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Sample records for care based sample

  1. Advances in paper-based sample pretreatment for point-of-care testing.

    Science.gov (United States)

    Tang, Rui Hua; Yang, Hui; Choi, Jane Ru; Gong, Yan; Feng, Shang Sheng; Pingguan-Murphy, Belinda; Huang, Qing Sheng; Shi, Jun Ling; Mei, Qi Bing; Xu, Feng

    2017-06-01

    In recent years, paper-based point-of-care testing (POCT) has been widely used in medical diagnostics, food safety and environmental monitoring. However, a high-cost, time-consuming and equipment-dependent sample pretreatment technique is generally required for raw sample processing, which are impractical for low-resource and disease-endemic areas. Therefore, there is an escalating demand for a cost-effective, simple and portable pretreatment technique, to be coupled with the commonly used paper-based assay (e.g. lateral flow assay) in POCT. In this review, we focus on the importance of using paper as a platform for sample pretreatment. We firstly discuss the beneficial use of paper for sample pretreatment, including sample collection and storage, separation, extraction, and concentration. We highlight the working principle and fabrication of each sample pretreatment device, the existing challenges and the future perspectives for developing paper-based sample pretreatment technique.

  2. Attrition and Opportunities Along the HIV Care Continuum: Findings From a Population-Based Sample, North West Province, South Africa.

    Science.gov (United States)

    Lippman, Sheri A; Shade, Starley B; El Ayadi, Alison M; Gilvydis, Jennifer M; Grignon, Jessica S; Liegler, Teri; Morris, Jessica; Naidoo, Evasen; Prach, Lisa M; Puren, Adrian; Barnhart, Scott

    2016-09-01

    Attrition along the HIV care continuum slows gains in mitigating the South African HIV epidemic. Understanding population-level gaps in HIV identification, linkage, retention in care, and viral suppression is critical to target programming. We conducted a population-based household survey, HIV rapid testing, point-of-care CD4 testing, and viral load measurement from dried blood spots using multistage cluster sampling in 2 subdistricts of North West Province from January to March, 2014. We used weighting and multiple imputation of missing data to estimate HIV prevalence, undiagnosed infection, linkage and retention in care, medication adherence, and viral suppression. We sampled 1044 respondents aged 18-49. HIV prevalence was 20.0% (95% confidence interval: 13.7 to 26.2) for men and 26.7% (95% confidence interval: 22.1 to 31.4) for women. Among those HIV positive, 48.4% of men and 75.7% of women were aware of their serostatus; 44.0% of men and 74.8% of women reported ever linking to HIV care; 33.1% of men and 58.4% of women were retained in care; and 21.6% of men and 50.0% of women had dried blood spots viral loads <5000 copies per milliliter. Among those already linked to care, 81.7% on antiretroviral treatment (ART) and 56.0% of those not on ART were retained in care, and 51.8% currently retained in care on ART had viral loads <5000 copies per milliliter. Despite expanded treatment in South Africa, attrition along the continuum of HIV care is slowing prevention progress. Improved detection is critically needed, particularly among men. Reported linkage and retention is reasonable for those on ART; however, failure to achieve viral suppression is worrisome.

  3. An integrated paper-based sample-to-answer biosensor for nucleic acid testing at the point of care.

    Science.gov (United States)

    Choi, Jane Ru; Hu, Jie; Tang, Ruihua; Gong, Yan; Feng, Shangsheng; Ren, Hui; Wen, Ting; Li, XiuJun; Wan Abas, Wan Abu Bakar; Pingguan-Murphy, Belinda; Xu, Feng

    2016-02-07

    With advances in point-of-care testing (POCT), lateral flow assays (LFAs) have been explored for nucleic acid detection. However, biological samples generally contain complex compositions and low amounts of target nucleic acids, and currently require laborious off-chip nucleic acid extraction and amplification processes (e.g., tube-based extraction and polymerase chain reaction (PCR)) prior to detection. To the best of our knowledge, even though the integration of DNA extraction and amplification into a paper-based biosensor has been reported, a combination of LFA with the aforementioned steps for simple colorimetric readout has not yet been demonstrated. Here, we demonstrate for the first time an integrated paper-based biosensor incorporating nucleic acid extraction, amplification and visual detection or quantification using a smartphone. A handheld battery-powered heating device was specially developed for nucleic acid amplification in POC settings, which is coupled with this simple assay for rapid target detection. The biosensor can successfully detect Escherichia coli (as a model analyte) in spiked drinking water, milk, blood, and spinach with a detection limit of as low as 10-1000 CFU mL(-1), and Streptococcus pneumonia in clinical blood samples, highlighting its potential use in medical diagnostics, food safety analysis and environmental monitoring. As compared to the lengthy conventional assay, which requires more than 5 hours for the entire sample-to-answer process, it takes about 1 hour for our integrated biosensor. The integrated biosensor holds great potential for detection of various target analytes for wide applications in the near future.

  4. Home-based care

    African Journals Online (AJOL)

    Mrs. Patience Edoho Samson-Akpan

    study was to ascertain the relationship between home-based care and quality of life of PLWHA in support groups in. Calabar South Local Government Area. A correlational design was utilized and a purposive sample of 74 PLWHA participated in the study. A self developed and well validated questionnaire was used for data ...

  5. Correction of estimates of retention in care among a cohort of HIV-positive patients in Uganda in the period before starting ART: a sampling-based approach.

    Science.gov (United States)

    Nyakato, Patience; Kiragga, Agnes N; Kambugu, Andrew; Bradley, John; Baisley, Kathy

    2018-04-20

    The aim of this study was to use a sampling-based approach to obtain estimates of retention in HIV care before initiation of antiretroviral treatment (ART), corrected for outcomes in patients who were lost according to clinic registers. Retrospective cohort study of HIV-positive individuals not yet eligible for ART (CD4 >500). Three urban and three rural HIV care clinics in Uganda; information was extracted from the clinic registers for all patients who had registered for pre-ART care between January and August 2015. A random sample of patients who were lost according to the clinic registers (>3 months late to scheduled visit) was traced to ascertain their outcomes. The proportion of patients lost from care was estimated using a competing risks approach, first based on the information in the clinic records alone and then using inverse probability weights to incorporate the results from tracing. Cox regression was used to determine factors associated with loss from care. Of 1153 patients registered for pre-ART care (68% women, median age 29 years, median CD4 count 645 cells/µL), 307 (27%) were lost according to clinic records. Among these, 195 (63%) were selected for tracing; outcomes were ascertained in 118 (61%). Seven patients (6%) had died, 40 (34%) were in care elsewhere and 71 (60%) were out of care. Loss from care at 9 months was 30.2% (95% CI 27.3% to 33.5%). After incorporating outcomes from tracing, loss from care decreased to 18.5% (95% CI 13.8% to 23.6%). Estimates of loss from HIV care may be too high if based on routine clinic data alone. A sampling-based approach is a feasible way of obtaining more accurate estimates of retention, accounting for transfers to other clinics. © 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.

  6. Sample size calculations based on a difference in medians for positively skewed outcomes in health care studies

    Directory of Open Access Journals (Sweden)

    Aidan G. O’Keeffe

    2017-12-01

    Full Text Available Abstract Background In healthcare research, outcomes with skewed probability distributions are common. Sample size calculations for such outcomes are typically based on estimates on a transformed scale (e.g. log which may sometimes be difficult to obtain. In contrast, estimates of median and variance on the untransformed scale are generally easier to pre-specify. The aim of this paper is to describe how to calculate a sample size for a two group comparison of interest based on median and untransformed variance estimates for log-normal outcome data. Methods A log-normal distribution for outcome data is assumed and a sample size calculation approach for a two-sample t-test that compares log-transformed outcome data is demonstrated where the change of interest is specified as difference in median values on the untransformed scale. A simulation study is used to compare the method with a non-parametric alternative (Mann-Whitney U test in a variety of scenarios and the method is applied to a real example in neurosurgery. Results The method attained a nominal power value in simulation studies and was favourable in comparison to a Mann-Whitney U test and a two-sample t-test of untransformed outcomes. In addition, the method can be adjusted and used in some situations where the outcome distribution is not strictly log-normal. Conclusions We recommend the use of this sample size calculation approach for outcome data that are expected to be positively skewed and where a two group comparison on a log-transformed scale is planned. An advantage of this method over usual calculations based on estimates on the log-transformed scale is that it allows clinical efficacy to be specified as a difference in medians and requires a variance estimate on the untransformed scale. Such estimates are often easier to obtain and more interpretable than those for log-transformed outcomes.

  7. Preferences for Depression Treatment Including Internet-Based Interventions: Results From a Large Sample of Primary Care Patients

    Directory of Open Access Journals (Sweden)

    Marie Dorow

    2018-05-01

    Full Text Available Background: To date, little is known about treatment preferences for depression concerning new media. This study aims to (1 investigate treatment preferences for depression including internet-based interventions and (2 examine subgroup differences concerning age, gender and severity of depression as well as patient-related factors associated with treatment preferences.Methods: Data were derived from the baseline assessment of the @ktiv-trial. Depression treatment preferences were assessed from n = 641 primary care patients with mild to moderate depression regarding the following treatments: medication, psychotherapy, combined treatment, alternative treatment, talking to friends and family, exercise, self-help literature, and internet-based interventions. Depression severity was specified by GPs according to ICD-10 criteria. Ordinal logistic regression models were conducted to identify associated factors of treatment preferences.Results: Patients had a mean age of 43.9 years (SD = 13.8 and more than two thirds (68.6% were female. About 43% of patients had mild depression while 57% were diagnosed with moderate depression. The majority of patients reported strong preferences for psychotherapy, talking to friends and family, and exercise. About one in five patients was very likely to consider internet-based interventions in case of depression. Younger patients expressed significantly stronger treatment preferences for psychotherapy and internet-based interventions than older patients. The most salient factors associated with treatment preferences were the patients' education and perceived self-efficacy.Conclusions: Patients with depression report individually different treatment preferences.Our results underline the importance of shared decision-making within primary care. Future studies should investigate treatment preferences for different types of internet-based interventions.

  8. Self-collected cervicovaginal sampling for site-of-care primary HPV-based cervical cancer screening: a pilot study in a rural underserved Greek population.

    Science.gov (United States)

    Chatzistamatiou, Kimon; Chatzaki, Εkaterini; Constantinidis, Τheocharis; Nena, Evangelia; Tsertanidou, Athena; Agorastos, Theodoros

    2017-11-01

    In the present pilot study, the feasibility of a site-of-care cervicovaginal self-sampling methodology for HPV-based screening was tested in 346 women residing in underserved rural areas of Northern Greece. These women provided self-collected cervicovaginal sample along with a study questionnaire. Following molecular testing, using the cobas ® HPV Test, Roche ® , HPV positive women, were referred to colposcopy and upon abnormal findings, to biopsy and treatment. Participation rate was 100%. Regular pap-test examination was reported for 17.1%. Among hrHPV testing, 11.9% were positive and colposcopy/biopsy revealed 2 CIN3 cases. Non-compliance was the most prevalent reason for no previous attendance. Most women reported non-difficulty and non-discomfort in self-sampling (77.6% and 82.4%, respectively). They would choose self-sampling over clinician-sampling (86.2%), and should self-sampling being available, they would test themselves more regularly (92.3%). In conclusion, self-sampling is feasible and well-accepted for HPV-based screening, and could increase population coverage in underserved areas, helping towards successful prevention.

  9. Community-Based Care

    Science.gov (United States)

    ... our e-newsletter! Aging & Health A to Z Community-Based Care Basic Facts & Information A variety of healthcare options ... day care centers are either in churches or community centers. Adult day care is commonly used to care for people who ...

  10. Judgment sampling: a health care improvement perspective.

    Science.gov (United States)

    Perla, Rocco J; Provost, Lloyd P

    2012-01-01

    Sampling plays a major role in quality improvement work. Random sampling (assumed by most traditional statistical methods) is the exception in improvement situations. In most cases, some type of "judgment sample" is used to collect data from a system. Unfortunately, judgment sampling is not well understood. Judgment sampling relies upon those with process and subject matter knowledge to select useful samples for learning about process performance and the impact of changes over time. It many cases, where the goal is to learn about or improve a specific process or system, judgment samples are not merely the most convenient and economical approach, they are technically and conceptually the most appropriate approach. This is because improvement work is done in the real world in complex situations involving specific areas of concern and focus; in these situations, the assumptions of classical measurement theory neither can be met nor should an attempt be made to meet them. The purpose of this article is to describe judgment sampling and its importance in quality improvement work and studies with a focus on health care settings.

  11. Living conditions, including life style, in primary-care patients with nonacute, nonspecific spinal pain compared with a population-based sample: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Odd Lindell

    2010-11-01

    Full Text Available Odd Lindell, Sven-Erik Johansson, Lars-Erik Strender1Center for Family and Community Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, SwedenBackground: Nonspecific spinal pain (NSP, comprising back and/or neck pain, is one of the leading disorders behind long-term sick-listing, including disability pensions. Early interventions to prevent long-term sick-listing require the identification of patients at risk. The aim of this study was to compare living conditions associated with long-term sick-listing for NSP in patients with nonacute NSP, with a nonpatient population-based sample. Nonacute NSP is pain that leads to full-time sick-listing>3 weeks.Methods: One hundred and twenty-five patients with nonacute NSP, 2000–2004, were included in a randomized controlled trial in Stockholm County with the objective of comparing cognitive–behavioral rehabilitation with traditional primary care. For these patients, a cross-sectional study was carried out with baseline data. Living conditions were compared between the patients and 338 nonpatients by logistic regression. The conditions from univariate analyses were included in a multivariate analysis. The nonsignificant variables were excluded sequentially to yield a model comprising only the significant factors (P <0.05. The results are shown as odds ratios (OR with 95% confidence intervals.Results: In the univariate analyses, 13 of the 18 living conditions had higher odds for the patients with a dominance of physical work strains and Indication of alcohol over-consumption, odds ratio (OR 14.8 (95% confidence interval [CI] 3.2–67.6. Five conditions qualified for the multivariate model: High physical workload, OR 13.7 (CI 5.9–32.2; Hectic work tempo, OR 8.4 (CI 2.5–28.3; Blue-collar job, OR 4.5 (CI 1.8–11.4; Obesity, OR 3.5 (CI 1.2–10.2; and Low education, OR 2.7 (CI 1.1–6.8.Conclusions: As most of the living conditions have previously been

  12. Oral Health Equity and Unmet Dental Care Needs in a Population-Based Sample: Findings From the Survey of the Health of Wisconsin

    Science.gov (United States)

    Wisk, Lauren E.; Walsh, Matthew; McWilliams, Christine; Eggers, Shoshannah; Olson, Melissa

    2015-01-01

    Objectives. We used objective oral health screening and survey data to explore individual-, psychosocial-, and community-level predictors of oral health status in a statewide population of adults. Methods. We examined oral health status in a sample of 1453 adult Wisconsin residents who participated in the Survey of the Health of Wisconsin Oral Health Screening project, conducted with the Wisconsin Department of Health Services during 2010. Results. We found significant disparities in oral health status across all individual-, psychosocial-, and community-level predictors. More than 15% of participants had untreated cavities, and 20% did not receive needed oral health care. Individuals who self-reported unmet need for dental care were 4 times as likely to have untreated cavities as were those who did not report such a need, after controlling for sociodemographic and behavioral factors. Conclusions. Our results suggested that costs were a primary predictor of access to care and poor oral health status. The results underscored the role that primary care, in conjunction with dental health care providers, could play in promoting oral health care, particularly in reducing barriers (e.g., the costs associated with unmet dental care) and promoting preventive health behaviors (e.g., teeth brushing). PMID:25905843

  13. Urine sampling techniques in symptomatic primary-care patients

    DEFF Research Database (Denmark)

    Holm, Anne; Aabenhus, Rune

    2016-01-01

    in infection rate between mid-stream-clean-catch, mid-stream-urine and random samples. Conclusions: At present, no evidence suggests that sampling technique affects the accuracy of the microbiological diagnosis in non-pregnant women with symptoms of urinary tract infection in primary care. However......Background: Choice of urine sampling technique in urinary tract infection may impact diagnostic accuracy and thus lead to possible over- or undertreatment. Currently no evidencebased consensus exists regarding correct sampling technique of urine from women with symptoms of urinary tract infection...... a randomized or paired design to compare the result of urine culture obtained with two or more collection techniques in adult, female, non-pregnant patients with symptoms of urinary tract infection. We evaluated quality of the studies and compared accuracy based on dichotomized outcomes. Results: We included...

  14. Detection of 17 β-Estradiol in Environmental Samples and for Health Care Using a Single-Use, Cost-Effective Biosensor Based on Differential Pulse Voltammetry (DPV).

    Science.gov (United States)

    Dai, Yifan; Liu, Chung Chiun

    2017-03-29

    Environmental estrogen pollution and estrogen effects on the female reproductive system are well recognized scientifically. Among the estrogens, 17 β-estradiol is a priority in environmental estrogen pollution, and it is also a major contributor to estrogen which regulates the female reproductive system. 17 β-estradiol is carcinogenic and has a tumor promotion effect relating to breast cancer, lung cancer and others. It also affects psychological well-being such as depression, fatigue and others. Thus, a simple method of detecting 17 β-estradiol will be important for both environmental estrogen pollution and health care. This study demonstrates a single-use, cost-effective 17 β-estradiol biosensor system which can be used for both environmental and health care applications. The bio-recognition mechanism is based on the influence of the redox couple, K₃Fe(CN)₆/K₄Fe(CN)₆ by the interaction between 17 β-estradiol antigen and its α-receptor (ER-α; α-estrogen antibody). The transduction mechanism is an electrochemical analytical technique, differential pulse voltammetry (DPV). The levels of 17 β-estradiol antigen studied were between 2.25 pg/mL and 2250 pg/mL; Phosphate buffered saline (PBS), tap water from the Cleveland regional water district, and simulated urine were used as the test media covering the potential application areas for 17 β-estradiol detection. An interference study by testosterone, which has a similar chemical structure and molecular weight as those of 17 β-estradiol, was carried out, and this 17 β-estradiol biosensor showed excellent specificity without any interference by similar chemicals.

  15. Correlation of Lactic Acid and Base Deficit Values Obtained From Arterial and Peripheral Venous Samples in a Pediatric Population During Intraoperative Care.

    Science.gov (United States)

    Bordes, Brianne M; Walia, Hina; Sebastian, Roby; Martin, David; Tumin, Dmitry; Tobias, Joseph D

    2017-12-01

    Lactic acid and base deficit (BD) values are frequently monitored in the intensive care unit and operating room setting to evaluate oxygenation, ventilation, cardiac output, and peripheral perfusion. Although generally obtained from an arterial cannula, such access may not always be available. The current study prospectively investigates the correlation of arterial and peripheral venous values of BD and lactic acid. The study cohort included 48 patients. Arterial BD values ranged from -8 to 4 mEq/L and peripheral venous BD values ranged from -8 to 4 mEq/L. Arterial lactic acid values ranged from 0.36 to 2.45 μmol/L and peripheral venous lactic acid values ranged from 0.38 to 4 μmol/L. The arterial BD (-0.4 ± 2.2 mEq/L) was not significantly different from the peripheral venous BD (-0.6 ± 2.2 mEq/L). The arterial lactic acid (1.0 ± 0.5 μmol/L) was not significantly different from the peripheral venous lactic acid (1.1 ± 0.6 μmol/L). Pearson correlation coefficients demonstrated a very high correlation between arterial and peripheral venous BD ( r = .88, P lactic acid ( r = .67, P lactic acid corresponded to a 0.9-unit increase in peripheral venous lactic acid (95% CI: 0.6-1.2; P lactic acid and BD values.

  16. The Edinburgh Addiction Cohort: recruitment and follow-up of a primary care based sample of injection drug users and non drug-injecting controls

    Directory of Open Access Journals (Sweden)

    Kimber Jo

    2010-02-01

    Full Text Available Abstract Background Injection drug use is an important public health problem. Epidemiological understanding of this problem is incomplete as longitudinal studies in the general population are difficult to undertake. In particular little is known about early life risk factors for later drug injection or about the life course of injection once established including the influence of medical and social interventions. Methods Individuals thought to be drug injectors were identified through a single primary medical care facility in Edinburgh between 1980 and 2006 and flagged with the General Registry Office. From October 2005 - October 2007, these cases were traced and invited to undergo interview assessment covering early life experience, substance use, health and social histories. Age and sex matched controls for confirmed cases (alive and dead were later recruited through the same health facility. Controls for living cases completed the same structured interview schedule. Data were also collected on cases and controls through linkage to routine primary care records, death registrations, hospital contact statistics and police and prison records. All interviews were conducted with the knowledge and permission of the current GP. Results The initial cohort size was 814. At start of follow up 227 had died. Of the remaining 587: 20 had no contact details and 5 had embarked from the UK; 40 declined participation; 38 did not respond to invitations; 14 were excluded by their GP on health or social grounds and 22 had their contact details withheld by administrative authorities. 448 were interviewed of whom 16 denied injection and were excluded. Of 191 dead cases with medical records 4 were excluded as their records contained no evidence of injection. 5 interviewed cases died before follow up was concluded though these individuals were counted as "live" cases. 1 control per case (dead and alive was recruited. Linkage to Scottish Morbidity Records data

  17. Comparing the Bioburden Measured by Adenosine Triphosphate (ATP) Luminescence Technology to Contact Plate-Based Microbiologic Sampling to Assess the Cleanliness of the Patient Care Environment.

    Science.gov (United States)

    Salsgiver, Elizabeth; Bernstein, Daniel; Simon, Matthew S; Greendyke, William; Jia, Haomiao; Robertson, Amy; Salter, Selma; Schuetz, Audrey N; Saiman, Lisa; Furuya, E Yoko; Calfee, David P

    2018-05-01

    The correlation between ATP concentration and bacterial burden in the patient care environment was assessed. These findings suggest that a correlation exists between ATP concentration and bacterial burden, and they generally support ATP technology manufacturer-recommended cutoff values. Despite relatively modest discriminative ability, this technology may serve as a useful proxy for cleanliness.Infect Control Hosp Epidemiol 2018;39:622-624.

  18. Caring for home-based care workers

    African Journals Online (AJOL)

    Winnie

    Explore the emotional impacts of care work for THBC frontline care workers to determine what ... Although rates of testing are low, 83% of participants would consider undergoing ... to promote the importance of VCT and the benefits of ARV.

  19. Montessori-based dementia care.

    Science.gov (United States)

    Cline, Janet

    2006-10-01

    Montessori-based Dementia Care is an approach used in Alzheimer's care that does not involve chemical or physical restraints. This program works by giving the elder with Alzheimer/Dementia a purpose by getting them involved. When staff/families care for a confused Alzheimer/Dementia patient, who is having behaviors, the Montessori program teaches them to look at what is causing the behavior. When assessing the elder to determine what is causing the behavior, the goal is to find the answer, but the answer cannot be dementia. The goal of the program is to bring meaning to the life of an Alzheimer/Dementia elder.

  20. Silicon based ultrafast optical waveform sampling

    DEFF Research Database (Denmark)

    Ji, Hua; Galili, Michael; Pu, Minhao

    2010-01-01

    A 300 nmx450 nmx5 mm silicon nanowire is designed and fabricated for a four wave mixing based non-linear optical gate. Based on this silicon nanowire, an ultra-fast optical sampling system is successfully demonstrated using a free-running fiber laser with a carbon nanotube-based mode-locker as th......A 300 nmx450 nmx5 mm silicon nanowire is designed and fabricated for a four wave mixing based non-linear optical gate. Based on this silicon nanowire, an ultra-fast optical sampling system is successfully demonstrated using a free-running fiber laser with a carbon nanotube-based mode......-locker as the sampling source. A clear eye-diagram of a 320 Gbit/s data signal is obtained. The temporal resolution of the sampling system is estimated to 360 fs....

  1. The evidence base for diabetes care

    National Research Council Canada - National Science Library

    Williams, D. R. R. (David Robert Rhys)

    2002-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix 1. The Evidence Base for Diabetes Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rhys Williams, William Herman, Ann-Louise Kinmonth...

  2. Adaptive Rate Sampling and Filtering Based on Level Crossing Sampling

    Directory of Open Access Journals (Sweden)

    Saeed Mian Qaisar

    2009-01-01

    Full Text Available The recent sophistications in areas of mobile systems and sensor networks demand more and more processing resources. In order to maintain the system autonomy, energy saving is becoming one of the most difficult industrial challenges, in mobile computing. Most of efforts to achieve this goal are focused on improving the embedded systems design and the battery technology, but very few studies target to exploit the input signal time-varying nature. This paper aims to achieve power efficiency by intelligently adapting the processing activity to the input signal local characteristics. It is done by completely rethinking the processing chain, by adopting a non conventional sampling scheme and adaptive rate filtering. The proposed approach, based on the LCSS (Level Crossing Sampling Scheme presents two filtering techniques, able to adapt their sampling rate and filter order by online analyzing the input signal variations. Indeed, the principle is to intelligently exploit the signal local characteristics—which is usually never considered—to filter only the relevant signal parts, by employing the relevant order filters. This idea leads towards a drastic gain in the computational efficiency and hence in the processing power when compared to the classical techniques.

  3. Sample Based Unit Liter Dose Estimates

    International Nuclear Information System (INIS)

    JENSEN, L.

    2000-01-01

    The Tank Waste Characterization Program has taken many core samples, grab samples, and auger samples from the single-shell and double-shell tanks during the past 10 years. Consequently, the amount of sample data available has increased, both in terms of quantity of sample results and the number of tanks characterized. More and better data is available than when the current radiological and toxicological source terms used in the Basis for Interim Operation (BIO) (FDH 1999a) and the Final Safety Analysis Report (FSAR) (FDH 1999b) were developed. The Nuclear Safety and Licensing (NS and L) organization wants to use the new data to upgrade the radiological and toxicological source terms used in the BIO and FSAR. The NS and L organization requested assistance in producing a statistically based process for developing the source terms. This report describes the statistical techniques used and the assumptions made to support the development of a new radiological source term for liquid and solid wastes stored in single-shell and double-shell tanks. The results given in this report are a revision to similar results given in an earlier version of the document (Jensen and Wilmarth 1999). The main difference between the results in this document and the earlier version is that the dose conversion factors (DCF) for converting μCi/g or μCi/L to Sv/L (sieverts per liter) have changed. There are now two DCFs, one based on ICRP-68 and one based on ICW-71 (Brevick 2000)

  4. Sample Based Unit Liter Dose Estimates

    International Nuclear Information System (INIS)

    JENSEN, L.

    1999-01-01

    The Tank Waste Characterization Program has taken many core samples, grab samples, and auger samples from the single-shell and double-shell tanks during the past 10 years. Consequently, the amount of sample data available has increased, both in terms of quantity of sample results and the number of tanks characterized. More and better data is available than when the current radiological and toxicological source terms used in the Basis for Interim Operation (BIO) (FDH 1999) and the Final Safety Analysis Report (FSAR) (FDH 1999) were developed. The Nuclear Safety and Licensing (NS and L) organization wants to use the new data to upgrade the radiological and toxicological source terms used in the BIO and FSAR. The NS and L organization requested assistance in developing a statistically based process for developing the source terms. This report describes the statistical techniques used and the assumptions made to support the development of a new radiological source term for liquid and solid wastes stored in single-shell and double-shell tanks

  5. Perceived social environment and adolescents' well-being and adjustment: Comparing a foster care sample with a matched sample

    OpenAIRE

    Farruggia, SP; Greenberger, E; Chen, C; Heckhausen, J

    2006-01-01

    Previous research has demonstrated that former foster care youth are at risk for poor outcomes (e.g., more problem behaviors, more depression, lower self-esteem, and poor social relationships). It is not clear, however, whether these findings reflect preemancipation developmental deficits. This study used 163 preemancipation foster care youth and a matched sample of 163 comparison youth. Results showed that foster-care youth did not differ from the comparison sample on measures of well-being,...

  6. Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses.

    Science.gov (United States)

    Jousi, Milla; Saikko, Simo; Nurmi, Jouni

    2017-09-11

    Point-of-care (POC) testing is highly useful when treating critically ill patients. In case of difficult vascular access, the intraosseous (IO) route is commonly used, and blood is aspirated to confirm the correct position of the IO-needle. Thus, IO blood samples could be easily accessed for POC analyses in emergency situations. The aim of this study was to determine whether IO values agree sufficiently with arterial values to be used for clinical decision making. Two samples of IO blood were drawn from 31 healthy volunteers and compared with arterial samples. The samples were analysed for sodium, potassium, ionized calcium, glucose, haemoglobin, haematocrit, pH, blood gases, base excess, bicarbonate, and lactate using the i-STAT® POC device. Agreement and reliability were estimated by using the Bland-Altman method and intraclass correlation coefficient calculations. Good agreement was evident between the IO and arterial samples for pH, glucose, and lactate. Potassium levels were clearly higher in the IO samples than those from arterial blood. Base excess and bicarbonate were slightly higher, and sodium and ionised calcium values were slightly lower, in the IO samples compared with the arterial values. The blood gases in the IO samples were between arterial and venous values. Haemoglobin and haematocrit showed remarkable variation in agreement. POC diagnostics of IO blood can be a useful tool to guide treatment in critical emergency care. Seeking out the reversible causes of cardiac arrest or assessing the severity of shock are examples of situations in which obtaining vascular access and blood samples can be difficult, though information about the electrolytes, acid-base balance, and lactate could guide clinical decision making. The analysis of IO samples should though be limited to situations in which no other option is available, and the results should be interpreted with caution, because there is not yet enough scientific evidence regarding the agreement of IO

  7. Team-Based Care: A Concept Analysis.

    Science.gov (United States)

    Baik, Dawon

    2017-10-01

    The purpose of this concept analysis is to clarify and analyze the concept of team-based care in clinical practice. Team-based care has garnered attention as a way to enhance healthcare delivery and patient care related to quality and safety. However, there is no consensus on the concept of team-based care; as a result, the lack of common definition impedes further studies on team-based care. This analysis was conducted using Walker and Avant's strategy. Literature searches were conducted using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, with a timeline from January 1985 to December 2015. The analysis demonstrates that the concept of team-based care has three core attributes: (a) interprofessional collaboration, (b) patient-centered approach, and (c) integrated care process. This is accomplished through understanding other team members' roles and responsibilities, a climate of mutual respect, and organizational support. Consequences of team-based care are identified with three aspects: (a) patient, (b) healthcare professional, and (c) healthcare organization. This concept analysis helps better understand the characteristics of team-based care in the clinical practice as well as promote the development of a theoretical definition of team-based care. © 2016 Wiley Periodicals, Inc.

  8. Stratified sampling design based on data mining.

    Science.gov (United States)

    Kim, Yeonkook J; Oh, Yoonhwan; Park, Sunghoon; Cho, Sungzoon; Park, Hayoung

    2013-09-01

    To explore classification rules based on data mining methodologies which are to be used in defining strata in stratified sampling of healthcare providers with improved sampling efficiency. We performed k-means clustering to group providers with similar characteristics, then, constructed decision trees on cluster labels to generate stratification rules. We assessed the variance explained by the stratification proposed in this study and by conventional stratification to evaluate the performance of the sampling design. We constructed a study database from health insurance claims data and providers' profile data made available to this study by the Health Insurance Review and Assessment Service of South Korea, and population data from Statistics Korea. From our database, we used the data for single specialty clinics or hospitals in two specialties, general surgery and ophthalmology, for the year 2011 in this study. Data mining resulted in five strata in general surgery with two stratification variables, the number of inpatients per specialist and population density of provider location, and five strata in ophthalmology with two stratification variables, the number of inpatients per specialist and number of beds. The percentages of variance in annual changes in the productivity of specialists explained by the stratification in general surgery and ophthalmology were 22% and 8%, respectively, whereas conventional stratification by the type of provider location and number of beds explained 2% and 0.2% of variance, respectively. This study demonstrated that data mining methods can be used in designing efficient stratified sampling with variables readily available to the insurer and government; it offers an alternative to the existing stratification method that is widely used in healthcare provider surveys in South Korea.

  9. Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines

    DEFF Research Database (Denmark)

    Losacco, Valentina; Cuttini, Marina; Greisen, Gorm

    2011-01-01

    Objective To describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations. Methods Information on use...... of heel blood sampling and associated procedures (oral sweet solutions, non-nutritive sucking, swaddling or positioning, topical anaesthetics and heel warming) were collected through a structured mail questionnaire. 284 NICUs (78% response rate) participated, but only 175 with >/=50 very low birth weight...... admissions per year were included in this analysis. Results Use of heel blood sampling appeared widespread. Most units in the Netherlands, UK, Denmark, Sweden and France predominantly adopted mechanical devices, while manual lance was still in use in the other countries. The two Scandinavian countries...

  10. Design-based estimators for snowball sampling

    OpenAIRE

    Shafie, Termeh

    2010-01-01

    Snowball sampling, where existing study subjects recruit further subjects from amongtheir acquaintances, is a popular approach when sampling from hidden populations.Since people with many in-links are more likely to be selected, there will be a selectionbias in the samples obtained. In order to eliminate this bias, the sample data must beweighted. However, the exact selection probabilities are unknown for snowball samplesand need to be approximated in an appropriate way. This paper proposes d...

  11. Paying more for faster care? Individuals' attitude toward price-based priority access in health care.

    Science.gov (United States)

    Benning, Tim M; Dellaert, Benedict G C

    2013-05-01

    Increased competition in the health care sector has led hospitals and other health care institutions to experiment with new access allocation policies that move away from traditional expert based allocation of care to price-based priority access (i.e., the option to pay more for faster care). To date, little is known about individuals' attitude toward price-based priority access and the evaluation process underlying this attitude. This paper addresses the role of individuals' evaluations of collective health outcomes as an important driver of their attitude toward (price-based) allocation policies in health care. The authors investigate how individuals evaluate price-based priority access by means of scenario-based survey data collected in a representative sample from the Dutch population (N = 1464). They find that (a) offering individuals the opportunity to pay for faster care negatively affects their evaluations of both the total and distributional collective health outcome achieved, (b) however, when health care supply is not restricted (i.e., when treatment can be offered outside versus within the regular working hours of the hospital) offering price-based priority access affects total collective health outcome evaluations positively instead of negatively, but it does not change distributional collective health outcome evaluations. Furthermore, (c) the type of health care treatment (i.e., life saving liver transplantation treatment vs. life improving cosmetic ear correction treatment - priced at the same level to the individual) moderates the effect of collective health outcome evaluations on individuals' attitude toward allocation policies. For policy makers and hospital managers the results presented in this article are helpful because they provide a better understanding of what drives individuals' preferences for health care allocation policies. In particular, the results show that policies based on the "paying more for faster care" principle are more

  12. Probability Sampling - A Guideline for Quantitative Health Care ...

    African Journals Online (AJOL)

    A more direct definition is the method used for selecting a given ... description of the chosen population, the sampling procedure giving ... target population, precision, and stratification. The ... survey estimates, it is recommended that researchers first analyze a .... The optimum sample size has a relation to the type of planned ...

