolment into THC-IPU. THC-IPU patients received a comprehensive assessment within two weeks of discharge; medication reconciliation; education using standardized action plans and a dedicated nurse case manager for up to 90 days after discharge. Patients who rejected enrolment into THC-IPU received usual post-discharge care planned by their attending hospital physician, and formed the control group. The primary outcome was the proportion of patients with at least one unscheduled readmission within 30 days after discharge. Results: We found a statistically significant reduction in 30-day readmissions and emergency department visits in patients on THC-IPU care compared to usual care, even after adjusting for confounders. Conclusion: Delivering transitional care to patients with functional dependence in the form of home visits and organized into an IPU reduced acute hospital utilization in this patient segment. Extending the program into the pre-hospital discharge phase to include discharge planning can have incremental effectiveness in reducing avoidable hospital readmissions.

  9. Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation

    Directory of Open Access Journals (Sweden)

    Olga Moshkovich

    2015-01-01

    Full Text Available Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen’s Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited.

  10. Daily home gardening improved survival for older people with mobility limitations: an 11-year follow-up study in Taiwan.

    Science.gov (United States)

    Lêng, Chhian Hūi; Wang, Jung-Der

    2016-01-01

    To test the hypothesis that gardening is beneficial for survival after taking time-dependent comorbidities, mobility, and depression into account in a longitudinal middle-aged (50-64 years) and older (≥65 years) cohort in Taiwan. The cohort contained 5,058 nationally sampled adults ≥50 years old from the Taiwan Longitudinal Study on Aging (1996-2007). Gardening was defined as growing flowers, gardening, or cultivating potted plants for pleasure with five different frequencies. We calculated hazard ratios for the mortality risks of gardening and adjusted the analysis for socioeconomic status, health behaviors and conditions, depression, mobility limitations, and comorbidities. Survival models also examined time-dependent effects and risks in each stratum contingent upon baseline mobility and depression. Sensitivity analyses used imputation methods for missing values. Daily home gardening was associated with a high survival rate (hazard ratio: 0.82; 95% confidence interval: 0.71-0.94). The benefits were robust for those with mobility limitations, but without depression at baseline (hazard ratio: 0.64, 95% confidence interval: 0.48-0.87) when adjusted for time-dependent comorbidities, mobility limitations, and depression. Chronic or relapsed depression weakened the protection of gardening. For those without mobility limitations and not depressed at baseline, gardening had no effect. Sensitivity analyses using different imputation methods yielded similar results and corroborated the hypothesis. Daily gardening for pleasure was associated with reduced mortality for Taiwanese >50 years old with mobility limitations but without depression.

  11. Design and implementation of an integrated, continuous evaluation, and quality improvement system for a state-based home-visiting program.

    Science.gov (United States)

    McCabe, Bridget K; Potash, Dru; Omohundro, Ellen; Taylor, Cathy R

    2012-10-01

    To describe the design and implementation of an evaluation system to facilitate continuous quality improvement (CQI) and scientific evaluation in a statewide home visiting program, and to provide a summary of the system's progress in meeting intended outputs and short-term outcomes. Help Us Grow Successfully (HUGS) is a statewide home visiting program that provides services to at-risk pregnant/post-partum women, children (0-5 years), and their families. The program goals are to improve parenting skills and connect families to needed services and thus improve the health of the service population. The evaluation system is designed to: (1) integrate evaluation into daily workflow; (2) utilize standardized screening and evaluation tools; (3) facilitate a culture of CQI in program management; and, (4) facilitate scientifically rigorous evaluations. The review of the system's design and implementation occurred through a formative evaluation process (reach, dose, and fidelity). Data was collected through electronic and paper surveys, administrative data, and notes from management meetings, and medical chart review. In the design phase, four process and forty outcome measures were selected and are tracked using standardized screening and monitoring tools. During implementation, the reach and dose of training were adequate to successfully launch the evaluation/CQI system. All staff (n = 165) use the system for management of families; the supervisors (n = 18) use the system to track routine program activities. Data quality and availability is sufficient to support periodic program reviews at the region and state level. In the first 7 months, the HUGS evaluation system tracked 3,794 families (7,937 individuals). System use and acceptance is high. A successful implementation of a structured evaluation system with a strong CQI component is feasible in an existing, large statewide program. The evaluation/CQI system is an effective mechanism to drive modest change in management

  12. Coaching and Quality Assistance in Quality Rating Improvement Systems: Approaches Used by TA Providers to Improve Quality in Early Care and Education Programs and Home-Based Settings

    Science.gov (United States)

    Smith, Sheila; Robbins, Taylor; Schneider, Will; Kreader, J. Lee; Ong, Christine

    2012-01-01

    Quality Rating Improvement Systems (QRISs) commonly offer on-site technical assistance (TA) and coaching to help early care and education settings achieve quality improvements and a higher QRIS rating. In surveys of administrators overseeing statewide QRISs, almost all states reported the use of on-site TA and coaching in both center-based and…

  13. Long-term independent brain-computer interface home use improves quality of life of a patient in the locked-in state: a case study.

    Science.gov (United States)

    Holz, Elisa Mira; Botrel, Loic; Kaufmann, Tobias; Kübler, Andrea

    2015-03-01

    Despite intense brain-computer interface (BCI) research for >2 decades, BCIs have hardly been established at patients' homes. The current study aimed at demonstrating expert independent BCI home use by a patient in the locked-in state and the effect it has on quality of life. In this case study, the P300 BCI-controlled application Brain Painting was facilitated and installed at the patient's home. Family and caregivers were trained in setting up the BCI system. After every BCI session, the end user indicated subjective level of control, loss of control, level of exhaustion, satisfaction, frustration, and enjoyment. To monitor BCI home use, evaluation data of every session were automatically sent and stored on a remote server. Satisfaction with the BCI as an assistive device and subjective workload was indicated by the patient. In accordance with the user-centered design, usability of the BCI was evaluated in terms of its effectiveness, efficiency, and satisfaction. The influence of the BCI on quality of life of the end user was assessed. At the patient's home. A 73-year-old patient with amyotrophic lateral sclerosis in the locked-in state. Not applicable. The BCI has been used by the patient independent of experts for >14 months. The patient painted in about 200 BCI sessions (1-3 times per week) with a mean painting duration of 81.86 minutes (SD=52.15, maximum: 230.41). BCI improved quality of life of the patient. In most of the BCI sessions the end user's satisfaction was high (mean=7.4, SD=3.24; range, 0-10). Dissatisfaction occurred mostly because of technical problems at the beginning of the study or varying BCI control. The subjective workload was moderate (mean=40.61; range, 0-100). The end user was highy satisfied with all components of the BCI (mean 4.42-5.0; range, 1-5). A perfect match between the user and the BCI technology was achieved (mean: 4.8; range, 1-5). Brain Painting had a positive impact on the patient's life on all three dimensions: competence

  14. Intensive client-centred occupational therapy in the home improves older adults' occupational performance. Results from a Danish randomized controlled trial.

    Science.gov (United States)

    Nielsen, Tove Lise; Andersen, Niels Trolle; Petersen, Kirsten Schultz; Polatajko, Helene; Nielsen, Claus Vinther

    2018-01-12

    There is growing interest in enabling older adults' occupational performance. We tested whether 11 weeks of intensive client-centred occupational therapy (ICC-OT) was superior to usual practice in improving the occupational performance of home-dwelling older adults. An assessor-masked randomized controlled trial among adults 60 + with chronic health issues, who received or applied for homecare services. Recruitment took place September 2012 to April 2014. All participants received practical and personal assistance and meal delivery as needed. In addition, they were randomized to receive either a maximum 22 sessions of occupation-based ICC-OT (N = 59) or to receive usual practice with a maximum three sessions of occupational therapy (N = 60). The primary outcome was self-rated occupational performance assessed with the Canadian Occupational Performance Measure (COPM). No important adverse events occurred. ICC-OT was accepted by 46 participants (88%), usual practice by 60 (100%). After 3 months, the ICC-OT-group had improved 1.86 points on COPM performance; the Usual-Practice group had improved 0.61 points. The between-group difference was statistically significant (95% confidence interval 0.50 to 2.02), t-test: p = 0.001. ICC-OT improved older adults' occupational performance more effectively than usual practice. This result may benefit older adults and support programmatic changes.

  15. Using Quality Improvement Methods to Implement an Electronic Medical Record (EMR) Supported Individualized Home Pain Management Plan for Children with Sickle Cell Disease.

    Science.gov (United States)

    Crosby, Lori E; Simmons, Kenya; Kaiser, Peggy; Davis, Blair; Boyd, Patricia; Eichhorn, Tiffany; Mahaney, Tracy; Joffe, Naomi; Morgan, Darice; Schibler, Kathy; Anderson, Viia; Quinn, Charles T; Kalinyak, Karen A

    2014-05-01

    Using quality improvement methodology, our goal was to develop and implement individualized home pain management plans (HPMP) that included pharmacologic as well as non-pharmacologic strategies for children with sickle cell disease (SCD). We hypothesized that successfully implemented HPMPs would have an impact on Emergency Department (ED) use, decreasing ED visits for uncomplicated SCD pain episodes. A multidisciplinary quality improvement team developed a questionnaire to assess the frequency, location and severity of a patient's pain during a routine, comprehensive visit in order to help the patient and family develop an effective pain management strategy using both pharmacologic and non-pharmacologic actions. Using plan do study act cycles (PDSAs), this team was able to build this process into the daily workflow for all SCD patients age 5 years to 21 years of age. Patients with comprehensive visits scheduled from January 2012 to May 2013 were included (N=188) in the intervention. By May of 2013, 88% of eligible patients had an individualized HPMP in place. There was a concomitant reduction in the percentage of SCD patients seen in the ED for uncomplicated SCD pain (6.9% vs. 1.1%). Using quality improvement methods, an individualized HPMP intervention was incorporated successfully into the daily workflow of a busy outpatient SCD clinic. This intervention has the potential to improve patient outcomes by decreasing avoidable ED visits as well as reducing overall healthcare costs.

  16. Improving the Physical Activity and Outdoor Play Environment of Family Child Care Homes in Nebraska Through Go Nutrition and Physical Activity Self-Assessment for Child Care.

    Science.gov (United States)

    Dinkel, Danae; Dev, Dipti; Guo, Yage; Hulse, Emily; Rida, Zainab; Sedani, Ami; Coyle, Brian

    2018-05-09

    The purpose of this study was to determine if the Go Nutrition and Physical Activity Self-Assessment in Child Care (Go NAP SACC) intervention was effective in improving best practices in the areas of infant and child physical activity and outdoor play and learning in family child care homes (FCCHs) in Nebraska. FCCHs (n = 201) participated in a pre-post evaluation using the Infant and Child Physical Activity and Outdoor Play and Learning assessments from the Go NAP SACC validated measure to assess compliance with best practices. At post, FCCHs demonstrated significant differences in 85% of the Infant and Child Physical Activity items (17 of 20) and 80% of the Outdoor Play and Learning items (12 of 15). Significant differences in best practices between urban and rural FCCH providers were also found. Go NAP SACC appears to be an effective intervention in Nebraska as, after participation in the initiative, providers were improving child care physical activity best practices. Additional research is needed to objectively determine if these changes resulted in objective improvements in children's physical activity levels. Further, efforts are needed to develop and/or identify geographic-specific resources for continued improvement.

  17. The Significance of Emotions and Professional Relations for Accommodating a Web-Based Ulcer Record and Improving Home-Based Care

    Directory of Open Access Journals (Sweden)

    Anne G. Ekeland

    2015-01-01

    Full Text Available Evidence of technological performance, medical improvements and economic effectiveness is generally considered sufficient for judging advances in healthcare. In this paper, I aim to add knowledge about the ways human emotions and professional relations play roles in the processes of accommodating new technologies for quality improvements. A newly-implemented, web-based ulcer record service for patients with chronic skin ulcers constitutes the case. After one year, only a few home care nurses were using the service, interacting with a specialist team. The result was disappointing, but the few users were enthusiastic. An explorative, qualitative study was initiated to understand the users, the processes that accounted for use and how improvements were enacted. In the paper, I expose the emotional aspects of the record accommodation by analyzing the ways emotions were translated in the process and how they influenced the improvements. I contend that use came about through a heterogeneous assemblage of ethical engagement and compassionate emotions stemming from frustration, combined with technological affordances and relations between different professionals. Certain aspects of the improvements are exposed. These are discussed as: (1 reconciliations between the medical facts and rational judgments, on one side, and the emotional and subjective values for judging quality, on the other; and (2 mediation between standardized and personalized care. The healing of ulcers was combined with a sense of purpose and wellbeing to validate improvements. Emotions were strongly involved, and the power of evaluative emotions and professional relations should be further explored to add to the understanding of innovation processes and to validate quality improvements.

  18. The Significance of Emotions and Professional Relations for Accommodating a Web-Based Ulcer Record and Improving Home-Based Care.

    Science.gov (United States)

    Ekeland, Anne G

    2015-01-22

    Evidence of technological performance, medical improvements and economic effectiveness is generally considered sufficient for judging advances in healthcare. In this paper, I aim to add knowledge about the ways human emotions and professional relations play roles in the processes of accommodating new technologies for quality improvements. A newly-implemented, web-based ulcer record service for patients with chronic skin ulcers constitutes the case. After one year, only a few home care nurses were using the service, interacting with a specialist team. The result was disappointing, but the few users were enthusiastic. An explorative, qualitative study was initiated to understand the users, the processes that accounted for use and how improvements were enacted. In the paper, I expose the emotional aspects of the record accommodation by analyzing the ways emotions were translated in the process and how they influenced the improvements. I contend that use came about through a heterogeneous assemblage of ethical engagement and compassionate emotions stemming from frustration, combined with technological affordances and relations between different professionals. Certain aspects of the improvements are exposed. These are discussed as: (1) reconciliations between the medical facts and rational judgments, on one side, and the emotional and subjective values for judging quality, on the other; and (2) mediation between standardized and personalized care. The healing of ulcers was combined with a sense of purpose and wellbeing to validate improvements. Emotions were strongly involved, and the power of evaluative emotions and professional relations should be further explored to add to the understanding of innovation processes and to validate quality improvements.

  19. Defective bacterial clearance is responsible for the enhanced lung pathology characteristic of Mannheimia haemolytica pneumonia in bighorn sheep.

    Science.gov (United States)

    Subramaniam, Renuka; Herndon, Caroline N; Shanthalingam, Sudarvili; Dassanayake, Rohana P; Bavananthasivam, Jegarubee; Potter, Kathleen A; Knowles, Donald P; Foreyt, William J; Srikumaran, Subramaniam

    2011-12-15

    The molecular and cellular basis for the enhanced lung pathology and mortality caused by Mannheimia haemolytica in bighorn sheep (BHS, Ovis canadenesis), in comparison to domestic sheep (DS, Ovis aries), is not clear. Polymorphonuclear leukocytes (PMNs) of BHS are four- to eight-fold more susceptible to M. haemolytica leukotoxin-induced cytolysis, which is likely to reduce the number of functional phagocytes in the lung. We hypothesized that enhanced lung pathology is due to defective clearance of M. haemolytica from the lungs of BHS. To test this hypothesis, M. haemolytica (1 × 10(7) colony forming units [cfu]) were inoculated intra-tracheally into three groups each of BHS and DS, which were euthanized and necropsied at 4, 12, and 18 h post-inoculation (hpi). Bacterial and leukocyte counts were performed on broncho-alveolar lavage fluid (BALF) collected at necropsy. BALF from BHS euthanized at 4 and 12 hpi contained a significantly higher number of M. haemolytica than that from DS. More importantly, DS did not have any bacteria in BALF at 18 hpi, while the BHS still had significant numbers. As expected, the BHS did exhibit more extensive lung lesions at 12 and 18 hpi when compared to DS. At 18 hpi, necrotic PMNs were observed in the lesional lung tissues of BHS, but not DS. Furthermore, BALF from BHS had significantly lower titers of antibodies to Lkt and surface antigens of M. haemolytica, than that of DS. These findings suggest that the enhanced pathology in BHS lungs is due to defective clearance of M. haemolytica from the lungs. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. Acylation Enhances, but Is Not Required for, the Cytotoxic Activity of Mannheimia haemolytica Leukotoxin in Bighorn Sheep.

    Science.gov (United States)

    Batra, Sai A; Shanthalingam, Sudarvili; Munske, Gerhard R; Raghavan, Bindu; Kugadas, Abirami; Bavanthasivam, Jegarubee; Highlander, Sarah K; Srikumaran, Subramaniam

    2015-10-01

    Mannheimia haemolytica causes pneumonia in domestic and wild ruminants. Leukotoxin (Lkt) is the most important virulence factor of the bacterium. It is encoded within the four-gene lktCABD operon: lktA encodes the structural protoxin, and lktC encodes a trans-acylase that adds fatty acid chains to internal lysine residues in the protoxin, which is then secreted from the cell by a type 1 secretion system apparatus encoded by lktB and lktD. It has been reported that LktC-mediated acylation is necessary for the biological effects of the toxin. However, an LktC mutant that we developed previously was only partially attenuated in its virulence for cattle. The objective of this study was to elucidate the role of LktC-mediated acylation in Lkt-induced cytotoxicity. We performed this study in bighorn sheep (Ovis canadensis) (BHS), since they are highly susceptible to M. haemolytica infection. The LktC mutant caused fatal pneumonia in 40% of inoculated BHS. On necropsy, a large number of necrotic polymorphonuclear leukocytes (PMNs) were observed in the lungs. Lkt from the mutant was cytotoxic to BHS PMNs in an in vitro cytotoxicity assay. Flow cytometric analysis of mutant Lkt-treated PMNs revealed the induction of necrosis. Scanning electron microscopic analysis revealed the presence of pores and blebs on mutant-Lkt-treated PMNs. Mass spectrometric analysis confirmed that the mutant secreted an unacylated Lkt. Taken together, these results suggest that acylation is not necessary for the cytotoxic activity of M. haemolytica Lkt but that it enhances the potency of the toxin. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  1. Using benchmarking to assist the improvement of service quality in home support services for older people-IN TOUCH (Integrated Networks Towards Optimising Understanding of Community Health).

    Science.gov (United States)

    Jacobs, Stephen P; Parsons, Matthew; Rouse, Paul; Parsons, John; Gunderson-Reid, Michelle

    2018-04-01

    Service providers and funders need ways to work together to improve services. Identifying critical performance variables provides a mechanism by which funders can understand what they are purchasing without getting caught up in restrictive service specifications that restrict the ability of service providers to meet the needs of the clients. An implementation pathway and benchmarking programme called IN TOUCH provided contracted providers of home support and funders with a consistent methodology to follow when developing and implementing new restorative approaches for service delivery. Data from performance measurement was used to triangulate the personal and social worlds of the stakeholders enabling them to develop a shared understanding of what is working and what is not. The initial implementation of IN TOUCH involved five District Health Boards. The recursive dialogue encouraged by the IN TOUCH programme supports better and more sustainable service development because performance management is anchored to agreed data that has meaning to all stakeholders. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Unimaginable homes

    DEFF Research Database (Denmark)

    Møller, Kristian; Klausen, Maja

    2018-01-01

    The chapter draw from critical mediatization theory, critical intimacy theory, and cultural gerontology and asks: How do elderly people practice their mediatized homes? Which roles do media play in constituting and disturbing the flows of bodies into the home? Moreover: how do dominant...... in the making of the mediatized home space. We conclude by returning to the research questions and making explicit how researching flows of bodies that in many ways inhabit homes of the in-between contributes to both gerontological and geomediatization research agendas....

  3. Participatory women's groups and counselling through home visits to improve child growth in rural eastern India: protocol for a cluster randomised controlled trial.

    Science.gov (United States)

    Nair, Nirmala; Tripathy, Prasanta; Sachdev, Harshpal S; Bhattacharyya, Sanghita; Gope, Rajkumar; Gagrai, Sumitra; Rath, Shibanand; Rath, Suchitra; Sinha, Rajesh; Roy, Swati Sarbani; Shewale, Suhas; Singh, Vijay; Srivastava, Aradhana; Pradhan, Hemanta; Costello, Anthony; Copas, Andrew; Skordis-Worrall, Jolene; Haghparast-Bidgoli, Hassan; Saville, Naomi; Prost, Audrey

    2015-04-15

    Child stunting (low height-for-age) is a marker of chronic undernutrition and predicts children's subsequent physical and cognitive development. Around one third of the world's stunted children live in India. Our study aims to assess the impact, cost-effectiveness, and scalability of a community intervention with a government-proposed community-based worker to improve growth in children under two in rural India. The study is a cluster randomised controlled trial in two rural districts of Jharkhand and Odisha (eastern India). The intervention tested involves a community-based worker carrying out two activities: (a) one home visit to all pregnant women in the third trimester, followed by subsequent monthly home visits to all infants aged 0-24 months to support appropriate feeding, infection control, and care-giving; (b) a monthly women's group meeting using participatory learning and action to catalyse individual and community action for maternal and child health and nutrition. Both intervention and control clusters also receive an intervention to strengthen Village Health Sanitation and Nutrition Committees. The unit of randomisation is a purposively selected cluster of approximately 1000 population. A total of 120 geographical clusters covering an estimated population of 121,531 were randomised to two trial arms: 60 clusters in the intervention arm receive home visits, group meetings, and support to Village Health Sanitation and Nutrition Committees; 60 clusters in the control arm receive support to Committees only. The study participants are pregnant women identified in the third trimester of pregnancy and their children (n = 2520). Mothers and their children are followed up at seven time points: during pregnancy, within 72 hours of delivery, and at 3, 6, 9, 12 and 18 months after birth. The trial's primary outcome is children's mean length-for-age Z scores at 18 months. Secondary outcomes include wasting and underweight at all time points, birth weight, growth

  4. Molecular cloning of interleukin-1β, interleukin-8, and tumor necrosis factor-α of bighorn sheep (Ovis canadensis) and comparison with those of other species.

    Science.gov (United States)

    Herndon, Caroline N; Dassanayake, Rohana P; Foreyt, William J; Srikumaran, Subramaniam

    2010-11-15

    The susceptibility to, and pathology induced by, Mannheimia haemolytica infection in bighorn sheep (BHS) and domestic sheep (DS) are distinctly different. Bighorn sheep are particularly susceptible to pneumonia caused by M. haemolytica, and the pneumonic lesions in infected BHS are more severe than those in DS. The molecular basis for this disparity has not been elucidated. Proinflammatory cytokines have been implicated in the pathogenesis of multiple lung diseases of humans and animals. It is possible that the enhanced pathology observed in the pneumonic lungs of M. haemolytica-infected BHS, in comparison to that of DS, is due to comparatively higher levels of proinflammatory cytokine expression in BHS. As the first step towards elucidating this concept, we have cloned and sequenced the cDNA encoding the cytokines interleukin-1β (IL-1β), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) of BHS. The cDNA of BHS IL-1β, IL-8, and TNF-α consists of 801, 306, and 705 base pairs encoding 266, 101, and 234 amino acids, respectively. The availability of cDNA encoding IL-1β, IL-8, and TNF-α of BHS should facilitate the elucidation of the role of these cytokines in the differential pathology induced by M. haemolytica infection in BHS and DS. Copyright © 2010 Elsevier B.V. All rights reserved.

  5. Assessing Timing and Causes of Neonatal Lamb Losses in a Bighorn Sheep ( Ovis canadensis canadensis ) Herd via Use of Vaginal Implant Transmitters.

    Science.gov (United States)

    Grigg, Jamin L; Wolfe, Lisa L; Fox, Karen A; Killion, Halcyon J; Jennings-Gaines, Jessica; Miller, Michael W; P Dreher, Brian

    2017-07-01

    We evaluated the use of vaginal implant transmitters (VITs) as a means of detecting, capturing, and radio collaring Rocky Mountain bighorn sheep ( Ovis canadensis canadensis) lambs to estimate survival and to facilitate carcass recovery to assess causes of mortality. We focused on one of several bighorn herds in Colorado, US, suffering from depressed recruitment that was not preceded by a classic all-age die-off. We captured, radio-collared, diagnosed pregnancy by ultrasound examination, and inserted VITs into 15 pregnant ewes from a herd residing near Granite, Colorado. We were subsequently able to collar a lamb from each of 13 VITs, and two additional lambs opportunistically from ewes without transmitters. As lambs died, we recovered and submitted carcasses for necropsy and laboratory assessment. All lambs captured and one additional lamb (carcass found opportunistically) were dead by about 130 d of age: 11 died of apparent pneumonia (all within 8-10 wk of age), one died from trauma after being kicked or trampled, one was killed by a mountain lion ( Puma concolor ), and three died of starvation likely caused by abandonment after capture. Pneumonic lambs had involvement of Mycoplasma ovipneumoniae and leukotoxigenic Bibersteinia trehalosi . The use of VITs and lamb collars enabled us to efficiently identify pneumonia as the predominant cause of depressed lamb recruitment in this herd; however, we urge care in neonatal lamb handling to minimize abandonment.

  6. Implementation of an Evidence-Based and Content Validated Standardized Ostomy Algorithm Tool in Home Care: A Quality Improvement Project.

    Science.gov (United States)

    Bare, Kimberly; Drain, Jerri; Timko-Progar, Monica; Stallings, Bobbie; Smith, Kimberly; Ward, Naomi; Wright, Sandra

    Many nurses have limited experience with ostomy management. We sought to provide a standardized approach to ostomy education and management to support nurses in early identification of stomal and peristomal complications, pouching problems, and provide standardized solutions for managing ostomy care in general while improving utilization of formulary products. This article describes development and testing of an ostomy algorithm tool.

  7. Review of, and improvements to, the techniques of trace element analysis of raw water for home dialysis

    Energy Technology Data Exchange (ETDEWEB)

    Cameron, A.P.; Drury, P.J.; Ineson, P.R.; Harston, G.A.

    1986-01-01

    The optimum operating conditions for the measurement of aluminium and iron concentrations in water by atomic absorption spectrometry have been determined experimentally. The characteristics of an ion-selective electrode for the measurement of fluoride have also been investigated. Contrary to other work, the addition of acid to samples did not improve their storage stability, although the acid-washing of polyethylene containers is recommended for the storage of water.

  8. Improving household air, drinking water and hygiene in rural Peru: a community-randomized–controlled trial of an integrated environmental home-based intervention package to improve child health

    Science.gov (United States)

    Hartinger, SM; Lanata, CF; Hattendorf, J; Verastegui, H; Gil, AI; Wolf, J; Mäusezahl, D

    2016-01-01

    Abstract Background: Diarrhoea and acute lower respiratory infections are leading causes of childhood morbidity and mortality, which can be prevented by simple low-cost interventions. Integrated strategies can provide additional benefits by addressing multiple health burdens simultaneously. Methods: We conducted a community-randomized–controlled trial in 51 rural communities in Peru to evaluate whether an environmental home-based intervention package, consisting of improved solid-fuel stoves, kitchen sinks, solar disinfection of drinking water and hygiene promotion, reduces lower respiratory infections, diarrhoeal disease and improves growth in children younger than 36 months. The attention control group received an early child stimulation programme. Results: We recorded 24 647 child-days of observation from 250 households in the intervention and 253 in the attention control group during 12-month follow-up. Mean diarrhoea incidence was 2.8 episodes per child-year in the intervention compared with 3.1 episodes in the control arm. This corresponds to a relative rate of 0.78 [95% confidence interval (CI): 0.58–1.05] for diarrhoea incidence and an odds ratio of 0.71 (95% CI: 0.47–1.06) for diarrhoea prevalence. No effects on acute lower respiratory infections or children’s growth rates were observed. Conclusions: Combined home-based environmental interventions slightly reduced childhood diarrhoea, but the confidence interval included unity. Effects on growth and respiratory outcomes were not observed, despite high user compliance of the interventions. The absent effect on respiratory health might be due to insufficient household air quality improvements of the improved stoves and additional time needed to achieve attitudinal and behaviour change when providing composite interventions. PMID:27818376

  9. Improving household air, drinking water and hygiene in rural Peru: a community-randomized-controlled trial of an integrated environmental home-based intervention package to improve child health.

    Science.gov (United States)

    Hartinger, S M; Lanata, C F; Hattendorf, J; Verastegui, H; Gil, A I; Wolf, J; Mäusezahl, D

    2016-12-01

    Diarrhoea and acute lower respiratory infections are leading causes of childhood morbidity and mortality, which can be prevented by simple low-cost interventions. Integrated strategies can provide additional benefits by addressing multiple health burdens simultaneously. We conducted a community-randomized-controlled trial in 51 rural communities in Peru to evaluate whether an environmental home-based intervention package, consisting of improved solid-fuel stoves, kitchen sinks, solar disinfection of drinking water and hygiene promotion, reduces lower respiratory infections, diarrhoeal disease and improves growth in children younger than 36 months. The attention control group received an early child stimulation programme. We recorded 24 647 child-days of observation from 250 households in the intervention and 253 in the attention control group during 12-month follow-up. Mean diarrhoea incidence was 2.8 episodes per child-year in the intervention compared with 3.1 episodes in the control arm. This corresponds to a relative rate of 0.78 [95% confidence interval (CI): 0.58-1.05] for diarrhoea incidence and an odds ratio of 0.71 (95% CI: 0.47-1.06) for diarrhoea prevalence. No effects on acute lower respiratory infections or children's growth rates were observed. Combined home-based environmental interventions slightly reduced childhood diarrhoea, but the confidence interval included unity. Effects on growth and respiratory outcomes were not observed, despite high user compliance of the interventions. The absent effect on respiratory health might be due to insufficient household air quality improvements of the improved stoves and additional time needed to achieve attitudinal and behaviour change when providing composite interventions. © The Author 2016. Published by Oxford University Press on behalf of the International Epidemiological Association

  10. An innovative brioche enriched in protein and energy improves the nutritional status of malnourished nursing home residents compared to oral nutritional supplement and usual breakfast: FARINE+ project.

    Science.gov (United States)

    Van Wymelbeke, Virginie; Brondel, Laurent; Bon, Francis; Martin-Pfitzenmeyer, Isabelle; Manckoundia, Patrick

    2016-10-01

    To compare the effects of a 12-week nutritional intervention, in which an innovative protein-and-energy-enriched brioche, an oral nutritional supplement or a usual breakfast were eaten, on food intake and nutritional status in nursing home residents. Three-armed, multicentre, controlled trial. Eight nursing homes in Burgundy, France. Sixty-eight malnourished participants aged between 70 and 99 years old. Participants were randomly assigned to one of three groups according to the breakfast provided: brioche group, one portion of 65 g brioche enriched in protein and energy (12.8 g and 180 kcal) added to usual breakfast; supplement group, 200-ml of a ready-to-use, energy-dense liquid (14 g protein and 200 kcal) added to usual breakfast or control group, a usual breakfast only. Total energy intakes were assessed for three days at different periods of the study (day 0, day 30 and day 90); blood parameters, nutritional status (mini nutritional assessment, weight) and functional capacities (grip strength and activity level) were measured at the beginning and at the end of the nutritional intervention study (day 0 and day 90). The participants of the brioche group had higher total energy intakes at day 30 (p value 0.004) and at day 90 (p value 0.018) compared with the supplement group and the control group. At the end of the interventional study, 72% of the participants in the brioche group had reached the recommended minimum level of protein of 0.8 g/kg/day, compared with 53% in the supplement group and 36% in the control group (p value 0.036). In addition, between day 0 and day 90 in the brioche group, blood levels of vitamins B 9 , B 2 , D (all p value <0.001), B 6 (p value 0.026) and B 12 (p value 0.036) had increased and plasma homocysteine had decreased (p value 0.024). The protein-and-energy-enriched brioche effectively increased energy and protein intakes and improved the nutritional status of elderly people living in nursing homes. It could be a good

  11. Use of Low Level of Continuous Heat as an Adjunct to Physical Therapy Improves Knee Pain Recovery and the Compliance for Home Exercise in Patients With Chronic Knee Pain: A Randomized Controlled Trial.

    Science.gov (United States)

    Petrofsky, Jerrold S; Laymon, Michael S; Alshammari, Faris S; Lee, Haneul

    2016-11-01

    Petrofsky, JS, Laymon, MS, Alshammari, FS, and Lee, H. Use of low level of continuous heat as an adjunct to physical therapy improves knee pain recovery and the compliance for home exercise in patients with chronic knee pain: a randomized controlled trial. J Strength Cond Res 30(11): 3107-3115, 2016-This study examined if the use of low level continuous heat (LLCH) wraps at home between physical therapy sessions at a clinic resulted in better therapy outcomes in patients with chronic knee pain. Fifty individuals with chronic nonspecific knee pain was randomly allocated to 2 groups: the LLCH group and the placebo group. All subjects underwent 1 hour of conventional physical therapy twice per week for 2 weeks at the outpatient clinic and they were asked to accomplish 1 hour of therapeutic exercise at home each day between sessions. The LLCH group applied LLCH knee wraps for 6 hours at home before home exercise while placebo group took a placebo ibuprofen. (This was done since placebo heat is impossible to use since subjects would notice that the wraps were cold) Before, during, and after intervention, pain intensity, active range of motion of the knee (AROM), knee strength, and home exercise compliance were measured. The LLCH group showed pain attenuation after 2 weeks of therapy sessions (p ≤ 0.05). AROM and strength of the knee significantly improved over time compared to the placebo group. Home exercise compliance was significantly higher in the LLCH group than placebo group (p ≤ 0.05). These results indicated that the use of LLCH as an adjunct to conventional physical therapy for chronic knee pain significantly improved pain attenuation and recovery of strength and movement in patients with chronic knee pain.

  12. Usefulness of circuit training at home for improving bone mass and muscle mass while losing fat mass in undergraduate female students.

    Science.gov (United States)

    Takahata, Yoko

    2018-05-09

    The purpose of this study was to determine whether or not circuit training at home affects the calcaneus quantitative ultrasound status as well as other indices of body composition among undergraduate female students. Forty-one adolescents were recruited (18.5 ± 0.6 years old). The stiffness index of the calcaneus, broadband ultrasound attenuation of the calcaneus, speed of sound of the calcaneus, and body frame index. This was a three-month intervention study, so the measurements were conducted at baseline, 2 months later, and 3 months later while the subjects underwent circuit training at home. The subjects were divided into two groups: namely, the exercising group and non-exercising group. In the exercising group, broadband ultrasound attenuation of the calcaneus was higher 2 months later (p = 0.033) as well as 3 months later (p = 0.036), and the speed of sound of the calcaneus was higher 3 months later (p = 0.018). In addition, the muscle mass was strongly positively correlated with the calcaneus QUS-SOS (p = 0.004), while the body fat percentage was a strongly negatively correlated with the calcaneus QUS-BUA (p = 0.043). In the non-exercising group, the stiffness index of the calcaneus was higher 2 months later (p = 0.002) as well as 3 months later (p = 0.002). Furthermore, the body percentage was strongly positively correlated with the calcaneus QUS-SI (p = 0.009). These findings suggest that the calcaneus quantitative ultrasound status and muscle mass while losing fat mass may be improved by means of a simple exercise regimen within a short period among undergraduate female students.

  13. Long-Term Pain Treatment Did Not Improve Sleep in Nursing Home Patients with Comorbid Dementia and Depression: A 13-Week Randomized Placebo-Controlled Trial

    Directory of Open Access Journals (Sweden)

    Kjersti M. Blytt

    2018-02-01

    Full Text Available Objective: Previous research indicates that pain treatment may improve sleep among nursing home patients. We aimed to investigate the long-term effect of pain treatment on 24-h sleep patterns in patients with comorbid depression and dementia.Design: A 13-week, multicenter, parallel-group, double-blind, placebo-controlled randomized clinical trial conducted between August 2014 and September 2016.Setting: Long-term patients from 47 nursing homes in Norway.Participants: We included 106 patients with comorbid dementia and depression according to the Mini Mental Status Examination (MMSE and the Cornell Scale for Depression in Dementia (CSDD.Intervention: Patients who were not using analgesics were randomized to receive either paracetamol (3 g/day or placebo tablets. Those who already received pain treatment were randomized to buprenorphine transdermal system (maximum 10 μg/h/7 days or placebo transdermal patches.Measurements: Sleep was assessed continuously for 7 days by actigraphy, at baseline and in week 13. Total sleep time (TST, sleep efficiency (SE, sleep onset latency (SOL, wake after sleep onset (WASO, early morning awakening (EMA, and number of wake bouts (NoW were evaluated. In addition, daytime total sleep time (DTS was estimated. Pain was assessed with Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2.Results: The linear mixed model analyses for TST, SE, SOL, WASO, EMA, NoW and DTS showed no statistically significant differences between patients who received active pain treatment and those who received placebo. Post hoc subgroup analyses showed that there were no statistically significant differences between active treatment and placebo from baseline to week 13 in patients who were in pain (MOBID-2 ≥ 3 at baseline, or in patients who had poor sleep (defined as SE < 85% at baseline. Patients who received active buprenorphine showed an increase in TST and SE compared to those who received active paracetamol

  14. Digital Education to Limit Salt in the Home (DELISH) Program Improves Knowledge, Self-Efficacy, and Behaviors Among Children.

    Science.gov (United States)

    Grimes, Carley Ann; Booth, Alison; Khokhar, Durreajam; West, Madeline; Margerison, Claire; Campbell, Karen Jane; Nowson, Caryl Anne

    2018-06-01

    To determine the efficacy of a Web-based salt reduction program on children's salt-related knowledge, attitudes, and behaviors (KABs), self-efficacy, and intake of dietary salt. Pretest and posttest. An online survey determined KABs and self-efficacy and a 24-hour urine collection revealed salt intake. Victoria, Australia. Child-parent dyads (n = 102) recruited from 5 government schools. A 5-week behavior-based education program delivered via weekly online interactive education sessions. Change in KABs, self-efficacy, and daily salt intake. Changes in outcomes were assessed using McNemar test, paired t test, and Cohen's δ (CD). A total of 83 children participated (mean age, 9.2 years [SD, 0.8 years]; 59% girls); 35% to 76% of children viewed weekly education session. Children with complete survey data (n = 75) had improved scores for salt-related knowledge (+3.6 ± 0.4 points; P < .001; CD: 1.16), behaviors (+1.3 ± 0.1 points; P < .001; CD: 1.08), and self-efficacy (+0.9 ± 0.2 points; P < .001; CD: 0.64), but not attitude. Children with valid urine collections (n = 51) showed no change in salt intake. Participation resulted in improvement of salt related knowledge, self-efficacy and behavior. Further research is required to confirm these results using a more robust study design which includes a control group. In addition, the long term impact on children's salt intakes of comparable education programs needs to be assessed. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  15. Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics.

    Science.gov (United States)

    Helfrich, Christian D; Dolan, Emily D; Fihn, Stephan D; Rodriguez, Hector P; Meredith, Lisa S; Rosland, Ann-Marie; Lempa, Michele; Wakefield, Bonnie J; Joos, Sandra; Lawler, Lauren H; Harvey, Henry B; Stark, Richard; Schectman, Gordon; Nelson, Karin M

    2014-12-01

    Team-based care is central to the patient-centered medical home (PCMH), but most PCMH evaluations measure team structure exclusively. We assessed team-based care in terms of team structure, process and effectiveness, and the association with improvements in teams׳ abilities to deliver patient-centered care. We fielded a cross-sectional survey among 913 VA primary care clinics implementing a PCMH model in 2012. The dependent variable was clinic-level respondent-reported improvements in delivery of patient-centered care. Independent variables included three sets of measures: (1) team structure, (2) team process, and (3) team effectiveness. We adjusted for clinic workload and patient comorbidity. 4819 surveys were returned (25% estimated response rate). The highest ratings were for team structure (median of 89% of respondents being assigned to a teamlet, i.e., a PCP working with the same clinical associate, nurse care manager and clerk) and lowest for team process (median of 10% of respondents reporting the lowest level of stress/chaos). In multivariable regression, perceived improvements in patient-centered care were most strongly associated with participatory decision making (β=32, Pteam processes). A stressful/chaotic clinic environment was associated with higher barriers to patient centered care (β=0.16-0.34, P=Team process and effectiveness measures, often omitted from PCMH evaluations, had stronger associations with perceived improvements in patient-centered care than team structure measures. Team process and effectiveness measures may facilitate synthesis of evaluation findings and help identify positive outlier clinics. Published by Elsevier Inc.