  13. Potential cost savings by minimisation of blood sample delays on care decision making in urgent care services

    Directory of Open Access Journals (Sweden)

    David M.S. Bodansky

    2017-08-01

    Conclusion: Sample rejection rate is high and is associated with increased in-hospital stay and cost. Blood sampling technique impacts on rejection rates. Reduction in sample rejection rates in emergency care areas in acute hospitals has the potential to impact on patient flow and reduce cost.

  14. Clinical evaluation of human papillomavirus detection by careHPV™ test on physician-samples and self-samples using the indicating FTA Elute® card.

    Science.gov (United States)

    Wang, Shao-Ming; Hu, Shang-Ying; Chen, Feng; Chen, Wen; Zhao, Fang-Hui; Zhang, Yu-Qing; Ma, Xin-Ming; Qiao, You-Lin

    2014-01-01

    To make the clinical evaluation of a solid-state human papillomavirus (HPV) sampling medium in combination with an economical HPV testing method (careHPV™) for cervical cancer screening. 396 women aged 25-65 years were enrolled for cervical cancer screening, and four samples were collected. Two samples were collected by woman themselves, among which one was stored in DCM preservative solution (called "liquid sample") and the other was applied on the Whatman Indicating FTA Elute® card (FTA card). Another two samples were collected by physician and stored in DCM preservative solution and FTA card, respectively. All the samples were detected by careHPV™ test. All the women were administered a colposcopy examination, and biopsies were taken for pathological confirmation if necessary. FTA card demonstrated a comparable sensitivity of detecting high grade Cervical Intraepithelial Neoplasia (CIN) with the liquid sample carrier for self and physician-sampling, but showed a higher specificity than that of liquid sample carrier for self-sampling (FTA vs Liquid: 79.0% vs 71.6%, p=0.02). Generally, the FTA card had a comparable accuracy with that of Liquid-based medium by different sampling operators, with an area under the curve of 0.807 for physician and FTA, 0.781 for physician and Liquid, 0.728 for self and FTA, and 0.733 for self and Liquid (p>0.05). FTA card is a promising sample carrier for cervical cancer screening. With appropriate education programmes and further optimization of the experimental workflow, FTA card based self-collection in combination with centralized careHPV™ testing can help expand the coverage of cervical cancer screening in low-resource areas.

  15. EURO-CARES as Roadmap for a European Sample Curation Facility

    Science.gov (United States)

    Brucato, J. R.; Russell, S.; Smith, C.; Hutzler, A.; Meneghin, A.; Aléon, J.; Bennett, A.; Berthoud, L.; Bridges, J.; Debaille, V.; Ferrière, L.; Folco, L.; Foucher, F.; Franchi, I.; Gounelle, M.; Grady, M.; Leuko, S.; Longobardo, A.; Palomba, E.; Pottage, T.; Rettberg, P.; Vrublevskis, J.; Westall, F.; Zipfel, J.; Euro-Cares Team

    2018-04-01

    EURO-CARES is a three-year multinational project funded under the European Commission Horizon2020 research program to develop a roadmap for a European Extraterrestrial Sample Curation Facility for samples returned from solar system missions.

  16. Barriers to compliance with evidence-based care in trauma.

    Science.gov (United States)

    Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Kudyakov, Rustam; Ballard, David; Gentilello, Larry M; Shafi, Shahid

    2012-03-01

    We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care. Records of a random sample of 774 patients admitted to a Level I trauma center (2006-2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus. These encompassed all aspects of trauma care, including initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention. Multivariate logistic regression was used to identify patients likely to receive recommended care. Study patients were eligible for a total of 2,603 T-POC, of which only 1,515 (58%) were provided to the patient. Compliance was highest for T-POC involving resuscitation (83%) and was lowest for neurosurgical interventions (17%). Increasing severity of head injuries was associated with lower compliance, while intensive care unit stay was associated with higher compliance. There was no relationship between compliance and patient demographics, socioeconomic status, overall injury severity, or daily volume of trauma admissions. Little over half of recommended care was delivered to trauma patients with moderate to severe injuries. Patients with increasing severity of traumatic brain injuries were least likely to receive optimal care. However, differences among patient subgroups are small in relation to the overall gap between observed and recommended care. II.

  17. Protocol-based care: the standardisation of decision-making?

    Science.gov (United States)

    Rycroft-Malone, Jo; Fontenla, Marina; Seers, Kate; Bick, Debra

    2009-05-01

    To explore how protocol-based care affects clinical decision-making. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. The successful implementation and judicious use of tools such as

  18. Template-Based Sampling of Anisotropic BRDFs

    Czech Academy of Sciences Publication Activity Database

    Filip, Jiří; Vávra, Radomír

    2014-01-01

    Roč. 33, č. 7 (2014), s. 91-99 ISSN 0167-7055. [Pacific Graphics 2014. Soul, 08.10.2014-10.10.2014] R&D Projects: GA ČR(CZ) GA14-02652S; GA ČR(CZ) GA14-10911S; GA ČR GAP103/11/0335 Institutional support: RVO:67985556 Keywords : BRDF database * material appearnce * sampling * measurement Subject RIV: BD - Theory of Information Impact factor: 1.642, year: 2014 http://library.utia.cas.cz/separaty/2014/RO/filip-0432894.pdf

  19. Random sampling or geostatistical modelling? Choosing between design-based and model-based sampling strategies for soil (with discussion)

    NARCIS (Netherlands)

    Brus, D.J.; Gruijter, de J.J.

    1997-01-01

    Classical sampling theory has been repeatedly identified with classical statistics which assumes that data are identically and independently distributed. This explains the switch of many soil scientists from design-based sampling strategies, based on classical sampling theory, to the model-based

  20. Sample size calculations for cluster randomised crossover trials in Australian and New Zealand intensive care research.

    Science.gov (United States)

    Arnup, Sarah J; McKenzie, Joanne E; Pilcher, David; Bellomo, Rinaldo; Forbes, Andrew B

    2018-06-01

    The cluster randomised crossover (CRXO) design provides an opportunity to conduct randomised controlled trials to evaluate low risk interventions in the intensive care setting. Our aim is to provide a tutorial on how to perform a sample size calculation for a CRXO trial, focusing on the meaning of the elements required for the calculations, with application to intensive care trials. We use all-cause in-hospital mortality from the Australian and New Zealand Intensive Care Society Adult Patient Database clinical registry to illustrate the sample size calculations. We show sample size calculations for a two-intervention, two 12-month period, cross-sectional CRXO trial. We provide the formulae, and examples of their use, to determine the number of intensive care units required to detect a risk ratio (RR) with a designated level of power between two interventions for trials in which the elements required for sample size calculations remain constant across all ICUs (unstratified design); and in which there are distinct groups (strata) of ICUs that differ importantly in the elements required for sample size calculations (stratified design). The CRXO design markedly reduces the sample size requirement compared with the parallel-group, cluster randomised design for the example cases. The stratified design further reduces the sample size requirement compared with the unstratified design. The CRXO design enables the evaluation of routinely used interventions that can bring about small, but important, improvements in patient care in the intensive care setting.

  1. Sample classroom activities based on climate science

    Science.gov (United States)

    Miler, T.

    2009-09-01

    We present several activities developed for the middle school education based on a climate science. The first activity was designed to teach about the ocean acidification. A simple experiment can prove that absorption of CO2 in water increases its acidity. A liquid pH indicator is suitable for the demonstration in a classroom. The second activity uses data containing coordinates of a hurricane position. Pupils draw a path of a hurricane eye in a tracking chart (map of the Atlantic ocean). They calculate an average speed of the hurricane, investigate its direction and intensity development. The third activity uses pictures of the Arctic ocean on September when ice extend is usually the lowest. Students measure the ice extend for several years using a square grid printed on a plastic foil. Then they plot a graph and discuss the results. All these activities can be used to improve the natural science education and increase the climate change literacy.

  2. Sample to answer visualization pipeline for low-cost point-of-care blood cell counting

    Science.gov (United States)

    Smith, Suzanne; Naidoo, Thegaran; Davies, Emlyn; Fourie, Louis; Nxumalo, Zandile; Swart, Hein; Marais, Philip; Land, Kevin; Roux, Pieter

    2015-03-01

    We present a visualization pipeline from sample to answer for point-of-care blood cell counting applications. Effective and low-cost point-of-care medical diagnostic tests provide developing countries and rural communities with accessible healthcare solutions [1], and can be particularly beneficial for blood cell count tests, which are often the starting point in the process of diagnosing a patient [2]. The initial focus of this work is on total white and red blood cell counts, using a microfluidic cartridge [3] for sample processing. Analysis of the processed samples has been implemented by means of two main optical visualization systems developed in-house: 1) a fluidic operation analysis system using high speed video data to determine volumes, mixing efficiency and flow rates, and 2) a microscopy analysis system to investigate homogeneity and concentration of blood cells. Fluidic parameters were derived from the optical flow [4] as well as color-based segmentation of the different fluids using a hue-saturation-value (HSV) color space. Cell count estimates were obtained using automated microscopy analysis and were compared to a widely accepted manual method for cell counting using a hemocytometer [5]. The results using the first iteration microfluidic device [3] showed that the most simple - and thus low-cost - approach for microfluidic component implementation was not adequate as compared to techniques based on manual cell counting principles. An improved microfluidic design has been developed to incorporate enhanced mixing and metering components, which together with this work provides the foundation on which to successfully implement automated, rapid and low-cost blood cell counting tests.

  3. Value based health care real estate strategies

    NARCIS (Netherlands)

    van der Voordt, Theo; van der Voordt, DJM; Dijkstra, K

    2009-01-01

    Subject/Research problem
    The healthcare sector in the Netherlands is shifting from a governmentally steered domain towards regulated market forces and performance-based financing. Organizational changes, new ideas about care and cure, demographical developments and technological innovations play

  4. Values-based recruitment in health care.

    Science.gov (United States)

    Miller, Sam Louise

    2015-01-27

    Values-based recruitment is a process being introduced to student selection for nursing courses and appointment to registered nurse posts. This article discusses the process of values-based recruitment and demonstrates why it is important in health care today. It examines the implications of values-based recruitment for candidates applying to nursing courses and to newly qualified nurses applying for their first posts in England. To ensure the best chance of success, candidates should understand the principles and process of values-based recruitment and how to prepare for this type of interview.

  5. Value-Based Care and Strategic Priorities.

    Science.gov (United States)

    Gross, Wendy L; Cooper, Lebron; Boggs, Steven; Gold, Barbara

    2017-12-01

    The anesthesia market continues to undergo disruption. Financial margins are shrinking, and buyers are demanding that anesthesia services be provided in an efficient, low-cost manner. To help anesthesiologists analyze their market, Drucker and Porter's framework of buyers, suppliers, quality, barriers to entry, substitution, and strategic priorities allows for a structured analysis. Once this analysis is completed, anesthesiologists must articulate their value to other medical professionals and to hospitals. Anesthesiologists can survive and thrive in a value-based health care environment if they are capable of providing services differently and able to deliver cost-effective care. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Proposing an Empirically Justified Reference Threshold for Blood Culture Sampling Rates in Intensive Care Units

    Science.gov (United States)

    Castell, Stefanie; Schwab, Frank; Geffers, Christine; Bongartz, Hannah; Brunkhorst, Frank M.; Gastmeier, Petra; Mikolajczyk, Rafael T.

    2014-01-01

    Early and appropriate blood culture sampling is recommended as a standard of care for patients with suspected bloodstream infections (BSI) but is rarely taken into account when quality indicators for BSI are evaluated. To date, sampling of about 100 to 200 blood culture sets per 1,000 patient-days is recommended as the target range for blood culture rates. However, the empirical basis of this recommendation is not clear. The aim of the current study was to analyze the association between blood culture rates and observed BSI rates and to derive a reference threshold for blood culture rates in intensive care units (ICUs). This study is based on data from 223 ICUs taking part in the German hospital infection surveillance system. We applied locally weighted regression and segmented Poisson regression to assess the association between blood culture rates and BSI rates. Below 80 to 90 blood culture sets per 1,000 patient-days, observed BSI rates increased with increasing blood culture rates, while there was no further increase above this threshold. Segmented Poisson regression located the threshold at 87 (95% confidence interval, 54 to 120) blood culture sets per 1,000 patient-days. Only one-third of the investigated ICUs displayed blood culture rates above this threshold. We provided empirical justification for a blood culture target threshold in ICUs. In the majority of the studied ICUs, blood culture sampling rates were below this threshold. This suggests that a substantial fraction of BSI cases might remain undetected; reporting observed BSI rates as a quality indicator without sufficiently high blood culture rates might be misleading. PMID:25520442

  7. Consensus of heterogeneous multi-agent systems based on sampled data with a small sampling delay

    International Nuclear Information System (INIS)

    Wang Na; Wu Zhi-Hai; Peng Li

    2014-01-01

    In this paper, consensus problems of heterogeneous multi-agent systems based on sampled data with a small sampling delay are considered. First, a consensus protocol based on sampled data with a small sampling delay for heterogeneous multi-agent systems is proposed. Then, the algebra graph theory, the matrix method, the stability theory of linear systems, and some other techniques are employed to derive the necessary and sufficient conditions guaranteeing heterogeneous multi-agent systems to asymptotically achieve the stationary consensus. Finally, simulations are performed to demonstrate the correctness of the theoretical results. (interdisciplinary physics and related areas of science and technology)

  8. The transition to value-based care.

    Science.gov (United States)

    Ray, Jordan C; Kusumoto, Fred

    2016-10-01

    Delivery of medical care is evolving rapidly worldwide. Over the past several years in the USA, there has been a rapid shift in reimbursement from a simple fee-for-service model to more complex models that attempt to link payment to quality and value. Change in any large system can be difficult, but with medicine, the transition to a value-based system has been particularly hard to implement because both quality and cost are difficult to quantify. Professional societies and other medical groups are developing different programs in an attempt to define high value care. However, applying a national standard of value for any treatment is challenging, since value varies from person to person, and the individual benefit must remain the central tenet for delivering best patient-centered medical care. Regardless of the specific operational features of the rapidly changing healthcare environment, physicians must first and foremost always remain patient advocates.

  9. A Story-Based Simulation for Teaching Sampling Distributions

    Science.gov (United States)

    Turner, Stephen; Dabney, Alan R.

    2015-01-01

    Statistical inference relies heavily on the concept of sampling distributions. However, sampling distributions are difficult to teach. We present a series of short animations that are story-based, with associated assessments. We hope that our contribution can be useful as a tool to teach sampling distributions in the introductory statistics…

  10. Control charts for location based on different sampling schemes

    NARCIS (Netherlands)

    Mehmood, R.; Riaz, M.; Does, R.J.M.M.

    2013-01-01

    Control charts are the most important statistical process control tool for monitoring variations in a process. A number of articles are available in the literature for the X̄ control chart based on simple random sampling, ranked set sampling, median-ranked set sampling (MRSS), extreme-ranked set

  11. HIV/aids related home based care practices among primary health care workers in Ogun state, Nigeria

    Directory of Open Access Journals (Sweden)

    E Amoran

    2012-05-01

    Full Text Available Abstract Background HIV/AIDS is fast becoming a chronic disease with the advent of antiretroviral drugs, therefore making home based care key in the management of chronically ill HIV/AIDS patient. The objective of this study was to determine the perception and practice of health care workers on HIV/AIDS related home based care in the health facilities in Ogun state, Nigeria. Methods This study is an analytical cross-sectional study. A multistage cluster sampling technique was used to obtain a representative sample of the primary health care workers in Ogun state. An interviewer administered structured questionnaire was administered by trained health workers to elicit the required information. Result A total of 350 health care workers were interviewed, 70% of the respondents could adequately describe the components of home based care. Only 38.7% were aware of the National guideline on home based care practices and 17.1% believe that home based care will not significantly improve the prognosis of PLWAs. Few 19.1% had ever been trained or ever involved 16.6% in home based care practices. Only 20 [5.7%] are involved on a weekly basis, 16 [4.6%] monthly and 22 [6.3%] quarterly. Reasons given for non implementation of home based care are inadequate number of healthcare workers 45%, lack of political will 24.4%, lack of implementation by facility managers 14% and inadequate funds 16.6%. Factors that were significantly associated with the practice of home based care were perception of its relevance in improving prognosis [OR = 54.21, C.I = 23.22-129.52] and presence of a support group in the facility [OR = 4.80, C.I = 2.40-9.57]. There was however no statistically significant relationship between adequate knowledge of home based care [OR = 0.78, C.I = 0.39-1.54] and previous training on home based care (OR = 1.43, C.I = 0.66-3.06]. Conclusion The practice of home based care for HIV/AIDS among the study population is low

  12. Efficient sampling algorithms for Monte Carlo based treatment planning

    International Nuclear Information System (INIS)

    DeMarco, J.J.; Solberg, T.D.; Chetty, I.; Smathers, J.B.

    1998-01-01

    Efficient sampling algorithms are necessary for producing a fast Monte Carlo based treatment planning code. This study evaluates several aspects of a photon-based tracking scheme and the effect of optimal sampling algorithms on the efficiency of the code. Four areas were tested: pseudo-random number generation, generalized sampling of a discrete distribution, sampling from the exponential distribution, and delta scattering as applied to photon transport through a heterogeneous simulation geometry. Generalized sampling of a discrete distribution using the cutpoint method can produce speedup gains of one order of magnitude versus conventional sequential sampling. Photon transport modifications based upon the delta scattering method were implemented and compared with a conventional boundary and collision checking algorithm. The delta scattering algorithm is faster by a factor of six versus the conventional algorithm for a boundary size of 5 mm within a heterogeneous geometry. A comparison of portable pseudo-random number algorithms and exponential sampling techniques is also discussed

  13. Very extensive nonmaternal care predicts mother-infant attachment disorganization: Convergent evidence from two samples.

    Science.gov (United States)

    Hazen, Nancy L; Allen, Sydnye D; Christopher, Caroline Heaton; Umemura, Tomotaka; Jacobvitz, Deborah B

    2015-08-01

    We examined whether a maximum threshold of time spent in nonmaternal care exists, beyond which infants have an increased risk of forming a disorganized infant-mother attachment. The hours per week infants spent in nonmaternal care at 7-8 months were examined as a continuous measure and as a dichotomous threshold (over 40, 50 and 60 hr/week) to predict infant disorganization at 12-15 months. Two different samples (Austin and NICHD) were used to replicate findings and control for critical covariates: mothers' unresolved status and frightening behavior (assessed in the Austin sample, N = 125), quality of nonmaternal caregiving (assessed in the NICHD sample, N = 1,135), and family income and infant temperament (assessed in both samples). Only very extensive hours of nonmaternal care (over 60 hr/week) and mothers' frightening behavior independently predicted attachment disorganization. A polynomial logistic regression performed on the larger NICHD sample indicated that the risk of disorganized attachment exponentially increased after exceeding 60 hr/week. In addition, very extensive hours of nonmaternal care only predicted attachment disorganization after age 6 months (not prior). Findings suggest that during a sensitive period of attachment formation, infants who spend more than 60 hr/week in nonmaternal care may be at an increased risk of forming a disorganized attachment.

  14. Variability in ADHD care in community-based pediatrics.

    Science.gov (United States)

    Epstein, Jeffery N; Kelleher, Kelly J; Baum, Rebecca; Brinkman, William B; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua

    2014-12-01

    Although many efforts have been made to improve the quality of care delivered to children with attention-deficit/hyperactivity disorder (ADHD) in community-based pediatric settings, little is known about typical ADHD care in these settings other than rates garnered through pediatrician self-report. Rates of evidence-based ADHD care and sources of variability (practice-level, pediatrician-level, patient-level) were determined by chart reviews of a random sample of 1594 patient charts across 188 pediatricians at 50 different practices. In addition, the associations of Medicaid-status and practice setting (ie, urban, suburban, and rural) with the quality of ADHD care were examined. Parent- and teacher-rating scales were used during ADHD assessment with approximately half of patients. The use of Diagnostic and Statistical Manual of Mental Disorders criteria was documented in 70.4% of patients. The vast majority (93.4%) of patients with ADHD were receiving medication and only 13.0% were receiving psychosocial treatment. Parent- and teacher-ratings were rarely collected to monitor treatment response or side effects. Further, fewer than half (47.4%) of children prescribed medication had contact with their pediatrician within the first month of prescribing. Most variability in pediatrician-delivered ADHD care was accounted for at the patient level; however, pediatricians and practices also accounted for significant variability on specific ADHD care behaviors. There is great need to improve the quality of ADHD care received by children in community-based pediatric settings. Improvements will likely require systematic interventions at the practice and policy levels to promote change. Copyright © 2014 by the American Academy of Pediatrics.

  15. Caring for home-based care workers | de Saxe Zerden | Southern ...

    African Journals Online (AJOL)

    care workers provide critical services, which include physical, psychosocial, and palliative care activities.1 A quantitative and qualitative study of home-based care workers in South Africa was conducted in 2005 to better understand the needs, fears and motivations of front-line care workers at Thembalethu Home Based ...

  16. Newborn care practices and home-based postnatal newborn care programme – Mewat, Haryana, India, 2013

    Directory of Open Access Journals (Sweden)

    Latika Nath Sinha

    2014-09-01

    Full Text Available Background: In India, the Home Based Postnatal Newborn Care programme by Accredited Social Health Activists (ASHAs under the National Rural Health Mission was initiated in 2011 to reduce neonatal mortality rates (NMRs. ASHAs get cash incentives for six postnatal home visits for newborn care. We studied newborn care practices among mothers in Mewat, Haryana, having a high NMR and determined risk factors for unsafe practices and described the knowledge and skills of ASHAs during home visits. Methods: A cross-sectional survey was conducted among mothers who had delivered a child during the previous seven months using cluster sampling. We interviewed mothers and ASHAs in the selected subcentres using semi–structured questionnaires on the six safe newborn care practices, namely safe breastfeeding, keeping cord and eyes clean, wrapping baby, kangaroo care, delayed bathing and hand washing. Results: We interviewed 320 mothers, 61 ASHAs and observed 19 home visits. Overall, 60% of mothers adopted less than three safe practices. Wrapping newborns (96% and delayed bathing (64% were better adopted than cord care (49%, safe breastfeeding (48%, hand washing (30%, kangaroo care (20% and eye care (9%. Cultural beliefs and traditional birth attendants influenced the mother’s practices. The lack of supervision by auxiliary nurse midwives (ANM, delayed referral and transportation were the other challenges. Conclusion: Knowledge–practice gaps existed among mothers counselled by ASHAs. Poor utilization of reproductive and child health services decreased opportunities for ASHA–mother dialogue on safe practices. Recommendations included training ANMs, training TBAs as ASHAs, innovative communication strategies for ASHAs and improved referral system.

  17. Direct Detection of Pharmaceuticals and Personal Care Products from Aqueous Samples with Thermally-Assisted Desorption Electrospray Ionization Mass Spectrometry

    Science.gov (United States)

    Campbell, Ian S.; Ton, Alain T.; Mulligan, Christopher C.

    2011-07-01

    An ambient mass spectrometric method based on desorption electrospray ionization (DESI) has been developed to allow rapid, direct analysis of contaminated water samples, and the technique was evaluated through analysis of a wide array of pharmaceutical and personal care product (PPCP) contaminants. Incorporating direct infusion of aqueous sample and thermal assistance into the source design has allowed low ppt detection limits for the target analytes in drinking water matrices. With this methodology, mass spectral information can be collected in less than 1 min, consuming ~100 μL of total sample. Quantitative ability was also demonstrated without the use of an internal standard, yielding decent linearity and reproducibility. Initial results suggest that this source configuration is resistant to carryover effects and robust towards multi-component samples. The rapid, continuous analysis afforded by this method offers advantages in terms of sample analysis time and throughput over traditional hyphenated mass spectrometric techniques.

  18. Ultra-High-Throughput Sample Preparation System for Lymphocyte Immunophenotyping Point-of-Care Diagnostics.

    Science.gov (United States)

    Walsh, David I; Murthy, Shashi K; Russom, Aman

    2016-10-01

    Point-of-care (POC) microfluidic devices often lack the integration of common sample preparation steps, such as preconcentration, which can limit their utility in the field. In this technology brief, we describe a system that combines the necessary sample preparation methods to perform sample-to-result analysis of large-volume (20 mL) biopsy model samples with staining of captured cells. Our platform combines centrifugal-paper microfluidic filtration and an analysis system to process large, dilute biological samples. Utilizing commercialization-friendly manufacturing methods and materials, yielding a sample throughput of 20 mL/min, and allowing for on-chip staining and imaging bring together a practical, yet powerful approach to microfluidic diagnostics of large, dilute samples. © 2016 Society for Laboratory Automation and Screening.

  19. Triangulation based inclusion probabilities: a design-unbiased sampling approach

    OpenAIRE

    Fehrmann, Lutz; Gregoire, Timothy; Kleinn, Christoph

    2011-01-01

    A probabilistic sampling approach for design-unbiased estimation of area-related quantitative characteristics of spatially dispersed population units is proposed. The developed field protocol includes a fixed number of 3 units per sampling location and is based on partial triangulations over their natural neighbors to derive the individual inclusion probabilities. The performance of the proposed design is tested in comparison to fixed area sample plots in a simulation with two forest stands. ...

  20. The Toggle Local Planner for sampling-based motion planning

    KAUST Repository

    Denny, Jory; Amato, Nancy M.

    2012-01-01

    Sampling-based solutions to the motion planning problem, such as the probabilistic roadmap method (PRM), have become commonplace in robotics applications. These solutions are the norm as the dimensionality of the planning space grows, i.e., d > 5

  1. Variable screening and ranking using sampling-based sensitivity measures

    International Nuclear Information System (INIS)

    Wu, Y-T.; Mohanty, Sitakanta

    2006-01-01

    This paper presents a methodology for screening insignificant random variables and ranking significant important random variables using sensitivity measures including two cumulative distribution function (CDF)-based and two mean-response based measures. The methodology features (1) using random samples to compute sensitivities and (2) using acceptance limits, derived from the test-of-hypothesis, to classify significant and insignificant random variables. Because no approximation is needed in either the form of the performance functions or the type of continuous distribution functions representing input variables, the sampling-based approach can handle highly nonlinear functions with non-normal variables. The main characteristics and effectiveness of the sampling-based sensitivity measures are investigated using both simple and complex examples. Because the number of samples needed does not depend on the number of variables, the methodology appears to be particularly suitable for problems with large, complex models that have large numbers of random variables but relatively few numbers of significant random variables

  2. A sampling-based approach to probabilistic pursuit evasion

    KAUST Repository

    Mahadevan, Aditya; Amato, Nancy M.

    2012-01-01

    Probabilistic roadmaps (PRMs) are a sampling-based approach to motion-planning that encodes feasible paths through the environment using a graph created from a subset of valid positions. Prior research has shown that PRMs can be augmented

  3. On incomplete sampling under birth-death models and connections to the sampling-based coalescent.

    Science.gov (United States)

    Stadler, Tanja

    2009-11-07

    The constant rate birth-death process is used as a stochastic model for many biological systems, for example phylogenies or disease transmission. As the biological data are usually not fully available, it is crucial to understand the effect of incomplete sampling. In this paper, we analyze the constant rate birth-death process with incomplete sampling. We derive the density of the bifurcation events for trees on n leaves which evolved under this birth-death-sampling process. This density is used for calculating prior distributions in Bayesian inference programs and for efficiently simulating trees. We show that the birth-death-sampling process can be interpreted as a birth-death process with reduced rates and complete sampling. This shows that joint inference of birth rate, death rate and sampling probability is not possible. The birth-death-sampling process is compared to the sampling-based population genetics model, the coalescent. It is shown that despite many similarities between these two models, the distribution of bifurcation times remains different even in the case of very large population sizes. We illustrate these findings on an Hepatitis C virus dataset from Egypt. We show that the transmission times estimates are significantly different-the widely used Gamma statistic even changes its sign from negative to positive when switching from the coalescent to the birth-death process.

  4. Burnout and Engagement: Relative Importance of Predictors and Outcomes in Two Health Care Worker Samples.

    Science.gov (United States)

    Fragoso, Zachary L; Holcombe, Kyla J; McCluney, Courtney L; Fisher, Gwenith G; McGonagle, Alyssa K; Friebe, Susan J

    2016-06-09

    This study's purpose was twofold: first, to examine the relative importance of job demands and resources as predictors of burnout and engagement, and second, the relative importance of engagement and burnout related to health, depressive symptoms, work ability, organizational commitment, and turnover intentions in two samples of health care workers. Nurse leaders (n = 162) and licensed emergency medical technicians (EMTs; n = 102) completed surveys. In both samples, job demands predicted burnout more strongly than job resources, and job resources predicted engagement more strongly than job demands. Engagement held more weight than burnout for predicting commitment, and burnout held more weight for predicting health outcomes, depressive symptoms, and work ability. Results have implications for the design, evaluation, and effectiveness of workplace interventions to reduce burnout and improve engagement among health care workers. Actionable recommendations for increasing engagement and decreasing burnout in health care organizations are provided. © 2016 The Author(s).

  5. The Value of a College Degree for Foster Care Alumni: Comparisons with General Population Samples

    Science.gov (United States)

    Salazar, Amy M.

    2013-01-01

    Higher education is associated with substantial adult life benefits, including higher income and improved quality of life, among others. The current study compared adult outcomes of 250 foster care alumni college graduates with two samples of general population graduates to explore the role higher education plays in these young adults' lives.…

  6. The value of a college degree for foster care alumni: comparisons with general population samples.

    Science.gov (United States)

    Salazar, Amy M

    2013-04-01

    Higher education is associated with substantial adult life benefits, including higher income and improved quality of life, among others. The current study compared adult outcomes of 250 foster care alumni college graduates with two samples of general population graduates to explore the role higher education plays in these young adults' lives. Outcomes compared include employment, income, housing, public assistance, physical and mental health, happiness, and other outcomes that are often found to be related to educational attainment. Foster care alumni college graduates were very similar to general population college graduates for individual income and rate of employment. However, foster care alumni graduates were behind general population graduates on factors such as self-reported job security, household earnings, health, mental health, financial satisfaction, home ownership, happiness, and public assistance usage. Results have implications for policy and practice regarding the most effective means of supporting postcollege stability of youths with foster care experience.

  7. Alpha Matting with KL-Divergence Based Sparse Sampling.

    Science.gov (United States)

    Karacan, Levent; Erdem, Aykut; Erdem, Erkut

    2017-06-22

    In this paper, we present a new sampling-based alpha matting approach for the accurate estimation of foreground and background layers of an image. Previous sampling-based methods typically rely on certain heuristics in collecting representative samples from known regions, and thus their performance deteriorates if the underlying assumptions are not satisfied. To alleviate this, we take an entirely new approach and formulate sampling as a sparse subset selection problem where we propose to pick a small set of candidate samples that best explains the unknown pixels. Moreover, we describe a new dissimilarity measure for comparing two samples which is based on KLdivergence between the distributions of features extracted in the vicinity of the samples. The proposed framework is general and could be easily extended to video matting by additionally taking temporal information into account in the sampling process. Evaluation on standard benchmark datasets for image and video matting demonstrates that our approach provides more accurate results compared to the state-of-the-art methods.

  8. [Influence of an observer in the haemolysis produced during the extraction of blood samples in primary care].

    Science.gov (United States)

    Bel-Peña, N; Mérida-de la Torre, F J

    2015-01-01

    To check whether an intervention based on direct observation and complementary information to nurses helps reduce haemolysis when drawing blood specimens. Random sampling study in primary care centres in the serrania de Málaga health management area, using a cross-sectional, longitudinal pre- and post-intervention design. The study period was from August 2012 to January 2015. The level of free haemoglobin was measured by direct spectrophotometry in the specimens extracted. It was then checked whether the intervention influenced the level of haemolysis, and if this was maintained over time. The mean haemolysis measured pre-intervention was 17%, and after intervention it was 6.1%. A year later and under the same conditions, the frequency of haemolysis was measured again the samples analysed, and the percentage was 9% These results are low when compared to the level obtained pre-intervention, but are higher when compared to the levels obtained immediately after the intervention. The transport and analysis conditions were the same. An intervention based on a direct and informative observation in the process of collecting blood samples contributes significantly to reduce the level of haemolysis. This effect is maintained in time. This intervention needs to be repeated to maintain its effectiveness. Audits and continuing education programs are useful for quality assurance procedures, and maintain the level of care needed for a good quality of care. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  9. An algorithm to improve sampling efficiency for uncertainty propagation using sampling based method

    International Nuclear Information System (INIS)

    Campolina, Daniel; Lima, Paulo Rubens I.; Pereira, Claubia; Veloso, Maria Auxiliadora F.

    2015-01-01

    Sample size and computational uncertainty were varied in order to investigate sample efficiency and convergence of the sampling based method for uncertainty propagation. Transport code MCNPX was used to simulate a LWR model and allow the mapping, from uncertain inputs of the benchmark experiment, to uncertain outputs. Random sampling efficiency was improved through the use of an algorithm for selecting distributions. Mean range, standard deviation range and skewness were verified in order to obtain a better representation of uncertainty figures. Standard deviation of 5 pcm in the propagated uncertainties for 10 n-samples replicates was adopted as convergence criterion to the method. Estimation of 75 pcm uncertainty on reactor k eff was accomplished by using sample of size 93 and computational uncertainty of 28 pcm to propagate 1σ uncertainty of burnable poison radius. For a fixed computational time, in order to reduce the variance of the uncertainty propagated, it was found, for the example under investigation, it is preferable double the sample size than double the amount of particles followed by Monte Carlo process in MCNPX code. (author)

  10. EURO-CARES: European Roadmap for a Sample Return Curation Facility and Planetary Protection Implications.

    Science.gov (United States)

    Brucato, John Robert

    2016-07-01

    A mature European planetary exploration program and evolving sample return mission plans gathers the interest of a wider scientific community. The interest is generated from studying extraterrestrial samples in the laborato-ry providing new opportunities to address fundamental issues on the origin and evolution of the Solar System, on the primordial cosmochemistry, and on the nature of the building blocks of terrestrial planets and on the origin of life. Major space agencies are currently planning for missions that will collect samples from a variety of Solar Sys-tem environments, from primitive (carbonaceous) small bodies, from the Moon, Mars and its moons and, final-ly, from icy moons of the outer planets. A dedicated sample return curation facility is seen as an essential re-quirement for the receiving, assessment, characterization and secure preservation of the collected extraterrestrial samples and potentially their safe distribution to the scientific community. EURO-CARES is a European Commission study funded under the Horizon-2020 program. The strategic objec-tive of EURO-CARES is to create a roadmap for the implementation of a European Extraterrestrial Sample Cu-ration Facility. The facility has to provide safe storage and handling of extraterrestrial samples and has to enable the preliminary characterization in order to achieve the required effectiveness and collaborative outcomes for the whole international scientific community. For example, samples returned from Mars could pose a threat on the Earth's biosphere if any living extraterrestrial organism are present in the samples. Thus planetary protection is an essential aspect of all Mars sample return missions that will affect the retrival and transport from the point of return, sample handling, infrastructure methodology and management of a future curation facility. Analysis of the state of the art of Planetary Protection technology shows there are considerable possibilities to define and develop

  11. Engagement with HIV prevention treatment and care among female sex workers in Zimbabwe: a respondent driven sampling survey.