  16. A pilot study to evaluate the efficacy of adding a structured home visiting intervention to improve outcomes for high-risk families attending the Incredible Years Parent Programme: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Lees, Dianne G; Fergusson, David M; Frampton, Christopher M; Merry, Sally N

    2014-02-25

    Antisocial behaviour and adult criminality often have their origins in childhood and are best addressed early in the child's life using evidence-based treatments such as the 'Incredible Years Parent Programme'. However, families with additional risk factors who are at highest risk for poor outcomes do not always make sufficient change while attending such programmes. Additional support to address barriers and improve implementation of positive parenting strategies while these families attend the Incredible Years Programme may improve overall outcomes.The study aims to evaluate the efficacy of adding a structured home visiting intervention (Home Parent Support) to improve outcomes in families most at risk of poor treatment response from the Incredible Years intervention. This study will inform the design of a larger prospective randomised controlled trial. A pilot single-blind, parallel, superiority, randomised controlled trial. Randomisation will be undertaken using a computer-generated sequence in a 1:1 ratio to the two treatments arranged in permuted blocks with stratification by age, sex, and ethnicity. One hundred and twenty six participants enrolled in the Incredible Years Parent Programme who meet the high-risk criteria will be randomly allocated to receive either Incredible Years Parent Programme and Home Parent Support, or the Incredible Years Parent Programme alone. The Home Parent Support is a 10-session structured home visiting intervention provided by a trained therapist, alongside the usual Incredible Years Parent Programme, to enhance the adoption of key parenting skills. The primary outcome is the change in child behaviour from baseline to post-intervention in parent reported Eyberg Child Behavior Inventory Problem Scale. This is the first formal evaluation of adding Home Parent Support alongside Incredible Years Parent Programme for families with risk factors who typically have poorer treatment outcomes. We anticipate that the intervention will help

  17. Can sleep quality and wellbeing be improved by changing the indoor lighting in the homes of healthy, elderly citizens?

    Science.gov (United States)

    Sander, Birgit; Markvart, Jakob; Kessel, Line; Argyraki, Aikaterini; Johnsen, Kjeld

    2015-01-01

    The study investigated the effect of bright blue-enriched versus blue-suppressed indoor light on sleep and wellbeing of healthy participants over 65 years. Twenty-nine participants in 20 private houses in a uniform settlement in Copenhagen were exposed to two light epochs of 3 weeks with blue-enriched (280 lux) and 3 weeks blue-suppressed (240 lux) indoor light or vice versa from 8 to 13 pm in a randomized cross-over design. The first light epoch was in October, the second in November and the two light epochs were separated by one week. Participants were examined at baseline and at the end of each light epoch. The experimental indoor light was well tolerated by the majority of the participants. Sleep duration was 7.44 (95% CI 7.14–7.74) hours during blue-enriched conditions and 7.31 (95% CI 7.01–7.62) hours during blue-suppressed conditions (p = 0.289). Neither rest hours, chromatic pupillometry, nor saliva melatonin profile showed significant changes between blue-enriched and blue-suppressed epochs. Baseline Pittsburgh Sleep Quality Index (PSQI) was significantly worse in females; 7.62 (95% CI 5.13–10.0) versus 4.06 (95% CI 2.64–5.49) in males, p = 0.009. For females, PSQI improved significantly during blue-enriched light exposure (p = 0.007); no significant changes were found for males. The subjective grading of indoor light quality doubled from participants habitual indoor light to the bright experimental light, while it was stable between light epochs, although there were clear differences between blue-enriched and blue-suppressed electrical light conditions imposed. Even though the study was carried out in the late autumn at northern latitude, the only significant difference in Actiwatch-measured total blue light exposure was from 8 to 9 am, because contributions from blue-enriched, bright indoor light were superseded by contributions from daylight. PMID:26181467

  18. Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes.

    Science.gov (United States)

    Gordon, Adam L; Goodman, Claire; Davies, Sue L; Dening, Tom; Gage, Heather; Meyer, Julienne; Schneider, Justine; Bell, Brian; Jordan, Jake; Martin, Finbarr C; Iliffe, Steve; Bowman, Clive; Gladman, John R F; Victor, Christina; Mayrhofer, Andrea; Handley, Melanie; Zubair, Maria

    2018-01-05

    care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which 'wraps around' care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise. © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society.

  19. Home visits as part of a new care pathway (iAID) to improve quality of care and quality of life in ostomy patients: a cluster-randomized stepped-wedge trial

    NARCIS (Netherlands)

    Sier, M. F.; Oostenbroek, R. J.; Dijkgraaf, M. G. W.; Veldink, G. J.; Bemelman, W. A.; Pronk, A.; Spillenaar-Bilgen, E. J.; Kelder, W.; Hoff, C.; Ubbink, D. T.; Havenga, K.; Veltkamp, S. C.; T Dekker, J. W.; Boerma, D.; Eijsbouts, Q. A. J.; Lamme, B.; Vuylsteke, R. J. C. L. M.; Tobon Morales, R. E.; van Tets, W. F.

    2017-01-01

    Aim Morbidity in patients with an ostomy is high. A new care pathway, including perioperative home visits by enterostomal therapists, was studied to assess whether more elaborate education and closer guidance could reduce stoma-related complications and improve quality of life (QoL), at acceptable

  20. Improving Outcomes for Teenage Pregnancy and Early Parenthood for Young People in Out-of-Home Care: A Review of the Literature

    Science.gov (United States)

    Mendes, Philip

    2009-01-01

    Young people leaving out-of-home care are overrepresented among teenage parents. This paper examines the research literature and identifies key factors that contribute to early pregnancy and parenthood for care leavers, the challenges of early parenting and the positive effects of early parenting. The implications for out-of-home care policy and…

  1. Home Rx: The Health Benefits of Home Performance

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, Jonathan [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Jacobs, David [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Reddy, Amanda [National Center for Healthy Housing (NCHH), Columbia, MD (United States); Tohn, Ellen [Tohn Environmental Strategies, Wayland, MA (United States); Cohen, Jonathan [Dept. of Energy (DOE), Washington DC (United States); Jacobsohn, Ely [Dept. of Energy (DOE), Washington DC (United States)

    2016-12-01

    Evidence in a new, groundbreaking U.S. Department of Energy report, Home Rx: The Health Benefits of Home Performance, shows that home performance upgrades can improve the quality of a home’s indoor environment by reducing the prevalence of harmful indoor air pollutants and contaminants. Until recently, no systematic review of this evidence had been conducted, limiting full understanding of the link between home performance and health. This new report summarizes current knowledge and identifies research gaps. The design characteristics and results of each of the 40 studies considered in the report are summarized in a searchable matrix.

  2. Act In case of Depression: The evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol

    Directory of Open Access Journals (Sweden)

    Vernooij-Dassen Myrra JFJ

    2011-05-01

    Full Text Available Abstract Background The aim of this study is evaluating the (cost- effectiveness of a multidisciplinary, evidence based care program to improve the management of depression in nursing home residents of somatic and dementia special care units. The care program is an evidence based standardization of the management of depression, including standardized use of measurement instruments and diagnostical methods, and protocolized psychosocial, psychological and pharmacological treatment. Methods/Design In a 19-month longitudinal controlled study using a stepped wedge design, 14 somatic and 14 dementia special care units will implement the care program. All residents who give informed consent on the participating units will be included. Primary outcomes are the frequency of depression on the units and quality of life of residents on the units. The effect of the care program will be estimated using multilevel regression analysis. Secondary outcomes include accuracy of depression-detection in usual care, prevalence of depression-diagnosis in the intervention group, and response to treatment of depressed residents. An economic evaluation from a health care perspective will also be carried out. Discussion The care program is expected to be effective in reducing the frequency of depression and in increasing the quality of life of residents. The study will further provide insight in the cost-effectiveness of the care program. Trial registration Netherlands Trial Register (NTR: NTR1477

  3. Home parenteral nutrition in children

    International Nuclear Information System (INIS)

    Kalousova, J.; Rouskova, B.; Styblova, J.

    2011-01-01

    Parenteral nutrition delivered at home presents a major improvement in the quality of life of children dependent on long term parenteral nutrition. Indications, technical conditions, logistics, complications, prognosis of home parenteral nutrition as well as some health-care issues to be addressed by pediatric practitioner are summarized. (author)

  4. Nurse-led home visitation programme to improve health-related quality of life and reduce disability among potentially frail community-dwelling older people in general practice: a theory-based process evaluation.

    Science.gov (United States)

    Stijnen, Mandy M N; Jansen, Maria W J; Duimel-Peeters, Inge G P; Vrijhoef, Hubertus J M

    2014-10-25

    Population ageing fosters new models of care delivery for older people that are increasingly integrated into existing care systems. In the Netherlands, a primary-care based preventive home visitation programme has been developed for potentially frail community-dwelling older people (aged ≥75 years), consisting of a comprehensive geriatric assessment during a home visit by a practice nurse followed by targeted interdisciplinary care and follow-up over time. A theory-based process evaluation was designed to examine (1) the extent to which the home visitation programme was implemented as planned and (2) the extent to which general practices successfully redesigned their care delivery. Using a mixed-methods approach, the focus was on fidelity (quality of implementation), dose delivered (completeness), dose received (exposure and satisfaction), reach (participation rate), recruitment, and context. Twenty-four general practices participated, of which 13 implemented the home visitation programme and 11 delivered usual care to older people. Data collection consisted of semi-structured interviews with practice nurses (PNs), general practitioners (GPs), and older people; feedback meetings with PNs; structured registration forms filled-out by PNs; and narrative descriptions of the recruitment procedures and registration of inclusion and drop-outs by members of the research team. Fidelity of implementation was acceptable, but time constraints and inadequate reach (i.e., the relatively healthy older people participated) negatively influenced complete delivery of protocol elements, such as interdisciplinary cooperation and follow-up of older people over time. The home visitation programme was judged positively by PNs, GPs, and older people. Useful tools were offered to general practices for organising proactive geriatric care. The home visitation programme did not have major shortcomings in itself, but the delivery offered room for improvement. General practices received

  5. Use of low level of continuous heat and Ibuprofen as an adjunct to physical therapy improves pain relief, range of motion and the compliance for home exercise in patients with nonspecific neck pain: A randomized controlled trial.

    Science.gov (United States)

    Petrofsky, Jerrold S; Laymon, Michael; Alshammari, Faris; Khowailed, Iman Akef; Lee, Haneul

    2017-01-01

    It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (ppain significantly improved pain attenuation and it causes greater compliance for home.

  6. Vascular access for home haemodialysis.

    Science.gov (United States)

    Al Shakarchi, Julien; Day, C; Inston, N

    2018-03-01

    Home haemodialysis has been advocated due to improved quality of life. However, there are very little data on the optimum vascular access for it. A retrospective cohort study was carried on all patients who initiated home haemodialysis between 2011 and 2016 at a large university hospital. Access-related hospital admissions and interventions were used as primary outcome measures. Our cohort consisted of 74 patients. On initiation of home haemodialysis, 62 individuals were using an arteriovenous fistula as vascular access, while the remaining were on a tunnelled dialysis catheter. Of the 12 patients who started on a tunnelled dialysis catheter, 5 were subsequently converted to either an arteriovenous fistula ( n = 4) or an arteriovenous graft ( n = 1). During the period of home haemodialysis use, four arteriovenous fistula failed or thrombosed with patients continuing on home haemodialysis using an arteriovenous graft ( n = 3) or a tunnelled dialysis catheter ( n = 1). To maintain uninterrupted home haemodialysis, interventional rates were 0.32 per arteriovenous fistula/arteriovenous graft access-year and 0.4 per tunnelled dialysis catheter access-year. Hospital admission rates for patients on home haemodialysis were 0.33 per patient-year. Our study has shown that home haemodialysis can be safely and independently performed at home within a closely managed home haemodialysis programme. The authors also advocate the use of arteriovenous fistulas for this cohort of patients due to both low complication and intervention rates.

  7. Genetic modification of mesenchymal stem cells to overexpress CXCR4 and CXCR7 does not improve the homing and therapeutic potentials of these cells in experimental acute kidney injury.

    Science.gov (United States)

    Gheisari, Yousof; Azadmanesh, Kayhan; Ahmadbeigi, Naser; Nassiri, Seyed Mahdi; Golestaneh, Azadeh Fahim; Naderi, Mahmood; Vasei, Mohammad; Arefian, Ehsan; Mirab-Samiee, Siamak; Shafiee, Abbas; Soleimani, Masoud; Zeinali, Sirous

    2012-11-01

    The therapeutic potential of bone marrow mesenchymal stem cells (MSCs) in kidney failure has been examined in some studies. However, recent findings indicate that after transplantation, these cells home to kidneys at very low levels. Interaction of stromal derived factor-1 (SDF-1) with its receptor, CXCR4, is of pivotal importance in migration and homing. Recently, CXCR7 has also been recognized as another SDF-1 receptor that interacts with CXCR4 and modulates its functions. In this study, CXCR4 and CXCR7 were separately and simultaneously overexpressed in BALB/c bone marrow MSCs by using a lentiviral vector system and the homing and renoprotective potentials of these cells were evaluated in a mouse model of cisplatin-induced acute kidney injury. Using flow cytometry, immunohistochemistry, and real-time PCR methods for detection of GFP-labeled MSCs, we found that although considerably entrapped in lungs, native MSCs home very rarely to kidneys and bone marrow and this rate cannot be significantly affected by CXCR4 and/or CXCR7 upregulation. Transplantation of neither native nor genetically engineered MSCs ameliorated kidney failure. We concluded that overexpression of CXCR4 and CXCR7 receptors in murine MSCs cannot improve the homing and therapeutic potentials of these cells and it can be due to severe chromosomal abnormalities that these cells bear during ex vivo expansion.

  8. Mining the Home Environment

    Science.gov (United States)

    Cook, Diane J.; Krishnan, Narayanan

    2014-01-01

    Individuals spend a majority of their time in their home or workplace and for many, these places are our sanctuaries. As society and technology advance there is a growing interest in improving the intelligence of the environments in which we live and work. By filling home environments with sensors and collecting data during daily routines, researchers can gain insights on human daily behavior and the impact of behavior on the residents and their environments. In this article we provide an overview of the data mining opportunities and challenges that smart environments provide for researchers and offer some suggestions for future work in this area. PMID:25506128

  9. Mining the Home Environment.

    Science.gov (United States)

    Cook, Diane J; Krishnan, Narayanan

    2014-12-01

    Individuals spend a majority of their time in their home or workplace and for many, these places are our sanctuaries. As society and technology advance there is a growing interest in improving the intelligence of the environments in which we live and work. By filling home environments with sensors and collecting data during daily routines, researchers can gain insights on human daily behavior and the impact of behavior on the residents and their environments. In this article we provide an overview of the data mining opportunities and challenges that smart environments provide for researchers and offer some suggestions for future work in this area.

  10. Returning home

    DEFF Research Database (Denmark)

    Agergaard, Jytte; Brøgger, Ditte

    2016-01-01

    flows. By focusing on these educational migrants, this paper explores how they connect to their rural homes. Guided by a critical reading of the migration-development scholarship, the paper examines how migrants and their relatives make sense of educational migrants’ remitting and returning practices......, and by comparing three groups of educational migrants, the migrants’ reasons for staying connected and sending remittances are scrutinized. The paper finds that although educational migrants do not generate extensive economic remittances for local development in Nepal, they stay connected to their rural homes...

  11. Building America Best Practices Series: Volume 3; Builders and Buyers Handbook for Improving New Home Efficiency, Comfort, and Durability in the Cold and Very Cold Climates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2005-08-01

    The guide book is a resource to help builders large and small build high-quality, energy-efficient homes that achieve 30% energy savings in space conditioning and water heating in the cold and very cold climates.

  12. Building America Best Practices Series: Volume 4; Builders and Buyers Handbook for Improving New Home Efficiency, Comfort, and Durability in the Mixed-Humid Climate

    Energy Technology Data Exchange (ETDEWEB)

    None

    2005-09-01

    This guide book is a resource to help builders large and small build high-quality, energy-efficient homes that achieve 30% energy savings in space conditioning and water heating in the mixed-humid climate region.

  13. Detailed methods of two home-based vegetable gardening intervention trials to improve diet, physical activity, and quality of life in two different populations of cancer survivors.

    Science.gov (United States)

    Cases, Mallory G; Frugé, Andrew D; De Los Santos, Jennifer F; Locher, Julie L; Cantor, Alan B; Smith, Kerry P; Glover, Tony A; Cohen, Harvey J; Daniel, Michael; Morrow, Casey D; Moellering, Douglas R; Demark-Wahnefried, Wendy

    2016-09-01

    Cancer survivors suffer from long-term adverse effects that reduce health-related quality of life (QOL) and physical functioning, creating an urgent need to develop effective, durable, and disseminable interventions. Harvest for Health, a home-based vegetable gardening intervention, holds promise for these domains. This report describes the methods and recruitment experiences from two randomized controlled feasibility trials that employ a waitlist-controlled design. Delivered in partnership with Cooperative Extension Master Gardeners, this intervention provides one-on-one mentorship of cancer survivors in planning and maintaining three seasonal vegetable gardens over 12months. The primary aim is to determine intervention feasibility and acceptability; secondary aims are to explore effects on objective and subjective measures of diet, physical activity and function, and QOL and examine participant factors associated with potential effects. One trial is conducted exclusively among 82 female breast cancer survivors residing in the Birmingham, AL metropolitan area (BBCS); another broadly throughout Alabama among 46 older cancer survivors aged >60 (ASCS). Response rates were 32.6% (BBCS) and 52.3% (ASCS). Both trials exceeded 80% of their accrual target. Leading reasons for ineligibility were removal of >10 lymph nodes (lymphedema risk factor), lack of physician approval, and unwillingness to be randomized to the waitlist. To date, recruitment and implementation of Harvest for Health appears feasible. Although both studies encountered recruitment challenges, lessons learned can inform future larger-scale studies. Vegetable gardening interventions are of interest to cancer survivors and may provide opportunities to gain life skills leading to improvements in overall health and QOL. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Fermilab | Home

    Science.gov (United States)

    Industry Students and teachers Media ... Five (more) fascinating facts about DUNE Engineering the Mathematics in Music June 2 10 a.m. Get to Know the Lederman Science Center June 3 1 p.m. Ask a Scientist Security, Privacy, Legal Use of Cookies Quick Links Home Contact Phone Book Fermilab at Work For Industry

  15. Home Automation

    OpenAIRE

    Ahmed, Zeeshan

    2010-01-01

    In this paper I briefly discuss the importance of home automation system. Going in to the details I briefly present a real time designed and implemented software and hardware oriented house automation research project, capable of automating house's electricity and providing a security system to detect the presence of unexpected behavior.

  16. Remote Health Care Provision in Care Homes.

    Science.gov (United States)

    Newbould, Louise; Mountain, Gail; Hawley, Mark; Ariss, Steve

    2017-01-01

    A survey was developed to map provision, knowledge, attitudes and views towards videoconferencing in care homes in Yorkshire and The Humber. The survey was sent to 859 care homes, with a 14% response rate. Twelve homes reported using videoconferencing. Non-users appeared skeptical, managers using the system reported improvements in outcomes.

  17. A 4-week, lifestyle-integrated, home-based exercise training programme elicits improvements in physical function and lean mass in older men and women: a pilot study.

    Science.gov (United States)

    Cegielski, Jessica; Brook, Matthew S; Quinlan, Jonathan I; Wilkinson, Daniel J; Smith, Kenneth; Atherton, Philip J; Phillips, Bethan E

    2017-01-01

    Developing alternative exercise programmes that can alleviate certain barriers to exercise such as psychological, environmental or socio-economical barriers, but provide similar physiological benefits e.g. increases in muscle mass and strength, is of grave importance. This pilot study aimed to assess the efficacy of an unsupervised, 4-week, whole-body home-based exercise training (HBET) programme, incorporated into daily living activities, on skeletal muscle mass, power and strength. Twelve healthy older volunteers (63±3 years, 7 men: 5 women, BMI: 29±1 kg/m²) carried out the 4-week "lifestyle-integrated" HBET of 8 exercises, 3x12 repetitions each, every day. Before and after HBET, a number of physical function tests were carried out: unilateral leg extension 1-RM (one- repetition maximum), MVC (maximal voluntary contraction) leg extension, lower leg muscle power (via Nottingham Power Rig), handgrip strength and SPPBT (short physical performance battery test). A D 3 -Creatine method was used for assessment of whole-body skeletal muscle mass, and ultrasound was used to measure the quadriceps cross-sectional area (CSA) and vastus lateralis muscle thickness. Four weeks HBET elicited significant (p<0.05) improvements in leg muscle power (276.7±38.5 vs. 323.4±43.4 W), maximal voluntary contraction (60°: 154.2±18.4 vs. 168.8±15.2 Nm, 90°: 152.1±10.5 vs. 159.1±11.4 Nm) and quadriceps CSA (57.5±5.4 vs. 59.0±5.3 cm 2 ), with a trend for an increase in leg strength (1-RM: 45.7±5.9 vs. 49.6±6.0 kg, P=0.08). This was despite there being no significant differences in whole-body skeletal muscle mass, as assessed via D 3 -Creatine. This study demonstrates that increases in multiple aspects of muscle function can be achieved in older adults with just 4-weeks of "lifestyle-integrated" HBET, with a cost-effective means. This training mode may prove to be a beneficial alternative for maintaining and/or improving muscle mass and function in older adults.