    Science.gov (United States)

    Cowan, Frances M; Mtetwa, Sibongile; Davey, Calum; Fearon, Elizabeth; Dirawo, Jeffrey; Wong-Gruenwald, Ramona; Ndikudze, Theresa; Chidiya, Samson; Benedikt, Clemens; Busza, Joanna; Hargreaves, James R

    2013-01-01

    To determine the HIV prevalence and extent of engagement with HIV prevention and care among a representative sample of Zimbabwean sex workers working in Victoria Falls, Hwange and Mutare. Respondent driven sampling (RDS) surveys conducted at each site. Sex workers were recruited using respondent driven sampling with each respondent limited to recruiting 2 peers. Participants completed an interviewer-administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Statistical analysis took account of sampling method. 870 women were recruited from the three sites. HIV prevalence was between 50 and 70%. Around half of those confirmed HIV positive were aware of their HIV status and of those 50-70% reported being enrolled in HIV care programmes. Overall only 25-35% of those with laboratory-confirmed HIV were accessing antiretroviral therapy. Among those reporting they were HIV negative, 21-28% reported having an HIV test in the last 6 months. Of those tested HIV negative, most (65-82%) were unaware of their status. Around two-thirds of sex workers reported consistent condom use with their clients. As in other settings, sex workers reported high rates of gender based violence and police harassment. This survey suggests that prevalence of HIV is high among sex workers in Zimbabwe and that their engagement with prevention, treatment and care is sub-optimal. Intensifying prevention and care interventions for sex workers has the potential to markedly reduce HIV and social risks for sex workers, their clients and the general population in Zimbabwe and elsewhere in the region.

  12. [A Maternal Health Care System Based on Mobile Health Care].

    Science.gov (United States)

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

  13. Health care utilization in a sample of Canadian lesbian women: predictors of risk and resilience.

    Science.gov (United States)

    Bergeron, Sherry; Senn, Charlene Y

    2003-01-01

    This study was designed to test an exploratory path model predicting health care utilization by lesbian women. Using structural equation modeling we examined the joint influence of internalized homophobia, feminism, comfort with health care providers (HCPs), education, and disclosure of sexual identity both in one's life and to one's HCP on health care utilization. Surveys were completed by 254 Canadian lesbian women (54% participation rate) recruited through snowball sampling and specialized media. The majority (95%) of women were White, 3% (n = 7) were women of colour, and the remaining six women did not indicate ethnicity. Participants ranged in age from 18 to 67 with a mean age of 38.85 years (SD = 9.12). In the final path model, higher education predicted greater feminism, more disclosure to HCPs, and better utilization of health services. Feminism predicted both decreased levels of internalized homophobia and increased disclosure across relationships. Being more open about one's sexual identity was related to increased disclosure to HCPs, which in turn, led to better health care utilization. Finally, the more comfortable women were with their HCP the more likely they were to seek preventive care. All paths were significant at p < .01. The path model offers insight into potential target areas for intervention with the goal of improving health care utilization in lesbian women.

  14. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.

    Science.gov (United States)

    Valentijn, Pim P; Schepman, Sanneke M; Opheij, Wilfrid; Bruijnzeels, Marc A

    2013-01-01

    Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care. The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method) and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework. The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration), meso (professional and organisational integration) and macro (system integration) level. Functional and normative integration ensure connectivity between the levels. The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective.

  15. Soft magnetic properties of bulk amorphous Co-based samples

    International Nuclear Information System (INIS)

    Fuezer, J.; Bednarcik, J.; Kollar, P.

    2006-01-01

    Ball milling of melt-spun ribbons and subsequent compaction of the resulting powders in the supercooled liquid region were used to prepare disc shaped bulk amorphous Co-based samples. The several bulk samples have been prepared by hot compaction with subsequent heat treatment (500 deg C - 575 deg C). The influence of the consolidation temperature and follow-up heat treatment on the magnetic properties of bulk samples was investigated. The final heat treatment leads to decrease of the coercivity to the value between the 7.5 to 9 A/m (Authors)

  16. A novel PMT test system based on waveform sampling

    Science.gov (United States)

    Yin, S.; Ma, L.; Ning, Z.; Qian, S.; Wang, Y.; Jiang, X.; Wang, Z.; Yu, B.; Gao, F.; Zhu, Y.; Wang, Z.

    2018-01-01

    Comparing with the traditional test system based on a QDC and TDC and scaler, a test system based on waveform sampling is constructed for signal sampling of the 8"R5912 and the 20"R12860 Hamamatsu PMT in different energy states from single to multiple photoelectrons. In order to achieve high throughput and to reduce the dead time in data processing, the data acquisition software based on LabVIEW is developed and runs with a parallel mechanism. The analysis algorithm is realized in LabVIEW and the spectra of charge, amplitude, signal width and rising time are analyzed offline. The results from Charge-to-Digital Converter, Time-to-Digital Converter and waveform sampling are discussed in detailed comparison.

  17. IMPLEMENTING AN ISO 10001-BASED PROMISE IN INPATIENTS CARE

    Directory of Open Access Journals (Sweden)

    Mohammad Ashiqur Rahman Khan

    2013-09-01

    Full Text Available This paper presents the implementation of a Customer Satisfaction Promise (CSP that requires nurses to introduce themselves and explain the care plan to the patients of a hospital unit in Canada. The CSP implementation, maintenance and improvement activities were based on ISO 10001:2007. Qualitative and quantitative performance data were collected from nurses, the unit manager and patients, and improvement suggestions were made. During the implementation, nurses introduced themselves 95% of the time and explained the care plan 86% of the time. When interviewed, some nurses stated that the CSP was a good reinforcement of a practice already expected of them, which made patients happy, satisfied and more comfortable. Data from a small sample of patients was not adequate in clearly indicating the CSP's performance or improvement, but was useful in validating the survey and the feedback form. To our knowledge, applications of ISO 10001:2007 in health care have not been studied. Furthermore, this paper may be the first example of the integrated use of ISO 10001 and ISO 10002 in health care.

  18. Sampling maternal care behaviour in domestic dogs: What's the best approach?

    Science.gov (United States)

    Czerwinski, Veronika H; Smith, Bradley P; Hynd, Philip I; Hazel, Susan J

    2017-07-01

    Our understanding of the frequency and duration of maternal care behaviours in the domestic dog during the first two postnatal weeks is limited, largely due to the inconsistencies in the sampling methodologies that have been employed. In order to develop a more concise picture of maternal care behaviour during this period, and to help establish the sampling method that represents these behaviours best, we compared a variety of time sampling methods Six litters were continuously observed for a total of 96h over postnatal days 3, 6, 9 and 12 (24h per day). Frequent (dam presence, nursing duration, contact duration) and infrequent maternal behaviours (anogenital licking duration and frequency) were coded using five different time sampling methods that included: 12-h night (1800-0600h), 12-h day (0600-1800h), one hour period during the night (1800-0600h), one hour period during the day (0600-1800h) and a one hour period anytime. Each of the one hour time sampling method consisted of four randomly chosen 15-min periods. Two random sets of four 15-min period were also analysed to ensure reliability. We then determined which of the time sampling methods averaged over the three 24-h periods best represented the frequency and duration of behaviours. As might be expected, frequently occurring behaviours were adequately represented by short (oneh) sampling periods, however this was not the case with the infrequent behaviour. Thus, we argue that the time sampling methodology employed must match the behaviour of interest. This caution applies to maternal behaviour in altricial species, such as canids, as well as all systematic behavioural observations utilising time sampling methodology. Copyright © 2017. Published by Elsevier B.V.

  19. Perceived Organizational Justice in Care Services: creation and multi-sample validation of a measure.

    Science.gov (United States)

    Pérez-Arechaederra, Diana; Briones, Elena; Lind, Allan; García-Ortiz, Luis

    2014-02-01

    Organizational justice (OJ) perceptions predict attitudes and behaviors of customers and employees across a broad range of services. Although OJ has proven predictive power and relevance, it has rarely been studied in health care settings. This stems partially from the lack of a reliable and valid measure of patients' OJ in health care encounters. The objective here was to create and validate a measure of patients' OJ. With that purpose, a survey study with two sampling contexts - the U.S. and Spain - was carried out in order to provide a cross-national validation of the scale in two versions: English (Perceived Organizational Justice in Care Services, PJustCS) and Spanish (Percepción de Justicia Organizacional en el Ámbito Sanitario, PJustAS). Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to select the appropriate items in the final version of the instrument. Reliability and validity of the measure were tested. A total of 406 patients in the U.S. and 473 patients in Spain participated. The measures used were the newly created scale of Perceived Organizational Justice in Care Services (PJustCS/PJustAS) and scales of patients' Satisfaction, Trust and Global Justice. Factor Analyses supported the four dimensional structure of the instrument for each group. Multigroup CFA substantiated invariant factor loadings and invariant structural models across both samples, hence, supporting that the instrument is applicable in its two versions: English and Spanish. Validation results showed expected positive relations of OJ with patients' satisfaction, trust in clinicians and global perceived justice. These results point out the importance of health care customers' perceived organizational justice in the explanation of health care dynamics. The scale has desirable psychometric properties and shows adequate validity, contributing to the potential development of the area. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. [Acceptance of lot sampling: its applicability to the evaluation of the primary care services portfolio].

    Science.gov (United States)

    López-Picazo Ferrer, J

    2001-05-15

    To determine the applicability of the acceptance of lot quality assurance sampling (LQAS) in the primary care service portfolio, comparing its results with those given by classic evaluation. Compliance with the minimum technical norms (MTN) of the service of diabetic care was evaluated through the classic methodology (confidence 95%, accuracy 5%, representativeness of area, sample of 376 histories) and by LQAS (confidence 95%, power 80%, representativeness of primary care team (PCT), defining a lot by MTN and PCT, sample of 13 histories/PCT). Effort, information obtained and its operative nature were assessed. 44 PCTs from Murcia Primary Care Region. Classic methodology: compliance with MTN ranged between 91.1% (diagnosis, 95% CI, 84.2-94.0) and 30% (repercussion in viscera, 95% CI, 25.4-34.6). Objectives in three MTN were reached (diagnosis, history and EKG). LQAS: no MTN was accepted in all the PCTs, being the most accepted (42 PCT, 95.6%) and the least accepted (24 PCT, 55.6%). In 9 PCT all were accepted (20.4%), and in 2 none were accepted (4.5%). Data were analysed through Pareto charts. Classic methodology offered accurate results, but did not identify which centres were those that did not comply (general focus). LQAS was preferable for evaluating MTN and probably coverage because: 1) it uses small samples, which foment internal quality-improvement initiatives; 2) it is easy and rapid to execute; 3) it identifies the PCT and criteria where there is an opportunity for improvement (specific focus), and 4) it can be used operatively for monitoring.

  1. Improved mesh based photon sampling techniques for neutron activation analysis

    International Nuclear Information System (INIS)

    Relson, E.; Wilson, P. P. H.; Biondo, E. D.

    2013-01-01

    The design of fusion power systems requires analysis of neutron activation of large, complex volumes, and the resulting particles emitted from these volumes. Structured mesh-based discretization of these problems allows for improved modeling in these activation analysis problems. Finer discretization of these problems results in large computational costs, which drives the investigation of more efficient methods. Within an ad hoc subroutine of the Monte Carlo transport code MCNP, we implement sampling of voxels and photon energies for volumetric sources using the alias method. The alias method enables efficient sampling of a discrete probability distribution, and operates in 0(1) time, whereas the simpler direct discrete method requires 0(log(n)) time. By using the alias method, voxel sampling becomes a viable alternative to sampling space with the 0(1) approach of uniformly sampling the problem volume. Additionally, with voxel sampling it is straightforward to introduce biasing of volumetric sources, and we implement this biasing of voxels as an additional variance reduction technique that can be applied. We verify our implementation and compare the alias method, with and without biasing, to direct discrete sampling of voxels, and to uniform sampling. We study the behavior of source biasing in a second set of tests and find trends between improvements and source shape, material, and material density. Overall, however, the magnitude of improvements from source biasing appears to be limited. Future work will benefit from the implementation of efficient voxel sampling - particularly with conformal unstructured meshes where the uniform sampling approach cannot be applied. (authors)

  2. Theory of sampling and its application in tissue based diagnosis

    Directory of Open Access Journals (Sweden)

    Kayser Gian

    2009-02-01

    Full Text Available Abstract Background A general theory of sampling and its application in tissue based diagnosis is presented. Sampling is defined as extraction of information from certain limited spaces and its transformation into a statement or measure that is valid for the entire (reference space. The procedure should be reproducible in time and space, i.e. give the same results when applied under similar circumstances. Sampling includes two different aspects, the procedure of sample selection and the efficiency of its performance. The practical performance of sample selection focuses on search for localization of specific compartments within the basic space, and search for presence of specific compartments. Methods When a sampling procedure is applied in diagnostic processes two different procedures can be distinguished: I the evaluation of a diagnostic significance of a certain object, which is the probability that the object can be grouped into a certain diagnosis, and II the probability to detect these basic units. Sampling can be performed without or with external knowledge, such as size of searched objects, neighbourhood conditions, spatial distribution of objects, etc. If the sample size is much larger than the object size, the application of a translation invariant transformation results in Kriege's formula, which is widely used in search for ores. Usually, sampling is performed in a series of area (space selections of identical size. The size can be defined in relation to the reference space or according to interspatial relationship. The first method is called random sampling, the second stratified sampling. Results Random sampling does not require knowledge about the reference space, and is used to estimate the number and size of objects. Estimated features include area (volume fraction, numerical, boundary and surface densities. Stratified sampling requires the knowledge of objects (and their features and evaluates spatial features in relation to

  3. Contingency inferences driven by base rates: Valid by sampling

    Directory of Open Access Journals (Sweden)

    Florian Kutzner

    2011-04-01

    Full Text Available Fiedler et al. (2009, reviewed evidence for the utilization of a contingency inference strategy termed pseudocontingencies (PCs. In PCs, the more frequent levels (and, by implication, the less frequent levels are assumed to be associated. PCs have been obtained using a wide range of task settings and dependent measures. Yet, the readiness with which decision makers rely on PCs is poorly understood. A computer simulation explored two potential sources of subjective validity of PCs. First, PCs are shown to perform above chance level when the task is to infer the sign of moderate to strong population contingencies from a sample of observations. Second, contingency inferences based on PCs and inferences based on cell frequencies are shown to partially agree across samples. Intriguingly, this criterion and convergent validity are by-products of random sampling error, highlighting the inductive nature of contingency inferences.

  4. Community-based survey versus sentinel site sampling in ...

    African Journals Online (AJOL)

    rural children. Implications for nutritional surveillance and the development of nutritional programmes. G. c. Solarsh, D. M. Sanders, C. A. Gibson, E. Gouws. A study of the anthropometric status of under-5-year-olds was conducted in the Nqutu district of Kwazulu by means of a representative community-based sample and.

  5. A sampling-based approach to probabilistic pursuit evasion

    KAUST Repository

    Mahadevan, Aditya

    2012-05-01

    Probabilistic roadmaps (PRMs) are a sampling-based approach to motion-planning that encodes feasible paths through the environment using a graph created from a subset of valid positions. Prior research has shown that PRMs can be augmented with useful information to model interesting scenarios related to multi-agent interaction and coordination. © 2012 IEEE.

  6. Sampling

    CERN Document Server

    Thompson, Steven K

    2012-01-01

    Praise for the Second Edition "This book has never had a competitor. It is the only book that takes a broad approach to sampling . . . any good personal statistics library should include a copy of this book." —Technometrics "Well-written . . . an excellent book on an important subject. Highly recommended." —Choice "An ideal reference for scientific researchers and other professionals who use sampling." —Zentralblatt Math Features new developments in the field combined with all aspects of obtaining, interpreting, and using sample data Sampling provides an up-to-date treat

  7. Is Team-Based Primary Care Associated with Less Access Problems and Self-Reported Unmet Need in Canada?

    Science.gov (United States)

    Zygmunt, Austin; Asada, Yukiko; Burge, Frederick

    2017-10-01

    As in many jurisdictions, the delivery of primary care in Canada is being transformed from solo practice to team-based care. In Canada, team-based primary care involves general practitioners working with nurses or other health care providers, and it is expected to improve equity in access to care. This study examined whether team-based care is associated with fewer access problems and less unmet need and whether socioeconomic gradients in access problems and unmet need are smaller in team-based care than in non-team-based care. Data came from the 2008 Canadian Survey of Experiences with Primary Health Care (sample size: 10,858). We measured primary care type as team-based or non-team-based and socioeconomic status by income and education. We created four access problem variables and four unmet need variables (overall and three specific components). For each, we ran separate logistic regression models to examine their associations with primary care type. We examined socioeconomic gradients in access problems and unmet need stratified by primary care type. Primary care type had no statistically significant, independent associations with access problems or unmet need. Among those with non-team-based care, a statistically significant education gradient for overall access problems existed, whereas among those with team-based care, no statistically significant socioeconomic gradients existed.

  8. Sample size calculation to externally validate scoring systems based on logistic regression models.

    Directory of Open Access Journals (Sweden)

    Antonio Palazón-Bru

    Full Text Available A sample size containing at least 100 events and 100 non-events has been suggested to validate a predictive model, regardless of the model being validated and that certain factors can influence calibration of the predictive model (discrimination, parameterization and incidence. Scoring systems based on binary logistic regression models are a specific type of predictive model.The aim of this study was to develop an algorithm to determine the sample size for validating a scoring system based on a binary logistic regression model and to apply it to a case study.The algorithm was based on bootstrap samples in which the area under the ROC curve, the observed event probabilities through smooth curves, and a measure to determine the lack of calibration (estimated calibration index were calculated. To illustrate its use for interested researchers, the algorithm was applied to a scoring system, based on a binary logistic regression model, to determine mortality in intensive care units.In the case study provided, the algorithm obtained a sample size with 69 events, which is lower than the value suggested in the literature.An algorithm is provided for finding the appropriate sample size to validate scoring systems based on binary logistic regression models. This could be applied to determine the sample size in other similar cases.

  9. Water, sanitation and hygiene in community based care ...

    African Journals Online (AJOL)

    Majority of the HIV/AIDS patients in South Africa receive health care services at home. However, limited studies have been conducted to examine the water, sanitation and hygiene (WASH) situation in the homes of the care receivers and its impact on community-based care. The main objective of this study was to explore ...

  10. Research on test of product based on spatial sampling criteria and variable step sampling mechanism

    Science.gov (United States)

    Li, Ruihong; Han, Yueping

    2014-09-01

    This paper presents an effective approach for online testing the assembly structures inside products using multiple views technique and X-ray digital radiography system based on spatial sampling criteria and variable step sampling mechanism. Although there are some objects inside one product to be tested, there must be a maximal rotary step for an object within which the least structural size to be tested is predictable. In offline learning process, Rotating the object by the step and imaging it and so on until a complete cycle is completed, an image sequence is obtained that includes the full structural information for recognition. The maximal rotary step is restricted by the least structural size and the inherent resolution of the imaging system. During online inspection process, the program firstly finds the optimum solutions to all different target parts in the standard sequence, i.e., finds their exact angles in one cycle. Aiming at the issue of most sizes of other targets in product are larger than that of the least structure, the paper adopts variable step-size sampling mechanism to rotate the product specific angles with different steps according to different objects inside the product and match. Experimental results show that the variable step-size method can greatly save time compared with the traditional fixed-step inspection method while the recognition accuracy is guaranteed.

  11. The Effect of Community-Based Specialist Palliative Care Teams on Place of Care.

    Science.gov (United States)

    Seow, Hsien; Dhaliwal, Gagan; Fassbender, Konrad; Rangrej, Jagadish; Brazil, Kevin; Fainsinger, Robin

    2016-01-01

    Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death. The study objective was to examine the place of care in the last 30 days of life. In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort. After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p care. Examining place of care in the last month can effectively illustrate the service use trajectory over time.

  12. Team-based primary care: The medical assistant perspective.

    Science.gov (United States)

    Sheridan, Bethany; Chien, Alyna T; Peters, Antoinette S; Rosenthal, Meredith B; Brooks, Joanna Veazey; Singer, Sara J

    Team-based care has the potential to improve primary care quality and efficiency. In this model, medical assistants (MAs) take a more central role in patient care and population health management. MAs' traditionally low status may give them a unique view on changing organizational dynamics and teamwork. However, little empirical work exists on how team-based organizational designs affect the experiences of low-status health care workers like MAs. The aim of this study was to describe how team-based primary care affects the experiences of MAs. A secondary aim was to explore variation in these experiences. In late 2014, the authors interviewed 30 MAs from nine primary care practices transitioning to team-based care. Interviews addressed job responsibilities, teamwork, implementation, job satisfaction, and learning. Data were analyzed using a thematic networks approach. Interviews also included closed-ended questions about workload and job satisfaction. Most MAs reported both a higher workload (73%) and a greater job satisfaction (86%) under team-based primary care. Interview data surfaced four mechanisms for these results, which suggested more fulfilling work and greater respect for the MA role: (a) relationships with colleagues, (b) involvement with patients, (c) sense of control, and (d) sense of efficacy. Facilitators and barriers to these positive changes also emerged. Team-based care can provide low-status health care workers with more fulfilling work and strengthen relationships across status lines. The extent of this positive impact may depend on supporting factors at the organization, team, and individual worker levels. To maximize the benefits of team-based care, primary care leaders should recognize the larger role that MAs play under this model and support them as increasingly valuable team members. Contingent on organizational conditions, practices may find MAs who are willing to manage the increased workload that often accompanies team-based care.

  13. A dashboard-based system for supporting diabetes care.

    Science.gov (United States)

    Dagliati, Arianna; Sacchi, Lucia; Tibollo, Valentina; Cogni, Giulia; Teliti, Marsida; Martinez-Millana, Antonio; Traver, Vicente; Segagni, Daniele; Posada, Jorge; Ottaviano, Manuel; Fico, Giuseppe; Arredondo, Maria Teresa; De Cata, Pasquale; Chiovato, Luca; Bellazzi, Riccardo

    2018-05-01

    To describe the development, as part of the European Union MOSAIC (Models and Simulation Techniques for Discovering Diabetes Influence Factors) project, of a dashboard-based system for the management of type 2 diabetes and assess its impact on clinical practice. The MOSAIC dashboard system is based on predictive modeling, longitudinal data analytics, and the reuse and integration of data from hospitals and public health repositories. Data are merged into an i2b2 data warehouse, which feeds a set of advanced temporal analytic models, including temporal abstractions, care-flow mining, drug exposure pattern detection, and risk-prediction models for type 2 diabetes complications. The dashboard has 2 components, designed for (1) clinical decision support during follow-up consultations and (2) outcome assessment on populations of interest. To assess the impact of the clinical decision support component, a pre-post study was conducted considering visit duration, number of screening examinations, and lifestyle interventions. A pilot sample of 700 Italian patients was investigated. Judgments on the outcome assessment component were obtained via focus groups with clinicians and health care managers. The use of the decision support component in clinical activities produced a reduction in visit duration (P ≪ .01) and an increase in the number of screening exams for complications (P < .01). We also observed a relevant, although nonstatistically significant, increase in the proportion of patients receiving lifestyle interventions (from 69% to 77%). Regarding the outcome assessment component, focus groups highlighted the system's capability of identifying and understanding the characteristics of patient subgroups treated at the center. Our study demonstrates that decision support tools based on the integration of multiple-source data and visual and predictive analytics do improve the management of a chronic disease such as type 2 diabetes by enacting a successful

  14. Using Community-Based Participatory Research to Investigate Meaningful Prenatal Care Among African American Women.

    Science.gov (United States)

    Nypaver, Cynthia F; Shambley-Ebron, Donna

    2016-11-01

    In the United States, African American babies die more than twice as often as White babies. The cause for this difference remains elusive, yet is likely complex with one factor being inadequate cultural care of pregnant African American women. The purpose of this study was to explore African American women's perspectives of meaningful prenatal care. Community-based participatory research was employed for this study using photovoice. The sample included 11 African American mothers in an urban community in Midwestern United States. Five themes were abstracted from the data: (1) Access to Care; (2) Soul Nourishment; (3) Companionship; (4) Help Me, Teach Me; and (5) The Future. Meaningful prenatal care is influenced by culture. African American women need physical, social, and soulful support to enhance meaningfulness of care during pregnancy. The findings support that meaningfulness of prenatal care for African American women may be enhanced by accessible and uniquely designed, culturally congruent models of prenatal care. © The Author(s) 2015.

  15. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

    2016-01-01

    Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2......, and monitoring delivered by medical assistants with usual care. Measurements: All-cause hospitalizations at 12 months (primary outcome) and quality of life scores (Short Form 12 Health Questionnaire [SF-12] and the Euroqol instrument [EQ-5D]). Results: Included patients had, on average, four co-occurring chronic...

  16. Implementing Evidenced Based Oral Care for Critically Ill Patients

    Science.gov (United States)

    2016-02-28

    practice . In G. LoBiondo-Wood & J Haber (Eds.), Nursing Research (5th ed.). St. Louis: Mosby-Year Book , Inc. 5. Titler, M., & Everett, L. (2001...determined if an evidence-based oral care program resulted in increased nurses’ knowledge and improved oral care practices compliance. Design: The project...process, and project specific oral care evidence-based practice instruction. Knowledge evaluations were conducted at three time points: before, immediately

  17. Using machine learning to accelerate sampling-based inversion

    Science.gov (United States)

    Valentine, A. P.; Sambridge, M.

    2017-12-01

    In most cases, a complete solution to a geophysical inverse problem (including robust understanding of the uncertainties associated with the result) requires a sampling-based approach. However, the computational burden is high, and proves intractable for many problems of interest. There is therefore considerable value in developing techniques that can accelerate sampling procedures.The main computational cost lies in evaluation of the forward operator (e.g. calculation of synthetic seismograms) for each candidate model. Modern machine learning techniques-such as Gaussian Processes-offer a route for constructing a computationally-cheap approximation to this calculation, which can replace the accurate solution during sampling. Importantly, the accuracy of the approximation can be refined as inversion proceeds, to ensure high-quality results.In this presentation, we describe and demonstrate this approach-which can be seen as an extension of popular current methods, such as the Neighbourhood Algorithm, and bridges the gap between prior- and posterior-sampling frameworks.

  18. Patch-based visual tracking with online representative sample selection

    Science.gov (United States)

    Ou, Weihua; Yuan, Di; Li, Donghao; Liu, Bin; Xia, Daoxun; Zeng, Wu

    2017-05-01

    Occlusion is one of the most challenging problems in visual object tracking. Recently, a lot of discriminative methods have been proposed to deal with this problem. For the discriminative methods, it is difficult to select the representative samples for the target template updating. In general, the holistic bounding boxes that contain tracked results are selected as the positive samples. However, when the objects are occluded, this simple strategy easily introduces the noises into the training data set and the target template and then leads the tracker to drift away from the target seriously. To address this problem, we propose a robust patch-based visual tracker with online representative sample selection. Different from previous works, we divide the object and the candidates into several patches uniformly and propose a score function to calculate the score of each patch independently. Then, the average score is adopted to determine the optimal candidate. Finally, we utilize the non-negative least square method to find the representative samples, which are used to update the target template. The experimental results on the object tracking benchmark 2013 and on the 13 challenging sequences show that the proposed method is robust to the occlusion and achieves promising results.

  19. The RBANS Effort Index: base rates in geriatric samples.

    Science.gov (United States)

    Duff, Kevin; Spering, Cynthia C; O'Bryant, Sid E; Beglinger, Leigh J; Moser, David J; Bayless, John D; Culp, Kennith R; Mold, James W; Adams, Russell L; Scott, James G

    2011-01-01

    The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.

  20. Ultrasonic-based membrane aided sample preparation of urine proteomes.

    Science.gov (United States)

    Jesus, Jemmyson Romário; Santos, Hugo M; López-Fernández, H; Lodeiro, Carlos; Arruda, Marco Aurélio Zezzi; Capelo, J L

    2018-02-01

    A new ultrafast ultrasonic-based method for shotgun proteomics as well as label-free protein quantification in urine samples is developed. The method first separates the urine proteins using nitrocellulose-based membranes and then proteins are in-membrane digested using trypsin. The enzymatic digestion process is accelerated from overnight to four minutes using a sonoreactor ultrasonic device. Overall, the sample treatment pipeline comprising protein separation, digestion and identification is done in just 3h. The process is assessed using urine of healthy volunteers. The method shows that male can be differentiated from female using the protein content of urine in a fast, easy and straightforward way. 232 and 226 proteins are identified in urine of male and female, respectively. From this, 162 are common to both genders, whilst 70 are unique to male and 64 to female. From the 162 common proteins, 13 are present at levels statistically different (p minimalism concept as outlined by Halls, as each stage of this analysis is evaluated to minimize the time, cost, sample requirement, reagent consumption, energy requirements and production of waste products. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study.

    Science.gov (United States)

    Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

    2016-02-01

    Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

  2. Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland

    Directory of Open Access Journals (Sweden)

    Bailey Kerry A

    2010-08-01

    Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.

  3. Prenatal Care: A Content-Based ESL Curriculum.

    Science.gov (United States)

    Hassel, Elissa Anne

    A content-based curriculum in English as a Second Language (ESL) focusing on prenatal self-care is presented. The course was designed as a solution to the problem of inadequate prenatal care for limited-English-proficient Mexican immigrant women. The first three sections offer background information on and discussion of (1) content-based ESL…

  4. Understanding the agency of home-based care volunteers ...

    African Journals Online (AJOL)

    In traditional Zulu communities, caregiving is rooted in compassionate and hardworking personal identity precepts and the traditional identity expectations of women. Home-based-care volunteerism in the community represents the performance of this identity. Data from a series of interviews with 15 home-based care ...

  5. GENERALISED MODEL BASED CONFIDENCE INTERVALS IN TWO STAGE CLUSTER SAMPLING

    Directory of Open Access Journals (Sweden)

    Christopher Ouma Onyango

    2010-09-01

    Full Text Available Chambers and Dorfman (2002 constructed bootstrap confidence intervals in model based estimation for finite population totals assuming that auxiliary values are available throughout a target population and that the auxiliary values are independent. They also assumed that the cluster sizes are known throughout the target population. We now extend to two stage sampling in which the cluster sizes are known only for the sampled clusters, and we therefore predict the unobserved part of the population total. Jan and Elinor (2008 have done similar work, but unlike them, we use a general model, in which the auxiliary values are not necessarily independent. We demonstrate that the asymptotic properties of our proposed estimator and its coverage rates are better than those constructed under the model assisted local polynomial regression model.

  6. Receipt of Post-Rape Medical Care in a National Sample of Female Victims

    Science.gov (United States)

    Zinzow, Heidi M.; Resnick, Heidi S.; Barr, Simone C.; Danielson, Carla K.; Kilpatrick, Dean G.

    2014-01-01

    Background It is important for rape victims to receive medical care to prevent and treat rape-related diseases and injuries, access forensic exams, and connect to needed resources. Few victims seek care, and factors associated with post-rape medical care–seeking are poorly understood. Purpose The current study examined prevalence and factors associated with post-rape medical care–seeking in a national sample of women who reported a most-recent or only incident of forcible rape, and drug- or alcohol-facilitated/incapacitated rape when they were aged ≥14 years. Methods A national sample of U.S. adult women (N=3001) completed structured telephone interviews in 2006, and data for this study were analyzed in 2011. Logistic regression analyses examined demographic variables, health, rape characteristics, and post-rape concerns in relation to post-rape medical care–seeking among 445 female rape victims. Results A minority of rape victims (21%) sought post-rape medical attention following the incident. In the final multivariate model, correlates of medical care included black race, rape-related injury, concerns about sexually transmitted diseases, pregnancy concerns, and reporting the incident to police. Conclusions Women who experience rapes consistent with stereotypic scenarios, acknowledge the rape, report the rape, and harbor health concerns appear to be more likely to seek post-rape medical services. Education is needed to increase rape acknowledgment, awareness of post-rape services that do not require formal reporting, and recognition of the need to treat rape-related health problems. PMID:22813683

  7. Integrating evidence-based interventions into client care plans.

    Science.gov (United States)

    Doran, Diane; Carryer, Jennifer; Paterson, Jane; Goering, Paula; Nagle, Lynn; Kushniruk, Andre; Bajnok, Irmajean; Clark, Carrie; Srivastava, Rani

    2009-01-01

    Within the mental health care system, there is an opportunity to improve patient safety and the overall quality of care by integrating clinical practice guidelines with the care planning process through the use of information technology. Electronic assessment tools such as the Resident Assessment Inventory - Mental Health (RAI-MH) are widely used to identify the health care needs and outcomes of clients. In this knowledge translation initiative, an electronic care planning tool was enhanced to include evidence-based clinical interventions from schizophrenia guidelines. This paper describes the development of a mental health decision support prototype, a field test by clinicians, and user experiences with the application.

  8. Sample-Based Extreme Learning Machine with Missing Data

    Directory of Open Access Journals (Sweden)

    Hang Gao

    2015-01-01

    Full Text Available Extreme learning machine (ELM has been extensively studied in machine learning community during the last few decades due to its high efficiency and the unification of classification, regression, and so forth. Though bearing such merits, existing ELM algorithms cannot efficiently handle the issue of missing data, which is relatively common in practical applications. The problem of missing data is commonly handled by imputation (i.e., replacing missing values with substituted values according to available information. However, imputation methods are not always effective. In this paper, we propose a sample-based learning framework to address this issue. Based on this framework, we develop two sample-based ELM algorithms for classification and regression, respectively. Comprehensive experiments have been conducted in synthetic data sets, UCI benchmark data sets, and a real world fingerprint image data set. As indicated, without introducing extra computational complexity, the proposed algorithms do more accurate and stable learning than other state-of-the-art ones, especially in the case of higher missing ratio.

  9. Precarious Situations of Care Workers in Home-Based Elder Care in Slovenia.

    Science.gov (United States)

    Hrženjak, Majda

    2018-02-01

    Based on policy analysis and individual interviews, the author analyzes the care workers' precarious situations in home-based elder care in Slovenia, a post-socialist, European Union country characterized by a rapidly aging population and delays in adapting a long-term care system to this new social risk. Employment and quasi-employment positions which coexist in home-based care can be sorted along two continuums: between public and market service; between formal and informal work. The author argues that working conditions in home-based care differ according to the position of the care worker on these two continuums, that is, being employed in public services, being self-employed, working in informal care markets, holding a status of family assistant, or being an informal family caregiver. Although the working conditions in public services are deteriorating, the analysis shows that precarity is more severe in market and informal care, while formalization and socialization of care bring about less precarious conditions.