  18. Bringing Your Baby Home

    Science.gov (United States)

    ... for Educators Search English Español Bringing Your Baby Home KidsHealth / For Parents / Bringing Your Baby Home What's ... recall your baby's seemingly endless crying episodes. The Home Front Introducing your baby to others at home ...

  19. The Medical Home

    Science.gov (United States)

    ... Videos for Educators Search English Español The Medical Home KidsHealth / For Parents / The Medical Home What's in ... for your child. What Does the Term "Medical Home" Mean? A medical home isn't a place ...

  20. Building America Best Practices Series: Volume 1; Builders and Buyers Handbook for Improving New Home Efficiency, Comfort, and Durability in the Hot and Humid Climate

    Energy Technology Data Exchange (ETDEWEB)

    Baechler, M. C.; Love, P. M.

    2004-11-01

    This Building America Best Practices guide book is a resource to help builders large and small build high-quality, energy-efficient homes that achieve 30% energy savings in space conditioning and water heating in the hot and humid climate. The savings are in comparison with the 1993 Model Energy Code. The guide contains chapters for every member of the builder's team. There is also a chapter for homeowners on how to use the book to provide help in selecting a new home or builder.

  1. Building America Best Practices Series: Volume 4; Builders and Buyers Handbook for Improving New Home Efficiency, Comfort, and Durability in the Mixed-Humid Climate

    Energy Technology Data Exchange (ETDEWEB)

    Baechler, M. C. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Taylor, Z. T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Bartlett, R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Gilbride, T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Hefty, M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Steward, H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Love, P. M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Palmer, J. A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2005-09-01

    This best practices guide is part of a series produced by Building America. The guide book is a resource to help builders large and small build high-quality, energy-efficient homes that achieve 30% energy savings in space conditioning and water heating in the mixed-humid climate region. The savings are in comparison with the 1993 Model Energy Code. The guide contains chapters for every member of the builders team-from the manager to the site planner to the designers, site supervisors, the trades, and marketers. There is also a chapter for homeowners on how to use the book to provide help in selecting a new home or builder.

  2. Adult survival, apparent lamb survival, and body condition of desert bighorn sheep in relation to habitat and precipitation on the Kofa National Wildlife Refuge, Arizona

    Science.gov (United States)

    Overstreet, Matthew; Caldwell, Colleen A.; Cain, James W.

    2014-01-01

    The decline of desert bighorn sheep on the Kofa National Wildlife Refuge (KNWR) beginning in 2003 stimulated efforts to determine the factors limiting survival and recruitment. We 1) determined pregnancy rates, body fat, and estimated survival rates of adults and lambs; 2) investigated the relationship between precipitation, forage conditions, previous year’s reproductive success, and adult body condition; 3) assessed the relative influence of body condition of adult females, precipitation, and forage characteristics on apparent survival of lambs; and 4) determined the prevalence of disease. To assess the influence of potential limiting factors on female desert bighorn sheep on the KNWR, we modeled percent body fat of adult females as a function of previous year’s reproductive effort, age class, and forage conditions (i.e., seasonal NDVI and seasonal precipitation). In addition, we assessed the relative influence of the body condition of adult females, precipitation, and forage conditions (NDVI) on length of time a lamb was observed at heel.Adult female survival was high in both 2009 (0.90 [SE = 0.05]) and 2010 (0.96 [SE = 0.03]). Apparent lamb survival to 6 months of age was 0.23 (SE = 0.05) during 2009-2010 and 0.21 (SE = 0.05) during 2010-2011 lambing seasons. Mean body fat for adult females was 12.03% (SE = 0.479) in 2009-2010 and 11.11% (SE= 0.486) in 2010-2011 and was not significantly different between years. Pregnancy rate was 100% in 2009 and 97.5% in 2010.Models containing the previous year’s reproductive effort, spring NDVI and previous year’s reproductive effort and spring precipitation best approximated data on percent body fat in adult females in 2009-2010. In 2010-2011, the two highest-ranking models included the previous year’s reproductive effort and winter NDVI and previous year’s reproductive effort, and winter and spring NDVI. None of the models assessing the influence of maternal body fat, precipitation, or forage conditions were

  3. Teaching a Model of Social Skills Training to Child Care Workers at a Group Home for Adolescents, for Improvement of Treatment Planning.

    Science.gov (United States)

    Gramling, Lyle T.

    This practicum study implemented a training program in the teaching of social skills for 4 child care workers at a group home for 12 adolescents having moderate to severe emotional and behavioral problems. The inservice training program involved teaching concepts, techniques, and social skills terminology during the first four sessions, with…

  4. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial.

    NARCIS (Netherlands)

    Ven, G. van de; Draskovic, I.; Adang, E.M.M.; Donders, R.; Post, A.; Zuidema, S.U.; Koopmans, R.T.C.M.; Vernooij-Dassen, M.J.F.J.

    2012-01-01

    BACKGROUND: The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the

  5. Building America Best Practices Series: Volume 1; Builders and Buyers Handbook for Improving New Home Efficiency, Comfort, and Durability in the Hot and Humid Climate

    Energy Technology Data Exchange (ETDEWEB)

    None

    2004-12-01

    This Building America Best Practices guide book is a resource to help builders large and small build high-quality, energy-efficient homes that achieve 30% energy savings in space conditioning and water heating in the hot and humid climate.

  6. Does additional prenatal care in the home improve birth outcomes for women with a prior preterm delivery? A randomized clinical trial.

    Science.gov (United States)

    Lutenbacher, Melanie; Gabbe, Patricia Temple; Karp, Sharon M; Dietrich, Mary S; Narrigan, Deborah; Carpenter, Lavenia; Walsh, William

    2014-07-01

    Women with a history of a prior preterm birth (PTB) have a high probability of a recurrent preterm birth. Some risk factors and health behaviors that contribute to PTB may be amenable to intervention. Home visitation is a promising method to deliver evidence based interventions. We evaluated a system of care designed to reduce preterm births and hospital length of stay in a sample of pregnant women with a history of a PTB. Single site randomized clinical trial. Eligibility: >18 years with prior live birth ≥20-home visits by certified nurse-midwives guided by protocols for specific risk factors (e.g., depressive symptoms, abuse, smoking). Data was collected via multiple methods and sources including intervention fidelity assessments. Average age 27.8 years; mean gestational age at enrollment was 15 weeks. Racial breakdown mirrored local demographics. Most had a partner, high school education, and 62% had Medicaid. No statistically significant group differences were found in gestational age at birth. Intervention participants had a shorter intrapartum length of stay. Enhanced prenatal care by nurse-midwife home visits may limit some risk factors and shorten intrapartum length of stay for women with a prior PTB. This study contributes to knowledge about evidence-based home visit interventions directed at risk factors associated with PTB.

  7. Building America Best Practices Series: Volume 5; Builders and Buyers Handbook for Improving New Home Efficiency, Comfort, and Durability in the Marine Climate

    Energy Technology Data Exchange (ETDEWEB)

    None

    2006-10-01

    This best practices guide is part of a series produced by Building America. The guide book is a resource to help builders large and small build high-quality, energy-efficient homes that achieve 30% energy savings in the Marine climate region.

  8. A Home Away from Home

    DEFF Research Database (Denmark)

    McIlvenny, Paul

    2008-01-01

    The House of Tiny Tearaways (HTT) first appeared on British television in May 2005. Over a six-day period, three families are invited to reside in a specially designed house together with a resident clinical psychologist. The house is to be “a home away from home” for the resident families...... in order to analyze excerpts from the program and to explore how the affordances and constraints of the specially designed house—its architecture and spatial configuration, as well as the surveillance technology embedded within its walls—are assembled within particular familial activities, and how...... the relationships between family members are reshaped as a result. The analysis focuses on several key phenomena: 1) practices of video observation in relation to the domestic sphere; 2) use of inscription devices, such as video displays, to capture and visualize behavior and action in the “home;” 3) practicing...

  9. A 12-week clinical and instrumental study evaluating the efficacy of a multisource radiofrequency home-use device for wrinkle reduction and improvement in skin tone, skin elasticity, and dermal collagen content.

    Science.gov (United States)

    Sadick, Neil S; Harth, Yoram

    2016-12-01

    This study was performed in order to evaluate the safety and efficacy of a new handheld home-use multisource radiofrequency device on facial rejuvenation. Forty-seven male and female subjects were enrolled. All subjects received a NEWA ® 3DEEP ™ home-use device (EndyMed Medical, Caesarea, Israel) to be used on facial skin three times per week for the first four weeks and then reduced to two times per week for the following eight weeks. Assessments included expert clinical grading for efficacy, instrumental evaluation, image analysis, and photography. Forty-five subjects completed the study; all subjects reported the treatment to be painless with only mild erythema lasting up to 15 minutes post-treatment. No other adverse events were reported. Statistically significant improvements were noted in the appearance of marionette lines, skin brightness, elasticity, firmness, lift (facial), lift (jawline), texture/smoothness, tone, and radiance/luminosity by expert visual assessment. Statistically significant improvements in skin firmness and elasticity were found using a Cutometer MPA 580, as well as in collagen and hemoglobin content of the skin using a SIAscope. The results of this study indicate that the NEWA ® multisource radiofrequency home-use device is effective in self-administered skin rejuvenation.

  10. Building America Best Practices Series: Volume 3; Builders and Buyers Handbook for Improving New Home Efficiency, Comfort, and Durability in Cold and Very Cold Climates

    Energy Technology Data Exchange (ETDEWEB)

    2005-08-01

    This best practices guide is part of a series produced by Building America. The guide book is a resource to help builders large and small build high-quality, energy-efficient homes that achieve 30% energy savings in space conditioning and water heating in the cold and very cold climates. The savings are in comparison with the 1993 Model Energy Code. The guide contains chapters for every member of the builder's team-from the manager to the site planner to the designers, site supervisors, the trades, and marketers. There is also a chapter for homeowners on how to use the book to provide help in selecting a new home or builder.

  11. Building America Best Practices Series: Volume 5; Builders and Buyers Handbook for Improving New Home Efficiency, Comfort, and Durability in the Marine Climate

    Energy Technology Data Exchange (ETDEWEB)

    Baechler, M. C.; Taylor, Z. T.; Bartlett, R.; Gilbride, T.; Hefty, M.; Steward, H.; Love, P. M.; Palmer, J. A.

    2006-10-01

    This best practices guide is part of a series produced by Building America. The guide book is a resource to help builders large and small build high-quality, energy-efficient homes that achieve 30% energy savings in space conditioning and water heating in the Marine climate region. The savings are in comparison with the 1993 Model Energy Code. The guide contains chapters for every member of the builder's team--from the manager to the site planner to the designers, site supervisors, the trades, and marketers. There is also a chapter for homeowners on how to use the book to provide help in selecting a new home or builder.

  12. A Three Month Home Exercise Programme Augmented with Nordic Poles for Patients with Intermittent Claudication Enhances Quality of Life and Continues to Improve Walking Distance and Compliance After One Year.

    Science.gov (United States)

    Oakley, C; Spafford, C; Beard, J D

    2017-05-01

    The objective of this study was to collect 1 year follow-up information on walking distance, speed, compliance, and cost in patients with intermittent claudication who took part in a previously reported 12 week randomised clinical trial of a home exercise programme augmented with Nordic pole walking versus controls who walked normally. A second objective was to look at quality of life and ankle brachial pressure indices (ABPIs) after a 12 week augmented home exercise programme. Thirty-two of the 38 patients who completed the original trial were followed-up after 6 and 12 months. Frequency, duration, speed, and distance of walking were recorded using diaries and pedometers. A new observational cohort of 29 patients was recruited to the same augmented home exercise programme. ABPIs, walking improvement, and quality of life questionnaire were recorded at baseline and 12 weeks (end of the programme). Both groups in the follow-up study continued to improve their walking distance and speed over the following year. Compliance was excellent: 98% of the augmented group were still walking with poles at both 6 and 12 months, while 74% of the control group were still walking at the same point. The augmented group increased their mean walking distance to 17.5 km by 12 months, with a mean speed of 4.2 km/hour. The control group only increased their mean walking distance from 4.2 km to 5.6 km, and speed to 3.3 km/hour. Repeated ANOVA showed the results to be highly significant (p = .002). The 21/29 patients who completed the observational study showed a statistically significant increase in resting ABPIs from baseline (mean ± SD 0.75 ± 0.12) to week 12 (mean ± SD 0.85 ± 0.12) (t = (20) -8.89, p = .000 [two-tailed]). All their walking improvement and quality of life parameters improved significantly (p = .002 or less in the six categories) over the same period and their mean health scores improved by 79%. Following a 12 week augmented home exercise

  13. Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh

    OpenAIRE

    Nahar, Baitun; Hossain, Md Iqbal; Hamadani, Jena D; Ahmed, Tahmeed; Grantham-McGregor, Sally; Persson, Lars-Ake

    2012-01-01

    Abstract Background Parenting programmes are effective in enhancing parenting practices and child development. This study evaluated the effects of a intervention with psychosocial stimulation (PS) on the quality of the home environment and mothers’ child-rearing practices in a community-based trial with severely malnourished Bangladeshi children. Method Severely underweight children (n = 507), 6–24 months of age, were randomly assigned to five groups: PS; food supplementation (FS); PS + FS; c...

  14. The effects of a nurse-supervised home exercise programme on improving patients' perceptions of the benefits and barriers to exercise: A randomised controlled trial.

    Science.gov (United States)

    Tao, Xingjuan; Chow, Susan Ka Yee; Wong, Frances Ky

    2017-09-01

    To explore the effects of a home exercise programme on patients' perceptions of the barriers and benefits to exercise and adherence to the programme. Great efforts have been made to encourage dialysis patients to participate in rehabilitation regimens. The promotion of exercise in this population is still limited. This was a post hoc analysis of a randomised, two-group parallel study. A total of 113 adult patients recruited from the haemodialysis units were randomised into two groups on a 1:1 ratio. Both groups received in-centre group exercise training weekly for 6 weeks. The intervention group patients were provided with an additional individualised nurse-led home exercise prescription and behavioural support for 12 weeks. The patients' perceptions of the barriers and benefits to exercise, adherence to the home exercise prescription and their exercise level at weeks 6 and 12 were evaluated. There was a significant between-group difference in the score on patient perceptions of the barriers and benefits to exercise, with the intervention group reporting a greater reduction in perceived barriers to exercise. Significant group differences were noted in exercise level upon the completion of the programme, with the intervention group reporting higher such levels. The average adherence rate to the negotiated exercise plans was 78.9%. The intervention group of patients did better at meeting or exceeding the minimum exercise goal than did the control group. Home exercise prescriptions and behavioural support provided by trained nurses are effective at helping patients to remove barriers to engaging in exercise training. Physical exercise in a clinical arena should not be considered the exclusive domain of physical therapists; the team could collaborate with nurses to play a core role in making physical exercise for patients an essential practice of care in a multidisciplinary team. © 2017 John Wiley & Sons Ltd.

  15. Using an expanded outcomes framework and continuing education evidence to improve facilitation of patient-centered medical home recognition and transformation.

    Science.gov (United States)

    Van Hoof, Thomas J; Kelvey-Albert, Michele; Katz, Matthew; Lalime, Ken; Sacks, Ken; Meehan, Thomas P

    2014-01-01

    The patient-centered medical home is a model for delivering primary care in the United States. Primary care clinicians and their staffs require assistance in understanding the innovation and in applying it to practice. The purpose of this article is to describe and to critique a continuing education program that is relevant to, and will become more common in, primary care. A multifaceted educational strategy prepared 20 primary care private practices to achieve National Committee for Quality Assurance Level 3 recognition as Patient-Centered Medical Homes. Eighteen (90%) practices submitted an application to the National Committee for Quality Assurance. On the first submission attempt, 13 of 18 (72%) achieved Level 3 recognition and 5 (28%) achieved Level 1 recognition. An interactive multifaceted educational strategy can be successful in preparing primary care practices for Patient-Centered Medical Homes recognition, but the strategy may not ensure transformation. Future educational activities should consider an expanded outcomes framework and the evidence of effective continuing education to be more successful with recognition and transformation.

  16. Comparison of passively transferred antibodies in bighorn and domestic lambs reveals one factor in differential susceptibility of these species to Mannheimia haemolytica-induced pneumonia.

    Science.gov (United States)

    Herndon, Caroline N; Shanthalingam, Sudarvili; Knowles, Donald P; Call, Douglas R; Srikumaran, Subramaniam

    2011-07-01

    Mannheimia haemolytica consistently causes fatal bronchopneumonia in bighorn sheep (BHS; Ovis canadensis) under natural and experimental conditions. Leukotoxin is the primary virulence factor of this organism. BHS are more susceptible to developing fatal pneumonia than the related species Ovis aries (domestic sheep [DS]). In BHS herds affected by pneumonia, lamb recruitment is severely impaired for years subsequent to an outbreak. We hypothesized that a lack of maternally derived antibodies (Abs) against M. haemolytica provides an immunologic basis for enhanced susceptibility of BH lambs to population-limiting pneumonia. Therefore, the objective of this study was to determine the titers of Abs directed against M. haemolytica in the sera of BH and domestic lambs at birth through 12 weeks of age. Results revealed that BH lambs had approximately 18-fold lower titers of Ab against surface antigens of M. haemolytica and approximately 20-fold lower titers of leukotoxin-neutralizing Abs than domestic lambs. The titers of leukotoxin-neutralizing Abs in the serum and colostrum samples of BH ewes were approximately 157- and 50-fold lower than those for domestic ewes, respectively. Comparatively, the higher titers of parainfluenza 3 virus-neutralizing Abs in the BH lambs ruled out the possibility that these BHS had an impaired ability to passively transfer Abs to their lambs. These results suggest that lower levels of leukotoxin-neutralizing Abs in the sera of BH ewes, and resultant low Ab titers in their lambs, may be a critical factor in the poor lamb recruitment in herds affected by pneumonia.

  17. Differences in leukocyte differentiation molecule abundances on domestic sheep (Ovis aries) and bighorn sheep (Ovis canadensis) neutrophils identified by flow cytometry.

    Science.gov (United States)

    Highland, Margaret A; Schneider, David A; White, Stephen N; Madsen-Bouterse, Sally A; Knowles, Donald P; Davis, William C

    2016-06-01

    Although both domestic sheep (DS) and bighorn sheep (BHS) are affected by similar respiratory bacterial pathogens, experimental and field data indicate BHS are more susceptible to pneumonia. Cross-reactive monoclonal antibodies (mAbs) for use in flow cytometry (FC) are valuable reagents for interspecies comparative immune system analyses. This study describes cross-reactive mAbs that recognize leukocyte differentiation molecules (LDMs) and major histocompatibility complex antigens on DS and BHS leukocytes. Characterization of multichannel eosinophil autofluorescence in this study permitted cell-type specific gating of granulocytes for evaluating LDMs, specifically on neutrophils, by single-label FC. Evaluation of relative abundances of LDMs by flow cytometry revealed greater CD11a, CD11b, CD18 (β2 integrins) and CD 172a (SIRPα) on DS neutrophils and greater CD14 (lipopolysaccharide receptor) on BHS neutrophils. Greater CD25 (IL-2) was identified on BHS lymphocytes following Concavalin A stimulation. While DS and BHS have similar total peripheral blood leukocyte counts, BHS have proportionately more neutrophils. Published by Elsevier Ltd.

  18. A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Bjerk, Maria; Brovold, Therese; Skelton, Dawn A; Bergland, Astrid

    2017-08-14

    Falls and fall-related injuries in older adults are associated with great burdens, both for the individuals, the health care system and the society. Previous research has shown evidence for the efficiency of exercise as falls prevention. An understudied group are older adults receiving home help services, and the effect of a falls prevention programme on health-related quality of life is unclear. The primary aim of this randomised controlled trial is to examine the effect of a falls prevention programme on quality of life, physical function and falls efficacy in older adults receiving home help services. A secondary aim is to explore the mediating factors between falls prevention and health-related quality of life. The study is a single-blinded randomised controlled trial. Participants are older adults, aged 67 or older, receiving home help services, who are able to walk with or without walking aids, who have experienced at least one fall during the last 12 months and who have a Mini Mental State Examination of 23 or above. The intervention group receives a programme, based on the Otago Exercise Programme, lasting 12 weeks including home visits and motivational telephone calls. The control group receives usual care. The primary outcome is health-related quality of life (SF-36). Secondary outcomes are leg strength, balance, walking speed, walking habits, activities of daily living, nutritional status and falls efficacy. All measurements are performed at baseline, following intervention at 3 months and at 6 months' follow-up. Sample size, based on the primary outcome, is set to 150 participants randomised into the two arms, including an estimated 15-20% drop out. Participants are recruited from six municipalities in Norway. This trial will generate new knowledge on the effects of an exercise falls prevention programme among older fallers receiving home help services. This knowledge will be useful for clinicians, for health managers in the primary health care service

  19. [A Case of HPN, In Which QOL Improvement Was Achieved by Combining Continuous Infusion with Once-Weekly Intermittent Infusion - Contribution of Pharmacists to Health Promotion among Home Patients Receiving Infusion Therapy].

    Science.gov (United States)

    Takeda, Namihiro; Hamana, Tomoko; Oka, Toyoka; Hirohara, Masayoshi; Kushida, Kazuki

    2016-12-01

    Patients receiving parenteral nutrition at home have the following two options: 24-h continuous or intermittent infusion. To date, for patients with impaired glucose tolerance and/or other metabolic disorders or for those with decreased cardiac/ pulmonary/renal function, it is desirable to opt for continuous infusion to minimize the variance in the body's metabolic rate as much as possible. Furthermore, it should be noted that continuous infusion evokes a stronger feeling among patients of being constrained because it restricts their everyday activities. This case witnesses collaborations among the patient's doctor, dispensary's pharmacy, and patient's family. Because ofthe use ofintermittent infusion more or less once per week in addition to continuous infusion, significant improvement in quality of life was achieved, and the patient was able to enjoy taking a short trip. To assist a home patient receiving infusion therapy, it is essential that the pharmacist be equipped with skills to manage risks associated with infusion therapy and have knowledge about insurance to cover incidents concerning infusion fluids or medical materials. It will certainly depend on the degree ofindependence ofpatients and the level ofcare their families can provide; however, should we manage to use a similar medical procedure in at least a few cases in the future, we may be able to contribute to "joie de vivre" in home patients receiving infusion therapy.

  20. An Overview of the HomePlug AV2 Technology

    Directory of Open Access Journals (Sweden)

    Larry Yonge

    2013-01-01

    Full Text Available HomePlug AV2 is the solution identified by the HomePlug Alliance to achieve the improved data rate performance required by the new generation of multimedia applications without the need to install extra wires. Developed by industry-leading participants in the HomePlug AV Technical Working Group, the HomePlug AV2 technology provides Gigabit-class connection speeds over the existing AC wires within home. It is designed to meet the market demands for the full set of future in-home networking connectivity. Moreover, HomePlug AV2 guarantees backward interoperability with other HomePlug systems. In this paper, the HomePlug AV2 system architecture is introduced and the technical details of the key features at both the PHY and MAC layers are described. The HomePlug AV2 performance is assessed, through simulations reproducing real home scenarios.

  1. Awareness of the need for safe storage of Methadone at home is not improved by the use of protocols on recording information giving

    Directory of Open Access Journals (Sweden)

    Crome Ilana B

    2008-04-01

    Full Text Available Abstract Background Methadone is a synthetic, narcotic analgesic used in the treatment of drug misuse. Tragedies involving children being poisoned by the accidental ingestion of methadone are no longer a rare occurrence. Following an audit of the effectiveness of the provision and recall of information to patients attending an NHS Methadone Clinic a protocol was introduced to ensure that staff documented the provision of such information and patients gave a written confirmation that they had received the information. Methods The study was undertaken in the setting of an NHS methadone clinic with the aim of re- auditing the storage of methadone at home following the introduction of the new protocols. 174 patients completed an anonymous questionnaire regarding where they store methadone at home and whether they recall being given advice about safe storage. Community pharmacists were contacted by telephone to assess the level of advice given to methadone patients regarding safety. Results Only 49 (28.2% patients recalled being given advice about safe storage, 24 (13.8% recalled that information was provided by clinic staff. 170 (97.7% patients regard methadone as being dangerous. (28.2%. Methadone is most commonly stored in a cupboard (37.9%. All methadone is dispensed in a bottle with a child resistant cap on it. All patients reported they stored their methadone in the original bottle provided by the pharmacist. Conclusion Recall of information on safety issues is very poor. Provision of written as well as verbal information is needed. The use of printed safety information cards which patients can take away for future reference may be of use. It is the responsibility of health professionals to ensure they provide information and advice to methadone users on the safe storage of their methadone at home.

  2. Pilot Randomized Controlled Trial of a Home Vegetable Gardening Intervention among Older Cancer Survivors Shows Feasibility, Satisfaction, and Promise in Improving Vegetable and Fruit Consumption, Reassurance of Worth, and the Trajectory of Central Adiposity.

    Science.gov (United States)

    Demark-Wahnefried, Wendy; Cases, Mallory G; Cantor, Alan B; Frugé, Andrew D; Smith, Kerry P; Locher, Julie; Cohen, Harvey J; Tsuruta, Yuko; Daniel, Michael; Kala, Rishabh; De Los Santos, Jennifer F

    2018-04-01

    Holistic approaches are sought to improve lifestyle behaviors and health of cancer survivors long term. Our aim was to explore whether a home-based vegetable gardening intervention is feasible and whether it improves diet and other health-related outcomes among older cancer survivors. We conducted a feasibility trial in which cancer survivors were randomized to receive a year-long gardening intervention immediately or to a wait-list control arm. Home visits at baseline and 1 year assessed physical performance, anthropometric indices, behavioral and psychosocial outcomes, and biomarkers. Participants included 46 older (aged 60+ years) survivors of locoregionally staged cancers across Alabama from 2014 to 2016. Forty-two completed 1-year follow-up. Cooperative extension master gardeners delivered guidance to establish three seasonal vegetable gardens at survivors' homes. Plants, seeds, and gardening supplies were provided. Primary outcomes were feasibility targets of 80% accrual and retention, and an absence of serious adverse events; other outcomes were secondary and explored potential benefits. Baseline to follow-up changes were assessed within and between arms using paired t, McNemar's, and χ 2 tests. This trial proved to be safe and demonstrated 91.3% retention; 70% of intervention participants rated their experience as "excellent," and 85% would "do it again." Data suggest significantly increased reassurance of worth (+0.49 vs -0.45) and attenuated increases in waist circumference (+2.30 cm vs +7.96 cm) in the gardening vs control arms (P=0.02). Vegetable and fruit consumption increased by approximately 1 serving/day within the gardening arm from baseline to follow-up (mean [standard error]=1.34 [1.2] to 2.25 [1.9] servings/day; P=0.02)] compared to controls (1.22 [1.1] to 1.12 [0.7]; P=0.77; between-arm P=0.06). The home vegetable gardening intervention among older cancer survivors was feasible and suggested improvements in vegetable and fruit consumption

  3. Exercise at Home

    Science.gov (United States)

    ... Home Health Insights Exercise & Weight Exercise at Home Exercise at Home Make an Appointment Ask a Question ... with the movement and contact your provider. Posture Exercises Better posture means better breathing and movement. Axial ...

  4. Respiratory Home Health Care

    Science.gov (United States)

    ... Us Home > Healthy Living > Living With Lung Disease > Respiratory Home Health Care Font: Aerosol Delivery Oxygen Resources ... Teenagers Living With Lung Disease Articles written by Respiratory Experts Respiratory Home Health Care Respiratory care at ...

  5. Asthma Home Environment Checklist

    Science.gov (United States)

    This checklist guides home care visitors in identifying environmental asthma triggers most commonly found in homes. It includes sections on the building, home interior and room interior and provides low-cost action steps for remediation.

  6. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... are chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help ...

  7. HOME Grantee Areas

    Data.gov (United States)

    Department of Housing and Urban Development — The HOME Investment Partnership Program (HOME) is authorized under Title II of the Cranston-Gonzalez National Affordable Housing Act. HOME provides formula grants to...

  8. Quality assessment of home births in Denmark

    DEFF Research Database (Denmark)

    Jensen, Sabrina; Colmorn, Lotte B.; Schroll, Anne-Mette

    2017-01-01

    by nulliparous at home. CONCLUSIONS: This study indicates that home births in Denmark are characterized by a high level of safety owing to low rates of perinatal mortality and morbidity. Missing registration on intrapartum transfers and planned versus unplanned home births in the DMBR are, however, major......INTRODUCTION: The safety of home births has been widely debated. Observational studies examining maternal and neonatal outcomes of home births have become more frequent, and the quality of these studies has improved. The aim of the present study was to describe neonatal outcomes of home births...... compared with hospital births and to discuss which data are needed to evaluate the safety of home births. METHODS: This was a register-based cohort study. Data on all births in Denmark (2003-2013) were collected from the Danish Medical Birth Registry (DMBR). The cohort included healthy women...

  9. Eldercare at Home: Choosing a Nursing Home

    Science.gov (United States)

    ... required, these services can be provided by a separate home health agency as directed by a doctor or ... complaints made by or on behalf of nursing home residents and work to resolve the problems. If they are unable ...

  10. A home-based, carer-enhanced exercise program improves balance and falls efficacy in community-dwelling older people with dementia.

    Science.gov (United States)

    Taylor, Morag E; Lord, Stephen R; Brodaty, Henry; Kurrle, Susan E; Hamilton, Sarah; Ramsay, Elisabeth; Webster, Lyndell; Payne, Narelle L; Close, Jacqueline C T

    2017-01-01

    Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia. Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial. Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.

  11. Home safe home: Evaluation of a childhood home safety program.

    Science.gov (United States)

    Stewart, Tanya Charyk; Clark, Andrew; Gilliland, Jason; Miller, Michael R; Edwards, Jane; Haidar, Tania; Batey, Brandon; Vogt, Kelly N; Parry, Neil G; Fraser, Douglas D; Merritt, Neil

    2016-09-01

    The London Health Sciences Centre Home Safety Program (HSP) provides safety devices, education, a safety video, and home safety checklist to all first-time parents for the reduction of childhood home injuries. The objective of this study was to evaluate the HSP for the prevention of home injuries in children up to 2 years of age. A program evaluation was performed with follow-up survey, along with an interrupted time series analysis of emergency department (ED) visits for home injuries 5 years before (2007-2013) and 2 years after (2013-2015) implementation. Spatial analysis of ED visits was undertaken to assess differences in home injury rates by dissemination areas controlling differences in socioeconomic status (i.e., income, education, and lone-parent status) at the neighborhood level. A total of 3,458 first-time parents participated in the HSP (a 74% compliance rate). Of these, 20% (n = 696) of parents responded to our questionnaire, with 94% reporting the program to be useful (median, 6; interquartile range, 2 on a 7-point Likert scale) and 81% learning new strategies for preventing home injuries. The median age of the respondent's babies were 12 months (interquartile range, 1). The home safety check list was used by 87% of respondents to identify hazards in their home, with 95% taking action to minimize the risk. The time series analysis demonstrated a significant decline in ED visits for home injuries in toddlers younger than2 years of age after HSP implementation. The declines in ED visits for home injuries remained significant over and above each socioeconomic status covariate. Removing hazards, supervision, and installing safety devices are key facilitators in the reduction of home injuries. Parents found the HSP useful to identify hazards, learn new strategies, build confidence, and provide safety products. Initial finding suggests that the program is effective in reducing home injuries in children up to 2 years of age. Therapeutic/care management study

  12. The safe home project.

    Science.gov (United States)

    Arphorn, Sara; Jiraniratisai, Sopaphan; Rungtakul, Rungsri; Phutta, Nikom

    2011-12-01

    The Thai Health Promotion Foundation supported the Improvement of Quality of Life of Informal Workers project in Ban Luang District, Amphur Photaram, Ratchaburi Province. There were many informal workers in Ban Luang District. Sweet-crispy fish producers in Ban Luang were the largest group among the sweet-crispy fish producers in Thailand. This project was aimed at improving living and working conditions of informal workers, with a focus on the sweet-crispy fish group. Good practices of improved living and working conditions were used to help informal workers build safe, healthy and productive work environments. These informal workers often worked in substandard conditions and were exposed to various hazards in the working area. These hazards included risk of exposure to hot work environment, ergonomics-related injuries, chemical hazards, electrical hazards etc. Ergonomics problems were commonly in the sweet-crispy fish group. Unnatural postures such as prolonged sitting were performed dominantly. One hundred and fifty informal workers participated in this project. Occupational health volunteers were selected to encourage occupational health and safety in four groups of informal workers in 2009. The occupational health volunteers trained in 2008 were farmers, beauty salon workers and doll makers. The occupational health and safety knowledge is extended to a new informal worker group: sweet-crispy fish producer, in 2009. The occupational health and safety training for sweet-crispy fish group is conducted by occupational health volunteers. The occupational health volunteers increased their skills and knowledge assist in to make safe home and safe community through participatory oriented training. The improvement of living and working condition is conducted by using a modified WISH, Work Improvement for Safe Home, checklist. The plans of improvement were recorded. The informal workers showed improvement mostly on material handling and storage. The safe uses and safe

  13. DEC Home

    Science.gov (United States)

    , improving, and protecting Alaska's natural resources and environment to enhance the health, safety, economic , Assessment and Restoration Environmental Health Drinking Water Food Safety & Sanitation Laboratory Environmental Conservation Alaska Department of Environmental Conservation Search DEC State of Alaska Conserving

  14. Improving community development by linking agriculture, nutrition and education: design of a randomised trial of "home-grown" school feeding in Mali.

    Science.gov (United States)

    Masset, Edoardo; Gelli, Aulo

    2013-02-21

    Providing food through schools has well documented effects in terms of the education, health and nutrition of school children. However, there is limited evidence in terms of the benefits of providing a reliable market for small-holder farmers through "home-grown" school feeding approaches. This study aims to evaluate the impact of school feeding programmes sourced from small-holder farmers on small-holder food security, as well as on school children's education, health and nutrition in Mali. In addition, this study will examine the links between social accountability and programme performance. This is a field experiment planned around the scale-up of the national school feeding programme, involving 116 primary schools in 58 communities in food insecure areas of Mali. The randomly assigned interventions are: 1) a school feeding programme group, including schools and villages where the standard government programme is implemented; 2) a "home-grown" school feeding and social accountability group, including schools and villages where the programme is implemented in addition to training of community based organisations and local government; and 3) the control group, including schools and household from villages where the intervention will be delayed by at least two years, preferably without informing schools and households. Primary outcomes include small-holder farmer income, school participation and learning, and community involvement in the programme. Other outcomes include nutritional status and diet-diversity. The evaluation will follow a mixed method approach, including household, school and village level surveys as well as focus group discussions with small-holder farmers, school children, parents and community members. The impact evaluation will be incorporated within the national monitoring and evaluation (M&E) system strengthening activities that are currently underway in Mali. Baselines surveys are planned for 2012. A monthly process monitoring visits, spot

  15. Fixing the broken image of care homes, could a 'care home innovation centre' be the answer?

    OpenAIRE

    Hockley, Jo; Harrison, Jennifer Kirsty; Watson, Julie; Randall, Marion; Murray, Scott

    2016-01-01

    The UK has many excellent care homes that provide high-quality care for their residents; however, across the care home sector, there is a significant need for improvement. Even though the majority of care homes receive a rating of 'good' from regulators, still significant numbers are identified as requiring 'improvement' or are 'inadequate'. Such findings resonate with the public perceptions of long-term care as a negative choice, to be avoided wherever possible-as well as impacting on the ca...

  16. Enabling Composition-Based Video-Conferencing for the Home

    NARCIS (Netherlands)

    A.J. Jansen (Jack); P.S. Cesar Garcia (Pablo Santiago); T. Stevens; I. Kegel; J. Issing

    2011-01-01

    htmlabstractThis paper describes a videoconferencing system that meets performance constraints and functional requirements for use in consumer homes. Our system improves existing home technologies (such as video chat) by providing high-quality audiovisual communication, efficient encoding

  17. Home visits as part of a new care pathway (iAID) to improve quality of care and quality of life in ostomy patients: a cluster-randomized stepped-wedge trial.

    Science.gov (United States)

    Sier, M F; Oostenbroek, R J; Dijkgraaf, M G W; Veldink, G J; Bemelman, W A; Pronk, A; Spillenaar-Bilgen, E J; Kelder, W; Hoff, C; Ubbink, D T

    2017-08-01

    Morbidity in patients with an ostomy is high. A new care pathway, including perioperative home visits by enterostomal therapists, was studied to assess whether more elaborate education and closer guidance could reduce stoma-related complications and improve quality of life (QoL), at acceptable cost. Patients requiring an ileostomy or colostomy, for any inflammatory or malignant bowel disease, were included in a 15-centre cluster-randomized 'stepped-wedge' study. Primary outcomes were stoma-related complications and QoL, measured using the Stoma-QOL, 3 months after surgery. Secondary outcomes included costs of care. The standard pathway (SP) was followed by 113 patients and the new pathway (NP) by 105 patients. Although the overall number of stoma-related complications was similar in both groups (SP 156, NP 150), the proportion of patients experiencing one or more stoma-related complications was significantly higher in the NP (72% vs 84%, risk difference 12%; 95% CI: 0.3-23.3%). Although in the NP more patients had stoma-related complications, QoL scores were significantly better (P improved quality of care and life, against similar costs. Based on these results the NP, including perioperative home visits by an enterostomal therapist, can be recommended. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

  18. Summer Temperature Extremes in the Northern Rockies: A Tree-Ring-Based Reconstruction (1670-2014) from the Bighorn Mountains, WY

    Science.gov (United States)

    Hudson, A.; Alfaro-Sanchez, R.; Belmecheri, S.; Moore, D. J.; Trouet, V.

    2017-12-01

    Anthropogenic climate change has caused global temperatures to rise in recent decades. Temperatures at the regional scale are influenced by various factors including topography, atmospheric circulation, and seasonality that superimpose year-to-year variability on this global warming trend. Here, we develop a tree-ring based summer temperature reconstruction for the northern Rockies in order to investigate the drivers of the year-to-year temperature variability in this region. For this purpose, we sampled 10 sites in the semi-arid Bighorn Mountains, WY and developed two tree-ring width chronologies for differing elevations. The high elevation Picea engelmannii chronology (>2,630m) is positively correlated with July temperature variability, whereas the low elevation (<2,580m) chronology - consisting of Pinus contorta, Pseudotsuga menziesii, and Pinus albicaulis - is sensitive to summer precipitation and negatively correlated with June and July temperatures. A reconstruction based on a combination of the two chronologies explains 30% of the variance in regional June and July temperatures over the instrumental period, covers the period 1670-2014, and is representative for the central United States and southern Canada region. Our reconstruction shows significantly lower summer temperatures in the year following the 16 largest tropical eruptions from 1670 to the present. The reconstruction further captures the high summer temperatures during the 1930s dust bowl era and shows a steep increase in variance in the late 20th century. Enhanced late 20th century variance has also been detected in climate and ecosystem dynamics in the Northeast Pacific, which suggests an impact of an amplified meridional flow on northern Rockies summer temperatures.