  10. CdTe detector based PIXE mapping of geological samples

    Energy Technology Data Exchange (ETDEWEB)

    Chaves, P.C., E-mail: cchaves@ctn.ist.utl.pt [Centro de Física Atómica da Universidade de Lisboa, Av. Prof. Gama Pinto 2, 1649-003 Lisboa (Portugal); IST/ITN, Instituto Superior Técnico, Universidade Técnica de Lisboa, Campus Tecnológico e Nuclear, EN10, 2686-953 Sacavém (Portugal); Taborda, A. [Centro de Física Atómica da Universidade de Lisboa, Av. Prof. Gama Pinto 2, 1649-003 Lisboa (Portugal); IST/ITN, Instituto Superior Técnico, Universidade Técnica de Lisboa, Campus Tecnológico e Nuclear, EN10, 2686-953 Sacavém (Portugal); Oliveira, D.P.S. de [Laboratório Nacional de Energia e Geologia (LNEG), Apartado 7586, 2611-901 Alfragide (Portugal); Reis, M.A. [Centro de Física Atómica da Universidade de Lisboa, Av. Prof. Gama Pinto 2, 1649-003 Lisboa (Portugal); IST/ITN, Instituto Superior Técnico, Universidade Técnica de Lisboa, Campus Tecnológico e Nuclear, EN10, 2686-953 Sacavém (Portugal)

    2014-01-01

    A sample collected from a borehole drilled approximately 10 km ESE of Bragança, Trás-os-Montes, was analysed by standard and high energy PIXE at both CTN (previous ITN) PIXE setups. The sample is a fine-grained metapyroxenite grading to coarse-grained in the base with disseminated sulphides and fine veinlets of pyrrhotite and pyrite. Matrix composition was obtained at the standard PIXE setup using a 1.25 MeV H{sup +} beam at three different spots. Medium and high Z elemental concentrations were then determined using the DT2fit and DT2simul codes (Reis et al., 2008, 2013 [1,2]), on the spectra obtained in the High Resolution and High Energy (HRHE)-PIXE setup (Chaves et al., 2013 [3]) by irradiation of the sample with a 3.8 MeV proton beam provided by the CTN 3 MV Tandetron accelerator. In this paper we present results, discuss detection limits of the method and the added value of the use of the CdTe detector in this context.

  11. Chemometric classification of casework arson samples based on gasoline content.

    Science.gov (United States)

    Sinkov, Nikolai A; Sandercock, P Mark L; Harynuk, James J

    2014-02-01

    Detection and identification of ignitable liquids (ILs) in arson debris is a critical part of arson investigations. The challenge of this task is due to the complex and unpredictable chemical nature of arson debris, which also contains pyrolysis products from the fire. ILs, most commonly gasoline, are complex chemical mixtures containing hundreds of compounds that will be consumed or otherwise weathered by the fire to varying extents depending on factors such as temperature, air flow, the surface on which IL was placed, etc. While methods such as ASTM E-1618 are effective, data interpretation can be a costly bottleneck in the analytical process for some laboratories. In this study, we address this issue through the application of chemometric tools. Prior to the application of chemometric tools such as PLS-DA and SIMCA, issues of chromatographic alignment and variable selection need to be addressed. Here we use an alignment strategy based on a ladder consisting of perdeuterated n-alkanes. Variable selection and model optimization was automated using a hybrid backward elimination (BE) and forward selection (FS) approach guided by the cluster resolution (CR) metric. In this work, we demonstrate the automated construction, optimization, and application of chemometric tools to casework arson data. The resulting PLS-DA and SIMCA classification models, trained with 165 training set samples, have provided classification of 55 validation set samples based on gasoline content with 100% specificity and sensitivity. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Comparison of Methods of Sampling for Toxocara Species and Fecal Coliforms in an Outdoor Day Care Environment

    Directory of Open Access Journals (Sweden)

    Hélène Carabin

    1998-01-01

    Full Text Available OBJECTIVE: To compare three sampling methods and to pretest methods for the determination of fecal coliform (FC counts and Toxocara species from sand in the day care outdoor environment.

  13. Older people--recipients but also providers of informal care: an analysis among community samples in the Republic of Ireland and Northern Ireland.

    LENUS (Irish Health Repository)

    McGee, Hannah M

    2008-09-01

    Data on both the provision and receipt of informal care among populations of older adults are limited. Patterns of both informal care provided and received by older adults in the Republic of Ireland (RoI) and Northern Ireland (NI) were evaluated. A cross-sectional community-based population survey was conducted. Randomly selected older people (aged 65+, n = 2033, mean age (standard deviation): 74.1 years (6.8), 43% men, 68% response rate) provided information on the provision and receipt of care, its location, and the person(s) who provided the care. Twelve per cent of the sample (251\\/2033) identified themselves as informal caregivers (8% RoI and 17% NI). Caregivers were more likely to be women, married, have less education and have less functional impairment. Forty-nine per cent (1033\\/2033, 49% RoI and 48% NI) reported receiving some form of care in the past year. Care recipients were more likely to be older, married, have more functional impairment, and poorer self-rated health. Receiving regular informal care (help at least once a week) from a non-resident relative was the most common form of help received [28% overall (578\\/2033); 27% RoI and 30% NI]. Five per cent (n = 102\\/2033) of the sample reported both providing and receiving informal care. Levels of informal care provided by community-dwelling older adults were notably higher than reported in single-item national census questions. The balance of formal and informal health and social care will become increasingly important as populations age. It is essential, therefore, to evaluate factors facilitating or impeding informal care delivery.

  14. Solution-based targeted genomic enrichment for precious DNA samples

    Directory of Open Access Journals (Sweden)

    Shearer Aiden

    2012-05-01

    Full Text Available Abstract Background Solution-based targeted genomic enrichment (TGE protocols permit selective sequencing of genomic regions of interest on a massively parallel scale. These protocols could be improved by: 1 modifying or eliminating time consuming steps; 2 increasing yield to reduce input DNA and excessive PCR cycling; and 3 enhancing reproducible. Results We developed a solution-based TGE method for downstream Illumina sequencing in a non-automated workflow, adding standard Illumina barcode indexes during the post-hybridization amplification to allow for sample pooling prior to sequencing. The method utilizes Agilent SureSelect baits, primers and hybridization reagents for the capture, off-the-shelf reagents for the library preparation steps, and adaptor oligonucleotides for Illumina paired-end sequencing purchased directly from an oligonucleotide manufacturing company. Conclusions This solution-based TGE method for Illumina sequencing is optimized for small- or medium-sized laboratories and addresses the weaknesses of standard protocols by reducing the amount of input DNA required, increasing capture yield, optimizing efficiency, and improving reproducibility.

  15. water, sanitation and hygiene in community- based care

    African Journals Online (AJOL)

    PUBLICATIONS1

    in home-based care and the implications on people living with HIV/AIDS/TB, their ... Data was collected using participant observation of care-giving activities; ... this affects the work of CHW. ..... Using water and sanitation as an entry point.

  16. Preview-based sampling for controlling gaseous simulations

    KAUST Repository

    Huang, Ruoguan

    2011-01-01

    In this work, we describe an automated method for directing the control of a high resolution gaseous fluid simulation based on the results of a lower resolution preview simulation. Small variations in accuracy between low and high resolution grids can lead to divergent simulations, which is problematic for those wanting to achieve a desired behavior. Our goal is to provide a simple method for ensuring that the high resolution simulation matches key properties from the lower resolution simulation. We first let a user specify a fast, coarse simulation that will be used for guidance. Our automated method samples the data to be matched at various positions and scales in the simulation, or allows the user to identify key portions of the simulation to maintain. During the high resolution simulation, a matching process ensures that the properties sampled from the low resolution simulation are maintained. This matching process keeps the different resolution simulations aligned even for complex systems, and can ensure consistency of not only the velocity field, but also advected scalar values. Because the final simulation is naturally similar to the preview simulation, only minor controlling adjustments are needed, allowing a simpler control method than that used in prior keyframing approaches. Copyright © 2011 by the Association for Computing Machinery, Inc.

  17. Nanotechnology-Based Cosmetics for Hair Care

    Directory of Open Access Journals (Sweden)

    Jamie Rosen

    2015-07-01

    Full Text Available Hair is a significant indicator of health and can have a major impact on an individual’s cosmetic appearance. Research within the cosmetics industry has revealed that when nanomaterials are engineered into hair care, they can enhance the benefits of active ingredients in order to improve hair cosmesis. Within the cosmetics arena, the unique size and intrinsic properties of nanoparticles can be tailored to target the hair follicle and shaft. This review aims to provide an overview of cosmetic nanocarriers that can be employed to improve the appearance of hair.

  18. Value Based Care and Patient-Centered Care: Divergent or Complementary?

    Science.gov (United States)

    Tseng, Eric K; Hicks, Lisa K

    2016-08-01

    Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.

  19. Quantum Ensemble Classification: A Sampling-Based Learning Control Approach.

    Science.gov (United States)

    Chen, Chunlin; Dong, Daoyi; Qi, Bo; Petersen, Ian R; Rabitz, Herschel

    2017-06-01

    Quantum ensemble classification (QEC) has significant applications in discrimination of atoms (or molecules), separation of isotopes, and quantum information extraction. However, quantum mechanics forbids deterministic discrimination among nonorthogonal states. The classification of inhomogeneous quantum ensembles is very challenging, since there exist variations in the parameters characterizing the members within different classes. In this paper, we recast QEC as a supervised quantum learning problem. A systematic classification methodology is presented by using a sampling-based learning control (SLC) approach for quantum discrimination. The classification task is accomplished via simultaneously steering members belonging to different classes to their corresponding target states (e.g., mutually orthogonal states). First, a new discrimination method is proposed for two similar quantum systems. Then, an SLC method is presented for QEC. Numerical results demonstrate the effectiveness of the proposed approach for the binary classification of two-level quantum ensembles and the multiclass classification of multilevel quantum ensembles.

  20. Soil classification basing on the spectral characteristics of topsoil samples

    Science.gov (United States)

    Liu, Huanjun; Zhang, Xiaokang; Zhang, Xinle

    2016-04-01

    Soil taxonomy plays an important role in soil utility and management, but China has only course soil map created based on 1980s data. New technology, e.g. spectroscopy, could simplify soil classification. The study try to classify soils basing on the spectral characteristics of topsoil samples. 148 topsoil samples of typical soils, including Black soil, Chernozem, Blown soil and Meadow soil, were collected from Songnen plain, Northeast China, and the room spectral reflectance in the visible and near infrared region (400-2500 nm) were processed with weighted moving average, resampling technique, and continuum removal. Spectral indices were extracted from soil spectral characteristics, including the second absorption positions of spectral curve, the first absorption vale's area, and slope of spectral curve at 500-600 nm and 1340-1360 nm. Then K-means clustering and decision tree were used respectively to build soil classification model. The results indicated that 1) the second absorption positions of Black soil and Chernozem were located at 610 nm and 650 nm respectively; 2) the spectral curve of the meadow is similar to its adjacent soil, which could be due to soil erosion; 3) decision tree model showed higher classification accuracy, and accuracy of Black soil, Chernozem, Blown soil and Meadow are 100%, 88%, 97%, 50% respectively, and the accuracy of Blown soil could be increased to 100% by adding one more spectral index (the first two vole's area) to the model, which showed that the model could be used for soil classification and soil map in near future.

  1. The functions of hospital-based home care for people with severe mental illness in Taiwan.

    Science.gov (United States)

    Huang, Xuan-Yi; Lin, Mei-Jue; Yang, Tuz-Ching; Hsu, Yuan-Shan

    2010-02-01

    The purposes of this study were to understand the functions of hospital-based home care for people with severe mental illness in Taiwan, and the factors that affect functions of professionals who provide hospital-based home care. Hospital-based home care is a service which provides those people with serious mental illnesses who are in crisis and who are candidates for admission to hospital. Home care has been shown to have several advantages over inpatient treatment. However, there is a lack of knowledge about the functions of hospital-based home care for people with severe mental illness in Taiwan. This qualitative study was based on the grounded theory method of Strauss and Corbin. The study was conducted in six different hospital areas in central Taiwan in 2007-2008. Data were collected using semi-structured face-to-face interviews. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected by theoretical sampling. When theoretical saturation was achieved, 21 clients with mental illness, 19 carers and 25 professionals were interviewed. Several functions were found when these professionals provided hospital-based home care services for people with severe mental illness in Taiwan, including stabilising the clients illness, supplying emergency care services, improving life-coping abilities, employment and welfare assistance, emotional support for both clients and carers, assistance with future and long-term arrangements and assistance with communication between carers and clients. Hospital-based home care provides several important services for helping clients and their families to live in the community. The recommendations based on the findings of this study can be used as a guide to improve the delivery of hospital-based home care services to community-dwelling clients with severe mental illness and their carers.

  2. Development of a hospital-based care coordination program for children with special health care needs.

    Science.gov (United States)

    Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten

    2013-01-01

    A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  3. Design-based Sample and Probability Law-Assumed Sample: Their Role in Scientific Investigation.

    Science.gov (United States)

    Ojeda, Mario Miguel; Sahai, Hardeo

    2002-01-01

    Discusses some key statistical concepts in probabilistic and non-probabilistic sampling to provide an overview for understanding the inference process. Suggests a statistical model constituting the basis of statistical inference and provides a brief review of the finite population descriptive inference and a quota sampling inferential theory.…

  4. Effects of home-based long-term care services on caregiver health according to age.

    Science.gov (United States)

    Chen, Ming-Chun; Kao, Chi-Wen; Chiu, Yu-Lung; Lin, Tzu-Ying; Tsai, Yu-Ting; Jian, Yi-Ting Zhang; Tzeng, Ya-Mei; Lin, Fu-Gong; Hwang, Shu-Ling; Li, Shan-Ru; Kao, Senyeong

    2017-10-23

    Caregiver health is a crucial public health concern due to the increasing number of elderly people with disabilities. Elderly caregivers are more likely to have poorer health and be a care recipient than younger caregivers. The Taiwan government offers home-based long-term care (LTC) services to provide formal care and decrease the burden of caregivers. This study examined the effects of home-based LTC services on caregiver health according to caregiver age. This cross-sectional study included a simple random sample of care recipients and their caregivers. The care recipients had used LTC services under the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. Data were collected through self-administered questionnaires from September 2012 to January 2013. The following variables were assessed for caregivers: health, sex, marital status, education level, relationship with care recipient, quality of relationship with care recipient, job, household monthly income, family income spent on caring for the care recipient (%) and caregiving period. Furthermore, the following factors were assessed for care recipients: age, sex, marital status, education level, living alone, number of family members living with the care recipient, quality of relationship with family and dependency level. The health of the caregivers and care recipients was measured using a self-rated question (self-rated health [SRH] was rated as very poor, poor, fair, good and very good). The study revealed that home nursing care was significantly associated with the health of caregivers aged 65 years or older; however, caregivers aged less than 65 who had used home nursing care, rehabilitation or respite care had poorer health than those who had not used these services. In addition, the following variables significantly improved the health of caregivers aged 65 years or older: caregiver employment, 20% or less of family income spent on caregiving than 81%-100% and higher care recipient health. The

  5. Population Health and Tailored Medical Care in the Home: the Roles of Home-Based Primary Care and Home-Based Palliative Care.

    Science.gov (United States)

    Ritchie, Christine S; Leff, Bruce

    2018-03-01

    With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. Home-based medical care services have two flavors that are related to historical context and specialty background-home-based primary care (HBPC) and home-based palliative care (HBPalC). Although the type of services provided by HBPC and HBPalC (together termed "home-based medical care") overlap, HBPC tends to encompass longitudinal and preventive care, while HBPalC often provides services for shorter durations focused more on distress management and goals of care clarification. Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework-where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  6. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Eva Helena; Kjaergaard, Hanne; Johansen, Christoffer

    2013-01-01

    BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety...... children and 43 parents in the home care group, and 47 children and 66 parents receiving standard hospital care. RESULTS: All parents in the HBHC program were satisfied and preferred home care. There were no serious adverse events associated with HBHC, and costs did not increase. When adjusting for age......, gender, diagnosis and time since diagnosis, we found significant higher HRQOL scores in parent-reported physical health (P = 0.04; 95% confidence interval (CI): -0.2-19.5) and worry (P = 0.04; 95% CI: -0.4-20.6) in the home-care group indicating better physical health and less worry for children...

  7. Can Nonurgent Emergency Department Care Costs be Reduced? Empirical Evidence from a U.S. Nationally Representative Sample.

    Science.gov (United States)

    Xin, Haichang; Kilgore, Meredith L; Sen, Bisakha Pia; Blackburn, Justin

    2015-09-01

    A well-functioning primary care system has the capacity to provide effective care for patients to avoid nonurgent emergency department (ED) use and related costs. This study examined how patients' perceived deficiency in ambulatory care is associated with nonurgent ED care costs nationwide. This retrospective cohort study used data from the 2010-2011 Medical Expenditure Panel Survey. This study chose usual source of care, convenience of needed medical care, and patient evaluation of care quality as the main independent variables. The marginal effect following a multivariate logit model was employed to analyze the urgent vs. nonurgent ED care costs in 2011, after controlling for covariates in 2010. The endogeneity was accounted for by the time lag effect and controlling for education levels. Sample weights and variance were adjusted with the survey procedures to make results nationally representative. Patient-perceived poor and intermediate levels of primary care quality had higher odds of nonurgent ED care costs (odds ratio [OR] = 2.22, p = 0.035, and OR = 2.05, p = 0.011, respectively) compared to high-quality care, with a marginal effect (at means) of 13.0% and 11.5% higher predicted probability of nonurgent ED care costs. Costs related to these ambulatory care quality deficiencies amounted to $229 million for private plans (95% confidence interval [CI] $100 million-$358 million), $58.5 million for public plans (95% CI $33.9 million-$83.1 million), and an overall of $379 million (95% CI $229 million-$529 million) nationally. These findings highlight the improvement in ambulatory care quality as the potential target area to effectively reduce nonurgent ED care costs. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Eva Helena; Kjaergaard, H; Schmiegelow, K

    2012-01-01

    , as it decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. According to family members of children with cancer, hospital-based home care support enhanced their quality of life during the child's cancer trajectory......The study aims to describe the experiences of a hospital-based home care programme in the families of children with cancer. Fourteen parents, representing 10 families, were interviewed about their experiences of a hospital-based home care programme during a 4-month period in 2009 at a university...... hospital in Denmark. Five children participated in all or part of the interview. The interviews were transcribed verbatim and analysed using qualitative content analysis. The findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment...

  9. The Care and Feeding of Evidence Based Medicine

    OpenAIRE

    Tabrah, Frank L

    2012-01-01

    Wide interest in evidence based medicine (EBM) and its value in patient care, insurance payment decisions, and public health planning has triggered intense medical journal and media coverage that merits review, explanation, and comment.

  10. A Table-Based Random Sampling Simulation for Bioluminescence Tomography

    Directory of Open Access Journals (Sweden)

    Xiaomeng Zhang

    2006-01-01

    Full Text Available As a popular simulation of photon propagation in turbid media, the main problem of Monte Carlo (MC method is its cumbersome computation. In this work a table-based random sampling simulation (TBRS is proposed. The key idea of TBRS is to simplify multisteps of scattering to a single-step process, through randomly table querying, thus greatly reducing the computing complexity of the conventional MC algorithm and expediting the computation. The TBRS simulation is a fast algorithm of the conventional MC simulation of photon propagation. It retained the merits of flexibility and accuracy of conventional MC method and adapted well to complex geometric media and various source shapes. Both MC simulations were conducted in a homogeneous medium in our work. Also, we present a reconstructing approach to estimate the position of the fluorescent source based on the trial-and-error theory as a validation of the TBRS algorithm. Good agreement is found between the conventional MC simulation and the TBRS simulation.

  11. Estimation of plant sampling uncertainty: an example based on chemical analysis of moss samples.

    Science.gov (United States)

    Dołęgowska, Sabina

    2016-11-01

    In order to estimate the level of uncertainty arising from sampling, 54 samples (primary and duplicate) of the moss species Pleurozium schreberi (Brid.) Mitt. were collected within three forested areas (Wierna Rzeka, Piaski, Posłowice Range) in the Holy Cross Mountains (south-central Poland). During the fieldwork, each primary sample composed of 8 to 10 increments (subsamples) was taken over an area of 10 m 2 whereas duplicate samples were collected in the same way at a distance of 1-2 m. Subsequently, all samples were triple rinsed with deionized water, dried, milled, and digested (8 mL HNO 3 (1:1) + 1 mL 30 % H 2 O 2 ) in a closed microwave system Multiwave 3000. The prepared solutions were analyzed twice for Cu, Fe, Mn, and Zn using FAAS and GFAAS techniques. All datasets were checked for normality and for normally distributed elements (Cu from Piaski, Zn from Posłowice, Fe, Zn from Wierna Rzeka). The sampling uncertainty was computed with (i) classical ANOVA, (ii) classical RANOVA, (iii) modified RANOVA, and (iv) range statistics. For the remaining elements, the sampling uncertainty was calculated with traditional and/or modified RANOVA (if the amount of outliers did not exceed 10 %) or classical ANOVA after Box-Cox transformation (if the amount of outliers exceeded 10 %). The highest concentrations of all elements were found in moss samples from Piaski, whereas the sampling uncertainty calculated with different statistical methods ranged from 4.1 to 22 %.

  12. NURSING CARE KNOWLEDGE MANAGEMENT BASED TRAINING DECREASE NOSOCOMIAL INFECTION INCIDEN IN POST SECTIO CESAREA PATIENTS

    Directory of Open Access Journals (Sweden)

    Ahsan Ahsan

    2017-04-01

    Full Text Available Introduction: Model of nursing care based on knowledge management can reduce the incidence of nosocomial infections through the performance of nurses in the prevention of infection. Nursing care based on knowledge management is established from identi fi cation knowledge which is required, prevention performance of nosocomial infections post caesarean section. Nosocomial infections component consists of wound culture result. Method: This study was an observational study with a quasy experimental design. The population were all of nursing staff who working in obstetrics installation and a number of patients who is treated in hospitals A and B post sectio caesarea. Sample is comparised a total population all the nursing staff who worked in obstetrics installation according to criteria of the sample, and most of patients were taken care by nursing staff post caesarean section which is taken by random sampling 15 patients. Data was collected through observation sheets and examination of the wound culture. Data analysis which is used the t test. Result: The result was showed that there was signi fi cant difference in the incidence of nosocomial infection in patients with post sesctio caesarea in hospital before and after nursing care training based on knowledge management (tvalue = 2.316 and p = 0.028 < α = 0.05 level, and the incidence of nosocomial infection was lower after training than before training. Discussion: It can be concluded that training knowledge management based on nursing care effectives to reduce Incidence of Nosocomial Infections in Patients after Sectio Caesarea.

  13. Improving long-term care provision: towards demand-based care by means of modularity

    Directory of Open Access Journals (Sweden)

    Meijboom Bert

    2010-09-01

    Full Text Available Abstract Background As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to

  14. Improving long-term care provision: towards demand-based care by means of modularity

    Science.gov (United States)

    2010-01-01

    Background As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to elaborate on how to further

  15. Home-based palliative care: challenges in the care of technology-dependent children.

    Science.gov (United States)

    Floriani, Ciro A

    2010-01-01

    To conceptualize palliative care and its indications in Pediatrics; to describe the difficulties involved in the delivery of such care at home for technology-dependent children; and to analyze, from a bioethical perspective, the moral dilemmas of palliative care assistance. A literature review of palliative care for technology-dependent children and a bioethical analysis of moral dilemmas. There are several obstacles to palliative care for technology-dependent children: structural difficulties at home; social isolation of both children and families; health professionals' sense of disbelief regarding this type of care; an excessive number of medical devices at home; uncertainty of a terminal prognosis; physical, emotional, social, material, and financial burden for parents and family; changes in family dynamics to adjust to these children; paternalistic relationship between professionals and family; changes in family roles, with shifts in the caregiver role. It is essential to outline an agenda based on the premise that the medical apparatus for technology-dependent children will change the landscape of the home, and such a change might become a problem to be faced by all those living together. Based on this assumption, actions performed in a setting other than a health care facility might exert an actual protective effect on children and family, offering support in their several needs and developing a model of care delivery that includes interventions in the different levels of burden on these vulnerated and unprotected individuals.

  16. Time providing care outside visits in a home-based primary care program.

    Science.gov (United States)

    Pedowitz, Elizabeth J; Ornstein, Katherine A; Farber, Jeffrey; DeCherrie, Linda V

    2014-06-01

    To assess how much time physicians in a large home-based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time and patient and provider-related factors that may contribute to that time were considered. Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included length of interaction, mode, nature, and with whom the interaction was for 3 weeks. MSVD, an academic home-visit program in Manhattan, New York. All primary care physicians (PCPs) in MSVD (n = 14) agreed to participate. Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Data on 1,151 interactions for 537 patients were collected. An average 8.2 h/wk was spent providing nonhome visit care for a full-time provider. Using the most conservative estimates, 3.6 h/wk was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found between patients with and without dementia, new and established patients, and primary-panel and covered patients. Home-based primary care providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  17. Global review of health care surveys using lot quality assurance sampling (LQAS), 1984-2004.

    Science.gov (United States)

    Robertson, Susan E; Valadez, Joseph J

    2006-09-01

    We conducted a global review on the use of lot quality assurance sampling (LQAS) to assess health care services, health behaviors, and disease burden. Publications and reports on LQAS surveys were sought from Medline and five other electronic databases; the World Health Organization; the World Bank; governments, nongovernmental organizations, and individual scientists. We identified a total of 805 LQAS surveys conducted by different management groups during January 1984 through December 2004. There was a striking increase in the annual number of LQAS surveys conducted in 2000-2004 (128/year) compared with 1984-1999 (10/year). Surveys were conducted in 55 countries, and in 12 of these countries there were 10 or more LQAS surveys. Geographically, 317 surveys (39.4%) were conducted in Africa, 197 (28.5%) in the Americas, 115 (14.3%) in the Eastern Mediterranean, 114 (14.2%) in South-East Asia, 48 (6.0%) in Europe, and 14 (1.8%) in the Western Pacific. Health care parameters varied, and some surveys assessed more than one parameter. There were 320 surveys about risk factors for HIV/AIDS/sexually transmitted infections; 266 surveys on immunization coverage, 240 surveys post-disasters, 224 surveys on women's health, 142 surveys on growth and nutrition, 136 surveys on diarrheal disease control, and 88 surveys on quality management. LQAS surveys to assess disease burden included 23 neonatal tetanus mortality surveys and 12 surveys on other diseases. LQAS is a practical field method which increasingly is being applied in assessment of preventive and curative health services, and may offer new research opportunities to social scientists. When LQAS data are collected recurrently at multiple time points, they can be used to measure the spatial variation in behavior change. Such data provide insight into understanding relationships between various investments in social, human, and physical capital, and into the effectiveness of different public health strategies in achieving

  18. Principle-based concept analysis: Caring in nursing education.

    Science.gov (United States)

    Salehian, Maryam; Heydari, Abbas; Aghebati, Nahid; Karimi Moonaghi, Hossein; Mazloom, Seyed Reza

    2016-03-01

    The aim of this principle-based concept analysis was to analyze caring in nursing education and to explain the current state of the science based on epistemologic, pragmatic, linguistic, and logical philosophical principles. A principle-based concept analysis method was used to analyze the nursing literature. The dataset included 46 English language studies, published from 2005 to 2014, and they were retrieved through PROQUEST, MEDLINE, CINAHL, ERIC, SCOPUS, and SID scientific databases. The key dimensions of the data were collected using a validated data-extraction sheet. The four principles of assessing pragmatic utility were used to analyze the data. The data were managed by using MAXQDA 10 software. The scientific literature that deals with caring in nursing education relies on implied meaning. Caring in nursing education refers to student-teacher interactions that are formed on the basis of human values and focused on the unique needs of the students (epistemological principle). The result of student-teacher interactions is the development of both the students and the teachers. Numerous applications of the concept of caring in nursing education are available in the literature (pragmatic principle). There is consistency in the meaning of the concept, as a central value of the faculty-student interaction (linguistic principle). Compared with other related concepts, such as "caring pedagogy," "value-based education," and "teaching excellence," caring in nursing education does not have exact and clear conceptual boundaries (logic principle). Caring in nursing education was identified as an approach to teaching and learning, and it is formed based on teacher-student interactions and sustainable human values. A greater understanding of the conceptual basis of caring in nursing education will improve the caring behaviors of teachers, create teaching-learning environments, and help experts in curriculum development.

  19. The evidence base for diabetes care

    National Research Council Canada - National Science Library

    Williams, D. R. R. (David Robert Rhys)

    2002-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3. Evidence-Based Definition and Classification: A Commentary . . . . . . Steve O'Rahilly 37 PART II: PREVENTION OF DIABETES 4. Prevention of Type 1 Diabetes...

  20. Web-based resources for critical care education.

    Science.gov (United States)

    Kleinpell, Ruth; Ely, E Wesley; Williams, Ged; Liolios, Antonios; Ward, Nicholas; Tisherman, Samuel A

    2011-03-01

    To identify, catalog, and critically evaluate Web-based resources for critical care education. A multilevel search strategy was utilized. Literature searches were conducted (from 1996 to September 30, 2010) using OVID-MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature with the terms "Web-based learning," "computer-assisted instruction," "e-learning," "critical care," "tutorials," "continuing education," "virtual learning," and "Web-based education." The Web sites of relevant critical care organizations (American College of Chest Physicians, American Society of Anesthesiologists, American Thoracic Society, European Society of Intensive Care Medicine, Society of Critical Care Medicine, World Federation of Societies of Intensive and Critical Care Medicine, American Association of Critical Care Nurses, and World Federation of Critical Care Nurses) were reviewed for the availability of e-learning resources. Finally, Internet searches and e-mail queries to critical care medicine fellowship program directors and members of national and international acute/critical care listserves were conducted to 1) identify the use of and 2) review and critique Web-based resources for critical care education. To ensure credibility of Web site information, Web sites were reviewed by three independent reviewers on the basis of the criteria of authority, objectivity, authenticity, accuracy, timeliness, relevance, and efficiency in conjunction with suggested formats for evaluating Web sites in the medical literature. Literature searches using OVID-MEDLINE, PubMed, and the Cumulative Index to Nursing and Allied Health Literature resulted in >250 citations. Those pertinent to critical care provide examples of the integration of e-learning techniques, the development of specific resources, reports of the use of types of e-learning, including interactive tutorials, case studies, and simulation, and reports of student or learner satisfaction, among other general

  1. Incentive-Based Primary Care: Cost and Utilization Analysis.

    Science.gov (United States)

    Hollander, Marcus J; Kadlec, Helena

    2015-01-01

    In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. The study used Ministry of Health administrative data for Fiscal Year 2010-2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). After controlling for patients' age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization.

  2. Shelter-based palliative care for the homeless terminally ill.

    Science.gov (United States)

    Podymow, Tiina; Turnbull, Jeffrey; Coyle, Doug

    2006-03-01

    The homeless have high rates of mortality, but live in environments not conducive to terminal care. Traditional palliative care hospitals may be reluctant to accept such patients, due to behavior or lifestyle concerns. The Ottawa Inner City Health Project (OICHP) is a pilot study to improve health care delivery to homeless adults. This is a retrospective analysis of a cohort of terminally ill homeless individuals and the effectiveness of shelter-based palliative care. As proof of principle, a cost comparison was performed. 28 consecutive homeless terminally ill patients were admitted and died at a shelter-based palliative care hospice. Demographics, diagnoses at admission and course were recorded. Burden of illness was assessed by medical and psychiatric diagnoses, addictions, Karnofsky scale and symptom management. An expert panel was convened to identify alternate care locations. Using standard costing scales, direct versus alternate care costs were compared. 28 patients had a mean age 49 years; average length of stay 120 days. DIAGNOSES: liver disease 43%, HIV/AIDS 25%, malignancy 25% and other 8%. Addiction to drugs or alcohol and mental illness in 82% of patients. Karnofsky performance score mean 40 +/- 16.8. Pain management with continuous opiates in 71%. The majority reunited with family. Compared to alternate care locations, the hospice projected 1.39 million dollars savings for the patients described. The homeless terminally ill have a heavy burden of disease including physical illness, psychiatric conditions and addictions. Shelter-based palliative care can provide effective end-of-life care to terminally ill homeless individuals at potentially substantial cost savings.

  3. Home-based intermediate care program vs hospitalization

    Science.gov (United States)

    Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael

    2008-01-01

    OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs. PMID:18208958

  4. The Toggle Local Planner for sampling-based motion planning

    KAUST Repository

    Denny, Jory

    2012-05-01

    Sampling-based solutions to the motion planning problem, such as the probabilistic roadmap method (PRM), have become commonplace in robotics applications. These solutions are the norm as the dimensionality of the planning space grows, i.e., d > 5. An important primitive of these methods is the local planner, which is used for validation of simple paths between two configurations. The most common is the straight-line local planner which interpolates along the straight line between the two configurations. In this paper, we introduce a new local planner, Toggle Local Planner (Toggle LP), which extends local planning to a two-dimensional subspace of the overall planning space. If no path exists between the two configurations in the subspace, then Toggle LP is guaranteed to correctly return false. Intuitively, more connections could be found by Toggle LP than by the straight-line planner, resulting in better connected roadmaps. As shown in our results, this is the case, and additionally, the extra cost, in terms of time or storage, for Toggle LP is minimal. Additionally, our experimental analysis of the planner shows the benefit for a wide array of robots, with DOF as high as 70. © 2012 IEEE.

  5. A primary care-based health needs assessment in inner city Dublin.

    LENUS (Irish Health Repository)

    O'Kelly, C M

    2012-02-01

    BACKGROUND: In 2001, a primary care-based health needs assessment (HNA) in South Inner City of Dublin identified high levels of morbidity and widespread and frequent use of primary care and specialist hospital services as particular concerns. AIMS: This study aims to determine the primary care health needs of a local community, from the perspective of service users and service providers. METHODS: A similar methodology to our 2001 HNA was adopted, involving semi-structured interviews with a convenience sample of patients attending two general practices and key informants regarding local health issues and health service utilisation. RESULTS: High levels of morbidity and chronic illness were found. A correlation between the local environment and ill-health was identified, as well as high utilisation of primary care services in the area. CONCLUSION: The establishment of a Primary Care Team would begin to address the health needs of the community.

  6. Caring buildings: user based indoor climate control

    NARCIS (Netherlands)

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

    2007-01-01

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

  7. Predicting Drug-Target Interactions Based on Small Positive Samples.

    Science.gov (United States)

    Hu, Pengwei; Chan, Keith C C; Hu, Yanxing

    2018-01-01

    evaluation of ODT shows that it can be potentially useful. It confirms that predicting potential or missing DTIs based on the known interactions is a promising direction to solve problems related to the use of uncertain and unreliable negative samples and those related to the great demand in computational resources. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  8. [Health care based on cooperation between professionals and affected people].