  19. Comparison of Passively Transferred Antibodies in Bighorn and Domestic Lambs Reveals One Factor in Differential Susceptibility of These Species to Mannheimia haemolytica-Induced Pneumonia ▿

    Science.gov (United States)

    Herndon, Caroline N.; Shanthalingam, Sudarvili; Knowles, Donald P.; Call, Douglas R.; Srikumaran, Subramaniam

    2011-01-01

    Mannheimia haemolytica consistently causes fatal bronchopneumonia in bighorn sheep (BHS; Ovis canadensis) under natural and experimental conditions. Leukotoxin is the primary virulence factor of this organism. BHS are more susceptible to developing fatal pneumonia than the related species Ovis aries (domestic sheep [DS]). In BHS herds affected by pneumonia, lamb recruitment is severely impaired for years subsequent to an outbreak. We hypothesized that a lack of maternally derived antibodies (Abs) against M. haemolytica provides an immunologic basis for enhanced susceptibility of BH lambs to population-limiting pneumonia. Therefore, the objective of this study was to determine the titers of Abs directed against M. haemolytica in the sera of BH and domestic lambs at birth through 12 weeks of age. Results revealed that BH lambs had approximately 18-fold lower titers of Ab against surface antigens of M. haemolytica and approximately 20-fold lower titers of leukotoxin-neutralizing Abs than domestic lambs. The titers of leukotoxin-neutralizing Abs in the serum and colostrum samples of BH ewes were approximately 157- and 50-fold lower than those for domestic ewes, respectively. Comparatively, the higher titers of parainfluenza 3 virus-neutralizing Abs in the BH lambs ruled out the possibility that these BHS had an impaired ability to passively transfer Abs to their lambs. These results suggest that lower levels of leukotoxin-neutralizing Abs in the sera of BH ewes, and resultant low Ab titers in their lambs, may be a critical factor in the poor lamb recruitment in herds affected by pneumonia. PMID:21613459

  20. Smart Home Hacking

    OpenAIRE

    Kodra, Suela

    2016-01-01

    Smart Home is an intelligent home equipped with devices and communications systems that enables the residents to connect and control their home appliances and systems. This technology has changed the way a consumer interacts with his home, enabling more control and convenience. Another advantage of this technology is the positive impact it has on savings on energy and other resources. However, despite the consumer's excitement about smart home, security and privacy have shown to be the strong...

  1. Brain Computer Interface on Track to Home.

    Science.gov (United States)

    Miralles, Felip; Vargiu, Eloisa; Dauwalder, Stefan; Solà, Marc; Müller-Putz, Gernot; Wriessnegger, Selina C; Pinegger, Andreas; Kübler, Andrea; Halder, Sebastian; Käthner, Ivo; Martin, Suzanne; Daly, Jean; Armstrong, Elaine; Guger, Christoph; Hintermüller, Christoph; Lowish, Hannah

    2015-01-01

    The novel BackHome system offers individuals with disabilities a range of useful services available via brain-computer interfaces (BCIs), to help restore their independence. This is the time such technology is ready to be deployed in the real world, that is, at the target end users' home. This has been achieved by the development of practical electrodes, easy to use software, and delivering telemonitoring and home support capabilities which have been conceived, implemented, and tested within a user-centred design approach. The final BackHome system is the result of a 3-year long process involving extensive user engagement to maximize effectiveness, reliability, robustness, and ease of use of a home based BCI system. The system is comprised of ergonomic and hassle-free BCI equipment; one-click software services for Smart Home control, cognitive stimulation, and web browsing; and remote telemonitoring and home support tools to enable independent home use for nonexpert caregivers and users. BackHome aims to successfully bring BCIs to the home of people with limited mobility to restore their independence and ultimately improve their quality of life.

  2. Brain Computer Interface on Track to Home

    Directory of Open Access Journals (Sweden)

    Felip Miralles

    2015-01-01

    Full Text Available The novel BackHome system offers individuals with disabilities a range of useful services available via brain-computer interfaces (BCIs, to help restore their independence. This is the time such technology is ready to be deployed in the real world, that is, at the target end users’ home. This has been achieved by the development of practical electrodes, easy to use software, and delivering telemonitoring and home support capabilities which have been conceived, implemented, and tested within a user-centred design approach. The final BackHome system is the result of a 3-year long process involving extensive user engagement to maximize effectiveness, reliability, robustness, and ease of use of a home based BCI system. The system is comprised of ergonomic and hassle-free BCI equipment; one-click software services for Smart Home control, cognitive stimulation, and web browsing; and remote telemonitoring and home support tools to enable independent home use for nonexpert caregivers and users. BackHome aims to successfully bring BCIs to the home of people with limited mobility to restore their independence and ultimately improve their quality of life.

  3. Randomized Video-Feedback Intervention in Home-Based Childcare: Improvement of Children's Wellbeing Dependent on Time Spent with Trusted Caregiver.

    Science.gov (United States)

    Groeneveld, Marleen G; Vermeer, Harriet J; van IJzendoorn, Marinus H; Linting, Mariëlle

    The childcare environment offers a wide array of developmental opportunities for children. Providing children with a feeling of security to explore this environment is one of the most fundamental goals of childcare. In the current study the effectiveness of Video-feedback Intervention to promote Positive Parenting-Child Care (VIPP-CC) was tested on children's wellbeing in home-based childcare in a randomized controlled trial. Forty-seven children and their caregivers were randomly assigned to the intervention group or control group. Children's wellbeing, caregiver sensitivity, and global childcare quality were observed during a pretest and a posttest. We did not find an overall intervention effect on child wellbeing, but a significant interaction effect with months spent with a trusted caregiver was present. Children who were less familiar with the caregiver showed an increase in wellbeing scores in both the intervention and control group, but for the group of children who were more familiar with the caregiver, wellbeing increased only in the intervention group. Although there was no overall effect of the VIPP-CC on children's wellbeing, the VIPP-CC seems effective in children who have been cared for by the same trusted caregiver for a longer period of time.

  4. Nursing perception of patient transitions from hospitals to home with home health.

    Science.gov (United States)

    Smith, Shannon Bright; Alexander, Judith W

    2012-01-01

    The study's purpose was to determine nurses' opinions of sending patients from the hospital to home with home health services. The study occurred in the Charleston, South Carolina, Tricounty area (Berkeley, Charleston, and Dorchester counties). Home health agencies and hospitals were invited to participate. The study used a survey design to gather information on nursing perceptions of current practices and needed changes to improve transition of patients. The population was nurses (licensed practical nurses (LPNs) and registered nurses (RNs)) employed at inpatient hospitals or home health agencies in the area. Thirty-four RNs responded with no LPNs respondents. Agency administrators/chief nursing officers agreed for their agencies to participate and distributed the survey using a Research Electronic Data Capture (REDCap) Internet-based survey tool. Using the survey results and information from a literature review, the study developed a list of propositions, which participating administrators reviewed, for improving transitions to home. Both home health and hospital nurses reported a need to improve the process of sending patients from hospital to home with home health services. This study provides hospitals and home health agencies with propositions to facilitate the establishment of a process to communicate effectively patients care needs and streamline the discharging patients from the hospital to home health care; thus, improving patient transition. Case managers and discharge planners will need interagency collaboration along with evidence-based interventions to transition patients from the hospital to home with home health services with various populations. Direct patient care nurses in both hospital and home health settings should share the same accountability as case managers to ensure successful transitions.

  5. Home care in Australia: an integrative review.

    Science.gov (United States)

    Palesy, Debra; Jakimowicz, Samantha; Saunders, Carla; Lewis, Joanne

    2018-01-01

    The home care sector comprises one of Australia's fastest growing workforces, yet few papers capture the overall landscape of Australian home care. This integrative review investigates home care with the aim of better understanding care recipients and their needs, funding, and regulation; care worker skills, tasks, demographics, employment conditions, and training needs. Over 2,700 pieces of literature were analyzed to inform this review. Results suggest sector fragmentation and a home care workforce who, although well-placed to improve outcomes for care recipients, are in need of better training and employment support. Suggestions for future research regarding Australian home care include studies that combine both aged and disability aspects of care, more research around care recipients, priority needs and strategies for addressing them, and how best to prepare home care workers for their roles.

  6. Effectiveness of interventions to reduce indoor air pollution and/or improve health in homes using solid fuel in lower and middle income countries: protocol for a systematic review.

    Science.gov (United States)

    Quansah, Reginald; Ochieng, Caroline A; Semple, Sean; Juvekar, Sanjar; Emina, Jacques; Armah, Frederick Ato; Luginaah, Isaac

    2015-03-04

    Indoor air pollution (IAP) interventions are widely promoted as a means of reducing indoor air pollution/health from solid fuel use; and research addressing impact of these interventions has increased substantially in the past two decades. It is timely and important to understand more about effectiveness of these interventions. We describe the protocol of a systematic review to (i) evaluate effectiveness of IAP interventions to improve indoor air quality and/or health in homes using solid fuel for cooking and/or heating in lower- and middle-income countries, (ii) identify the most effective intervention to improve indoor air quality and/or health, and (iii) identify future research needs. This review will be conducted according to the National Institute for Health and Care Excellence (NICE) guidelines and will be reported following the PRISMA statement. Ovid MEDLINE, Ovid Embase, SCOPUS, and PubMed searches were conducted in September 2013 and updated in November 2014 (and include any further search updates in February 2015). Additional references will be located through searching the references cited by identified studies and through the World Health Organization Global database of household air pollution measurements. We will also search our own archives. Data extraction and risk of bias assessment of all included papers will be conducted independently by five reviewers. The study will provide insights into what interventions are most effective in reducing indoor air pollution and/or adverse health outcomes in homes using solid fuel for cooking or heating in lower- or middle-income countries. The findings from this review will be used to inform future IAP interventions and policy on poverty reduction and health improvement in poor communities who rely on biomass and solid fuels for cooking and heating. The review has been registered with PROSPERO (registration number CRD42014009768 ).

  7. Early discharge hospital at home.

    Science.gov (United States)

    Gonçalves-Bradley, Daniela C; Iliffe, Steve; Doll, Helen A; Broad, Joanna; Gladman, John; Langhorne, Peter; Richards, Suzanne H; Shepperd, Sasha

    2017-06-26

    0.40 to 0.98; N = 574, 4 trials, low-certainty evidence) and might slightly improve patient satisfaction (N = 795, low-certainty evidence). Hospital at home probably reduces hospital length of stay, as moderate-certainty evidence found that people assigned to hospital at home are discharged from the intervention about seven days earlier than people receiving inpatient care (95% CI 10.19 to 3.17 days earlier, N = 528, 4 trials). It is uncertain whether hospital at home has an effect on cost (very low-certainty evidence).Studies recruiting people with a mix of medical conditionsEarly discharge hospital at home probably makes little or no difference to mortality (RR 1.07, 95% CI 0.76 to 1.49; N = 1247, 8 trials, moderate-certainty evidence). In people with chronic obstructive pulmonary disease (COPD) there was insufficient information to determine the effect of these two approaches on mortality (RR 0.53, 95% CI 0.25 to 1.12, N = 496, 5 trials, low-certainty evidence). The intervention probably increases the risk of hospital readmission in a mix of medical conditions, although the results are also compatible with no difference and a relatively large increase in the risk of readmission (RR 1.25, 95% CI 0.98 to 1.58, N = 1276, 9 trials, moderate-certainty evidence). Early discharge hospital at home may decrease the risk of readmission for people with COPD (RR 0.86, 95% CI 0.66 to 1.13, N = 496, 5 trials low-certainty evidence). Hospital at home may lower the risk of living in an institutional setting (RR 0.69, 0.48 to 0.99; N = 484, 3 trials, low-certainty evidence). The intervention might slightly improve patient satisfaction (N = 900, low-certainty evidence). The effect of early discharge hospital at home on hospital length of stay for older patients with a mix of conditions ranged from a reduction of 20 days to a reduction of less than half a day (moderate-certainty evidence, N = 767). It is uncertain whether hospital at home has an effect on cost (very low

  8. An Overview of the HomePlug AV2 Technology

    OpenAIRE

    Yonge, Larry; Abad, Jose; Afkhamie, Kaywan; Guerrieri, Lorenzo; Katar, Srinivas; Lioe, Hidayat; Pagani, Pascal; Riva, Raffaele; Schneider, Daniel M.; Schwager, Andreas

    2013-01-01

    HomePlug AV2 is the solution identified by the HomePlug Alliance to achieve the improved data rate performance required by the new generation of multimedia applications without the need to install extra wires. Developed by industry-leading participants in the HomePlug AV Technical Working Group, the HomePlug AV2 technology provides Gigabit-class connection speeds over the existing AC wires within home. It is designed to meet the market demands for the full set of future in-home networking co...

  9. Institutional and Cultural Perspectives on Home Birth in Israel

    Science.gov (United States)

    Meroz, Michal (Rosie); Gesser-Edelsburg, Anat

    2015-01-01

    ABSTRACT This study exposes doctors’ and midwives’ perceptions and misperceptions regarding home birth by examining their views on childbirth in general and on risk associated with home births in particular. It relies on an approach of risk communication and an anthropological framework. In a qualitative-constructive study, 19 in-depth interviews were conducted with hospital doctors, hospital midwives, home-birth midwives, and a home-birth obstetrician. Our findings reveal that hospital midwives and doctors suffer from lack of exposure to home births, leading to disagreement regarding norms and risk; it also revealed sexist or patriarchal worldviews. Recommendations include improving communication between home-birth midwives and hospital counterparts; increased exposure of hospital doctors to home birth, creating new protocols in collaboration with home-birth midwives; and establishing a national database of home births. PMID:26937159

  10. Enhancing condom use experiences among young men to improve correct and consistent condom use: feasibility of a home-based intervention strategy (HIS-UK).

    Science.gov (United States)

    Stone, Nicole; Graham, Cynthia; Anstee, Sydney; Brown, Katherine; Newby, Katie; Ingham, Roger

    2018-01-01

    Condoms remain the main protection against sexually transmitted infections (STIs) when used correctly and consistently. Yet, there are many reported barriers to their use such as negative attitudes, reduced sexual pleasure, fit-and-feel problems and erection difficulties. The UK home-based intervention strategy (HIS-UK) is a behaviour change condom promotion intervention for use among young men (aged 16-25 years) designed to increase condom use by enhancing enjoyment of condom-protected intercourse. The objective of this feasibility study was to test HIS-UK for viability, operability and acceptability. Along with an assessment of the recruitment strategy and adherence to the intervention protocol, the study tested the reliability and suitability of a series of behavioural and condom use outcome measures to assess condom use attitudes, motivations, self-efficacy, use experience, errors and problems and fit and feel. The HIS-UK intervention and associated assessment instruments were tested for feasibility using a single-arm, repeated measures design with baseline measurement and two follow-up measurements over 3 months. A 3-month target of 50 young men completing the baseline questionnaire was set. Twenty process and acceptability evaluation interviews with participants and health promotion professionals were conducted post trial. Of the 61 young men who registered for the study, 57 completed the baseline questionnaire and 33 met with the study researcher to receive the HIS-UK condom kit. Twenty-one young men remained for the duration of the study (64% retention). The Cronbach's alpha scores for the condom use outcome measures were 0.84 attitudes, 0.78 self-efficacy, 0.83 use experience, 0.69 errors and problems and 0.75 fit and feel. Participant and health professional feedback indicated strong acceptability of the intervention. The feasibility study demonstrated that our recruitment strategy was appropriate and the target sample size was achieved. Adherence was

  11. Home teleworkers need more time to recover after work

    NARCIS (Netherlands)

    Smulders, P.G.W.; Houtman, I.L.D.

    2007-01-01

    In the Netherlands, on average 4.6% of employees perform normal working hours at home. However, large differences emerge between occupational groups and in the relation between job demands and hours worked at home. Although working at home is perceived as improving work–life balance, in fact it is

  12. TRAVEL AND HOME LEAVE

    CERN Multimedia

    Human Resources Division

    2002-01-01

    Administrative procedures for : Travel to the home station and home leave (hl) Additional travel to the home station (at) Travel to the home station and home leave for family reasons (hlf) As part of the process of simplifying administrative procedures, HR and AS Divisions have devised a new, virtually automatic procedure for payment of travel expenses to the home station. The changes are aimed at rationalising administrative procedures and not at reducing benefits. The conditions of eligibility are unchanged. The new procedure, which will be operational with effect from 1st June 2002, will greatly simplify the administrative processing of claims for travel expenses and the recording of home leaves. Currently, requests for payment are introduced manually into the Advances and Claims system (AVCL) by divisional secretariats. All travel to the home station starting prior to 1st June 2002 will be processed according to the existing system whereas that starting on 1st June and after will be processed accordi...

  13. Home blood sugar testing

    Science.gov (United States)

    Diabetes - home glucose testing; Diabetes - home blood sugar testing ... Usual times to test your blood sugar are before meals and at bedtime. Your provider may ask you to check your blood sugar 2 hours after a meal or ...

  14. Nursing Home Quality Initiative

    Data.gov (United States)

    U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses quality...

  15. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Overview The skills kit contains: A booklet with information on the operation, home skills such as emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma ...

  16. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... JACS Jobs Events Find a Surgeon Patients and Family Contact My Profile Shop ( 0 ) Cart Donate American College of Surgeons Education Patients and Family Skills Programs Ostomy Home Skills Program Ostomy Home ...

  17. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... kit contains: A booklet with information on the operation, home skills such as emptying and changing a pouch, problem solving, and home management. A DVD with demonstration of each skill Stoma ...

  18. Home Health Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — Home Health Compare has information about the quality of care provided by Medicare-certified home health agencies throughout the nation. Medicare-certified means the...

  19. Using oxygen at home

    Science.gov (United States)

    ... at Home Tell your local fire department, electric company, and telephone company that you use oxygen in your home. They ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  20. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Careers at ACS Careers at ACS About ACS Career Types Working at ACS ... American College of Surgeons Education Patients and Family Skills Programs Ostomy Home Skills Program Ostomy Home Skills ...

  1. HOME Rent Limits

    Data.gov (United States)

    Department of Housing and Urban Development — In accordance with 24 CFR Part 92.252, HUD provides maximum HOME rent limits. The maximum HOME rents are the lesser of: The fair market rent for existing housing for...

  2. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... ACS Careers at ACS About ACS Career Types Working at ACS ... Education Patients and Family Skills Programs Ostomy Home Skills Program Ostomy Home Skills Program Adult Ostomy ...

  3. Community Nursing Home (CNH)

    Data.gov (United States)

    Department of Veterans Affairs — The Community Nursing Home (CNH) database contains a list of all Community Nursing Home facilities under local contract to Veterans Health Administration (VHA). CNH...

  4. Home Canning and Botulism

    Science.gov (United States)

    ... this? Submit What's this? Submit Button Past Emails Home Canning and Botulism Language: English (US) Español (Spanish) ... myself and others safe when it comes to home-canned foods? Many cases of foodborne botulism have ...

  5. In-Home Synchronous Telespeech Therapy to Improve Functional Communication in Chronic Poststroke Aphasia: Results from a Quasi-Experimental Study.

    Science.gov (United States)

    Macoir, Joël; Sauvageau, Vincent Martel; Boissy, Patrick; Tousignant, Marilyn; Tousignant, Michel

    2017-08-01

    Although the use of telepractice in speech-language therapy for assessment purposes is well documented, its effectiveness and potential for rehabilitation in poststroke aphasia remain largely unknown. The purpose of this study was to investigate the effectiveness of a remotely delivered synchronous pragmatic telespeech language therapy for improving functional communication in aphasia. A pre-/post-test design was chosen in which each participant was his or her own control. Using a telerehabilitation platform and software (Oralys TeleTherapy) based on the Promoting Aphasics' Communicative Effectiveness (PACE) approach, 20 participants with chronic poststroke aphasia received 9 speech therapy sessions over a 3-week period. Teletreatment with the PACE pragmatic rehabilitation approach led to improvements in functional communication, marked by (a) an increase in communication effectiveness, reflecting significantly improved autonomy in functional communication; (b) a decrease in communication exchange duration, meaning that the treatment made communication faster and more efficient; (c) a decrease in the number of communication acts, meaning that, after treatment, less information was needed to be efficiently understood by the communication partner; and (d) an increase in the number of different communication strategies used, meaning that the treatment fostered the use of a variety of alternative communication modes. This study provides additional arguments about the benefits of telerehabilitation for poststroke patients with aphasia. It showed that multimodal language therapy delivered through synchronous telerehabilitation had positive effects on functional communication in chronic aphasia.

  6. SIRI on your wrist: making your home smart

    OpenAIRE

    Ojuroye, Olivia; Wilde, Adriana

    2015-01-01

    The adoption of smart devices in the homes is on the increase. There are tangible benefits for those making the leap, such as increased independence and improved quality of life. This project addresses these issues with the development of a two-part proof-of-concept system for smart home dwellers, consisting of a flexible wearable wristband device that communicates wirelessly with a voice-activated home hub, which, in a future version of this project, would increase accessibility in the home ...