    Science.gov (United States)

    Muriel-Fernández, Rafael; García-Domínguez, José-Miguel; Rodríguez-Gómez, Susana; Sagués-Amadó, Antonio

    2016-01-01

    The purpose of this article is to support the need for a change of care, based on cooperation between those who provide care and those who receive it. This article develops the decisive factors for change: the investee cooperation, the reference in case management, the concept of recovery and terminal care, the reduction of suffering and the value of change reflected in the 'win-win'. In each of them a questioning of the current situation, a methodological analysis and an input of tools and consequences of the change is made. To conclude, the article incorporates the 'itinerary of shared care' as a resource and one of the ways to bring these changes to the reality of day-to-day care. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  9. Integrated community-based dementia care: the Geriant model

    Directory of Open Access Journals (Sweden)

    Ludo Glimmerveen

    2015-09-01

    Full Text Available This article gives an in-depth description of the service delivery model of Geriant, a Dutch organization providing community-based care services for people suffering from dementia. Core to its model is the provision of clinical case management, embedded in multidisciplinary dementia care teams. As Geriant's client group includes people from the first presumption of dementia until they can no longer live at home, its care model provides valuable lessons about how different mechanisms of integration are flexibly put to use if the complexity of clients” care needs increases. It showcases how the integration of services for a specific sub-population is combined with alignment of these services with generalist network partners. After a detailed description of the programme and its results, this article builds on the work of Walter Leutz for a conceptual discussion of Geriant's approach to care integration. 

  10. Explaining health care expenditure variation: large-sample evidence using linked survey and health administrative data.

    Science.gov (United States)

    Ellis, Randall P; Fiebig, Denzil G; Johar, Meliyanni; Jones, Glenn; Savage, Elizabeth

    2013-09-01

    Explaining individual, regional, and provider variation in health care spending is of enormous value to policymakers but is often hampered by the lack of individual level detail in universal public health systems because budgeted spending is often not attributable to specific individuals. Even rarer is self-reported survey information that helps explain this variation in large samples. In this paper, we link a cross-sectional survey of 267 188 Australians age 45 and over to a panel dataset of annual healthcare costs calculated from several years of hospital, medical and pharmaceutical records. We use this data to distinguish between cost variations due to health shocks and those that are intrinsic (fixed) to an individual over three years. We find that high fixed expenditures are positively associated with age, especially older males, poor health, obesity, smoking, cancer, stroke and heart conditions. Being foreign born, speaking a foreign language at home and low income are more strongly associated with higher time-varying expenditures, suggesting greater exposure to adverse health shocks. Copyright © 2013 John Wiley & Sons, Ltd.

  11. Predictors of utilisation of dental care services in a nationally representative sample of adults.

    Science.gov (United States)

    Guiney, H; Woods, N; Whelton, H; Morgan, K

    2011-12-01

    The objective of this study was to identify the predictors of utilisation of dental care services in Ireland. The 2007 Irish Survey of Lifestyle, Attitudes and Nutrition is a cross-sectional study, conducted in 2006/2007 (n = 10,364), by interviews at home to a representative sample of adults aged 18 years or over. Multivariate logistic regression was used to investigate the influence of socioeconomic, predisposing and enabling factors on the odds of males and females having a dental visit in the past year. The significant predictors of visiting the dentist in the past year were for males: having 3rd level education, employment status, earning 50,000 euros or more, location of residence, use of a car, brushing frequently, and dentition status. For females, the predictors were being between 25-34 or 55-64 years-old, education level, earning 50,000 euros or more, location of residence, use of a car, brushing frequently and dentition status. Predictors of the use of dental services vary by gender. Predictors common to both genders were education level, higher income, location of residence, use of a car, brushing frequently and dentition status. Many of the predictors of dental visiting in the past year are also related to social inequalities in health. These predictors may be useful markers of impact for policies designed to address inequalities in access to oral health services.

  12. Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample.

    Science.gov (United States)

    Kodish, Tamar; Herres, Joanna; Shearer, Annie; Atte, Tita; Fein, Joel; Diamond, Guy

    2016-05-01

    Suicide is a serious public health concern for US youth. Research has established an association between bullying and suicide risk. However, several questions remain regarding this relationship. The present study examined (a) whether experiences of verbal, physical, and cyber bullying were uniquely associated with general suicide risk; (b) whether each specific form of bullying was related to suicide attempt; and (c) whether depression moderated the relationship between each type of bullying and suicide risk. The sample included medical records of 5,429 youth screened in primary care when providers had mental health concerns. Patients were screened using the Behavioral Health Screen (BHS), which assessed a range of mental health problems and behaviors, including bullying, depression, and suicide. All types of bullying were associated with suicide risk, but verbal bullying was uniquely associated with suicide attempt. Depression significantly moderated the relationship between each type of bullying and suicide risk. The study's limitations include the use of cross-sectional and self-data reports. When medical providers evaluate suicide risk, bullying should be considered as a possible precipitant, especially if the patient is depressed. Verbal bullying may be particularly important in understanding severity of suicide risk.

  13. A Home-Based Palliative Care Consult Service for Veterans.

    Science.gov (United States)

    Golden, Adam G; Antoni, Charles; Gammonley, Denise

    2016-11-01

    We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.

  14. THE ASSOCIATION OF ISLAMIC BASED CARING MODEL AND COMMITMENT TO ORGANIZATION IN STAFF NURSES

    Directory of Open Access Journals (Sweden)

    Yuda Ayu Timorita

    2017-12-01

    Full Text Available Background: Strong organizational commitment is needed by hospitals to attract and retain nursing staffs in order to consistently deliver good quality of nursing services. The decrease in organizational commitment among nurses can cause many losses to the organization, including increased organizational spending, breakdown in patient care, and cause performance trends that appear not for the benefit of the organization or unit, but more for personal self-interest. Objective: To analyze the relationship of the application of Islamic Based Caring (IBC model with organizational commitment among nurses. Methods: This was a correlation analytic research with cross sectional design. There were 108 nurses selected using a propotionate stratified random sampling. Islamic Based Caring was measured using a questionnaire developed based on the theory of Suhartini Ismail (2016, and organizational commitment was measured using a questionnaire developed based on the concept of Caldwell, O’Reilly & Chatmann (1990 and Mowday, Porter dan Steers (1982 in Asmaningrum (2009. Logistic regression and forward stepwise (conditional method were used for data analysis. Results: There was a statistically significant correlation of a healing presence (p=0.000, caring relationship (p=0.010, caring environment (p=0.045 and belief in God (p=0.000. Belief in God (Allah SWT has the highest correlation (OR=6.660 with organizational commitment among nurses. Conclusion: There is a positive and significant relationship between the implementation of Islamic Based Caring with the organization's commitment among nurses.

  15. ProvenCare perinatal: a model for delivering evidence/ guideline-based care for perinatal populations.

    Science.gov (United States)

    Berry, Scott A; Laam, Leslie A; Wary, Andrea A; Mateer, Harry O; Cassagnol, Hans P; McKinley, Karen E; Nolan, Ruth A

    2011-05-01

    Geisinger Health System (GHS) has applied its ProvenCare model to demonstrate that a large integrated health care delivery system, enabled by an electronic health record (EHR), could reengineer a complicated clinical process, reduce unwarranted variation, and provide evidence-based care for patients with a specified clinical condition. In 2007 GHS began to apply the model to a more complicated, longer-term condition of "wellness"--perinatal care. ADAPTING PROVENCARE TO PERINATAL CARE: The ProvenCare Perinatal initiative was more complex than the five previous ProvenCare endeavors in terms of breadth, scope, and duration. Each of the 22 sites created a process flow map to depict the current, real-time process at each location. The local practice site providers-physicians and mid-level practitioners-reached consensus on 103 unique best practice measures (BPMs), which would be tracked for every patient. These maps were then used to create a single standardized pathway that included the BPMs but also preserved some unique care offerings that reflected the needs of the local context. A nine-phase methodology, expanded from the previous six-phase model, was implemented on schedule. Pre- to postimplementation improvement occurred for all seven BPMs or BPM bundles that were considered the most clinically relevant, with five statistically significant. In addition, the rate of primary cesarean sections decreased by 32%, and birth trauma remained unchanged as the number of vaginal births increased. Preliminary experience suggests that integrating evidence/guideline-based best practices into work flows in inpatient and outpatient settings can achieve improvements in daily patient care processes and outcomes.

  16. Nature-based supportive care opportunities: a conceptual framework.

    Science.gov (United States)

    Blaschke, Sarah; O'Callaghan, Clare C; Schofield, Penelope

    2018-03-22

    Given preliminary evidence for positive health outcomes related to contact with nature for cancer populations, research is warranted to ascertain possible strategies for incorporating nature-based care opportunities into oncology contexts as additional strategies for addressing multidimensional aspects of cancer patients' health and recovery needs. The objective of this study was to consolidate existing research related to nature-based supportive care opportunities and generate a conceptual framework for discerning relevant applications in the supportive care setting. Drawing on research investigating nature-based engagement in oncology contexts, a two-step analytic process was used to construct a conceptual framework for guiding nature-based supportive care design and future research. Concept analysis methodology generated new representations of understanding by extracting and synthesising salient concepts. Newly formulated concepts were transposed to findings from related research about patient-reported and healthcare expert-developed recommendations for nature-based supportive care in oncology. Five theoretical concepts (themes) were formulated describing patients' reasons for engaging with nature and the underlying needs these interactions address. These included: connecting with what is genuinely valued, distancing from the cancer experience, meaning-making and reframing the cancer experience, finding comfort and safety, and vital nurturance. Eight shared patient and expert recommendations were compiled, which address the identified needs through nature-based initiatives. Eleven additional patient-reported recommendations attend to beneficial and adverse experiential qualities of patients' nature-based engagement and complete the framework. The framework outlines salient findings about helpful nature-based supportive care opportunities for ready access by healthcare practitioners, designers, researchers and patients themselves. © Article author(s) (or their

  17. Designing an Elderly Assistance Program Based-on Home Care

    Science.gov (United States)

    Umusya'adah, L.; Juwaedah, A.; Jubaedah, Y.; Ratnasusanti, H.; Puspita, R. H.

    2018-02-01

    PKH (Program Keluarga Harapan) is a program of Indonesia’s Government through the ministry of social directorate to accelerate the poverty reduction and the achievement of Millennium Development Goals (MDGs) target as well as the policies development in social protection and social welfare domain or commonly referred to as Indonesian Conditional Cash Transfer (CCT) Program. This research is motivated that existing participants of the family expectation program (PKH) that already exist in Sumedang, Indoensia, especially in the South Sumedang on the social welfare components is only limited to the health checking, while for assisting the elderly based Home Care program there has been no structured and systematic, where as the elderly still need assistance, especially from the family and community environment. This study uses a method of Research and Development with Model Addie which include analysis, design, development, implementation and evaluation. Participants in this study using purposive sampling, where selected families of PKH who provide active assistance to the elderly with 82 participants. The program is designed consists of program components: objectives, goals, forms of assistance, organizing institutions and implementing the program, besides, program modules include assisting the elderly. Form of assistance the elderly cover physical, social, mental and spiritual. Recommended for families and companions PKH, the program can be implemented to meet the various needs of the elderly. For the elderly should introspect, especially in the health and follow the advice recommended by related parties

  18. The European EUCCLID pilot study on care and complications in an unselected sample of people with type 2 diabetes in primary care

    DEFF Research Database (Denmark)

    Gorter, K.J.; Wens, J.; Khunti, K.

    2010-01-01

    indicators, UKPDS-risk engine, psychological and general well-being. RESULTS: We included 103 participants from 22 GPs in 11 countries. Central data and laboratory samples were successfully collected. Of the participants 54% were female, mean age was 66 years and mean duration of diabetes was 9.6 years......BACKGROUND: European studies on quality of diabetes care in an unselected primary care diabetes population are scarce. RESEARCH QUESTION: To test the feasibility of the set-up and logistics of a cross-sectional EUropean study on Care and Complications in patients with type 2 diabetes (T2DM......) in Primary Care (EUCCLID) in 12 European countries. METHOD: One rural and one urban practice from each country participated. The central coordinating centre randomly selected five patients from each practice. Patient characteristics were assessed including medical history, anthropometric measures, quality...

  19. Selecting Sample Preparation Workflows for Mass Spectrometry-Based Proteomic and Phosphoproteomic Analysis of Patient Samples with Acute Myeloid Leukemia.

    Science.gov (United States)

    Hernandez-Valladares, Maria; Aasebø, Elise; Selheim, Frode; Berven, Frode S; Bruserud, Øystein

    2016-08-22

    Global mass spectrometry (MS)-based proteomic and phosphoproteomic studies of acute myeloid leukemia (AML) biomarkers represent a powerful strategy to identify and confirm proteins and their phosphorylated modifications that could be applied in diagnosis and prognosis, as a support for individual treatment regimens and selection of patients for bone marrow transplant. MS-based studies require optimal and reproducible workflows that allow a satisfactory coverage of the proteome and its modifications. Preparation of samples for global MS analysis is a crucial step and it usually requires method testing, tuning and optimization. Different proteomic workflows that have been used to prepare AML patient samples for global MS analysis usually include a standard protein in-solution digestion procedure with a urea-based lysis buffer. The enrichment of phosphopeptides from AML patient samples has previously been carried out either with immobilized metal affinity chromatography (IMAC) or metal oxide affinity chromatography (MOAC). We have recently tested several methods of sample preparation for MS analysis of the AML proteome and phosphoproteome and introduced filter-aided sample preparation (FASP) as a superior methodology for the sensitive and reproducible generation of peptides from patient samples. FASP-prepared peptides can be further fractionated or IMAC-enriched for proteome or phosphoproteome analyses. Herein, we will review both in-solution and FASP-based sample preparation workflows and encourage the use of the latter for the highest protein and phosphorylation coverage and reproducibility.

  20. Selecting Sample Preparation Workflows for Mass Spectrometry-Based Proteomic and Phosphoproteomic Analysis of Patient Samples with Acute Myeloid Leukemia

    Directory of Open Access Journals (Sweden)

    Maria Hernandez-Valladares

    2016-08-01

    Full Text Available Global mass spectrometry (MS-based proteomic and phosphoproteomic studies of acute myeloid leukemia (AML biomarkers represent a powerful strategy to identify and confirm proteins and their phosphorylated modifications that could be applied in diagnosis and prognosis, as a support for individual treatment regimens and selection of patients for bone marrow transplant. MS-based studies require optimal and reproducible workflows that allow a satisfactory coverage of the proteome and its modifications. Preparation of samples for global MS analysis is a crucial step and it usually requires method testing, tuning and optimization. Different proteomic workflows that have been used to prepare AML patient samples for global MS analysis usually include a standard protein in-solution digestion procedure with a urea-based lysis buffer. The enrichment of phosphopeptides from AML patient samples has previously been carried out either with immobilized metal affinity chromatography (IMAC or metal oxide affinity chromatography (MOAC. We have recently tested several methods of sample preparation for MS analysis of the AML proteome and phosphoproteome and introduced filter-aided sample preparation (FASP as a superior methodology for the sensitive and reproducible generation of peptides from patient samples. FASP-prepared peptides can be further fractionated or IMAC-enriched for proteome or phosphoproteome analyses. Herein, we will review both in-solution and FASP-based sample preparation workflows and encourage the use of the latter for the highest protein and phosphorylation coverage and reproducibility.

  1. New Approach Based on Compressive Sampling for Sample Rate Enhancement in DASs for Low-Cost Sensing Nodes

    Directory of Open Access Journals (Sweden)

    Francesco Bonavolontà

    2014-10-01

    Full Text Available The paper deals with the problem of improving the maximum sample rate of analog-to-digital converters (ADCs included in low cost wireless sensing nodes. To this aim, the authors propose an efficient acquisition strategy based on the combined use of high-resolution time-basis and compressive sampling. In particular, the high-resolution time-basis is adopted to provide a proper sequence of random sampling instants, and a suitable software procedure, based on compressive sampling approach, is exploited to reconstruct the signal of interest from the acquired samples. Thanks to the proposed strategy, the effective sample rate of the reconstructed signal can be as high as the frequency of the considered time-basis, thus significantly improving the inherent ADC sample rate. Several tests are carried out in simulated and real conditions to assess the performance of the proposed acquisition strategy in terms of reconstruction error. In particular, the results obtained in experimental tests with ADC included in actual 8- and 32-bits microcontrollers highlight the possibility of achieving effective sample rate up to 50 times higher than that of the original ADC sample rate.

  2. Moral distress experienced by health care professionals who provide home-based palliative care.

    Science.gov (United States)

    Brazil, Kevin; Kassalainen, Sharon; Ploeg, Jenny; Marshall, Denise

    2010-11-01

    Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice. Copyright © 2010 Elsevier Ltd. All rights reserved.

  3. Preview-based sampling for controlling gaseous simulations

    KAUST Repository

    Huang, Ruoguan; Melek, Zeki; Keyser, John

    2011-01-01

    to maintain. During the high resolution simulation, a matching process ensures that the properties sampled from the low resolution simulation are maintained. This matching process keeps the different resolution simulations aligned even for complex systems

  4. Estimated ventricle size using Evans index: reference values from a population-based sample.

    Science.gov (United States)

    Jaraj, D; Rabiei, K; Marlow, T; Jensen, C; Skoog, I; Wikkelsø, C

    2017-03-01

    Evans index is an estimate of ventricular size used in the diagnosis of idiopathic normal-pressure hydrocephalus (iNPH). Values >0.3 are considered pathological and are required by guidelines for the diagnosis of iNPH. However, there are no previous epidemiological studies on Evans index, and normal values in adults are thus not precisely known. We examined a representative sample to obtain reference values and descriptive data on Evans index. A population-based sample (n = 1235) of men and women aged ≥70 years was examined. The sample comprised people living in private households and residential care, systematically selected from the Swedish population register. Neuropsychiatric examinations, including head computed tomography, were performed between 1986 and 2000. Evans index ranged from 0.11 to 0.46. The mean value in the total sample was 0.28 (SD, 0.04) and 20.6% (n = 255) had values >0.3. Among men aged ≥80 years, the mean value of Evans index was 0.3 (SD, 0.03). Individuals with dementia had a mean value of Evans index of 0.31 (SD, 0.05) and those with radiological signs of iNPH had a mean value of 0.36 (SD, 0.04). A substantial number of subjects had ventricular enlargement according to current criteria. Clinicians and researchers need to be aware of the range of values among older individuals. © 2017 EAN.

  5. Computational fragment-based screening using RosettaLigand: the SAMPL3 challenge

    Science.gov (United States)

    Kumar, Ashutosh; Zhang, Kam Y. J.

    2012-05-01

    SAMPL3 fragment based virtual screening challenge provides a valuable opportunity for researchers to test their programs, methods and screening protocols in a blind testing environment. We participated in SAMPL3 challenge and evaluated our virtual fragment screening protocol, which involves RosettaLigand as the core component by screening a 500 fragments Maybridge library against bovine pancreatic trypsin. Our study reaffirmed that the real test for any virtual screening approach would be in a blind testing environment. The analyses presented in this paper also showed that virtual screening performance can be improved, if a set of known active compounds is available and parameters and methods that yield better enrichment are selected. Our study also highlighted that to achieve accurate orientation and conformation of ligands within a binding site, selecting an appropriate method to calculate partial charges is important. Another finding is that using multiple receptor ensembles in docking does not always yield better enrichment than individual receptors. On the basis of our results and retrospective analyses from SAMPL3 fragment screening challenge we anticipate that chances of success in a fragment screening process could be increased significantly with careful selection of receptor structures, protein flexibility, sufficient conformational sampling within binding pocket and accurate assignment of ligand and protein partial charges.

  6. The logic of tax-based financing for health care.

    Science.gov (United States)

    Bodenheimer, T; Sullivan, K

    1997-01-01

    Employment-based health insurance faces serious problems. For the first time, the number of Americans covered by such health insurance is falling. Employers strongly oppose the employer mandate approach to extending health insurance. Employment-based financing is regressive and complex. Serious debate is needed on an alternative solution to financing health care for all Americans. Taxation represents a clear alternative to employment-based health care financing. The major criterion for choosing a tax is equity, with simplicity a second criterion. An earmarked, progressive individual income tax is a fair and potentially simple tax with which to finance health care. The political feasibility of such a tax is greater than that of employer mandate legislation.

  7. Health Care Leadership: Managing Knowledge Bases as Stakeholders.

    Science.gov (United States)

    Rotarius, Timothy

    Communities are composed of many organizations. These organizations naturally form clusters based on common patterns of knowledge, skills, and abilities of the individual organizations. Each of these spontaneous clusters represents a distinct knowledge base. The health care knowledge base is shown to be the natural leader of any community. Using the Central Florida region's 5 knowledge bases as an example, each knowledge base is categorized as a distinct type of stakeholder, and then a specific stakeholder management strategy is discussed to facilitate managing both the cooperative potential and the threatening potential of each "knowledge base" stakeholder.

  8. netCare, a new collaborative primary health care service based in Swiss community pharmacies.

    Science.gov (United States)

    Erni, Pina; von Overbeck, Jan; Reich, Oliver; Ruggli, Martine

    2016-01-01

    The Swiss Pharmacists Association has launched a new collaborative project, netCare. Community pharmacists provide a standard form with structured triage based on decision trees and document findings. As a backup, they can collaborate with physicians via video consultation. The aim of the study was to evaluate the impact of this service on the Swiss health care system. All pharmacists offering netCare completed two training courses, a course covering the most common medical conditions observed in primary health care and a specific course on all of the decision trees. The pharmacists were free to decide whether they would provide the usual care or offer netCare triage. The patient was also free to accept or refuse netCare. Pharmacists reported the type of ailment, procedure of the consultation, treatment, patient information and outcomes of the follow-up call on a standardized form submitted to the study center. Pharmacists from 162 pharmacies performed 4118 triages over a period of 21 months. A backup consultation was needed for 17% of the cases. In follow-up calls, 84% of the patients who were seen only by pharmacists reported complete relief or symptom reduction. netCare is a low-threshold service by which pharmacists can manage common medical conditions with physician backup, if needed. This study showed that a pharmacist could resolve a large proportion of the cases. However, to be efficient and sustainable, this service must be fully integrated into the health care system. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Time based management in health care system: The chosen aspects

    Directory of Open Access Journals (Sweden)

    Joanna Kobza

    2014-08-01

    Full Text Available Time-based management (TBM is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms. Over the past two decades a systematic review of Polish literature (since 1990 and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011 have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary

  10. [Time based management in health care system: the chosen aspects].

    Science.gov (United States)

    Kobza, Joanna; Syrkiewicz-Świtała, Magdalena

    2014-01-01

    Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001-2011) have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary.

  11. Home-based care, technology, and the maintenance of selves.

    Science.gov (United States)

    Parks, Jennifer A

    2015-06-01

    In this paper, I will argue that there is a deep connection between home-based care, technology, and the self. Providing the means for persons (especially older persons) to receive care at home is not merely a kindness that respects their preference to be at home: it is an important means of extending their selfhood and respecting the unique selves that they are. Home-based technologies like telemedicine and robotic care may certainly be useful tools in providing care for persons at home, but they also have important implications for sustaining selfhood in ways that are of value to individuals and those who care for them. I will argue, by appealing to Hilde Lindemann's notion of "holding" persons' identities in place, that technological interventions are not only useful tools for improving and sustaining health and good care at home, but that they may also help to extend our personal identities and relational capacities in ways that are practically and ethically good. Because of these important goods, I will claim that there is a prima facie moral duty to do this "holding" work and that it is best done by family members and loved ones who are well suited to the job because of their history and relationship with the individual that needs to be "held" in place.

  12. Speeding Up Non-Parametric Bootstrap Computations for Statistics Based on Sample Moments in Small/Moderate Sample Size Applications.

    Directory of Open Access Journals (Sweden)

    Elias Chaibub Neto

    Full Text Available In this paper we propose a vectorized implementation of the non-parametric bootstrap for statistics based on sample moments. Basically, we adopt the multinomial sampling formulation of the non-parametric bootstrap, and compute bootstrap replications of sample moment statistics by simply weighting the observed data according to multinomial counts instead of evaluating the statistic on a resampled version of the observed data. Using this formulation we can generate a matrix of bootstrap weights and compute the entire vector of bootstrap replications with a few matrix multiplications. Vectorization is particularly important for matrix-oriented programming languages such as R, where matrix/vector calculations tend to be faster than scalar operations implemented in a loop. We illustrate the application of the vectorized implementation in real and simulated data sets, when bootstrapping Pearson's sample correlation coefficient, and compared its performance against two state-of-the-art R implementations of the non-parametric bootstrap, as well as a straightforward one based on a for loop. Our investigations spanned varying sample sizes and number of bootstrap replications. The vectorized bootstrap compared favorably against the state-of-the-art implementations in all cases tested, and was remarkably/considerably faster for small/moderate sample sizes. The same results were observed in the comparison with the straightforward implementation, except for large sample sizes, where the vectorized bootstrap was slightly slower than the straightforward implementation due to increased time expenditures in the generation of weight matrices via multinomial sampling.

  13. Health care professionals' beliefs about using wiki-based reminders to promote best practices in trauma care.

    Science.gov (United States)

    Archambault, Patrick Michel; Bilodeau, Andrea; Gagnon, Marie-Pierre; Aubin, Karine; Lavoie, André; Lapointe, Jean; Poitras, Julien; Croteau, Sylvain; Pham-Dinh, Martin; Légaré, France

    2012-04-19

    Wikis are knowledge translation tools that could help health professionals implement best practices in acute care. Little is known about the factors influencing professionals' use of wikis. To identify and compare the beliefs of emergency physicians (EPs) and allied health professionals (AHPs) about using a wiki-based reminder that promotes evidence-based care for traumatic brain injuries. Drawing on the theory of planned behavior, we conducted semistructured interviews to elicit EPs' and AHPs' beliefs about using a wiki-based reminder. Previous studies suggested a sample of 25 EPs and 25 AHPs. We purposefully selected participants from three trauma centers in Quebec, Canada, to obtain a representative sample. Using univariate analyses, we assessed whether our participants' gender, age, and level of experience were similar to those of all eligible individuals. Participants viewed a video showing a clinician using a wiki-based reminder, and we interviewed participants about their behavioral, control, and normative beliefs-that is, what they saw as advantages, disadvantages, barriers, and facilitators to their use of a reminder, and how they felt important referents would perceive their use of a reminder. Two reviewers independently analyzed the content of the interview transcripts. We considered the 75% most frequently mentioned beliefs as salient. We retained some less frequently mentioned beliefs as well. Of 66 eligible EPs and 444 eligible AHPs, we invited 55 EPs and 39 AHPs to participate, and 25 EPs and 25 AHPs (15 nurses, 7 respiratory therapists, and 3 pharmacists) accepted. Participating AHPs had more experience than eligible AHPs (mean 14 vs 11 years; P = .04). We noted no other significant differences. Among EPs, the most frequently reported advantage of using a wiki-based reminder was that it refreshes the memory (n = 14); among AHPs, it was that it provides rapid access to protocols (n = 16). Only 2 EPs mentioned a disadvantage (the wiki added stress

  14. Finding metastabilities in reversible Markov chains based on incomplete sampling

    Directory of Open Access Journals (Sweden)

    Fackeldey Konstantin

    2017-01-01

    Full Text Available In order to fully characterize the state-transition behaviour of finite Markov chains one needs to provide the corresponding transition matrix P. In many applications such as molecular simulation and drug design, the entries of the transition matrix P are estimated by generating realizations of the Markov chain and determining the one-step conditional probability Pij for a transition from one state i to state j. This sampling can be computational very demanding. Therefore, it is a good idea to reduce the sampling effort. The main purpose of this paper is to design a sampling strategy, which provides a partial sampling of only a subset of the rows of such a matrix P. Our proposed approach fits very well to stochastic processes stemming from simulation of molecular systems or random walks on graphs and it is different from the matrix completion approaches which try to approximate the transition matrix by using a low-rank-assumption. It will be shown how Markov chains can be analyzed on the basis of a partial sampling. More precisely. First, we will estimate the stationary distribution from a partially given matrix P. Second, we will estimate the infinitesimal generator Q of P on the basis of this stationary distribution. Third, from the generator we will compute the leading invariant subspace, which should be identical to the leading invariant subspace of P. Forth, we will apply Robust Perron Cluster Analysis (PCCA+ in order to identify metastabilities using this subspace.

  15. E-mental health care among young adults and help-seeking behaviors: a transversal study in a community sample.

    Science.gov (United States)

    Younes, Nadia; Chollet, Aude; Menard, Estelle; Melchior, Maria

    2015-05-15

    The Internet is widely used by young people and could serve to improve insufficient access to mental health care. Previous information on this topic comes from selected samples (students or self-selected individuals) and is incomplete. In a community sample of young adults, we aimed to describe frequency of e-mental health care study-associated factors and to determine if e-mental health care was associated with the use of conventional services for mental health care. Using data from the 2011 wave of the TEMPO cohort study of French young adults (N=1214, aged 18-37 years), we examined e-mental health care and associated factors following Andersen's behavioral model: predisposing factors (age, sex, educational attainment, professional activity, living with a partner, children, childhood negative events, chronic somatic disease, parental history of depression), enabling factors (social support, financial difficulties, parents' income), and needs-related factors (lifetime major depression or anxiety disorders, suicidal ideation, ADHD, cannabis use). We compared traditional service use (seeking help from a general practitioner, a psychiatrist, a psychologist; antidepressant or anxiolytics/hypnotics use) between participants who used e-mental health care versus those who did not. Overall, 8.65% (105/1214) of participants reported seeking e-mental health care in case of psychological difficulties in the preceding 12 months and 15.7% (104/664) reported psychological difficulties. Controlling for all covariates, the likelihood of e-mental health care was positively associated with 2 needs-related factors, lifetime major depression or anxiety disorder (OR 2.36, 95% CI 1.36-4.09) and lifetime suicidal ideation (OR 1.91, 95% CI 1.40-2.60), and negatively associated with a predisposing factor: childhood life events (OR 0.60, 95% CI 0.38-0.93). E-mental health care did not hinder traditional care, but was associated with face-to-face psychotherapy (66.2%, 51/77 vs 52.4%, 186

  16. Organizations Concerned with Early Care and Education in Illinois: A Sample

    Science.gov (United States)

    Early Childhood Research & Practice, 2013

    2013-01-01

    Several sectors and levels of organizations, agencies, and projects are involved in promoting and providing education, care, and intervention services for young children and their families in Illinois. State government entities involved in matters of early care and education include the Illinois State Board of Education (ISBE), the Department of…

  17. Innovative solutions: sample financial management business plan: neurosurgical intensive care unit.

    Science.gov (United States)

    Villanueva-Baldonado, Analiza; Barrett-Sheridan, Shirley E

    2010-01-01

    This article describes one institution's intention to implement a financial management business plan for a neurosurgical intensive care unit in a level I trauma center. The financial objective of this proposed business plan includes a service increase in the patient population requiring critical care in a way that will help control costs.

  18. Reliability assessment based on small samples of normal distribution

    International Nuclear Information System (INIS)

    Ma Zhibo; Zhu Jianshi; Xu Naixin

    2003-01-01

    When the pertinent parameter involved in reliability definition complies with normal distribution, the conjugate prior of its distributing parameters (μ, h) is of normal-gamma distribution. With the help of maximum entropy and the moments-equivalence principles, the subjective information of the parameter and the sampling data of its independent variables are transformed to a Bayesian prior of (μ,h). The desired estimates are obtained from either the prior or the posterior which is formed by combining the prior and sampling data. Computing methods are described and examples are presented to give demonstrations

  19. CD-Based Microfluidics for Primary Care in Extreme Point-of-Care Settings

    Directory of Open Access Journals (Sweden)

    Suzanne Smith

    2016-01-01

    Full Text Available We review the utility of centrifugal microfluidic technologies applied to point-of-care diagnosis in extremely under-resourced environments. The various challenges faced in these settings are showcased, using areas in India and Africa as examples. Measures for the ability of integrated devices to effectively address point-of-care challenges are highlighted, and centrifugal, often termed CD-based microfluidic technologies, technologies are presented as a promising platform to address these challenges. We describe the advantages of centrifugal liquid handling, as well as the ability of a standard CD player to perform a number of common laboratory tests, fulfilling the role of an integrated lab-on-a-CD. Innovative centrifugal approaches for point-of-care in extremely resource-poor settings are highlighted, including sensing and detection strategies, smart power sources and biomimetic inspiration for environmental control. The evolution of centrifugal microfluidics, along with examples of commercial and advanced prototype centrifugal microfluidic systems, is presented, illustrating the success of deployment at the point-of-care. A close fit of emerging centrifugal systems to address a critical panel of tests for under-resourced clinic settings, formulated by medical experts, is demonstrated. This emphasizes the potential of centrifugal microfluidic technologies to be applied effectively to extremely challenging point-of-care scenarios and in playing a role in improving primary care in resource-limited settings across the developing world.

  20. Two sample Bayesian prediction intervals for order statistics based on the inverse exponential-type distributions using right censored sample

    Directory of Open Access Journals (Sweden)

    M.M. Mohie El-Din

    2011-10-01

    Full Text Available In this paper, two sample Bayesian prediction intervals for order statistics (OS are obtained. This prediction is based on a certain class of the inverse exponential-type distributions using a right censored sample. A general class of prior density functions is used and the predictive cumulative function is obtained in the two samples case. The class of the inverse exponential-type distributions includes several important distributions such the inverse Weibull distribution, the inverse Burr distribution, the loglogistic distribution, the inverse Pareto distribution and the inverse paralogistic distribution. Special cases of the inverse Weibull model such as the inverse exponential model and the inverse Rayleigh model are considered.

  1. Individual and pen-based oral fluid sampling: A welfare-friendly sampling method for group-housed gestating sows.

    Science.gov (United States)

    Pol, Françoise; Dorenlor, Virginie; Eono, Florent; Eudier, Solveig; Eveno, Eric; Liégard-Vanhecke, Dorine; Rose, Nicolas; Fablet, Christelle

    2017-11-01

    The aims of this study were to assess the feasibility of individual and pen-based oral fluid sampling (OFS) in 35 pig herds with group-housed sows, compare these methods to blood sampling, and assess the factors influencing the success of sampling. Individual samples were collected from at least 30 sows per herd. Pen-based OFS was performed using devices placed in at least three pens for 45min. Information related to the farm, the sows, and their living conditions were collected. Factors significantly associated with the duration of sampling and the chewing behaviour of sows were identified by logistic regression. Individual OFS took 2min 42s on average; the type of floor, swab size, and operator were associated with a sampling time >2min. Pen-based OFS was obtained from 112 devices (62.2%). The type of floor, parity, pen-level activity, and type of feeding were associated with chewing behaviour. Pen activity was associated with the latency to interact with the device. The type of floor, gestation stage, parity, group size, and latency to interact with the device were associated with a chewing time >10min. After 15, 30 and 45min of pen-based OFS, 48%, 60% and 65% of the sows were lying down, respectively. The time spent after the beginning of sampling, genetic type, and time elapsed since the last meal were associated with 50% of the sows lying down at one time point. The mean time to blood sample the sows was 1min 16s and 2min 52s if the number of operators required was considered in the sampling time estimation. The genetic type, parity, and type of floor were significantly associated with a sampling time higher than 1min 30s. This study shows that individual OFS is easy to perform in group-housed sows by a single operator, even though straw-bedded animals take longer to sample than animals housed on slatted floors, and suggests some guidelines to optimise pen-based OFS success. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Guiding Principles for Team-Based Pediatric Care.

    Science.gov (United States)

    Katkin, Julie P; Kressly, Susan J; Edwards, Anne R; Perrin, James M; Kraft, Colleen A; Richerson, Julia E; Tieder, Joel S; Wall, Liz

    2017-07-24

    The American Academy of Pediatrics (AAP) recognizes that children's unique and ever-changing needs depend on a variety of support systems. Key components of effective support systems address the needs of the child and family in the context of their home and community and are dynamic so that they reflect, monitor, and respond to changes as the needs of the child and family change. The AAP believes that team-based care involving medical providers and community partners (eg, teachers and state agencies) is a crucial and necessary component of providing high-quality care to children and their families. Team-based care builds on the foundation of the medical home by reaching out to a potentially broad array of participants in the life of a child and incorporating them into the care provided. Importantly, the AAP believes that a high-functioning team includes children and their families as essential partners. The overall goal of team-based care is to enhance communication and cooperation among the varied medical, social, and educational partners in a child's life to better meet the global needs of children and their families, helping them to achieve their best potential. In support of the team-based approach, the AAP urges stakeholders to invest in infrastructure, education, and privacy-secured technology to meet the needs of children. This statement includes limited specific examples of potential team members, including health care providers and community partners, that are meant to be illustrative and in no way represent a complete or comprehensive listing of all team members who may be of importance for a specific child and family. Copyright © 2017 by the American Academy of Pediatrics.

  3. Agreement among the Productivity Components of Eight Presenteeism Tests in a Sample of Health Care Workers.

    Science.gov (United States)

    Thompson, Angus H; Waye, Arianna

    2018-06-01

    Presenteeism (reduced productivity at work) is thought to be responsible for large economic costs. Nevertheless, much of the research supporting this is based on self-report questionnaires that have not been adequately evaluated. To examine the level of agreement among leading tests of presenteeism and to determine the inter-relationship of the two productivity subcategories, amount and quality, within the context of construct validity and method variance. Just under 500 health care workers from an urban health area were asked to complete a questionnaire containing the productivity items from eight presenteeism instruments. The analysis included an examination of test intercorrelations, separately for amount and quality, supplemented by principal-component analyses to determine whether either construct could be described by a single factor. A multitest, multiconstruct analysis was performed on the four tests that assessed both amount and quality to test for the relative contributions of construct and method variance. A total of 137 questionnaires were completed. Agreement among tests was positive, but modest. Pearson r ranges were 0 to 0.64 (mean = 0.32) for Amount and 0.03 to 0.38 (mean = 0.25) for Quality. Further analysis suggested that agreement was influenced more by method variance than by the productivity constructs the tests were designed to measure. The results suggest that presenteeism tests do not accurately assess work performance. Given their importance in the determination of policy-relevant conclusions, attention needs to be given to test improvement in the context of criterion validity assessment. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  4. Dietary intakes of pesticides based on community duplicate diet samples.

    Science.gov (United States)

    Melnyk, Lisa Jo; Xue, Jianping; Brown, G Gordon; McCombs, Michelle; Nishioka, Marcia; Michael, Larry C

    2014-01-15

    The calculation of dietary intake of selected pesticides was accomplished using food samples collected from individual representatives of a defined demographic community using a community duplicate diet approach. A community of nine participants was identified in Apopka, FL from which intake assessments of organophosphate (OP) and pyrethroid pesticides were made. From these nine participants, sixty-seven individual samples were collected and subsequently analyzed by gas chromatography/mass spectrometry. Measured concentrations were used to estimate dietary intakes for individuals and for the community. Individual intakes of total OP and pyrethroid pesticides ranged from 6.7 to 996 ng and 1.2 to 16,000 ng, respectively. The community intake was 256 ng for OPs and 3430 ng for pyrethroid pesticides. The most commonly detected pesticide was permethrin, but the highest overall intake was of bifenthrin followed by esfenvalerate. These data indicate that the community in Apopka, FL, as represented by the nine individuals, was potentially exposed to both OP and pyrethroid pesticides at levels consistent with a dietary model and other field studies in which standard duplicate diet samples were collected. Higher levels of pyrethroid pesticides were measured than OPs, which is consistent with decreased usage of OPs. The diversity of pyrethroid pesticides detected in food samples was greater than expected. Continually changing pesticide usage patterns need to be considered when determining analytes of interest for large scale epidemiology studies. The Community Duplicate Diet Methodology is a tool for researchers to meet emerging exposure measurement needs that will lead to more accurate assessments of intake which may enhance decisions for chemical regulation. Successfully determining the intake of pesticides through the dietary route will allow for accurate assessments of pesticide exposures to a community of individuals, thereby significantly enhancing the research benefit

  5. The Performance Analysis Based on SAR Sample Covariance Matrix

    Directory of Open Access Journals (Sweden)

    Esra Erten

    2012-03-01

    Full Text Available Multi-channel systems appear in several fields of application in science. In the Synthetic Aperture Radar (SAR context, multi-channel systems may refer to different domains, as multi-polarization, multi-interferometric or multi-temporal data, or even a combination of them. Due to the inherent speckle phenomenon present in SAR images, the statistical description of the data is almost mandatory for its utilization. The complex images acquired over natural media present in general zero-mean circular Gaussian characteristics. In this case, second order statistics as the multi-channel covariance matrix fully describe the data. For practical situations however, the covariance matrix has to be estimated using a limited number of samples, and this sample covariance matrix follow the complex Wishart distribution. In this context, the eigendecomposition of the multi-channel covariance matrix has been shown in different areas of high relevance regarding the physical properties of the imaged scene. Specifically, the maximum eigenvalue of the covariance matrix has been frequently used in different applications as target or change detection, estimation of the dominant scattering mechanism in polarimetric data, moving target indication, etc. In this paper, the statistical behavior of the maximum eigenvalue derived from the eigendecomposition of the sample multi-channel covariance matrix in terms of multi-channel SAR images is simplified for SAR community. Validation is performed against simulated data and examples of estimation and detection problems using the analytical expressions are as well given.

  6. The quality of paper-based versus electronic nursing care plan in Australian aged care homes: A documentation audit study.

    Science.gov (United States)

    Wang, Ning; Yu, Ping; Hailey, David

    2015-08-01

    The nursing care plan plays an essential role in supporting care provision in Australian aged care. The implementation of electronic systems in aged care homes was anticipated to improve documentation quality. Standardized nursing terminologies, developed to improve communication and advance the nursing profession, are not required in aged care practice. The language used by nurses in the nursing care plan and the effect of the electronic system on documentation quality in residential aged care need to be investigated. To describe documentation practice for the nursing care plan in Australian residential aged care homes and to compare the quantity and quality of documentation in paper-based and electronic nursing care plans. A nursing documentation audit was conducted in seven residential aged care homes in Australia. One hundred and eleven paper-based and 194 electronic nursing care plans, conveniently selected, were reviewed. The quantity of documentation in a care plan was determined by the number of phrases describing a resident problem and the number of goals and interventions. The quality of documentation was measured using 16 relevant questions in an instrument developed for the study. There was a tendency to omit 'nursing problem' or 'nursing diagnosis' in the nursing process by changing these terms (used in the paper-based care plan) to 'observation' in the electronic version. The electronic nursing care plan documented more signs and symptoms of resident problems and evaluation of care than the paper-based format (48.30 vs. 47.34 out of 60, Ppaper-based system (Ppaper-based system. Omission of the nursing problem or diagnosis from the nursing process may reflect a range of factors behind the practice that need to be understood. Further work is also needed on qualitative aspects of the nurse care plan, nurses' attitudes towards standardized terminologies and the effect of different documentation practice on care quality and resident outcomes. Copyright

  7. Some Biomaterials based on Collagen in Human Health care

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Some Biomaterials based on Collagen in Human Health care. Ophthalmology. Wound healing. Burn Dressing. Tumor Treatment. Tissue Engineered devices. for cardio-vascular functions; For managing chronic illnesses including diabetic ulcers and foot. Smart shoe.

  8. Who are good home-based care volunteers? | Marincowitz | South ...

    African Journals Online (AJOL)

    Aim: The aim of the study was to describe the characteristics of volunteers who remained active in the home-based care project located in Tzaneen (Limpopo Province) and thereby assist the project leaders to improve the recruitment and quality of the service in the future. Methodology: Structured questionnaires were ...

  9. Evidence-based care: an innovation to improve nursing practice ...

    African Journals Online (AJOL)

    Evidence-based care: an innovation to improve nursing practice globally. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... best available evidence from research findings, expert ideas from specialists in the various health ... need to be addressed to enhance utilization of the best available evidence in nursing practice.

  10. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Helena; Hallström, Inger; Kjaergaard, Hanne

    2011-01-01

    Hospital-based home care (HBHC) is widely applied in Pediatric Oncology. We reviewed the potential effect of HBHC on children's physical health and risk of adverse events, parental and child satisfaction, quality of life of children and their parents, and costs. A search of PubMed, CINAHL...

  11. Patient and family/friend satisfaction in a sample of Jordanian Critical Care Units.

    Science.gov (United States)

    Mosleh, S; Alja'afreh, M; Lee, A J

    2015-12-01

    The aim of the study was to assess the validity of family members/friends as proxies by comparing perceptions of satisfaction with care and decision making between critically ill patients and their family/friends. A comparative, descriptive cross-sectional study. Seven Critical Care Units across four public and military hospitals in the centre and southern regions of Jordan. A modified version of the Family Satisfaction-ICU (FS-ICU) questionnaire was distributed to Critical Care Unit (CCU) patients before hospital discharge. In addition, up to two family members/close friends were also asked to complete the questionnaire. A total of 213 patients (response rate 72%) and 246 family members/friends (response rate 79%) completed and returned the questionnaire. Although the majority of family members/friends and patients were satisfied with overall care, patients were generally significantly less satisfied (mean (SD) care subscale 75.6 (17.8) and 70.9 (17.3), respectively, (p=0.005). When individual items were examined, significant differences in nursing care (family/friends 80.1 (20.7) versus patient 75.9 (22.2), p=0.038) and inclusion in decision making (family/friends 53.9 (33.2) versus patient 62.0 (34.2), p=0.010) were found. The study showed a degree of congruence between patients and their family members/friends in relation to their satisfaction with the CCU experience. Thus, views of family/friends may serve as a proxy in assessing care and decision making processes of critically ill patients. Appropriate training of the critical care team and provision of strategies to address the concerns of patients' families are needed to improve overall patient satisfaction. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Cloud based emergency health care information service in India.

    Science.gov (United States)

    Karthikeyan, N; Sukanesh, R

    2012-12-01

    A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the

  13. The frequency of outdoor play for preschool age children cared for at home-based child care settings.

    Science.gov (United States)

    Tandon, Pooja S; Zhou, Chuan; Christakis, Dimitri A

    2012-01-01

    Given that more than 34% of U.S. children are cared for in home-based child care settings and outdoor play is associated with physical activity and other health benefits, we sought to characterize the outdoor play frequency of preschoolers cared for at home-based child care settings and factors associated with outdoor play. Cross-sectional study of 1900 preschoolers (representing approximately 862,800 children) cared for in home-based child care settings (including relative and nonrelative care) using the nationally representative Early Childhood Longitudinal Study, Birth Cohort. Only 50% of home-based child care providers reported taking the child outside to walk or play at least once/day. More than one-third of all children did not go outside to play daily with either their parent(s) or home-based child care provider. There were increased odds of going outside daily for children cared for by nonrelatives in the child's home compared with care from a relative. Children with ≥3 regular playmates had greater odds of being taken outdoors by either the parents or child care provider. We did not find statistically significant associations between other child level (age, sex, screen-time), family level (highest education in household, mother's race, employment, exercise frequency), and child care level (hours in care, provider's educational attainment, perception of neighborhood safety) factors and frequency of outdoor play. At a national level, the frequency of outdoor play for preschoolers cared for in home-based child care settings is suboptimal. Further study and efforts to increase outdoor playtime for children in home-based child care settings are needed. Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  14. Feasibility of self-sampled dried blood spot and saliva samples sent by mail in a population-based study

    International Nuclear Information System (INIS)

    Sakhi, Amrit Kaur; Bastani, Nasser Ezzatkhah; Ellingjord-Dale, Merete; Gundersen, Thomas Erik; Blomhoff, Rune; Ursin, Giske

    2015-01-01

    In large epidemiological studies it is often challenging to obtain biological samples. Self-sampling by study participants using dried blood spots (DBS) technique has been suggested to overcome this challenge. DBS is a type of biosampling where blood samples are obtained by a finger-prick lancet, blotted and dried on filter paper. However, the feasibility and efficacy of collecting DBS samples from study participants in large-scale epidemiological studies is not known. The aim of the present study was to test the feasibility and response rate of collecting self-sampled DBS and saliva samples in a population–based study of women above 50 years of age. We determined response proportions, number of phone calls to the study center with questions about sampling, and quality of the DBS. We recruited women through a study conducted within the Norwegian Breast Cancer Screening Program. Invitations, instructions and materials were sent to 4,597 women. The data collection took place over a 3 month period in the spring of 2009. Response proportions for the collection of DBS and saliva samples were 71.0% (3,263) and 70.9% (3,258), respectively. We received 312 phone calls (7% of the 4,597 women) with questions regarding sampling. Of the 3,263 individuals that returned DBS cards, 3,038 (93.1%) had been packaged and shipped according to instructions. A total of 3,032 DBS samples were sufficient for at least one biomarker analysis (i.e. 92.9% of DBS samples received by the laboratory). 2,418 (74.1%) of the DBS cards received by the laboratory were filled with blood according to the instructions (i.e. 10 completely filled spots with up to 7 punches per spot for up to 70 separate analyses). To assess the quality of the samples, we selected and measured two biomarkers (carotenoids and vitamin D). The biomarker levels were consistent with previous reports. Collecting self-sampled DBS and saliva samples through the postal services provides a low cost, effective and feasible

  15. Feasibility of self-sampled dried blood spot and saliva samples sent by mail in a population-based study.

    Science.gov (United States)

    Sakhi, Amrit Kaur; Bastani, Nasser Ezzatkhah; Ellingjord-Dale, Merete; Gundersen, Thomas Erik; Blomhoff, Rune; Ursin, Giske

    2015-04-11

    In large epidemiological studies it is often challenging to obtain biological samples. Self-sampling by study participants using dried blood spots (DBS) technique has been suggested to overcome this challenge. DBS is a type of biosampling where blood samples are obtained by a finger-prick lancet, blotted and dried on filter paper. However, the feasibility and efficacy of collecting DBS samples from study participants in large-scale epidemiological studies is not known. The aim of the present study was to test the feasibility and response rate of collecting self-sampled DBS and saliva samples in a population-based study of women above 50 years of age. We determined response proportions, number of phone calls to the study center with questions about sampling, and quality of the DBS. We recruited women through a study conducted within the Norwegian Breast Cancer Screening Program. Invitations, instructions and materials were sent to 4,597 women. The data collection took place over a 3 month period in the spring of 2009. Response proportions for the collection of DBS and saliva samples were 71.0% (3,263) and 70.9% (3,258), respectively. We received 312 phone calls (7% of the 4,597 women) with questions regarding sampling. Of the 3,263 individuals that returned DBS cards, 3,038 (93.1%) had been packaged and shipped according to instructions. A total of 3,032 DBS samples were sufficient for at least one biomarker analysis (i.e. 92.9% of DBS samples received by the laboratory). 2,418 (74.1%) of the DBS cards received by the laboratory were filled with blood according to the instructions (i.e. 10 completely filled spots with up to 7 punches per spot for up to 70 separate analyses). To assess the quality of the samples, we selected and measured two biomarkers (carotenoids and vitamin D). The biomarker levels were consistent with previous reports. Collecting self-sampled DBS and saliva samples through the postal services provides a low cost, effective and feasible

  16. Polymeric ionic liquid-based portable tip microextraction device for on-site sample preparation of water samples.

    Science.gov (United States)

    Chen, Lei; Pei, Junxian; Huang, Xiaojia; Lu, Min

    2018-06-05

    On-site sample preparation is highly desired because it avoids the transportation of large-volume samples and ensures the accuracy of the analytical results. In this work, a portable prototype of tip microextraction device (TMD) was designed and developed for on-site sample pretreatment. The assembly procedure of TMD is quite simple. Firstly, polymeric ionic liquid (PIL)-based adsorbent was in-situ prepared in a pipette tip. After that, the tip was connected with a syringe which was driven by a bidirectional motor. The flow rates in adsorption and desorption steps were controlled accurately by the motor. To evaluate the practicability of the developed device, the TMD was used to on-site sample preparation of waters and combined with high-performance liquid chromatography with diode array detection to measure trace estrogens in water samples. Under the most favorable conditions, the limits of detection (LODs, S/N = 3) for the target analytes were in the range of 4.9-22 ng/L, with good coefficients of determination. Confirmatory study well evidences that the extraction performance of TMD is comparable to that of the traditional laboratory solid-phase extraction process, but the proposed TMD is more simple and convenient. At the same time, the TMD avoids complicated sampling and transferring steps of large-volume water samples. Copyright © 2018 Elsevier B.V. All rights reserved.

  17. Randomization-Based Inference about Latent Variables from Complex Samples: The Case of Two-Stage Sampling

    Science.gov (United States)

    Li, Tiandong

    2012-01-01

    In large-scale assessments, such as the National Assessment of Educational Progress (NAEP), plausible values based on Multiple Imputations (MI) have been used to estimate population characteristics for latent constructs under complex sample designs. Mislevy (1991) derived a closed-form analytic solution for a fixed-effect model in creating…

  18. Users’ dissatisfaction with dental care: a population-based household study

    Science.gov (United States)

    Martins, Andréa Maria Eleutério de Barros Lima; Ferreira, Raquel Conceição; dos Santos, Pedro Eleutério; Carreiro, Danilo Lima; Souza, João Gabriel Silva; Ferreira e Ferreira, Efigênia

    2015-01-01

    OBJECTIVE To examine whether demographic, socioeconomic conditions, oral health subjectivity and characterization of dental care are associated with users’ dissatisfaction with such are. METHODS Cross-sectional study of 781 people who required dental care in Montes Claros, MG, Southeastern Brazil, in 2012, a city with of medium-sized population situated in the North of Minas Gerais. Household interviews were conducted to assess the users’ dissatisfaction with dental care (dependent variable), demographic, socioeconomic conditions, oral health subjectivity and characterization of dental care (independent variables). Sample calculation was used for the finite population, with estimates made for proportions of dissatisfaction in 50.0% of the population, a 5.0% error margin, a non-response rate of 5.0% and a 2.0% design effect. Logistic regression was used, and the odds ratio was calculated with a 5% significance level and 95% confidence intervals. RESULTS Of the interviewed individuals, 9.0% (7.9%, with correction for design effect) were dissatisfied with the care provided. These were associated with lower educational level; negative self-assessment of oral health; perception that the care provider was unable to give dental care; negative evaluation of the way the patient was treated, the cleanliness of the rooms, based on the examination rooms and the toilets, and the size of the waiting and examination rooms. CONCLUSIONS The rate of dissatisfaction with dental care was low. This dissatisfaction was associated with socioeconomic conditions, subjectivity of oral health, skill of the health professionals relating to the professional-patient relationship and facility infrastructure. Educational interventions are suggested that aim at improving the quality of care among professionals by responsible agencies as is improving the infrastructure of the care units. PMID:26270017

  19. Users’ dissatisfaction with dental care: a population-based household study

    Directory of Open Access Journals (Sweden)

    Andréa Maria Eleutério de Barros Lima Martins

    2015-01-01

    Full Text Available OBJECTIVE To examine whether demographic, socioeconomic conditions, oral health subjectivity and characterization of dental care are associated with users’ dissatisfaction with such are.METHODS Cross-sectional study of 781 people who required dental care in Montes Claros, MG, Southeastern Brazil, in 2012, a city with of medium-sized population situated in the North of Minas Gerais. Household interviews were conducted to assess the users’ dissatisfaction with dental care (dependent variable, demographic, socioeconomic conditions, oral health subjectivity and characterization of dental care (independent variables. Sample calculation was used for the finite population, with estimates made for proportions of dissatisfaction in 50.0% of the population, a 5.0% error margin, a non-response rate of 5.0% and a 2.0% design effect. Logistic regression was used, and the odds ratio was calculated with a 5% significance level and 95% confidence intervals.RESULTS Of the interviewed individuals, 9.0% (7.9%, with correction for design effect were dissatisfied with the care provided. These were associated with lower educational level; negative self-assessment of oral health; perception that the care provider was unable to give dental care; negative evaluation of the way the patient was treated, the cleanliness of the rooms, based on the examination rooms and the toilets, and the size of the waiting and examination rooms.CONCLUSIONS The rate of dissatisfaction with dental care was low. This dissatisfaction was associated with socioeconomic conditions, subjectivity of oral health, skill of the health professionals relating to the professional-patient relationship and facility infrastructure. Educational interventions are suggested that aim at improving the quality of care among professionals by responsible agencies as is improving the infrastructure of the care units.

  20. Evidence-based medicine and quality of care.

    Science.gov (United States)

    Dickenson, Donna; Vineis, Paolo

    2002-01-01

    In this paper we set out to examine the arguments for and against the claim that Evidence-Based Medicine (EBM) will improve the quality of care. In particular, we examine the following issues: 1. Are there hidden ethical assumptions in the methodology of EBM? 2. Is there a tension between the duty of care and EBM? 3. How can patient preferences be incorporated into quality guidelines and effectiveness studies? 4. Is there a tension between the quality of a particular intervention and overall quality of care? 5. Are certain branches of medicine and patient groups innately or prima facie disadvantaged by a shift to EBM? In addition we consider a case study in the ethics of EBM, on a clinical trial concerning the collection of umbilical cord blood in utero and ex utero, during or after labour in childbirth.

  1. Bridging the gap to evidence-based eye care

    Directory of Open Access Journals (Sweden)

    Richard Wormald

    2004-10-01

    Full Text Available In the first article in this series, I touched on the enormous challenge to make access to information equal for those who need it at the time and place when they need it. Only if this is achieved can we successfully promote an evidence-based approach to health care. The move towards open access publishing is taking us some way to achieving this. However, there are further gaps to be bridged if we are to turn eye care workers into evidence-based practitioners. We can define an evidence-based practitioner as one who combines their individual knowledge and expertise with the best available external clinical evidence from systematic research.

  2. Adaptive Sampling for Nonlinear Dimensionality Reduction Based on Manifold Learning

    DEFF Research Database (Denmark)

    Franz, Thomas; Zimmermann, Ralf; Goertz, Stefan

    2017-01-01

    We make use of the non-intrusive dimensionality reduction method Isomap in order to emulate nonlinear parametric flow problems that are governed by the Reynolds-averaged Navier-Stokes equations. Isomap is a manifold learning approach that provides a low-dimensional embedding space that is approxi...... to detect and fill up gaps in the sampling in the embedding space. The performance of the proposed manifold filling method will be illustrated by numerical experiments, where we consider nonlinear parameter-dependent steady-state Navier-Stokes flows in the transonic regime.......We make use of the non-intrusive dimensionality reduction method Isomap in order to emulate nonlinear parametric flow problems that are governed by the Reynolds-averaged Navier-Stokes equations. Isomap is a manifold learning approach that provides a low-dimensional embedding space...

  3. All-polymer microfluidic systems for droplet based sample analysis

    DEFF Research Database (Denmark)

    Poulsen, Carl Esben

    In this PhD project, I pursued to develop an all-polymer injection moulded microfluidic platform with integrated droplet based single cell interrogation. To allow for a proper ”one device - one experiment” methodology and to ensure a high relevancy to non-academic settings, the systems presented ...

  4. Sampling in image space for vision based SLAM

    NARCIS (Netherlands)

    Booij, O.; Zivkovic, Z.; Kröse, B.

    2008-01-01

    Loop closing in vision based SLAM applications is a difficult task. Comparing new image data with all previous image data acquired for the map is practically impossible because of the high computational costs. This problem is part of the bigger problem to acquire local geometric constraints from

  5. Aging as a predictor of nursing workload in Intensive Care Unit: results from a Brazilian Sample.

    Science.gov (United States)

    Ferretti-Rebustini, Renata Eloah de Lucena; Nogueira, Lilia de Souza; Silva, Rita de Cassia Gengo E; Poveda, Vanessa de Brito; Machado, Selma Pinheiro; Oliveira, Elaine Machado de; Andolhe, Rafaela; Padilha, Katia Grillo

    2017-04-03

    Verify if aging is an independent predictor of NW in ICU, according to age groups, and its predictive value as a determinant of NW in ICU. Study was conducted from 2012 to 2016. A convenience sample composed by patients (age ≥ 18) admitted to nine ICU belonging to a Brazilian hospital, was analyzed. Age was assumed as an independent variable and NW (measured by the Nursing Activities Score - NAS) as dependent. Linear regression model and ROC curve were used for the analysis. 890 participants (361 older people), mostly males (58.1%). The mean NAS score was higher among older participants in comparison to adults (p=0.004) but not within categories of aging (p=0.697). Age was responsible for 0.6% of NAS score. Each year of age increases NAS score in 0.081 points (p=0.015). However, age was not a good predictor of NAS score (AUC = 0.394; p=0.320). The care of older people in ICU is associated with an increase in NW, compared to adults. Aging can be considered an associated factor but not a good predictor of NW in ICU. Verificar si el envejecimiento es un predictor independiente de la Carga de Trabajo de Enfermería (CTE) en la Unidad de Cuidados Intensivos (UCI), según grupos etarios y su valor predictivo como determinante de la CTE en la UCI. Se analizó una muestra de conveniencia compuesta por pacientes (edad ≥ 18) ingresados en nueve UCI pertenecientes a un hospital brasileño. La edad se asumió como variable independiente y como variable dependiente la carga de trabajo de enfermería -medida por el sistema Nursing Activities Score (NAS) de puntuación de actividades de enfermería. Para el análisis, se utilizaron el modelo de regresión lineal y la curva ROC. 890 participantes (361 adultos mayores), en su mayoría varones (58,1%). La puntuación NAS promedio fue mayor entre los participantes adultos mayores en comparación con los adultos (p=0,004), pero no en las categorías de envejecimiento (p=0,697). La edad fue responsable del 0,6% de la puntuaci

  6. Protein expression based multimarker analysis of breast cancer samples

    International Nuclear Information System (INIS)

    Presson, Angela P; Horvath, Steve; Yoon, Nam K; Bagryanova, Lora; Mah, Vei; Alavi, Mohammad; Maresh, Erin L; Rajasekaran, Ayyappan K; Goodglick, Lee; Chia, David

    2011-01-01

    Tissue microarray (TMA) data are commonly used to validate the prognostic accuracy of tumor markers. For example, breast cancer TMA data have led to the identification of several promising prognostic markers of survival time. Several studies have shown that TMA data can also be used to cluster patients into clinically distinct groups. Here we use breast cancer TMA data to cluster patients into distinct prognostic groups. We apply weighted correlation network analysis (WGCNA) to TMA data consisting of 26 putative tumor biomarkers measured on 82 breast cancer patients. Based on this analysis we identify three groups of patients with low (5.4%), moderate (22%) and high (50%) mortality rates, respectively. We then develop a simple threshold rule using a subset of three markers (p53, Na-KATPase-β1, and TGF β receptor II) that can approximately define these mortality groups. We compare the results of this correlation network analysis with results from a standard Cox regression analysis. We find that the rule-based grouping variable (referred to as WGCNA*) is an independent predictor of survival time. While WGCNA* is based on protein measurements (TMA data), it validated in two independent Affymetrix microarray gene expression data (which measure mRNA abundance). We find that the WGCNA patient groups differed by 35% from mortality groups defined by a more conventional stepwise Cox regression analysis approach. We show that correlation network methods, which are primarily used to analyze the relationships between gene products, are also useful for analyzing the relationships between patients and for defining distinct patient groups based on TMA data. We identify a rule based on three tumor markers for predicting breast cancer survival outcomes

  7. PTSD risk and mental health care engagement in a multi-war era community sample of women veterans.

    Science.gov (United States)

    Washington, Donna L; Davis, Teri D; Der-Martirosian, Claudia; Yano, Elizabeth M

    2013-07-01

    Post-traumatic stress disorder (PTSD) is common in women veterans (WVs), and associated with significant co-morbidity. Effective treatment is available; however, PTSD is often unrecognized. Identify PTSD prevalence and mental healthcare (MHC) use in a representative national WV sample. Cross-sectional, population-based 2008-2009 national survey of 3,611 WVs, weighted to the population. We screened for PTSD using a validated instrument, and also assessed demographic characteristics, health characteristics, and MHC use in the prior 12 months. Among those screening positive, we conducted multivariate logistic regression to identify independent predictors of MHC use. Overall, 13.0 % (95 % confidence interval [CI] 9.8-16.2) of WVs screened PTSD-positive. Veterans Health Administration (VA) healthcare was used by 31.1 % of PTSD-positives and 11.4 % of PTSD-negatives (phealth care (OR=0.2; 95 % CI 0.1-0.4) and household income below the federal poverty level (OR=0.2; 95 % CI 0.1-0.5) predicted nonuse. More than one in eight WVs screened positive for PTSD. Though a majority of VA-users received MHC, low income predicted nonuse. Only a minority of VA-nonusers received MHC. The majority of WVs use non-VA healthcare providers, who may be unaware of their veteran status and PTSD risk. VA outreach to educate VA-nonusers and their healthcare providers about WVs' PTSD risk and available evidence-based VA treatment options is one approach to extend the reach of VA MHC. Research to characterize barriers to VA MHC use for VA-nonusers and low income VA-users is warranted to better understand low service utilization, and to inform program development to engage more WVs in needed MHC.

  8. Respiratory Acid-Base Disorders in the Critical Care Unit.

    Science.gov (United States)

    Hopper, Kate

    2017-03-01

    The incidence of respiratory acid-base abnormalities in the critical care unit (CCU) is unknown, although respiratory alkalosis is suspected to be common in this population. Abnormal carbon dioxide tension can have many physiologic effects, and changes in Pco 2 may have a significant impact on outcome. Monitoring Pco 2 in CCU patients is an important aspect of critical patient assessment, and identification of respiratory acid-base abnormalities can be valuable as a diagnostic tool. Treatment of respiratory acid-base disorders is largely focused on resolution of the primary disease, although mechanical ventilation may be indicated in cases with severe respiratory acidosis. Published by Elsevier Inc.

  9. Enviromental sampling at remote sites based on radiological screening assessments

    International Nuclear Information System (INIS)

    Ebinger, M.H.; Hansen, W.R.; Wenz, G.; Oxenberg, T.P.

    1996-01-01

    Environmental radiation monitoring (ERM) data from remote sites on the White Sands Missile Range, New Mexico, were used to estimate doses to humans and terrestrial mammals from residual radiation deposited during testing of components containing depleted uranium (DU) and thorium (Th). ERM data were used with the DOE code RESRAD and a simple steady-state pathway code to estimate the potential adverse effects from DU and Th to workers in the contaminated zones, to hunters consuming animals from the contaminated zones, and to terrestrial mammals that inhabit the contaminated zones. Assessments of zones contaminated with DU and Th and DU alone were conducted. Radiological doses from Th and DU in soils were largest with a maximum of about 3.5 mrem y -1 in humans and maximum of about 0.1 mrad d -1 in deer. Dose estimates from DU alone in soils were significantly less with a maximum of about 1 mrem y -1 in humans and about 0.04 mrad d -1 in deer. The results of the dose estimates suggest strongly that environmental sampling in these affected areas can be infrequent and still provide adequate assessments of radiological doses to workers, hunters, and terrestrial mammals

  10. Prevalence of depression: Comparisons of different depression definitions in population-based samples of older adults.

    Science.gov (United States)

    Sjöberg, Linnea; Karlsson, Björn; Atti, Anna-Rita; Skoog, Ingmar; Fratiglioni, Laura; Wang, Hui-Xin

    2017-10-15

    Depression prevalence in older adults varies largely across studies, which probably reflects methodological rather than true differences. This study aims to explore whether and to what extent the prevalence of depression varies when using different diagnostic criteria and rating scales, and various samples of older adults. A population-based sample of 3353 individuals aged 60-104 years from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were examined in 2001-2004. Point prevalence of depression was estimated by: 1) diagnostic criteria, ICD-10 and DSM-IV-TR/DSM-5; 2) rating scales, MADRS and GDS-15; and 3) self-report. Depression prevalence in sub-samples by dementia status, living place, and socio-demographics were compared. The prevalence of any depression (including all severity grades) was 4.2% (moderate/severe: 1.6%) for ICD-10 and 9.3% (major: 2.1%) for DSM-IV-TR; 10.6% for MADRS and 9.2% for GDS-15; and 9.1% for self-report. Depression prevalence was lower in the dementia-free sample as compared to the total population. Furthermore, having poor physical function, or not having a partner were independently associated with higher depression prevalence, across most of the depression definitions. The response rate was 73.3% and this may have resulted in an underestimation of depression. Depression prevalence was similar across all depression definitions except for ICD-10, showing much lower figures. However, independent of the definition used, depression prevalence varies greatly by dementia status, physical functioning, and marital status. These findings may be useful for clinicians when assessing depression in older adults and for researchers when exploring and comparing depression prevalence across studies. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Sampling Key Populations for HIV Surveillance: Results From Eight Cross-Sectional Studies Using Respondent-Driven Sampling and Venue-Based Snowball Sampling.

    Science.gov (United States)

    Rao, Amrita; Stahlman, Shauna; Hargreaves, James; Weir, Sharon; Edwards, Jessie; Rice, Brian; Kochelani, Duncan; Mavimbela, Mpumelelo; Baral, Stefan

    2017-10-20

    In using regularly collected or existing surveillance data to characterize engagement in human immunodeficiency virus (HIV) services among marginalized populations, differences in sampling methods may produce different pictures of the target population and may therefore result in different priorities for response. The objective of this study was to use existing data to evaluate the sample distribution of eight studies of female sex workers (FSW) and men who have sex with men (MSM), who were recruited using different sampling approaches in two locations within Sub-Saharan Africa: Manzini, Swaziland and Yaoundé, Cameroon. MSM and FSW participants were recruited using either respondent-driven sampling (RDS) or venue-based snowball sampling. Recruitment took place between 2011 and 2016. Participants at each study site were administered a face-to-face survey to assess sociodemographics, along with the prevalence of self-reported HIV status, frequency of HIV testing, stigma, and other HIV-related characteristics. Crude and RDS-adjusted prevalence estimates were calculated. Crude prevalence estimates from the venue-based snowball samples were compared with the overlap of the RDS-adjusted prevalence estimates, between both FSW and MSM in Cameroon and Swaziland. RDS samples tended to be younger (MSM aged 18-21 years in Swaziland: 47.6% [139/310] in RDS vs 24.3% [42/173] in Snowball, in Cameroon: 47.9% [99/306] in RDS vs 20.1% [52/259] in Snowball; FSW aged 18-21 years in Swaziland 42.5% [82/325] in RDS vs 8.0% [20/249] in Snowball; in Cameroon 15.6% [75/576] in RDS vs 8.1% [25/306] in Snowball). They were less educated (MSM: primary school completed or less in Swaziland 42.6% [109/310] in RDS vs 4.0% [7/173] in Snowball, in Cameroon 46.2% [138/306] in RDS vs 14.3% [37/259] in Snowball; FSW: primary school completed or less in Swaziland 86.6% [281/325] in RDS vs 23.9% [59/247] in Snowball, in Cameroon 87.4% [520/576] in RDS vs 77.5% [238/307] in Snowball) than the snowball

  12. 76 FR 21372 - Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions...