  7. 6. Home deliveries

    African Journals Online (AJOL)

    Sitwala

    determine factors associated with home deliveries. Main outcome ... deliver at home than a health facility compared to those who .... regression analysis, women who had four years of schooling or .... by report bias, the burden of home deliveries is a real challenge .... Journal of Econometrics 1987; 36: 185-204. 14. Michelo ...

  8. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Ostomy Home Skills Program Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo ...

  9. Home area networks

    NARCIS (Netherlands)

    Koonen, A.M.J.

    2013-01-01

    This article consists of a collection of slides from the author's conference presentation. Some of the specific areas/topics discussed include: Convergence in home networks, home service scenarios; Home wired network architectures, CapEx and OpEx; Residential Gateway; Optical fiber types;

  10. Home in the Making

    DEFF Research Database (Denmark)

    Kreuzer, Maria; von Wallpach, Sylvia; Muehlbacher, Hans

    2016-01-01

    In a context of unprecedented migration home reaches high relevance. This study aims at understanding the (re-)construction of home by first generation consumer migrants. The findings provide insights into consumers’ (re-)construction of various dimensions of home and identify “inner home” as a n...

  11. Home Energy Saver

    Science.gov (United States)

    release announcing Home Energy Saver and a Q-and-A. The "About" page should tell you everything you need to know about using Home Energy Saver. If you have any questions, please email the project leader, Dr. Evan Mills. News Releases Microsoft Licenses Berkeley Lab's Home Energy Saver Code for Its

  12. Home geriatric physiological measurements.

    Science.gov (United States)

    Tamura, Toshiyo

    2012-10-01

    In an ageing society, the elderly can be monitored with numerous physiological, physical and passive devices. Sensors can be installed in the home for continuous mobility assistance and unobtrusive disease prevention. This review presents several modern sensors, which improve the quality of life and assist the elderly, disabled people and their caregivers. The main concept of geriatric sensors is that they are capable of providing assistance without limiting or disturbing the subject's daily routine, giving him or her greater comfort, pleasure and well-being. Furthermore, this review includes associated technologies of wearable/implantable monitoring systems and the 'smart-house' project. This review concludes by discussing future challenges of the future aged society.

  13. Home geriatric physiological measurements

    International Nuclear Information System (INIS)

    Tamura, Toshiyo

    2012-01-01

    In an ageing society, the elderly can be monitored with numerous physiological, physical and passive devices. Sensors can be installed in the home for continuous mobility assistance and unobtrusive disease prevention. This review presents several modern sensors, which improve the quality of life and assist the elderly, disabled people and their caregivers. The main concept of geriatric sensors is that they are capable of providing assistance without limiting or disturbing the subject's daily routine, giving him or her greater comfort, pleasure and well-being. Furthermore, this review includes associated technologies of wearable/implantable monitoring systems and the ‘smart-house’ project. This review concludes by discussing future challenges of the future aged society. (topical review)

  14. Strategy Guideline: Demonstration Home

    Energy Technology Data Exchange (ETDEWEB)

    Savage, C.; Hunt, A.

    2012-12-01

    This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

  15. Strategy Guideline. Demonstration Home

    Energy Technology Data Exchange (ETDEWEB)

    Hunt, A.; Savage, C.

    2012-12-01

    This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

  16. Digital Living at Home

    DEFF Research Database (Denmark)

    Andersen, Pernille Viktoria Kathja; Christiansen, Ellen Tove

    2013-01-01

    of these user voices has directed us towards a ‘home-keeping’ design discourse, which opens new horizons for design of digital home control systems by allowing users to perform as self-determined controllers and groomers of their habitat. The paper concludes by outlining the implications of a ‘home......Does living with digital technology inevitably lead to digital living? Users talking about a digital home control system, they have had in their homes for eight years, indicate that there is more to living with digital technology than a functional-operational grip on regulation. Our analysis......-keeping’ design discourse....

  17. Leaving home in Denmark

    DEFF Research Database (Denmark)

    Nielsen, Rikke Skovgaard

    2015-01-01

    The paper focuses on ethnic differences in the timing and patterns of leaving the parental home. Leaving home is a key transition in the life course of the individual, and extensive research has been conducted on the timing and patterns of leaving it. However, ethnic differences in these patterns...... of leaving home. Results showed that while some differences disappeared when controlling for covariates, others persisted, thus indicating ethnic differences in home-leaving patterns. A strong link between leaving home and marriage was substantiated for Turks, but not for Somalis. The home-leaving patterns...... of Somalis were much more similar to those of Danes. Overall, Turkish descendants were similar to Turkish immigrants but with some differentiation. The analyses identified the existence of ethnic differences in home-leaving patterns but also found evidence of a shift towards less traditional patterns, i...

  18. Care Management Medical Home Center Model: Preliminary Results of a Patient-Centered Approach to Improving Care Quality for Diabetic Patients.

    Science.gov (United States)

    Page, Timothy F; Amofah, St Anthony; McCann, Shelia; Rivo, Julie; Varghese, Asha; James, Terisa; Rivo, Marc; Williams, Mark L

    2015-07-01

    This article presents preliminary findings of the impact of an innovative care management model for diabetic patients. The model was implemented by seven Federally Qualified Health Centers serving 10,000 diabetic patients in Miami-Dade County. A primary intervention of this model is a centralized care management team that makes previsit phone calls to diabetic patients who have scheduled appointments. These previsit phone calls optimize patient knowledge and self-management goals, and provide patient care coordinators with relevant clinical information to optimize the office visit and help to ensure completion of recommended diabetic preventive and chronic care services. Data suggest that following the implementation of this care management model, more diabetic patients are receiving regular care, and compliance with recommended tests and screenings has improved. © 2015 Society for Public Health Education.

  19. Monitoring results for the Factor 9 home

    International Nuclear Information System (INIS)

    Fugler, D.; Dumont, R.

    2009-01-01

    The Factor 9 home is a new demonstration project that consists of a single family residence located in Regina, Saskatchewan. The home features extremely high levels of energy and water use efficiency. The home was completed in April 2007. Energy and water savings targets were established for the Factor 9 home. In order to assess the extent to which the performance objectives were met, a project was undertaken to monitor energy and water use for a one-year period ending May 31, 2008. Several indoor air quality indicators were also measured. This paper discussed the findings of the project, with particular reference to energy conservation features; water conservation features; performance results; incremental cost of energy and water efficiency features; indoor air quality; and suggested improvements to the Factor 9 home. It was concluded that the demonstration project house showcased high levels of energy efficiency, renewable energy, and water efficiency with proven technologies. 3 refs., 4 figs.

  20. Quality assessment of home births in Denmark

    DEFF Research Database (Denmark)

    Jensen, Sabrina; Colmorn, Lotte B.; Schroll, Anne-Mette

    2017-01-01

    INTRODUCTION: The safety of home births has been widely debated. Observational studies examining maternal and neonatal outcomes of home births have become more frequent, and the quality of these studies has improved. The aim of the present study was to describe neonatal outcomes of home births...... compared with hospital births and to discuss which data are needed to evaluate the safety of home births. METHODS: This was a register-based cohort study. Data on all births in Denmark (2003-2013) were collected from the Danish Medical Birth Registry (DMBR). The cohort included healthy women...... with uncomplicated pregnancies and no medical interventions during delivery. A total of 6,395 home births and 266,604 hospital births were eligible for analysis. Comparative analyses were performed separately in nulliparous and multiparous women. The outcome measures were neonatal mortality and morbidity. RESULTS...

  1. LHC@home gets new home

    CERN Multimedia

    Oates, John

    2007-01-01

    "The distributed computing project LHC@home is moving to London from Cern in Switzerland. Researchers at Qeen Mary University have been trialling the system since June, but are now ready for the offical launch" (1 page)

  2. Exploring new operational research opportunities within the Home Care context: the chemotherapy at home.

    Science.gov (United States)

    Chahed, Salma; Marcon, Eric; Sahin, Evren; Feillet, Dominique; Dallery, Yves

    2009-06-01

    Home Care (HC) services provide complex and coordinated medical and paramedical care to patients at their homes. As health care services move into the home setting, the need for developing innovative approaches that improve the efficiency of home care organizations increases. We first conduct a literature review of investigations dealing with operation planning within the area of home care management. We then address a particular issue dealing with the planning of operations related to chemotherapy at home as it is an emergent problem in the French context. Our interest is focused on issues specific to the anti-cancer drug supply chain. We identify various models that can be developed and analyze one of them.

  3. Home range and travels

    Science.gov (United States)

    Stickel, L.F.; King, John A.

    1968-01-01

    The concept of home range was expressed by Seton (1909) in the term 'home region,' which Burr (1940, 1943) clarified with a definition of home range and exemplified in a definitive study of Peromyscus in the field. Burt pointed out the ever-changing characteristics of home-range area and the consequent absence of boundaries in the usual sense--a finding verified by investigators thereafter. In the studies summarized in this paper, sizes of home ranges of Peromyscus varied within two magnitudes, approximately from 0.1 acre to ten acres, in 34 studies conducted in a variety of habitats from the seaside dunes of Florida to the Alaskan forests. Variation in sizes of home ranges was correlated with both environmental and physiological factors; with habitat it was conspicuous, both in the same and different regions. Food supply also was related to size of home range, both seasonally and in relation to habitat. Home ranges generally were smallest in winter and largest in spring, at the onset of the breeding season. Activity and size also were affected by changes in weather. Activity was least when temperatures were low and nights were bright. Effects of rainfall were variable. Sizes varied according to sex and age; young mice remained in the parents' range until they approached maturity, when they began to travel more widely. Adult males commonly had larger home ranges than females, although there were a number of exceptions. An inverse relationship between population density and size of home range was shown in several studies and probably is the usual relationship. A basic need for activity and exploration also appeared to influence size of home range. Behavior within the home range was discussed in terms of travel patterns, travels in relation to home sites and refuges, territory, and stability of size of home range. Travels within the home range consisted of repeated use of well-worn trails to sites of food, shelter, and refuge, plus more random exploratory travels

  4. Factors affecting death at home in Japan.

    Science.gov (United States)

    Sauvaget, C; Tsuji, I; Li, J H; Hosokawa, T; Fukao, A; Hisamichi, S

    1996-10-01

    Despite the wish of the Japanese people to spend their final moments at home, the percentage of deaths at home among elderly is decreasing. Moreover, large variations in this rate were observed over the country. The present ecological study analyzed the relationship between the percentage of deaths at home for decedents aged 70 and over, and demographic, medical and socioeconomic characteristics. The data published in 1990 by the Japanese National Government were analyzed by correlation, principal-component, and multiple linear regression analyses. The results showed that the percentage of deaths at home for decedents aged 70 and over was positively associated with the number of persons per household, and the area of floor space per house. The divorce rate, the national tax per capita, and the mean length of hospitalization for stroke showed a negative association with the percentage of deaths at home. In the prefectures where the crude death rates of stroke and senility were high, elderly were more likely to die at home. These results suggested the importance of the number of family caregivers, and the housing conditions for terminal care at home. This research may lead to improve home medical assistance which is still underdeveloped in Japan.

  5. Home health agency work environments and hospitalizations.

    Science.gov (United States)

    Jarrín, Olga; Flynn, Linda; Lake, Eileen T; Aiken, Linda H

    2014-10-01

    An important goal of home health care is to assist patients to remain in community living arrangements. Yet home care often fails to prevent hospitalizations and to facilitate discharges to community living, thus putting patients at risk of additional health challenges and increasing care costs. To determine the relationship between home health agency work environments and agency-level rates of acute hospitalization and discharges to community living. Analysis of linked Center for Medicare and Medicaid Services Home Health Compare data and nurse survey data from 118 home health agencies. Robust regression models were used to estimate the effect of work environment ratings on between-agency variation in rates of acute hospitalization and community discharge. Home health agencies with good work environments had lower rates of acute hospitalizations and higher rates of patient discharges to community living arrangements compared with home health agencies with poor work environments. Improved work environments in home health agencies hold promise for optimizing patient outcomes and reducing use of expensive hospital and institutional care.

  6. Microneedle arrays coated with charge reversal pH-sensitive copolymers improve antigen presenting cells-homing DNA vaccine delivery and immune responses.

    Science.gov (United States)

    Duong, Huu Thuy Trang; Kim, Nak Won; Thambi, Thavasyappan; Giang Phan, V H; Lee, Min Sang; Yin, Yue; Jeong, Ji Hoon; Lee, Doo Sung

    2018-01-10

    Successful delivery of a DNA vaccine to antigen-presenting cells and their subsequent stimulation of CD4 + and CD8 + T cell immunity remains an inefficient process. In general, the delivery of prophylactic vaccines is mainly mired by low transfection efficacy, poor immunogenicity, and safety issues from the materials employed. Currently, several strategies have been exploited to improve immunogenicity, but an effective strategy for safe and pain-free delivery of DNA vaccines is complicated. Herein, we report the rapid delivery of polyplex-based DNA vaccines using microneedle arrays coated with a polyelectrolyte multilayer assembly of charge reversal pH-responsive copolymer and heparin. The charge reversal pH-responsive copolymer, composed of oligo(sulfamethazine)-b-poly(ethylene glycol)-b-poly(amino urethane) (OSM-b-PEG-b-PAEU), was used as a triggering layer in the polyelectrolyte multilayer assembly on microneedles. Charge reversal characteristics of this copolymer, that is, the OSM-b-PEG-b-PAEU copolymer exhibit, positive charge at low pH (pH4.03) and becoming negative charge when exposed to physiological pH conditions (pH7.4), allowing the facile assembly and disassembly of polyelectrolyte multilayers. The electrostatic repulsion between heparin and OSM-b-PEG-b-PAEU charge reversal copolymer triggered the release of DNA vaccines. DNA vaccines laden on microneedles are effectively transfected into RAW 264.7 macrophage cells in vitro. Vaccination of BALB/c mice by DNA vaccine-loaded microneedle arrays coated with a polyelectrolyte multilayer generated antigen-specific robust immune responses. These findings provide potential strategy of charge reversal pH-responsive copolymers coated microneedles for DNA vaccine delivery. Copyright © 2017. Published by Elsevier B.V.

  7. Green House Adoption and Nursing Home Quality.

    Science.gov (United States)

    Afendulis, Christopher C; Caudry, Daryl J; O'Malley, A James; Kemper, Peter; Grabowski, David C

    2016-02-01

    To evaluate the impact of the Green House (GH) model on nursing home resident-level quality of care measures. Resident-level minimum data set (MDS) assessments merged with Medicare inpatient claims for the period 2005 through 2010. Using a difference-in-differences framework, we compared changes in care quality and outcomes in 15 nursing homes that adopted the GH model relative to changes over the same time period in 223 matched nursing homes that had not adopted the GH model. For individuals residing in GH homes, adoption of the model lowered readmissions and several MDS measures of poor quality, including bedfast residents, catheter use, and pressure ulcers, but these results were not present across the entire GH organization, suggesting possible offsetting effects for residents of non-GH "legacy" units within the GH organization. GH adoption led to improvement in rehospitalizations and certain nursing home quality measures for individuals residing in a GH home. The absence of evidence of a decline in other clinical quality measures in GH nursing homes should reassure anyone concerned that GH might have sacrificed clinical quality for improved quality of life. © Health Research and Educational Trust.

  8. News Teaching: The epiSTEMe project: KS3 maths and science improvement Field trip: Pupils learn physics in a stately home Conference: ShowPhysics welcomes fun in Europe Student numbers: Physics numbers increase in UK Tournament: Physics tournament travels to Singapore Particle physics: Hadron Collider sets new record Astronomy: Take your classroom into space Forthcoming Events

    Science.gov (United States)

    2010-05-01

    Teaching: The epiSTEMe project: KS3 maths and science improvement Field trip: Pupils learn physics in a stately home Conference: ShowPhysics welcomes fun in Europe Student numbers: Physics numbers increase in UK Tournament: Physics tournament travels to Singapore Particle physics: Hadron Collider sets new record Astronomy: Take your classroom into space Forthcoming Events

  9. HomePort

    DEFF Research Database (Denmark)

    Madsen, Per Printz

    2009-01-01

    In the last couple of year's computer based home control systems are getting more and more common in modern homes. For instance these systems take care of light control, heat control and security systems.  The latest trend is to use wireless communication like Z-Wave and ZigBee to interconnect...... different components in these systems. One of the characteristics is that each system, like for instance heat and light, has their own specific way of using the communication system.   This paper describes a way to connect different home control systems through an intelligent gateway, called a Home......Port. The HomePort consists of a number of Subsystem communication drivers, a virtual communication layer, an interpreter and a PC- based compiler for a high level control language, called GIL (Gateway intelligence language). The focus in this paper will be on the upper two layers in the Home...

  10. Facilitating home birth.

    Science.gov (United States)

    Finigan, Valerie; Chadderton, Diane

    2015-06-01

    The birth of a baby is a family experience. However, in the United Kingdom birth often occurs outside the family environment, in hospital. Both home and hospital births have risks and benefits, but research shows that, for most women, it is as safe to give birth at home as it is in hospital. Women report home-birth to be satisfying with lowered risks of intervention and less likelihood of being separated from their family. It is also more cost effective for the National Health Service. Yet, whilst midwives are working hard to promote home birth as an option, it remains controversial. The aim of this paper is to raise awareness of the safety of home birth and the needs of women and midwives when a home birth is chosen. It provides an overview of care required and the role of the midwife in the ensuring care is woman-centred and personalised.

  11. Water-quality characteristics of quaternary unconsolidated-deposit aquifers and lower tertiary aquifers of the Bighorn Basin, Wyoming and Montana, 1999-2001

    Science.gov (United States)

    Bartos, Timothy T.; Eddy-Miller, Cheryl A.; Norris, Jody R.; Gamper, Merry E.; Hallberg, Laura L.

    2004-01-01

    As part of the Yellowstone River Basin National Water Quality Assessment study, ground-water samples were collected from Quaternary unconsolidated-deposit and lower Tertiary aquifers in the Bighorn Basin of Wyoming and Montana from 1999 to 2001. Samples from 54 wells were analyzed for physical characteristics, major ions, trace elements, nutrients, dissolved organic carbon, radionuclides, pesticide compounds, and volatile organic compounds (VOCs) to evaluate current water-quality conditions in both aquifers. Water-quality samples indicated that waters generally were suitable for most uses, and that natural conditions, rather than the effects of human activities, were more likely to limit uses of the waters. Waters in both types of aquifers generally were highly mineralized, and total dissolved-solids concentrations frequently exceeded the U.S. Environmental Protection Agency (USEPA) Secondary Maximum Contaminant Level (SMCL) of 500 milligrams per liter (mg/L). Because of generally high mineralization, waters from nearly one-half of the samples from Quaternary aquifers and more than one-half of the samples from lower Tertiary aquifers were not classified as fresh (dissolved-solids concentration were not less than 1,000 mg/L). The anions sulfate, fluoride, and chloride were measured in some ground-water samples at concentrations greater than SMCLs. Most waters from the Quaternary aquifers were classified as very hard (hardness greater than 180 mg/L), but hardness varied much more in waters from the lower Tertiary aquifers and ranged from soft (less than 60 mg/L) to very hard (greater than 180 mg/L). Major-ion chemistry varied with dissolved-solids concentrations. In both types of aquifers, the predominant anion changes from bicarbonate to sulfate with increasing dissolved-solids concentrations. Samples from Quaternary aquifers with fresh waters generally were calcium-bicarbonate, calcium-sodium-bicarbonate, and calcium-sodium-sulfate-bicarbonate type waters, whereas

  12. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... Advocate at Home Program State Legislative Action Center Leadership & Advocacy Summit Webinars Practice Management Practice Management Practice Management CPT Coding Bulletin Articles ...

  13. Explaining Home Bias in Trade: The Role of Time Costs

    Directory of Open Access Journals (Sweden)

    Inkoo Lee

    2010-12-01

    Full Text Available We study how time costs, combined with elasticity of substitution across home and foreign goods, can explain the home bias puzzle in a framework of flexible prices. Using a simple two-country model, we show that introducing time costs to an otherwise standard competitive model improves its ability to rationalize home bias in trade. Our analysis suggests that home bias and corresponding incomplete risk-sharing naturally arise in the presence of time costs, even under the assumption of complete financial markets and low elasticity of substitution between home and foreign goods.