    Science.gov (United States)

    2011-04-15

    ...] Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions Program... interested parties of an opportunity to apply to participate in the Medicare Community-based Care Transitions.... 111-148, enacted on March 23, 2010) (Affordable Care Act) authorized the Medicare Community-based Care...

  13. Deducing magnetic resonance neuroimages based on knowledge from samples.

    Science.gov (United States)

    Jiang, Yuwei; Liu, Feng; Fan, Mingxia; Li, Xuzhou; Zhao, Zhiyong; Zeng, Zhaoling; Wang, Yi; Xu, Dongrong

    2017-12-01

    Because individual variance always exists, using the same set of predetermined parameters for magnetic resonance imaging (MRI) may not be exactly suitable for each participant. We propose a knowledge-based method that can repair MRI data of undesired contrast as if a new scan were acquired using imaging parameters that had been individually optimized. The method employed a strategy called analogical reasoning to deduce voxel-wise relaxation properties using morphological and biological similarity. The proposed framework involves steps of intensity normalization, tissue segmentation, relaxation time deducing, and image deducing. This approach has been preliminarily validated using conventional MRI data at 3T from several examples, including 5 normal and 9 clinical datasets. It can effectively improve the contrast of real MRI data by deducing imaging data using optimized imaging parameters based on deduced relaxation properties. The statistics of deduced images shows a high correlation with real data that were actually collected using the same set of imaging parameters. The proposed method of deducing MRI data using knowledge of relaxation times alternatively provides a way of repairing MRI data of less optimal contrast. The method is also capable of optimizing an MRI protocol for individual participants, thereby realizing personalized MR imaging. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Order of draw practices in venous blood sampling at clinical biochemistry departments in the Danish health care system

    DEFF Research Database (Denmark)

    Jacobsen, Katja Kemp; Brandt, Ida; Christensen, Anne Vindahl

    2018-01-01

    the procedures in venous blood sampling among clinical biochemistry departments to assess the uniformity of order of blood draw and adherence to international guidelines in the Danish health care system. METHODS: We collected venous order of draw procedures from 49 clinical biochemistry departments at 22 public...... 15189:2012 accreditation (p = .57). CONCLUSIONS: Venous order of draw procedures is diverse at Danish clinical biochemistry departments and show moderate adherence to international guidelines....

  15. Smartphone based point-of-care detector of urine albumin

    Science.gov (United States)

    Cmiel, Vratislav; Svoboda, Ondrej; Koscova, Pavlina; Provaznik, Ivo

    2016-03-01

    Albumin plays an important role in human body. Its changed level in urine may indicate serious kidney disorders. We present a new point-of-care solution for sensitive detection of urine albumin - the miniature optical adapter for iPhone with in-built optical filters and a sample slot. The adapter exploits smart-phone flash to generate excitation light and camera to measure the level of emitted light. Albumin Blue 580 is used as albumin reagent. The proposed light-weight adapter can be produced at low cost using a 3D printer. Thus, the miniaturized detector is easy to use out of lab.

  16. Efficient approach for reliability-based optimization based on weighted importance sampling approach

    International Nuclear Information System (INIS)

    Yuan, Xiukai; Lu, Zhenzhou

    2014-01-01

    An efficient methodology is presented to perform the reliability-based optimization (RBO). It is based on an efficient weighted approach for constructing an approximation of the failure probability as an explicit function of the design variables which is referred to as the ‘failure probability function (FPF)’. It expresses the FPF as a weighted sum of sample values obtained in the simulation-based reliability analysis. The required computational effort for decoupling in each iteration is just single reliability analysis. After the approximation of the FPF is established, the target RBO problem can be decoupled into a deterministic one. Meanwhile, the proposed weighted approach is combined with a decoupling approach and a sequential approximate optimization framework. Engineering examples are given to demonstrate the efficiency and accuracy of the presented methodology

  17. Scleroderma prevalence: demographic variations in a population-based sample.

    Science.gov (United States)

    Bernatsky, S; Joseph, L; Pineau, C A; Belisle, P; Hudson, M; Clarke, A E

    2009-03-15

    To estimate the prevalence of systemic sclerosis (SSc) using population-based administrative data, and to assess the sensitivity of case ascertainment approaches. We ascertained SSc cases from Quebec physician billing and hospitalization databases (covering approximately 7.5 million individuals). Three case definition algorithms were compared, and statistical methods accounting for imperfect case ascertainment were used to estimate SSc prevalence and case ascertainment sensitivity. A hierarchical Bayesian latent class regression model that accounted for possible between-test dependence conditional on disease status estimated the effect of patient characteristics on SSc prevalence and the sensitivity of the 3 ascertainment algorithms. Accounting for error inherent in both the billing and the hospitalization data, we estimated SSc prevalence in 2003 at 74.4 cases per 100,000 women (95% credible interval [95% CrI] 69.3-79.7) and 13.3 cases per 100,000 men (95% CrI 11.1-16.1). Prevalence was higher for older individuals, particularly in urban women (161.2 cases per 100,000, 95% CrI 148.6-175.0). Prevalence was lowest in young men (in rural areas, as low as 2.8 cases per 100,000, 95% CrI 1.4-4.8). In general, no single algorithm was very sensitive, with point estimates for sensitivity ranging from 20-73%. We found marked differences in SSc prevalence according to age, sex, and region. In general, no single case ascertainment approach was very sensitive for SSc. Therefore, using data from multiple sources, with adjustment for the imperfect nature of each, is an important strategy in population-based studies of SSc and similar conditions.

  18. Adolescent health care: improving access by school-based service.

    Science.gov (United States)

    Gonzales, C; Mulligan, D; Kaufman, A; Davis, S; Hunt, K; Kalishman, N; Wallerstein, N

    1985-10-01

    Participants in this discussion of the potential of school-based health care services for adolescents included family medicine physicians, school health coordinators, a school nurse, and a community worker. It was noted that health care for adolescents tends to be either inaccessible or underutilized, largely because of a lack of sensitivity to adolescent culture and values. An ideal service for adolescents would offer immediate services for crises, strict confidentiality, ready access to prescribed medications, a sliding-scale scheme, and a staff that is tolerant of divergent values and life-styles. School-based pilot adolescent clinics have been established by the University of New Mexico's Department of Family, Community, and Emergency Medicine to test the community-oriented health care model. On-site clinics provide urgent medical care, family planning, pregnancy testing, psychological counseling, alcohol and drug counseling, and classroom health education. Experience with these programs has demonstrated the necessity for an alliance among the health team and the school administration, parents, and students. Financial, ethical, and political factors can serve as constraints to school-based programs. In some cases, school administrators have been resistant to the provision of contraception to students on school grounds and parents have been unwilling to accept the adolescent's right to confidentiality. These problems in part stem from having 2 separate systems, each with its own values, orientation, and responsibilities, housed in 1 facility. In addition, there have been problems generating awareness of the school-based clinic among students. Health education theater groups, peer counseling, and student-run community services have been effective, however, in increasing student participation. It has been helpful to mold clinic services to meet the needs identified by teenagers themselves. There is an interest not only in curative services, but in services focused

  19. Passive sampling of pharmaceuticals and personal care products in aquatic environments

    Czech Academy of Sciences Publication Activity Database

    Křesinová, Zdena; Petrů, Klára; Lhotský, O.; Rodsand, T.; Cajthaml, Tomáš

    2016-01-01

    Roč. 6, č. 1 (2016), s. 43-46 ISSN 1805-0174 Institutional support: RVO:61388971 Keywords : passive sampling * polar organic chemical integrative samplers * aquatic matrices Subject RIV: EE - Microbiology, Virology

  20. Regional differences in infection control conditions in a sample of primary health care services in Brazil

    Directory of Open Access Journals (Sweden)

    Mauro Henrique Nogueira Guimarães de Abreu

    2017-11-01

    Full Text Available International guidelines have pointed out the importance of the physical environment of health care facilities in preventing and controlling infection. We aimed to describe the physical environment of dental care facilities in Brazil in 2014, focusing on characteristics designed to control infections. Exactly 16,202 dental offices in the Brazilian Unified National Health System (SUS participated in this survey. Trained researchers extracted information about the infection control characteristics of health facilities by using a structured instrument. We used data from 12 dichotomous questions that evaluated the wall, floor, sink and tap conditions, and the presence and condition of sterilization equipment. We calculated a score by summing the number of characteristics handled appropriately for infection control, which could range from 0 to 12. Hierarchical cluster analyses were developed. None of the 12 criteria were met by all the oral health teams. Only 208 (1.3% dental offices correctly performed all 12-infection control practices. Two clusters, with different frequencies of structure for infection control in dental offices, were identified. South and Southeast regions had the highest frequencies for Cluster 1, with better structure of infection control in dental offices. Dental care facilities of oral health teams were not typically meeting the infection control guidelines regarding clinic design and equipment. Adherence to the guidelines varied among the Brazilian geographic regions.

  1. The social construction of identity in HIV/AIDS home-based care ...

    African Journals Online (AJOL)

    Thirusha Naidu * Thirusha Naidu is a practising clinical psychologist and lecturer in Behavioural Medicine at the Nelson R Mandela School of Medicine at the University of KwaZulu-Natal. She is a practitioner and advocate for Narrative Therapy and narrative methods in research.  Her research interests include social and cultural psychology in relation to health, psychotherapy models and methods, psychotherapy training, narrative methodology and narrative medicine.  Her doctoral research involves identity, culture and context with home-based care volunteers. naidut10@ukzn.ac.za, Yvonne Sliep Yvonne Sliep is a critical community health specialist and currently associate Professor at the School of Psychology, University KwaZulu-Natal (UKZN). Her PhD focused on community based counselling in relation to HIV/AIDS within a rural African context. She is an international scholar with a keen interest to translate good research into sound practice. & Wenche Dageid Wenche Dageid is a post-doctoral researcher at the Dep

    2012-06-20

    Jun 20, 2012 ... ... give any warranty express or implied or make any representation that the contents ... Keywords: HIV/AIDS care and support, volunteers, narratives, social .... ing community-based care as the basis of palliative care for HIV.

  2. [Implementation of evidence based medicine in primary care].

    Science.gov (United States)

    Rinnerberger, Andreas; Grafinger, Michaela; Melchardt, Thomas; Sönnichsen, Andreas

    2009-01-01

    The particular situation of primary care - i.e. decentralized setting, comprehensive medical care, and limited access to continuous medical education - makes it difficult to implement evidence-based medicine into daily practice. Therefore, the Institute of General Practice of the Paracelsus University (PMU) in Salzburg and Actavis GmbH Austria developed "REM" (Rechercheservice evidenzbasierte Medizin). This is a web-based enquiry service offered mainly to GPs who can submit questions arising in daily practice which are answered by the service according to current best evidence. In 8.5 months 176 physicians registered to participate. A total of 31 submitted at least one question. In total, REM processed 134 questions. The number of physicians registered and the frequency of enquiries show that REM can facilitate the implementation of evidence-based medicine in primary care. Nonetheless, only a small proportion of the physicians registered actually made use of the service. Improvements are necessary to promote interest in this new way of continuous medical education.

  3. Organizational culture, team climate and diabetes care in small office-based practices

    OpenAIRE

    Bosch, Marije; Dijkstra, Rob; Wensing, Michel; van der Weijden, Trudy; Grol, Richard

    2008-01-01

    Abstract Background Redesigning care has been proposed as a lever for improving chronic illness care. Within primary care, diabetes care is the most widespread example of restructured integrated care. Our goal was to assess to what extent important aspects of restructured care such as multidisciplinary teamwork and different types of organizational culture are associated with high quality diabetes care in small office-based general practices. Methods We conducted cross-sectional analyses of d...

  4. Economic burden associated with alcohol dependence in a German primary care sample: a bottom-up study

    Directory of Open Access Journals (Sweden)

    Jakob Manthey

    2016-08-01

    Full Text Available Abstract Background A considerable economic burden has been repeatedly associated with alcohol dependence (AD – mostly calculated using aggregate data and alcohol-attributable fractions (top-down approach. However, this approach is limited by a number of assumptions, which are hard to test. Thus, cost estimates should ideally be validated with studies using individual data to estimate the same costs (bottom-up approach. However, bottom-up studies on the economic burden associated with AD are lacking. Our study aimed to fill this gap using the bottom-up approach to examine costs for AD, and also stratified the results by the following subgroups: sex, age, diagnostic approach and severity of AD, as relevant variations could be expected by these factors. Methods Sample: 1356 primary health care patients, representative for two German regions. AD was diagnosed by a standardized instrument and treating physicians. Individual costs were calculated by combining resource use and productivity data representing a period of six months prior to the time of interview, with unit costs derived from the literature or official statistics. The economic burden associated with AD was determined via excess costs by comparing utilization of various health care resources and impaired productivity between people with and without AD, controlling for relevant confounders. Additional analyses for several AD characteristics were performed. Results Mean costs among alcohol dependent patients were 50 % higher compared to the remaining patients, resulting in 1836 € excess costs per alcohol dependent patient in 6 months. More than half of these excess costs incurred through increased productivity loss among alcohol dependent patients. Treatment for alcohol problems represents only 6 % of these costs. The economic burden associated with AD incurred mainly among males and among 30 to 49 year old patients. Both diagnostic approaches were significantly related to the

  5. Establishing an ISO 10001-based promise in inpatients care.

    Science.gov (United States)

    Khan, Mohammad Ashiqur Rahman; Karapetrovic, Stanislav

    2015-01-01

    The purpose of this paper is to explore ISO 10001:2007 in planning, designing and developing a customer satisfaction promise (CSP) intended for inpatients care. Through meetings and interviews with research participants, who included a program manager, unit managers and registered nurses, information about potential promises and their implementation was obtained and analyzed. A number of promises were drafted and one was finally selected to be developed as a CSP. Applying the standard required adaptation and novel interpretation. Additionally, ISO 10002:2004 (Clause 7) was used to design the feedback handling activities. A promise initially chosen for development turned out to be difficult to implement, experience that helped in selecting and developing the final promise. Research participants found the ISO 10001-based method useful and comprehensible. This paper presents a specific health care example of how to adapt a standard's guideline in establishing customer promises. The authors show how a promise can be used in alleviating an existing issue (i.e. communication between carers and patients). The learning can be beneficial in various health care settings. To the knowledge, this paper shows the first example of applying ISO 10001:2007 in a health care case. A few activities suggested by the standard are further detailed, and a new activity is introduced. The integrated use of ISO 10001:2007 and 10002:2004 is presented and how one can be "augmented" by the other is demonstrated.

  6. A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP

    Directory of Open Access Journals (Sweden)

    Francis Rebecca

    2010-01-01

    Full Text Available Abstract Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT. Methods/Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. Trial registration The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR with number ACTRN12609000251224.

  7. Partnership-Based Health Care: Suggestions for Effective Application

    Directory of Open Access Journals (Sweden)

    Teddie M Potter

    2015-06-01

    Full Text Available Societal transformation often starts with one visionary and a compelling idea. However, if there are no followers, the idea quickly becomes marginalized. It “takes a village” to build a movement, and the more system layers that can be addressed, the more likely the transformation will take hold. This article describes the framework for creating the necessary changes for partnership-based health care. It also makes suggestions for ensuring successful application of partnership-based systems change. This article is for all readers seeking to apply partnership principles in their own fields of influence.

  8. Assessing the precision of a time-sampling-based study among GPs: balancing sample size and measurement frequency.

    Science.gov (United States)

    van Hassel, Daniël; van der Velden, Lud; de Bakker, Dinny; van der Hoek, Lucas; Batenburg, Ronald

    2017-12-04

    Our research is based on a technique for time sampling, an innovative method for measuring the working hours of Dutch general practitioners (GPs), which was deployed in an earlier study. In this study, 1051 GPs were questioned about their activities in real time by sending them one SMS text message every 3 h during 1 week. The required sample size for this study is important for health workforce planners to know if they want to apply this method to target groups who are hard to reach or if fewer resources are available. In this time-sampling method, however, standard power analyses is not sufficient for calculating the required sample size as this accounts only for sample fluctuation and not for the fluctuation of measurements taken from every participant. We investigated the impact of the number of participants and frequency of measurements per participant upon the confidence intervals (CIs) for the hours worked per week. Statistical analyses of the time-use data we obtained from GPs were performed. Ninety-five percent CIs were calculated, using equations and simulation techniques, for various different numbers of GPs included in the dataset and for various frequencies of measurements per participant. Our results showed that the one-tailed CI, including sample and measurement fluctuation, decreased from 21 until 3 h between one and 50 GPs. As a result of the formulas to calculate CIs, the increase of the precision continued and was lower with the same additional number of GPs. Likewise, the analyses showed how the number of participants required decreased if more measurements per participant were taken. For example, one measurement per 3-h time slot during the week requires 300 GPs to achieve a CI of 1 h, while one measurement per hour requires 100 GPs to obtain the same result. The sample size needed for time-use research based on a time-sampling technique depends on the design and aim of the study. In this paper, we showed how the precision of the

  9. The generalization ability of online SVM classification based on Markov sampling.

    Science.gov (United States)

    Xu, Jie; Yan Tang, Yuan; Zou, Bin; Xu, Zongben; Li, Luoqing; Lu, Yang

    2015-03-01

    In this paper, we consider online support vector machine (SVM) classification learning algorithms with uniformly ergodic Markov chain (u.e.M.c.) samples. We establish the bound on the misclassification error of an online SVM classification algorithm with u.e.M.c. samples based on reproducing kernel Hilbert spaces and obtain a satisfactory convergence rate. We also introduce a novel online SVM classification algorithm based on Markov sampling, and present the numerical studies on the learning ability of online SVM classification based on Markov sampling for benchmark repository. The numerical studies show that the learning performance of the online SVM classification algorithm based on Markov sampling is better than that of classical online SVM classification based on random sampling as the size of training samples is larger.

  10. [Glocalization: the outlook for Taiwan evidence based health care].

    Science.gov (United States)

    Chen, Chiehfeng

    2014-12-01

    Public attention to evidence-based health care (EBHC) has increased significantly in recent years. Key problems related to applying EBHC in current healthcare practice include the timely update of up-to-date knowledge and skills and the methodology used to implement EBHC in clinical settings. EBHC has been introduced to the Taiwan healthcare system for the past two decades. The annual EBM (Evidence based medicine) National Competition is a unique and important EBHC activity in Taiwan. EBHC has been promoted widely in medicine, nursing, pharmacy, public health and other professions, and EBHC-related organizations such as the Taiwan Evidence Based Medicine Association (TEBMA), and Taiwan Evidence Based Nursing Association (TEBNA), have increased in number and grown in membership. In addition to domestic developments, Taiwan is also actively involved in global organizations, such as the Cochrane Collaboration, East Asian Cochrane Alliance (EACA), and the International Society for Evidence Based Health Care (ISEHC). In Taiwan, most medical professionals work cooperatively to promote EBHC, which facilitates the gradual improvement of healthcare quality.

  11. Whole arm manipulation planning based on feedback velocity fields and sampling-based techniques.

    Science.gov (United States)

    Talaei, B; Abdollahi, F; Talebi, H A; Omidi Karkani, E

    2013-09-01

    Changing the configuration of a cooperative whole arm manipulator is not easy while enclosing an object. This difficulty is mainly because of risk of jamming caused by kinematic constraints. To reduce this risk, this paper proposes a feedback manipulation planning algorithm that takes grasp kinematics into account. The idea is based on a vector field that imposes perturbation in object motion inducing directions when the movement is considerably along manipulator redundant directions. Obstacle avoidance problem is then considered by combining the algorithm with sampling-based techniques. As experimental results confirm, the proposed algorithm is effective in avoiding jamming as well as obstacles for a 6-DOF dual arm whole arm manipulator. Copyright © 2013 ISA. Published by Elsevier Ltd. All rights reserved.

  12. An outcomes approach to stroke care: the importance of teamwork and evidence-based nursing care.

    Science.gov (United States)

    Middleton, Sandy

    2012-04-01

    The Quality in Acute Stroke Care (QASC) was a cluster randomised control trial (CRCT) which evaluated the effectiveness of evidence-based clinical treatment protocols for the management of fever, hyperglycaemia and swallowing, in conjunction with multidisciplinary team building workshops, and a standardised interactive staff education program (collectively known as the Fever, Sugar, Swallowing (FeSS) intervention) to improve patient outcomes 90-days. We found that patients cared for in stroke units who received our intervention were 15·7% more likely to be alive and independent 90 days following their stroke. They also had significantly: fewer episodes of fever, lower mean temperatures, lower mean blood glucose levels, and better screening for swallowing difficulties. © 2012 The Author. International Journal of Stroke © 2012 World Stroke Organization.

  13. Utility of a summative scale based on the Children with Special Health Care Needs (CSHCN) Screener to identify CSHCN with special dental care needs.

    Science.gov (United States)

    Iida, Hiroko; Lewis, Charlotte W

    2012-08-01

    Our objective was to determine if a summative scale reflecting the number of positive criteria on the Children with Special Health Care Needs (CSHCN) Screener is useful in identifying subgroups of CSHCN at risk for poorer oral health and unmet dental care needs and who should be considered to have special dental care needs. Data were analyzed for a population-based sample of 91,642 US children needs in the past 12 months. Descriptive and multivariable logistic regression analyses were performed for each outcome using the survey command in Stata to account for the sampling design. A summative scale based on the number of positive CSHCN Screener criteria was independently associated with various parent-perceived poorer oral health outcomes in children. CSHCN who met 4 or 5 screener criteria had 4 and 4.5 times, respectively, the odds of having fair-poor condition of teeth and bleeding gums relative to non-CSHCN. They also had 87% higher odds for parent-perceived toothache and 2 and 2.5 times the odds of having recent broken teeth and unmet dental care needs relative to non-CSHCN, respectively. There was no dose-dependent association between summative number of positive CSHCN Screener criteria and reported cavities in children. Application of a summative score based on the CSHCN Screener has utility in identifying the CSHCN subgroup with special dental care needs.

  14. The magnitude, share and determinants of unpaid care costs for home-based palliative care service provision in Toronto, Canada.

    Science.gov (United States)

    Chai, Huamin; Guerriere, Denise N; Zagorski, Brandon; Coyte, Peter C

    2014-01-01

    With increasing emphasis on the provision of home-based palliative care in Canada, economic evaluation is warranted, given its tremendous demands on family caregivers. Despite this, very little is known about the economic outcomes associated with home-based unpaid care-giving at the end of life. The aims of this study were to (i) assess the magnitude and share of unpaid care costs in total healthcare costs for home-based palliative care patients, from a societal perspective and (ii) examine the sociodemographic and clinical factors that account for variations in this share. One hundred and sixty-nine caregivers of patients with a malignant neoplasm were interviewed from time of referral to a home-based palliative care programme provided by the Temmy Latner Centre for Palliative Care at Mount Sinai Hospital, Toronto, Canada, until death. Information regarding palliative care resource utilisation and costs, time devoted to care-giving and sociodemographic and clinical characteristics was collected between July 2005 and September 2007. Over the last 12 months of life, the average monthly cost was $14 924 (2011 CDN$) per patient. Unpaid care-giving costs were the largest component - $11 334, accounting for 77% of total palliative care expenses, followed by public costs ($3211; 21%) and out-of-pocket expenditures ($379; 2%). In all cost categories, monthly costs increased exponentially with proximity to death. Seemingly unrelated regression estimation suggested that the share of unpaid care costs of total costs was driven by patients' and caregivers' sociodemographic characteristics. Results suggest that overwhelming the proportion of palliative care costs is unpaid care-giving. This share of costs requires urgent attention to identify interventions aimed at alleviating the heavy financial burden and to ultimately ensure the viability of home-based palliative care in future. © 2013 John Wiley & Sons Ltd.

  15. Knowledge, Attitudes, Practices and Beliefs about Medical Male Circumcision (MMC among a Sample of Health Care Providers in Haiti.

    Directory of Open Access Journals (Sweden)

    Jessy G Dévieux

    Full Text Available Haiti has the highest number of people living with HIV infection in the Caribbean/Latin America region. Medical male circumcision (MMC has been recommended to help prevent the spread of HIV. We sought to assess knowledge, attitudes, practices and beliefs about MMC among a sample of health care providers in Haiti.A convenience sample of 153 health care providers at the GHESKIO Centers in Haiti responded to an exploratory survey that collected information on several topics relevant to health providers about MMC. Descriptive statistics were calculated for the responses and multivariable logistic regression was conducted to determine opinions of health care providers about the best age to perform MMC on males. Bayesian network analysis and sensitivity analysis were done to identify the minimum level of change required to increase the acceptability of performing MMC at age less than 1 year.The sample consisted of medical doctors (31.0%, nurses (49.0%, and other health care professionals (20.0%. Approximately 76% showed willingness to offer MMC services if they received training. Seventy-six percent believed that their male patients would accept circumcision, and 59% believed infancy was the best age for MMC. More than 90% of participants said that MMC would reduce STIs. Physicians and nurses who were willing to offer MMC if provided with adequate training were 2.5 (1.15-5.71 times as likely to choose the best age to perform MMC as less than one year. Finally, if the joint probability of choosing "the best age to perform MMC" as one year or older and having the mistaken belief that "MMC prevents HIV entirely" is reduced by 63% then the probability of finding that performing MMC at less than one year acceptable to health care providers is increased by 35%.Participants demonstrated high levels of knowledge and positive attitudes towards MMC. Although this study suggests that circumcision is acceptable among certain health providers in Haiti, studies

  16. Home-based Self-care: Understanding and Designing Pervasive Technology to Support Care Management Work at Home

    DEFF Research Database (Denmark)

    Verdezoto, Nervo

    the self-care management work at home. People need to know which care activities to perform, when to perform them, how to proceed and why these are important. While at home, an active lifestyle and comorbidity not only challenge self-care activities but also the use of self-care technologies in non...... that fit into people’s everyday life. Through a design research approach applying user-centered design methods and prototyping, the main focus of this dissertation is on exploring and providing a holistic understanding of the self-care work practices in non-clinical settings. Several home-based care...... practices are investigated to (a) further understand the self-care management work in nonclinical settings, and (b) inform future design of pervasive healthcare technology that accounts for people’s perspectives on self-care and everyday life. First, we explore two selfcare practices of medication...

  17. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care.

    NARCIS (Netherlands)

    Valentijn, P.P.; Schepman, S.M.; Opheij, W.; Bruijnzeels, M.A.

    2013-01-01

    Introduction: Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to

  18. Implementation of antimicrobial peptides for sample preparation prior to nucleic acid amplification in point-of-care settings.

    Science.gov (United States)

    Krõlov, Katrin; Uusna, Julia; Grellier, Tiia; Andresen, Liis; Jevtuševskaja, Jekaterina; Tulp, Indrek; Langel, Ülo

    2017-12-01

    A variety of sample preparation techniques are used prior to nucleic acid amplification. However, their efficiency is not always sufficient and nucleic acid purification remains the preferred method for template preparation. Purification is difficult and costly to apply in point-of-care (POC) settings and there is a strong need for more robust, rapid, and efficient biological sample preparation techniques in molecular diagnostics. Here, the authors applied antimicrobial peptides (AMPs) for urine sample preparation prior to isothermal loop-mediated amplification (LAMP). AMPs bind to many microorganisms such as bacteria, fungi, protozoa and viruses causing disruption of their membrane integrity and facilitate nucleic acid release. The authors show that incubation of E. coli with antimicrobial peptide cecropin P1 for 5 min had a significant effect on the availability of template DNA compared with untreated or even heat treated samples resulting in up to six times increase of the amplification efficiency. These results show that AMPs treatment is a very efficient sample preparation technique that is suitable for application prior to nucleic acid amplification directly within biological samples. Furthermore, the entire process of AMPs treatment was performed at room temperature for 5 min thereby making it a good candidate for use in POC applications.

  19. Barriers to early initiation of antenatal care in a multi-ethnic sample in South Auckland, New Zealand.

    Science.gov (United States)

    Corbett, Sarah; Chelimo, Carol; Okesene-Gafa, Kara

    2014-10-17

    To identify barriers to early initiation of antenatal care amongst pregnant women in South Auckland, New Zealand. Women in late pregnancy (>37 weeks gestation) or who had recently delivered (18 weeks (late bookers). The ethnic composition of the sample was: 43% Pacific Peoples, 20% Maori, 14% Asian, and 21% European or other ethnicities. The multivariate analysis indicated that women were significantly more likely to book late for antenatal care if they had limited resources (OR=1.86; 95% CI=1.17-2.93), no tertiary education (OR=1.96; 95% CI=1.23-3.15), or were not living with a husband/partner (OR=2.34; 95% CI=1.48-3.71). In addition, the odds of late booking for antenatal care was almost six times higher among Maori (OR=5.70; 95% CI=2.57-12.64) and Pacific (OR=5.90; 95% CI=2.83-12.29) women compared to those of European and other ethnicities. Late booking for antenatal care in the Counties Manukau District Health Board area (South Auckland) is associated with sociodemographic factors, social deprivation, and inadequate social support.

  20. Deficits in knowledge, attitude, and practice towards blood culture sampling: results of a nationwide mixed-methods study among inpatient care physicians in Germany.

    Science.gov (United States)

    Raupach-Rosin, Heike; Duddeck, Arne; Gehrlich, Maike; Helmke, Charlotte; Huebner, Johannes; Pletz, Mathias W; Mikolajczyk, Rafael; Karch, André

    2017-08-01

    Blood culture (BC) sampling rates in Germany are considerably lower than recommended. Aim of our study was to assess knowledge, attitudes, and practice of physicians in Germany regarding BC diagnostics. We conducted a cross-sectional mixed-methods study among physicians working in inpatient care in Germany. Based on the results of qualitative focus groups, a questionnaire-based quantitative study was conducted in 2015-2016. In total, 706 medical doctors and final-year medical students from 11 out of 16 federal states in Germany participated. BC sampling was considered an important diagnostic tool by 95% of the participants. However, only 23% of them would collect BCs in three scenarios for which BC ordering is recommended by present guidelines in Germany; almost one out of ten physicians would not have taken blood cultures in any of the three scenarios. The majority of participants (74%) reported not to adhere to the guideline recommendation that blood culture sampling should include at least two blood culture sets from two different injection sites. High routine in blood culture sampling, perceived importance of blood culture diagnostics, the availability of an in-house microbiological lab, and the department the physician worked in were identified as predictors for good blood culture practice. Our study suggests that there are substantial deficits in BC ordering and the application of guidelines for good BC practice in Germany. Based on these findings, multimodal interventions appear necessary for improving BC diagnostics.

  1. Activity-based costing of health-care delivery, Haiti.

    Science.gov (United States)

    McBain, Ryan K; Jerome, Gregory; Leandre, Fernet; Browning, Micaela; Warsh, Jonathan; Shah, Mahek; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Gottlieb, Gary; Rhatigan, Joseph; Kaplan, Robert

    2018-01-01

    To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.

  2. Evaluating the effect of sample type on American alligator (Alligator mississippiensis) analyte values in a point-of-care blood analyser.

    Science.gov (United States)

    Hamilton, Matthew T; Finger, John W; Winzeler, Megan E; Tuberville, Tracey D

    2016-01-01

    The assessment of wildlife health has been enhanced by the ability of point-of-care (POC) blood analysers to provide biochemical analyses of non-domesticated animals in the field. However, environmental limitations (e.g. temperature, atmospheric humidity and rain) and lack of reference values may inhibit researchers from using such a device with certain wildlife species. Evaluating the use of alternative sample types, such as plasma, in a POC device may afford researchers the opportunity to delay sample analysis and the ability to use banked samples. In this study, we examined fresh whole blood, fresh plasma and frozen plasma (sample type) pH, partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3 (-)), total carbon dioxide (TCO2), base excess (BE), partial pressure of oxygen (PO2), oxygen saturation (sO2) and lactate concentrations in 23 juvenile American alligators (Alligator mississippiensis) using an i-STAT CG4+ cartridge. Our results indicate that sample type had no effect on lactate concentration values (F 2,65 = 0.37, P = 0.963), suggesting that the i-STAT analyser can be used reliably to quantify lactate concentrations in fresh and frozen plasma samples. In contrast, the other seven blood parameters measured by the CG4+ cartridge were significantly affected by sample type. Lastly, we were able to collect blood samples from all alligators within 2 min of capture to establish preliminary reference ranges for juvenile alligators based on values obtained using fresh whole blood.

  3. Health Care Professionals’ Beliefs About Using Wiki-Based Reminders to Promote Best Practices in Trauma Care

    Science.gov (United States)

    Bilodeau, Andrea; Gagnon, Marie-Pierre; Aubin, Karine; Lavoie, André; Lapointe, Jean; Poitras, Julien; Croteau, Sylvain; Pham-Dinh, Martin; Légaré, France

    2012-01-01

    Background Wikis are knowledge translation tools that could help health professionals implement best practices in acute care. Little is known about the factors influencing professionals’ use of wikis. Objectives To identify and compare the beliefs of emergency physicians (EPs) and allied health professionals (AHPs) about using a wiki-based reminder that promotes evidence-based care for traumatic brain injuries. Methods Drawing on the theory of planned behavior, we conducted semistructured interviews to elicit EPs’ and AHPs’ beliefs about using a wiki-based reminder. Previous studies suggested a sample of 25 EPs and 25 AHPs. We purposefully selected participants from three trauma centers in Quebec, Canada, to obtain a representative sample. Using univariate analyses, we assessed whether our participants’ gender, age, and level of experience were similar to those of all eligible individuals. Participants viewed a video showing a clinician using a wiki-based reminder, and we interviewed participants about their behavioral, control, and normative beliefs—that is, what they saw as advantages, disadvantages, barriers, and facilitators to their use of a reminder, and how they felt important referents would perceive their use of a reminder. Two reviewers independently analyzed the content of the interview transcripts. We considered the 75% most frequently mentioned beliefs as salient. We retained some less frequently mentioned beliefs as well. Results Of 66 eligible EPs and 444 eligible AHPs, we invited 55 EPs and 39 AHPs to participate, and 25 EPs and 25 AHPs (15 nurses, 7 respiratory therapists, and 3 pharmacists) accepted. Participating AHPs had more experience than eligible AHPs (mean 14 vs 11 years; P = .04). We noted no other significant differences. Among EPs, the most frequently reported advantage of using a wiki-based reminder was that it refreshes the memory (n = 14); among AHPs, it was that it provides rapid access to protocols (n = 16). Only 2 EPs

  4. Psychological Resilience, Affective Mechanisms, and Symptom Burden in a Tertiary Care Sample of Patients with Fibromyalgia

    Science.gov (United States)

    McAllister, Samantha J; Vincent, Ann; Hassett, Afton L; Whipple, Mary O; Oh, Terry H; Benzo, Roberto P; Toussaint, Loren L

    2014-01-01

    Research demonstrates that patients with fibromyalgia who have higher positive and lower negative affect have lower symptom burden. Affect has been shown to be associated with resilience. This study examined the relationship between affect, resilience, and fibromyalgia symptom burden in a clinical sample of patients with fibromyalgia. We hypothesized that (a) positive and negative affect would be associated with fibromyalgia symptom burden; (b) resilience would be associated with positive and negative affect; (c) resilience would be associated with fibromyalgia symptom burden; and (d) the connection between resilience and fibromyalgia symptom burden would be mediated by both positive and negative affect. A sample of 858 patients with fibromyalgia completed questionnaires. Mediation modeling revealed statistically significant direct effects of resilience on fibromyalgia symptom burden (β =−.10, P fibromyalgia symptom burden through affect (β =−.36, P fibromyalgia symptom burden. Our results suggest that improving affect through resiliency training could be studied as a modality for improving fibromyalgia symptom burden. PMID:24376184

  5. Multiscale sample entropy and cross-sample entropy based on symbolic representation and similarity of stock markets

    Science.gov (United States)

    Wu, Yue; Shang, Pengjian; Li, Yilong

    2018-03-01

    A modified multiscale sample entropy measure based on symbolic representation and similarity (MSEBSS) is proposed in this paper to research the complexity of stock markets. The modified algorithm reduces the probability of inducing undefined entropies and is confirmed to be robust to strong noise. Considering the validity and accuracy, MSEBSS is more reliable than Multiscale entropy (MSE) for time series mingled with much noise like financial time series. We apply MSEBSS to financial markets and results show American stock markets have the lowest complexity compared with European and Asian markets. There are exceptions to the regularity that stock markets show a decreasing complexity over the time scale, indicating a periodicity at certain scales. Based on MSEBSS, we introduce the modified multiscale cross-sample entropy measure based on symbolic representation and similarity (MCSEBSS) to consider the degree of the asynchrony between distinct time series. Stock markets from the same area have higher synchrony than those from different areas. And for stock markets having relative high synchrony, the entropy values will decrease with the increasing scale factor. While for stock markets having high asynchrony, the entropy values will not decrease with the increasing scale factor sometimes they tend to increase. So both MSEBSS and MCSEBSS are able to distinguish stock markets of different areas, and they are more helpful if used together for studying other features of financial time series.