  14. Quality assessment of home births in Denmark.

    Science.gov (United States)

    Jensen, Sabrina; Colmorn, Lotte B; Schroll, Anne-Mette; Krebs, Lone

    2017-05-01

    The safety of home births has been widely debated. Observational studies examining maternal and neonatal outcomes of home births have become more frequent, and the quality of these studies has improved. The aim of the present study was to describe neonatal outcomes of home births compared with hospital births and to discuss which data are needed to evaluate the safety of home births. This was a register-based cohort study. Data on all births in Denmark (2003-2013) were collected from the Danish Medical Birth Registry (DMBR). The cohort included healthy women with uncomplicated pregnancies and no medical interventions during delivery. A total of 6,395 home births and 266,604 hospital births were eligible for analysis. Comparative analyses were performed separately in nulliparous and multiparous women. The outcome measures were neonatal mortality and morbidity. Frequencies of admission to a neonatal intensive care unit and treatment with continuous positive airway pressure were significantly lower in infants born at home than in infants born at a hospital. A slightly, but significantly increased rate of early neonatal death was found among infants delivered by nulliparous at home. This study indicates that home births in Denmark are characterized by a high level of safety owing to low rates of perinatal mortality and morbidity. Missing registration on intrapartum transfers and planned versus unplanned home births in the DMBR are, however, major limitations to the validity and utility of the reported results. Registration of these items of information is necessary to make reasonable assessments of home births in the future. none. not relevant. Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

  15. Comparing Sleep Quality and General Health Among the Elderly Living at Home and at Nursing Home

    Directory of Open Access Journals (Sweden)

    Mansour Beyrami

    2014-01-01

    Full Text Available Objectives: Survey about the issues and problems related to elderly in order to improve their quality of life of this increasing population has become a universal concern.This study was performed by the purpose of comparing the sleep quality and general health among the Elderly Residing at Home and Old People's Homes. Methods & Materials: This study is descriptive-analytic type. Population of this investigation consisted of elderly men and women (upper than 60 years old living at personal home and at nursing home in Tabriz. Sample group composed of 100 elderly (50 men and 50 women 50 living at home and 50 living at nursing home who were selected through available sampling method. For collecting data, Goldberg General Health Questionnaire and Pittsburgh Sleep Quality Index were used. Data were analyzed by Multivariate analysis of variance (MANOVA. Results: Findings showed that In terms of general health and its components (Physical symptoms, anxiety, social dysfunction and depression and Sleep quality and its components (Subjective quality of sleep, time for sleep, total sleep time, sleep efficiency, routine, sleep disorders, sleep medications and daily dysfunction there were significant differences between nursing home residents and elderly residents in nursing homes (P=0.001. Conclusion: Findings indicated that elderly residents in nursing home are experiencing more symptoms of anxiety, depression, physical symptoms and social dysfunction Compared with the elderly whom resident at home. Also the results showed that the elderly residents of nursing homes have poor sleep quality than ones whom residents at home. On the other hand Future development of elderly care institution is inevitable. Therefore, more attention to the living conditions of elderly residents of institutions seems necessary.

  16. Design of the DIRECT-project: interventions to increase job resources and recovery opportunities to improve job-related health, well-being, and performance outcomes in nursing homes

    Directory of Open Access Journals (Sweden)

    Hamers Jan PH

    2010-05-01

    Full Text Available Abstract Background Because of high demands at work, nurses are at high risk for occupational burnout and physical complaints. The presence of job resources (such as job autonomy or social support and recovery opportunities could counteract the adverse effect of high job demands. However, it is still unclear how job resources and recovery opportunities can be translated into effective workplace interventions aiming to improve employee health, well-being, and performance-related outcomes. The aim of the current research project is developing and implementing interventions to optimize job resources and recovery opportunities, which may lead to improved health, well-being and performance of nurses. Methods/design The DIRECT-project (DIsc Risk Evaluating Controlled Trial is a longitudinal, quasi-experimental field study. Nursing home staff of 4 intervention wards and 4 comparison wards will be involved. Based on the results of a base-line survey, interventions will be implemented to optimize job resources and recovery opportunities. After 12 and 24 month the effect of the interventions will be investigated with follow-up surveys. Additionally, a process evaluation will be conducted to map factors that either stimulated or hindered successful implementation as well as the effectiveness of the interventions. Discussion The DIRECT-project fulfils a strong need for intervention research in the field of work, stress, performance, and health. The results could reveal (1 how interventions can be tailored to optimize job resources and recovery opportunities, in order to counteract job demands, and (2 what the effects of these interventions will be on health, well-being, and performance of nursing staff.

  17. Design of the DIRECT-project: interventions to increase job resources and recovery opportunities to improve job-related health, well-being, and performance outcomes in nursing homes.

    Science.gov (United States)

    Spoor, Ellen; de Jonge, Jan; Hamers, Jan P H

    2010-05-28

    Because of high demands at work, nurses are at high risk for occupational burnout and physical complaints. The presence of job resources (such as job autonomy or social support) and recovery opportunities could counteract the adverse effect of high job demands. However, it is still unclear how job resources and recovery opportunities can be translated into effective workplace interventions aiming to improve employee health, well-being, and performance-related outcomes. The aim of the current research project is developing and implementing interventions to optimize job resources and recovery opportunities, which may lead to improved health, well-being and performance of nurses. The DIRECT-project (DIsc Risk Evaluating Controlled Trial) is a longitudinal, quasi-experimental field study. Nursing home staff of 4 intervention wards and 4 comparison wards will be involved. Based on the results of a base-line survey, interventions will be implemented to optimize job resources and recovery opportunities. After 12 and 24 month the effect of the interventions will be investigated with follow-up surveys. Additionally, a process evaluation will be conducted to map factors that either stimulated or hindered successful implementation as well as the effectiveness of the interventions. The DIRECT-project fulfils a strong need for intervention research in the field of work, stress, performance, and health. The results could reveal (1) how interventions can be tailored to optimize job resources and recovery opportunities, in order to counteract job demands, and (2) what the effects of these interventions will be on health, well-being, and performance of nursing staff.

  18. Health Information Technology and Nursing Homes

    Science.gov (United States)

    Liu, Darren

    2009-01-01

    Nursing homes are considered lagging behind in adopting health information technology (HIT). Many studies have highlighted the use of HIT as a means of improving health care quality. However, these studies overwhelmingly do not provide empirical information proving that HIT can actually achieve these improvements. The main research goal of this…

  19. Sex Away from Home

    Science.gov (United States)

    Greenwald, Harold

    1971-01-01

    The reasons why people who are normally truthful to their spouses engage in sex away from home are discussed. These reasons can include loneliness, ego building or the opportunity to have homosexual relations. Sex away from home is likely to increase since the number of people traveling is increasing. (Author/CG)

  20. SETI@home

    Science.gov (United States)

    Project Help Donate Porting Graphics Add-ons Science About SETI@home About Astropulse Science Community Message boards Questions and Answers Teams Profiles User search Web sites Pictures and music User University of California SETI@home and Astropulse are funded by grants from the National Science Foundation

  1. Home | SREL Herpetology Program

    Science.gov (United States)

    Savannah River Ecology Laboratory Herpetology Program Herp Home Research Publications Herps of SC /GA P.A.R.C. Outreach SREL Home powered by Google Search Herpetology at SREL The University of SREL herpetology research programs have always included faculty of the University of Georgia, post

  2. Home Teaching and Herbart.

    Science.gov (United States)

    Rust, Val D.; Reed, Frances

    1979-01-01

    Viewing the growing disenchantment with state-controlled schooling, the authors predict that home teaching will become an established educational alternative within a short time, and they reflect on the teachings and writings of Johann Friedrich Herbart, an eighteenth-century advocate of educating children at home. (Editor/SJL)

  3. Creating a new home

    DEFF Research Database (Denmark)

    Gram-Hanssen, Kirsten; Bech-Danielsen, Claus

    2012-01-01

    Housing research is increasingly focusing on how different groups of residents use their dwelling and transform it into a home. In this article, we look at the homes of immigrants in Danish social housing. The article is based on qualitative interviews with Somali, Iraqi and Turkish immigrants, a...

  4. Health Begins at Home

    Centers for Disease Control (CDC) Podcasts

    2009-03-30

    Clean and well-maintained homes can prevent many illnesses and injuries. This podcast discusses how good health begins at home.  Created: 3/30/2009 by Coordinating Center for Environmental Health and Injury Prevention (CCEHIP).   Date Released: 3/30/2009.

  5. Ostomy Home Skills Program

    Medline Plus

    Full Text Available ... de Destrezas para manejo Doméstico de Ostomía Ostomy Home Skills Program Adult Ostomy Pediatric Ostomy Programa de Destrezas para manejo Doméstico de Ostomía The Ostomy Home Skills Kit supports patients with educational and simulation ...

  6. Technologies for Home Networking

    DEFF Research Database (Denmark)

    A broad overview of the home networking field, ranging from wireless technologies to practical applications. In the future, it is expected that private networks (e.g. home networks) will become part of the global network ecosystem, participating in sharing their own content, running IP...

  7. Genetics Home Reference

    Science.gov (United States)

    ... Page Search Home Health Conditions Genes Chromosomes & mtDNA Resources Help Me Understand Genetics Share: Email Facebook Twitter Genetics Home Reference provides consumer-friendly information about the effects of genetic variation on human health. Health Conditions More than 1,200 health ...

  8. Ownership conversions and nursing home performance.

    Science.gov (United States)

    Grabowski, David C; Stevenson, David G

    2008-08-01

    To examine the effects of ownership conversions on nursing home performance. Online Survey, Certification, and Reporting system data from 1993 to 2004, and the Minimum Data Set (MDS) facility reports from 1998 to 2004. Regression specification incorporating facility fixed effects, with terms to identify trends in the pre- and postconversion periods. The annual rate of nursing home conversions almost tripled between 1994 and 2004. Our regression results indicate converting facilities are generally different throughout the pre/postconversion years, suggesting little causal effect of ownership conversions on nursing home performance. Before and after conversion, nursing homes converting from nonprofit to for-profit status generally exhibit deterioration in their performance, while nursing homes converting from for-profit to nonprofit status generally exhibit improvement. Policy makers have expressed concern regarding the implications of ownership conversions for nursing home performance. Our results imply that regulators and policy makers should not only monitor the outcomes of nursing home conversions, but also the targets of these conversions.

  9. Technology-dependent Children and Home Care

    Directory of Open Access Journals (Sweden)

    Nurdan Akçay Didişen

    2017-12-01

    Full Text Available Today, with the rapid development in the field of healthcare technology which is reflected in medicine and patient care, the number of children who are dependent on technological tools and in need of special care, and sustain life in the home environment is rapidly increasing. These children require a multidisciplinary, multifunctional care at home. In the provision of care, healthcare workers, such as physicians, nurses, physiotherapists, social workers and psychologists, work in coordination. The aim of this review was to draw attention to the care of the technology-dependent children at home. In order to achieve the goals of the care given to the technology-dependent child, inclusion of the family in the provision of care is of importance. In order to improve the care given to these children at home, home care services must be well planned and their families should be trained on the issue because delaying the discharge of these children may increase their risk of developing a hospital-acquired infection and can extend the length of their stay in the hospital. This not only increases hospital costs but also leads to the occupation of a bed in the pediatric intensive care unit. Therefore, home healthcare is an alternative for technology-dependent children with chronic diseases and for their families. Therefore, more efforts should be made to plan and evaluate home care services, to set up support and training systems, and to make legal arrangements.

  10. Paramedic-Initiated Home Care Referrals and Use of Home Care and Emergency Medical Services.

    Science.gov (United States)

    Verma, Amol A; Klich, John; Thurston, Adam; Scantlebury, Jordan; Kiss, Alex; Seddon, Gayle; Sinha, Samir K

    2018-01-01

    We examined the association between paramedic-initiated home care referrals and utilization of home care, 9-1-1, and Emergency Department (ED) services. This was a retrospective cohort study of individuals who received a paramedic-initiated home care referral after a 9-1-1 call between January 1, 2011 and December 31, 2012 in Toronto, Ontario, Canada. Home care, 9-1-1, and ED utilization were compared in the 6 months before and after home care referral. Nonparametric longitudinal regression was performed to assess changes in hours of home care service use and zero-inflated Poisson regression was performed to assess changes in the number of 9-1-1 calls and ambulance transports to ED. During the 24-month study period, 2,382 individuals received a paramedic-initiated home care referral. After excluding individuals who died, were hospitalized, or were admitted to a nursing home, the final study cohort was 1,851. The proportion of the study population receiving home care services increased from 18.2% to 42.5% after referral, representing 450 additional people receiving services. In longitudinal regression analysis, there was an increase of 17.4 hours in total services per person in the six months after referral (95% CI: 1.7-33.1, p = 0.03). The mean number of 9-1-1 calls per person was 1.44 (SD 9.58) before home care referral and 1.20 (SD 7.04) after home care referral in the overall study cohort. This represented a 10% reduction in 9-1-1 calls (95% CI: 7-13%, p home care referral and 0.79 (SD 6.27) after home care referral, representing a 7% reduction (95% CI: 3-11%, p home care records were included in the analysis, the reductions in 9-1-1 calls and ambulance transports to ED were attenuated but remained statistically significant. Paramedic-initiated home care referrals in Toronto were associated with improved access to and use of home care services and may have been associated with reduced 9-1-1 calls and ambulance transports to ED.

  11. Reasons Why Women Choose Home Birth

    Directory of Open Access Journals (Sweden)

    Mary Angelie P. Andrino

    2016-11-01

    Full Text Available Maternal deaths in the Philippines remain high. These deaths are mostly due to the large proportion of home births, complications of pregnancy and delivery, and lack of access to facilities and competently trained staff. Utilizing a descriptive, one-shot survey design, the study aimed to determine the reasons why women in a municipality in Iloilo prefer home birth. The respondents were interviewed using a validated questionnaire. Descriptive statistics were used to analyze and interpret the findings. The study revealed that the proportion of home births progressively declined from 2012 to 2014. Birth being imminent or inevitable is the number one reason that supports home birth. Autonomy, safety, affordability, readily available birthing equipment and supplies, accessibility of birth attendant, remote access by going to the birthing center, lack of transportation, and bad weather conditions also led women to give birth at home. Women from the rural areas of the municipality utilized available resources in the community which prompted the predominance of home deliveries assisted by traditional birth attendants (TBAs and even midwives, who were readily available nearby. This study recommends continuous improvement in existing maternal health interventions and strategies through engagement of women in policy planning, improvement of health service delivery, infrastructural enhancement, better care practices and continuous health education.

  12. 'Smart' homes and telecare for independent living.

    Science.gov (United States)

    Tang, P; Venables, T

    2000-01-01

    Telecare services and 'smart' homes share a common technological base in information technology and telecommunications. There is growing interest in both telecare services and smart homes, although they have been studied in isolation. Telecare has been driven largely by perceived cost savings and improved service delivery to the home, leading to improved quality of life and independent living. Smart homes are also expected to provide better and safer living conditions. The integration of the two should produce more secure and autonomous living. There are different forms of telecare services, as there are different types of smart homes, each ranging from basic systems involving the use of alarms and the ordinary telephone to intelligent monitoring with sensors and interactive communication. The introduction of these systems has policy implications, such as the need for coordination between health, social services and housing policy makers, which will reduce duplication and inefficient allocation of resources. Successful delivery of telecare to the home is as much dependent on the construction and condition of the housing stock as it is on the ability of the care provider to meet users' needs. If the UK National Health Service (NHS) could replace a significant proportion of domiciliary nursing visits by telephone calls, then savings of up of 200 million Pounds per annum would be possible.

  13. On-line hemodiafiltration at home.

    Science.gov (United States)

    Vega, Almudena; Abad, Soraya; Macías, Nicolás; Aragoncillo, Inés

    2018-04-01

    Survival with online hemodiafiltration (OL-HDF) is higher than with hemodialysis; frequent hemodialysis has also improved survival and quality of life. Home hemodialysis facilitates frequent therapy. We report our experience with 2 patients with stage 5 CKD who started home hemodialysis with OL-HDF in November 2016. After a training period at the hospital, they started home hemodialysis with OL-HDF after learning how to manage dialysis monitors and how to administer water treatment. We used the "5008-home" (FMC © ) monitor, and the Acqua C © (Fresenius Medical Care) for water treatment. Water conductivity was always checked before and during dialysis sessions and was always 2.5 to 3 mS/cm. Water cultures always fulfilled the criteria for ultrapurity. As far as we know, this is the first report on patients receiving OL-HDF at home. The technique proved to be safe and valid for renal replacement therapy and transfers the benefits of hospital convective therapy to the home setting. Future data will enable us to determine whether survival has also improved. © 2017 International Society for Hemodialysis.

  14. Biometrics for home networks security

    KAUST Repository

    Ansari, Imran Shafique

    2009-01-01

    Hacking crimes committed to the home networks are increasing. Advanced network protection is not always possible for the home networks. In this paper we will study the ability of using biometric systems for authentication in home networks. ©2009 IEEE.

  15. Biometrics for home networks security

    KAUST Repository

    Ansari, Imran Shafique; Ahmad, Qutbuddin S.

    2009-01-01

    Hacking crimes committed to the home networks are increasing. Advanced network protection is not always possible for the home networks. In this paper we will study the ability of using biometric systems for authentication in home networks. ©2009

  16. Building America Best Practices Series: Volume 2; Builders and Buyers Handbook for Improving New Home Efficiency, Comfort, and Durability in the Hot-Dry and Mixed-Dry Climates

    Energy Technology Data Exchange (ETDEWEB)

    None

    2005-09-01

    This guidebook is a resource to help builders large and small build high-quality, energy-efficient homes that achieve 30% energy savings in space conditioning and water heating in the hot-dry and mixed-dry climates.

  17. The Hospital at Home program: no place like home.

    Science.gov (United States)

    Lippert, M; Semmens, S; Tacey, L; Rent, T; Defoe, K; Bucsis, M; Shykula, T; Crysdale, J; Lewis, V; Strother, D; Lafay-Cousin, L

    2017-02-01

    The treatment of children with cancer is associated with significant burden for the entire family. Frequent clinic visits and extended hospital stays can negatively affect quality of life for children and their families. Here, we describe the development of a Hospital at Home program (H@H) that delivers therapy to pediatric hematology, oncology, and blood and marrow transplant (bmt) patients in their homes. The services provided include short infusions of chemotherapy, supportive-care interventions, antibiotics, post-chemotherapy hydration, and teaching. From 2013 to 2015, the H@H program served 136 patients, making 1701 home visits, for patients mainly between the ages of 1 and 4 years. Referrals came from oncology in 82% of cases, from hematology in 11%, and from bmt in 7%. Since inception of the program, no adverse events have been reported. Family surveys suggested less disruption in daily routines and appreciation of specialized care by hematology and oncology nurses. Staff surveys highlighted a perceived benefit of H@H in contributing to early discharge of patients by supporting out-of-hospital monitoring and teaching. The development of a H@H program dedicated to the pediatric hematology, oncology, or bmt patient appears feasible. Our pilot program offers a potential contribution to improvement in patient quality of life and in cost-benefit for parents and the health care system.

  18. Integrating Features of Islamic Traditional Home and Smart Home

    Directory of Open Access Journals (Sweden)

    Mona El Basyouni

    2017-06-01

    Full Text Available Architecture is a mirror that reflects the various elements of its environment and surroundings, such as climate, geographical characteristics, standard architectural principles, and social, cultural and scientific developments. Muslims of different regions were able, through architecture, to portray their temperaments and environments, free of external influence and guarantee life goals for users. Every day, building owners and occupants experience the constant challenges of comfort, convenience, cost, productivity, performance and sustainability. Owners, designers, builders, and operators are continuously faced with new processes, technologies and offerings to help them achieve better building performance. Since an intelligent building is run by a “system of systems” that is integrated to deliver a higher level of operational efficiency and an improved set of user-interface tools than are usually found in traditional building automation; at the other hand Arab homes with Islamic Identity guarantee all life goals for use.. Hence, this research focus on the smart environmental treatments of Islamic features for traditional architecture in Arabs homes, features of smart home and life goals for resident users.Trying to achieve a methodology combining them for enriching Arab experience of traditio