  6. Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings

    Science.gov (United States)

    Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie

    2015-01-01

    The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…

  7. Analysis of area-wide management of insect pests based on sampling

    Science.gov (United States)

    David W. Onstad; Mark S. Sisterson

    2011-01-01

    The control of invasive species greatly depends on area-wide pest management (AWPM) in heterogeneous landscapes. Decisions about when and where to treat a population with pesticide are based on sampling pest abundance. One of the challenges of AWPM is sampling large areas with limited funds to cover the cost of sampling. Additionally, AWPM programs are often confronted...

  8. Arts-based and creative approaches to dementia care.

    Science.gov (United States)

    McGreevy, Jessica

    2016-02-01

    This article presents a review of arts-based and creative approaches to dementia care as an alternative to antipsychotic medications. While use of antipsychotics may be appropriate for some people, the literature highlights the success of creative approaches and the benefits of their lack of negative side effects associated with antipsychotics. The focus is the use of biographical approaches, music, dance and movement to improve wellbeing, enhance social networks, support inclusive practice and enable participation. Staff must be trained to use these approaches. A case study is presented to demonstrate how creative approaches can be implemented in practice and the outcomes that can be expected when used appropriately.

  9. The Recent Developments in Sample Preparation for Mass Spectrometry-Based Metabolomics.

    Science.gov (United States)

    Gong, Zhi-Gang; Hu, Jing; Wu, Xi; Xu, Yong-Jiang

    2017-07-04

    Metabolomics is a critical member in systems biology. Although great progress has been achieved in metabolomics, there are still some problems in sample preparation, data processing and data interpretation. In this review, we intend to explore the roles, challenges and trends in sample preparation for mass spectrometry- (MS-) based metabolomics. The newly emerged sample preparation methods were also critically examined, including laser microdissection, in vivo sampling, dried blood spot, microwave, ultrasound and enzyme-assisted extraction, as well as microextraction techniques. Finally, we provide some conclusions and perspectives for sample preparation in MS-based metabolomics.

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

    Science.gov (United States)

    Henry, Linda S; Henry, James D

    2007-12-01

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

  11. Sampling in interview-based qualitative research: A theoretical and practical guide

    OpenAIRE

    Robinson, Oliver

    2014-01-01

    Sampling is central to the practice of qualitative methods, but compared with data collection and analysis, its processes are discussed relatively little. A four-point approach to sampling in qualitative interview-based research is presented and critically discussed in this article, which integrates theory and process for the following: (1) Defining a sample universe, by way of specifying inclusion and exclusion criteria for potential participation; (2) Deciding upon a sample size, through th...

  12. Feminist Interruptions: Creating Care-ful and Collaborative Community-Based Research with Students

    Directory of Open Access Journals (Sweden)

    Kelly Concannon

    2014-05-01

    Full Text Available This article describes a feminist community-based research project involving faculty and student collaboration to evaluate a dating and domestic violence awareness initiative. Using a critical ethics of care that emphasizes relationships and allows for constant reflection about power dynamics, role, positionality, and emotions, the authors reflect on what was learned during the research process. Faculty and student researchers share their perspectives and offer suggestions for future feminist collaborative research projects. Significant lessons learned include ensuring that all are invested from the outset of the project, guaranteeing that student researchers understand why their role is so critical in community-based research, and acknowledging not just faculty power over students but student privilege as well.

  13. Trends in monitoring pharmaceuticals and personal-care products in the aquatic environment by use of passive sampling devices

    Science.gov (United States)

    Mills, G.A.; Vrana, B.; Allan, I.; Alvarez, D.A.; Huckins, J.N.; Greenwood, R.

    2007-01-01

    The use of passive sampling in monitoring pharmaceuticals and personal-care products (PPCPs) in the aquatic environment is discussed. The utility of passive sampling methods for monitoring the fraction of heavy metals and the biologically available fraction of non-polar organic priority pollutants is recognized and these technologies are being used in surveys of water quality. These devices are used to measure the dissolved fraction and they can yield information that can be used in the development of risk assessments models. These devices can also be used to locate illegal dumping and to monitor specific sources of input of PPCPs into the environment, or to monitor the effectiveness of water treatment processes in the removal of these compounds from wastewater. These devices can provide representative information at low cost which necessitate a combination of laboratory calibration and field studies for emerging pollutants.

  14. Introducing the Index of Care: A web-based application supporting archaeological research into health-related care.

    Science.gov (United States)

    Tilley, Lorna; Cameron, Tony

    2014-09-01

    The Index of Care is a web-based application designed to support the recently proposed four-stage 'bioarchaeology of care' methodology for identifying and interpreting health-related care provision in prehistory. The Index offers a framework for guiding researchers in 'thinking through' the steps of a bioarchaeology of care analysis; it continuously prompts consideration of biological and archaeological evidence relevant to care provision; it operationalises key concepts such as 'disability' and 'care'; and it encourages transparency in the reasoning underlying conclusions, facilitating review. This paper describes the aims, structure and content of the Index, and provides an example of its use. The Index of Care is freely available on-line; it is currently in active development, and feedback is sought to improve its utility and usability. This is the first time in bioarchaeology that an instrument for examining behaviour as complex as caregiving has been proposed. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. RF Sub-sampling Receiver Architecture based on Milieu Adapting Techniques

    DEFF Research Database (Denmark)

    Behjou, Nastaran; Larsen, Torben; Jensen, Ole Kiel

    2012-01-01

    A novel sub-sampling based architecture is proposed which has the ability of reducing the problem of image distortion and improving the signal to noise ratio significantly. The technique is based on sensing the environment and adapting the sampling rate of the receiver to the best possible...

  16. Antibiogram of escherichia coli isolated from urine samples at a tertiary care hospital

    International Nuclear Information System (INIS)

    Chaudary, Z.A.; Hasan, A.; Alizai, S.A.

    2015-01-01

    To determine prevalence and antibiotic susceptibility pattern of the E. coli isolated from urine in our setup, especially in low income group of population. Methodology: The study was carried out from July 2010 to June 2011 at surgical and urological units of a hospital in Islamabad. E.coli were isolated from urine specimens by following standard microbiological techniques. Antimicrobial susceptibility test was performed by using the Kirby-Bauer disc diffusion techniques according to CLSI guidelines. Results: The prevalence of E. coli isolated from urine samples was 28.22%. Highest resistance was seen against ampicillin (80.3%). Imipenem was found out to be highly effective. Conclusion: Imipenem, ciprofloxacin and sparfloxacin can be reliably used against E. coli causing urinary tract infections. Gentamicin and moxifloxacin also showed satisfactory results. (author)

  17. Sample to answer visualization pipeline for low-cost point-of-care blood cell counting

    CSIR Research Space (South Africa)

    Smith, S

    2015-02-01

    Full Text Available and flow rates, and 2) a microscopy analysis system to investigate homogeneity and concentration of blood cells. Fluidic parameters were derived from the optical flow as well as color-based segmentation of the different fluids using a hue...

  18. Study of microtip-based extraction and purification of DNA from human samples for portable devices

    Science.gov (United States)

    Fotouhi, Gareth

    DNA sample preparation is essential for genetic analysis. However, rapid and easy-to-use methods are a major challenge to obtaining genetic information. Furthermore, DNA sample preparation technology must follow the growing need for point-of-care (POC) diagnostics. The current use of centrifuges, large robots, and laboratory-intensive protocols has to be minimized to meet the global challenge of limited access healthcare by bringing the lab to patients through POC devices. To address these challenges, a novel extraction method of genomic DNA from human samples is presented by using heat-cured polyethyleneimine-coated microtips generating a high electric field. The microtip extraction method is based on recent work using an electric field and capillary action integrated into an automated device. The main challenges to the method are: (1) to obtain a stable microtip surface for the controlled capture and release of DNA and (2) to improve the recovery of DNA from samples with a high concentration of inhibitors, such as human samples. The present study addresses these challenges by investigating the heat curing of polyethyleneimine (PEI) coated on the surface of the microtip. Heat-cured PEI-coated microtips are shown to control the capture and release of DNA. Protocols are developed for the extraction and purification of DNA from human samples. Heat-cured PEI-coated microtip methods of DNA sample preparation are used to extract genomic DNA from human samples. It is discovered through experiment that heat curing of a PEI layer on a gold-coated surface below 150°C could inhibit the signal of polymerase chain reaction (PCR). Below 150°C, the PEI layer is not completely cured and dissolved off the gold-coated surface. Dissolved PEI binds with DNA to inhibit PCR. Heat curing of a PEI layer above 150°C on a gold-coated surface prevents inhibition to PCR and gel electrophoresis. In comparison to gold-coated microtips, the 225°C-cured PEI-coated microtips improve the

  19. Research on the cultivation path of smart home-based care service mode in Internet+ vision

    OpenAIRE

    Peng Qingchao

    2016-01-01

    Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explor...

  20. Contextual facilitators and maintaining of compassion-based care: An ethnographic study

    Directory of Open Access Journals (Sweden)

    Sima Babaei

    2017-01-01

    Full Text Available Background: Compassion is an important part of nursing. It fosters better relationships between nurses and their patients. Moreover, it gives patients more confidence in the care they receive. Determining facilitators of compassion are essential to holistic care. The purpose of this study was to explore these facilitators. Materials and Methods: This ethnographic study was conducted in 2014–2015 with 20 nurses, 12 patients, and 4 family members in the medical and surgical wards. Data collection was done through observations and in-depth semi-structured interviews with purposive sampling. The study was carried out in 15 months. Data analysis was performed using constant comparison based on Strauss and Corbin. Results: Data analysis defined three main themes and eight subthemes as the fundamentals of compassion-based care. Nurses' personal factors with subcategories of personality, attitudes, and values and holistic view; and socio-cultural factors with subcategories of kindness role model, religious, and cultural values are needed to elicit compassionate behaviors. Initiator factors, with subcategories of patient suffering, patient communication demands, and patient emotional and psychological necessity are also needed to start compassionate behaviors. Conclusions: The findings of this study showed that nurses' communication with patients is nurse's duty in order to understand and respect the needs of patients. Attention should be paid to issues relating to compassion in nursing and practice educational programs. Indeed, creating a care environment with compassion, regardless of any shortcomings in the work condition, would help in the development of effective nursing.

  1. 75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

    Science.gov (United States)

    2010-11-03

    ...] Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting AGENCY: Centers for Medicare... guidance and ask questions about the upcoming Community-based Care Transitions Program. The meeting is open... conference will also provide an overview of the Community-based Care Transitions Program (CCTP) and provide...

  2. Incorporating Mobile Phone Technologies to Expand Evidence-Based Care.

    Science.gov (United States)

    Jones, Deborah J; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin

    2015-08-01

    Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach.

  3. Incorporating Mobile Phone Technologies to Expand Evidence-Based Care

    Science.gov (United States)

    Jones, Deborah J.; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin

    2014-01-01

    Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach. PMID:26213458

  4. Value-based health care for inflammatory bowel diseases.

    Science.gov (United States)

    van Deen, Welmoed K; Esrailian, Eric; Hommes, Daniel W

    2015-05-01

    Increasing healthcare costs worldwide put the current healthcare systems under pressure. Although many efforts have aimed to contain costs in medicine, only a few have achieved substantial changes. Inflammatory bowel diseases rank among the most costly of chronic diseases, and physicians nowadays are increasingly engaged in health economics discussions. Value-based health care [VBHC] has gained a lot of attention recently, and is thought to be the way forward to contain costs while maintaining quality. The key concept behind VBHC is to improve achieved outcomes per encountered costs, and evaluate performance accordingly. Four main components need to be in place for the system to be effective: [1] accurate measurement of health outcomes and costs; [2] reporting of these outcomes and benchmarking against other providers; [3] identification of areas in need of improvement based on these data and adjusting the care delivery processes accordingly; and [4] rewarding high-performing participants. In this article we will explore the key components of VBHC, we will review available evidence focussing on inflammatory bowel diseases, and we will present our own experience as a guide for other providers. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  5. Nursing Care Model Based on Knowledge Management in Preventing Nosocomial Infection After Caesarean Section in Hospital

    Directory of Open Access Journals (Sweden)

    Ahsan Ahsan

    2016-09-01

    Full Text Available Introduction: Nosocomial infection is one indicator of the quality of health services in the community, which also determines the image of health care institutions becauseit was a major cause of morbidityand death rate (mortality in hospital. Nursing care based on knowledge management is established from identification knowledge which is required, prevention performance of nosocomial infections post section caesarea. Nosocomial infections component consists of wound culture result. Method: This study was an observational study with a quasi experimental design. The population was all of nursing staff who working in obstetrics installation in hospitals A and B as much as 46 people. Sample was the total population. Data was collected through questionnaire, observation sheets and examination of the wound culture. Data was analyzed using t test B 1.274 dan p=0.028 Result: The result showed that 1 there was difference in knowledge management implementation before and after training; 2 there was difference in nurse’s performance in preventing nosocomial infection before and after training; 3 there is significant relationship between nurse’s performance in preventing nosocomial infection and infection incidence; 4 there is no significant difference of nursing care impementation on nosocomial incidence. Discussion: In conclusion, the development of nursing care based on knowledge management as a synthesis or induction of findings directed at 1 nurses’ knowledge does not affect the performance of the prevention of nosocomial infections; 2 knowledge management has a positive effect on the performance of the prevention of nosocomial infections; 3 implementation of infection prevention is integrated capabilities between knowledge, skills and attitudes of nurses in implementing performance in care. Keywords: model prevention, nosocomial infections, nursing care, knowledge management, sectio Caesarea

  6. Blood gas sample spiking with total parenteral nutrition, lipid emulsion, and concentrated dextrose solutions as a model for predicting sample contamination based on glucose result.

    Science.gov (United States)

    Jara-Aguirre, Jose C; Smeets, Steven W; Wockenfus, Amy M; Karon, Brad S

    2018-05-01

    Evaluate the effects of blood gas sample contamination with total parenteral nutrition (TPN)/lipid emulsion and dextrose 50% (D50) solutions on blood gas and electrolyte measurement; and determine whether glucose concentration can predict blood gas sample contamination with TPN/lipid emulsion or D50. Residual lithium heparin arterial blood gas samples were spiked with TPN/lipid emulsion (0 to 15%) and D50 solutions (0 to 2.5%). Blood gas (pH, pCO2, pO2), electrolytes (Na+, K+ ionized calcium) and hemoglobin were measured with a Radiometer ABL90. Glucose concentration was measured in separated plasma by Roche Cobas c501. Chart review of neonatal blood gas results with glucose >300 mg/dL (>16.65 mmol/L) over a seven month period was performed to determine whether repeat (within 4 h) blood gas results suggested pre-analytical errors in blood gas results. Results were used to determine whether a glucose threshold could predict contamination resulting in blood gas and electrolyte results with greater than laboratory-defined allowable error. Samples spiked with 5% or more TPN/lipid emulsion solution or 1% D50 showed glucose concentration >500 mg/dL (>27.75 mmol/L) and produced blood gas (pH, pO 2 , pCO 2 ) results with greater than laboratory-defined allowable error. TPN/lipid emulsion, but not D50, produced greater than allowable error in electrolyte (Na + ,K + ,Ca ++ ,Hb) results at these concentrations. Based on chart review of 144 neonatal blood gas results with glucose >250 mg/dL received over seven months, four of ten neonatal intensive care unit (NICU) patients with glucose results >500 mg/dL and repeat blood gas results within 4 h had results highly suggestive of pre-analytical error. Only 3 of 36 NICU patients with glucose results 300-500 mg/dL and repeat blood gas results within 4 h had clear pre-analytical errors in blood gas results. Glucose concentration can be used as an indicator of significant blood sample contamination with either TPN

  7. Twinning rate in a sample from a Brazilian hospital with a high standard of reproductive care

    Directory of Open Access Journals (Sweden)

    Gloria Maria Duccini Dal Colletto

    Full Text Available CONTEXT: Epidemiological studies on twin births have been motivated mostly by the positive correlation between twinning rate and human fertility, prematurity, low birth weight, increased risk of infant death and long term risk for morbidity. OBJECTIVE: This paper intends to estimate the incidence of multiple births in a private hospital in Brazil with a high standard of reproductive care, and to evaluate the effects of maternal age, gestation order and assisted fertilization on twinning rate. DESIGN: Retrospective analysis. SETTING: First-class tertiary private hospital, São Paulo, Brazil. PARTICIPANTS: The multiple birth rate was investigated among 7,997 deliveries from 1995 to 1998, including 7,786 singletons, 193 twins, 17 triplets and one quadruplet. RESULTS: The rates per 1,000 dizygotic and monozygotic pairs and for triplets were estimated as 19.51, 4.50 and 2.13, respectively. The dizygotic and triplet rates were the highest observed in Brazil up to the present day. The twinning rate among primigravidae older than 30 years was very high (45.02 per 1,000 and was due to a disproportionately high frequency of dizygotic pairs. The triplet rate was also very high among the mothers of this age group (5.71 per 1,000. These facts are strong indicators that these women were the ones most frequently submitted to assisted reproductive techniques. The mean maternal age of the studied population was about six years higher than that estimated for mothers in the general population of southeastern Brazil. Primigravidae aged under 30 years as well as multigravidae showed similar twinning rates, which were almost 20 per 1,000. Among the deliveries of multigravidae older than 30 years, an unusually high frequency of monozygotic twins was observed (7.04 per 1,000, probably as a consequence of the residual effect of long-term use of oral contraceptives. CONCLUSIONS: The dizygotic twinning rate increased from 13.51 to 28.98 per 1,000 over the four years

  8. Supplementing electronic health records through sample collection and patient diaries: A study set within a primary care research database.

    Science.gov (United States)

    Joseph, Rebecca M; Soames, Jamie; Wright, Mark; Sultana, Kirin; van Staa, Tjeerd P; Dixon, William G

    2018-02-01

    To describe a novel observational study that supplemented primary care electronic health record (EHR) data with sample collection and patient diaries. The study was set in primary care in England. A list of 3974 potentially eligible patients was compiled using data from the Clinical Practice Research Datalink. Interested general practices opted into the study then confirmed patient suitability and sent out postal invitations. Participants completed a drug-use diary and provided saliva samples to the research team to combine with EHR data. Of 252 practices contacted to participate, 66 (26%) mailed invitations to patients. Of the 3974 potentially eligible patients, 859 (22%) were at participating practices, and 526 (13%) were sent invitations. Of those invited, 117 (22%) consented to participate of whom 86 (74%) completed the study. We have confirmed the feasibility of supplementing EHR with data collected directly from patients. Although the present study successfully collected essential data from patients, it also underlined the requirement for improved engagement with both patients and general practitioners to support similar studies. © 2017 The Authors. Pharmacoepidemiology & Drug Safety published by John Wiley & Sons Ltd.

  9. Assessing the mental health needs and barriers to care among a diverse sample of Asian American older adults.

    Science.gov (United States)

    Sorkin, Dara H; Nguyen, Hannah; Ngo-Metzger, Quyen

    2011-06-01

    Asian Americans represent a mix of cultures and immigration experiences, which may put them differentially at risk for mental health problems. Yet, little is known about the mental health needs of older adults from various Asian subgroups compared to non-Hispanic whites. To compare the prevalence rates of mental distress of Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese older adults (aged 55 and older) to that of non-Hispanic whites; and to examine subgroup differences in utilization of mental health services. A cross-sectional analysis of a population-based sample of California adults responding to the 2007 California Health Interview Survey. Multivariable logistic regression analysis was used to examine subgroup differences in mental health status and use of mental health services among the six different Asian subgroups and non-Hispanic whites, adjusting for respondents' demographic and health characteristics, socioeconomic status, and English-language proficiency. A total of 20,712 respondents were included. Filipino [aOR=2.25; 95% CI=1.14-4.47] and Korean Americans [aOR=2.10; 95% CI=1.06-4.17] were more likely to report symptoms indicative of mental distress compared to non-Hispanic whites, yet were less likely to have seen a primary care provider [Filipino: aOR=0.41; 95% CI=0.18-0.90; Korean: aOR=0.24; 95% CI = 0.08-0.69] or have taken a prescription medication [Filipino: aOR=0.20; 95% CI=0.10-0.40; Korean: aOR=0.15; 95% CI=0.05-0.40], even after adjusting for indicators of respondents' demographic and health characteristics, socioeconomic status, and English-language proficiency. In contrast, Japanese Americans were less likely to report symptoms indicative of mental distress [aOR=0.43; 95% CI=0.21-0.90], and were less likely to make use of mental health services compared to non-Hispanic whites. The findings from this study not only highlight the unmet mental health needs among older Asian Americans, but also illustrate significant

  10. Evidence-based models of care for people with epilepsy.

    LENUS (Irish Health Repository)

    Fitzsimons, Mary

    2012-02-01

    Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

  11. Variability of nursing care by APR-DRG and by severity of illness in a sample of nine Belgian hospitals.

    Science.gov (United States)

    Pirson, Magali; Delo, Caroline; Di Pierdomenico, Lionel; Laport, Nancy; Biloque, Veronique; Leclercq, Pol

    2013-10-10

    As soon as Diagnosis related Groups (DRG) were introduced in many hospital financing systems, most nursing research revealed that DRG were not very homogeneous with regard to nursing care. However, few studies are based on All Patient refined Diagnosis related Groups (APR-DRGs) and few of them use recent data. Objectives of this study are: (1) to evaluate if nursing activity is homogeneous by APR-DRG and by severity of illness (SOI) (2) to evaluate the outlier's rate associated with the nursing activity and (3) to compare nursing cost homogeneity per DRG and SOI. Study done in 9 Belgian hospitals on a selection of APR-DRG with more than 30 patients (7 638 inpatient stays). The evaluation of the homogeneity is based on coefficients of variation (CV). The 75th percentile + 1.5 × inter-quartile range was used to select high outliers. 25th percentile -1.5 × inter-quartile range was used to select low outliers. Nursing costs per ward were distributed on inpatient stays of each ward following two techniques (the LOS vs. the number of nursing care minutes per stay). The homogeneity of LOS by DRG and by SOI is relatively good (CV: 0.56). The homogeneity of the nursing activity by DRG is less good (CVs between 0.36 and 1.54) and is influenced by nursing activity outliers (high outliers' rate: 5.19%, low outliers' rate: 0.14%). The outlier's rate varies according to the studied variable. The high outliers' rate is higher for nursing activity than for LOS. The homogeneity of nursing costs is higher when costs are based on the LOS of patients than when based on minutes of nursing care (CVs between 0.26 and 1.46 for nursing costs based on LOS and between 0.49 and 2.04 for nursing costs based on minutes of nursing care). It is essential that the calculation of nursing cost by stay and by DRG for hospital financing purposes was based on nursing activity data, that more reflect resources used in wards, and not on LOS data. The only way to obtain this information is

  12. Sampling guidelines for oral fluid-based surveys of group-housed animals.

    Science.gov (United States)

    Rotolo, Marisa L; Sun, Yaxuan; Wang, Chong; Giménez-Lirola, Luis; Baum, David H; Gauger, Phillip C; Harmon, Karen M; Hoogland, Marlin; Main, Rodger; Zimmerman, Jeffrey J

    2017-09-01

    Formulas and software for calculating sample size for surveys based on individual animal samples are readily available. However, sample size formulas are not available for oral fluids and other aggregate samples that are increasingly used in production settings. Therefore, the objective of this study was to develop sampling guidelines for oral fluid-based porcine reproductive and respiratory syndrome virus (PRRSV) surveys in commercial swine farms. Oral fluid samples were collected in 9 weekly samplings from all pens in 3 barns on one production site beginning shortly after placement of weaned pigs. Samples (n=972) were tested by real-time reverse-transcription PCR (RT-rtPCR) and the binary results analyzed using a piecewise exponential survival model for interval-censored, time-to-event data with misclassification. Thereafter, simulation studies were used to study the barn-level probability of PRRSV detection as a function of sample size, sample allocation (simple random sampling vs fixed spatial sampling), assay diagnostic sensitivity and specificity, and pen-level prevalence. These studies provided estimates of the probability of detection by sample size and within-barn prevalence. Detection using fixed spatial sampling was as good as, or better than, simple random sampling. Sampling multiple barns on a site increased the probability of detection with the number of barns sampled. These results are relevant to PRRSV control or elimination projects at the herd, regional, or national levels, but the results are also broadly applicable to contagious pathogens of swine for which oral fluid tests of equivalent performance are available. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  13. Defining Value-Based Care in Cardiac and Vascular Anesthesiology: The Past, Present, and Future of Perioperative Cardiovascular Care.

    Science.gov (United States)

    Kolarczyk, Lavinia M; Arora, Harendra; Manning, Michael W; Zvara, David A; Isaak, Robert S

    2018-02-01

    Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes. In order to meet these patient outcomes, multidisciplinary care pathways must be designed, implemented, and sustained, a process that is challenging at best. This review (1) provides a historical perspective of health care reimbursement; (2) defines value as it pertains to quality, service, and cost; (3) reviews the history of value-based care for cardiac surgery; (4) describes the drive toward optimization for vascular surgery patients; and (5) discusses how programs like Enhanced Recovery After Surgery assist with the delivery of value-based care. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. Research on the cultivation path of smart home-based care service mode in Internet+ vision

    Directory of Open Access Journals (Sweden)

    Peng Qingchao

    2016-01-01

    Full Text Available Home-based care for the aged is an effective method to solve the problem of caring the aged in China. This thesis analyzes some problems existing in the development of current home-based care service for the aged in our country and the positive effects brought by Internet+ in home-based care service. It proposes a new service mode of care for the aged--Internet+ home-based care service, and explains the establishment of this system and the responsibilities of the participants. Also, it explores the path to realize the establishment of Internet+ home-based care service mode so as to promote the healthy development of home-based care service in China.

  15. LVQ-SMOTE - Learning Vector Quantization based Synthetic Minority Over-sampling Technique for biomedical data.

    Science.gov (United States)

    Nakamura, Munehiro; Kajiwara, Yusuke; Otsuka, Atsushi; Kimura, Haruhiko

    2013-10-02

    Over-sampling methods based on Synthetic Minority Over-sampling Technique (SMOTE) have been proposed for classification problems of imbalanced biomedical data. However, the existing over-sampling methods achieve slightly better or sometimes worse result than the simplest SMOTE. In order to improve the effectiveness of SMOTE, this paper presents a novel over-sampling method using codebooks obtained by the learning vector quantization. In general, even when an existing SMOTE applied to a biomedical dataset, its empty feature space is still so huge that most classification algorithms would not perform well on estimating borderlines between classes. To tackle this problem, our over-sampling method generates synthetic samples which occupy more feature space than the other SMOTE algorithms. Briefly saying, our over-sampling method enables to generate useful synthetic samples by referring to actual samples taken from real-world datasets. Experiments on eight real-world imbalanced datasets demonstrate that our proposed over-sampling method performs better than the simplest SMOTE on four of five standard classification algorithms. Moreover, it is seen that the performance of our method increases if the latest SMOTE called MWMOTE is used in our algorithm. Experiments on datasets for β-turn types prediction show some important patterns that have not been seen in previous analyses. The proposed over-sampling method generates useful synthetic samples for the classification of imbalanced biomedical data. Besides, the proposed over-sampling method is basically compatible with basic classification algorithms and the existing over-sampling methods.

  16. The use of care robots in aged care: A systematic review of argument-based ethics literature.

    Science.gov (United States)

    Vandemeulebroucke, Tijs; Dierckx de Casterlé, Bernadette; Gastmans, Chris

    2018-01-01

    As care robots become more commonplace in aged-care settings, the ethical debate on their use becomes increasingly important. Our objective was to examine the ethical arguments and underlying concepts used in the ethical debate on care robot use in aged care. We conducted a systematic literature search for argument-based ethics publications focusing on care robot use in aged-care practices. We used an innovative methodology that consisted of three steps: (a) identifying conceptual-ethical questions, (b) conducting a literature search, and (c) identifying, describing and analyzing the ethical arguments in connection with the conceptual-ethical questions. Twenty-eight appropriate publications were identified. All were published between 2002 and 2016. Four primary ethical approaches were distinguished: (a) a deontological, (b) a principlist, (c) an objective-list, and (d) a care-ethical. All approaches were equally represented across the articles, and all used similar concepts that grounded their diverse ethical arguments. A small group of publications could not be linked to an ethical approach. All included publications presented a strong ethical rationale based on fully elaborated normative arguments. Although the reviewed studies used similar grounding concepts, the studies' arguments were very diverse and sometimes diametrically opposed. Our analysis shows how one envisions care robot use in aged-care settings is influenced by how one views the traditional boundaries of the ethical landscape in aged care. We suggest that an ethical analysis of care robot use employs "democratic spaces," in which all stakeholders in aged care, especially care recipients, have a voice in the ethical debate. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Team-Based Care with Pharmacists to Improve Blood Pressure: a Review of Recent Literature.

    Science.gov (United States)

    Kennelty, Korey A; Polgreen, Linnea A; Carter, Barry L

    2018-01-18

    We review studies published since 2014 that examined team-based care strategies and involved pharmacists to improve blood pressure (BP). We then discuss opportunities and challenges to sustainment of team-based care models in primary care clinics. Multiple studies presented in this review have demonstrated that team-based care including pharmacists can improve BP management. Studies highlighted the cost-effectiveness of a team-based pharmacy intervention for BP control in primary care clinics. Little information was found on factors influencing sustainability of team-based care interventions to improve BP control. Future work is needed to determine the best populations to target with team-based BP programs and how to implement team-based approaches utilizing pharmacists in diverse clinical settings. Future studies need to not only identify unmet clinical needs but also address reimbursement issues and stakeholder engagement that may impact sustainment of team-based care interventions.

  18. Primary Care Providers' experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle

    2012-01-01

    Full Text Available This study explored primary care providers' (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 "MTM is just part of our team approach to the practice of medicine": MTM as an integral part of PCPs' practices; (2 "Frankly it's education for the patient but it's also education for me": MTM services as a source of education; (3 "It's not exactly just the pharmacist that passes out the medicines at the pharmacy": The MTM practitioner is different from the dispensing pharmacist; (4 "So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved": MTM services as preventative health care efforts; (5"I think that time is the big thing": MTM pharmacists spend more time with patients; (6 "There's an access piece, there's an availability piece, there's a finance piece": MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge äóñmedication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients' medications, and their capability to

  19. Primary Care Providers’ experiences with Pharmaceutical Care-based Medication Therapy Management Services

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle, Pharm.D.

    2012-01-01

    Full Text Available This study explored primary care providers’ (PCPs experiences with the practice of pharmaceutical care-based medication therapy management (MTM. Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6 themes uncovered from the interviews included: (1 “MTM is just part of our team approach to the practice of medicine”: MTM as an integral part of PCPs’ practices; (2 “Frankly it’s education for the patient but it’s also education for me”: MTM services as a source of education; (3 “It’s not exactly just the pharmacist that passes out the medicines at the pharmacy”: The MTM practitioner is different from the dispensing pharmacist; (4 “So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved”: MTM services as preventative health care efforts; (5“I think that time is the big thing”: MTM pharmacists spend more time with patients; (6 “There’s an access piece, there’s an availability piece, there’s a finance piece”: MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge –medication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients

  20. THE INDEPENDENCE OF POST SECTIO CAESAREA MOTHER WITH DISCHARGE PLANNING BASED ON OREM'S SELF CARE THEORY

    Directory of Open Access Journals (Sweden)

    Tinok Ayu Putri W

    2017-04-01

    Full Text Available Introduction: Discharge planning is one of nursing intervention that aim to promote the independence of patient's self care-activities after discharge from hospital. This study was aimed to examine the effect of discharge planning on wound care independence of post sectio caesarea mother at Melati Room, Dr. Soegiri Hospital, Lamongan. Method: Design of this study was quasy experiment. The population were post sectio caesarea mother at Melati Room Dr. Soegiri Hospital Lamongan, since May – June 2012. The samples were taken by purposive sampling technique. Fourteen responsdents matched with the inclusion criteria and divided into treatment and control groups. The datas were collected by using questionnaire and observation sheet. Then datas were analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U Test with significance level of α ≤ 0.05. Result: The result of this study showed that post sectio caesarea mother knowledge had significance level of p = 0.027 in treatment group, and in control group was p = 0.034, for post sectio caesarea patient's skill p = 0.015 in treatment group and in control group was p = 0.017. The result of Mann Whitney U test was p = 0.001, it means there was different in knowledge, and skill of wound care on post sectio caesarea patient between treatment and control groups. Discussion: It can be concluded that there are significant effect of wound care independence of post sectio caesarea patient with discharge planning approach based on orem's self care theory to improve patient's independence. Hospital need to develop discharge planning procedure to meet the needs of patient with post sectio caesarea wound and decrease the number of surgical wound infection.

  1. Evidence-based health care: its place within clinical governance.

    Science.gov (United States)

    McSherry, R; Haddock, J

    This article explores the principles of evidence-based practice and its role in achieving quality improvements within the clinical governance framework advocated by the recent White Papers 'The New NHS: Modern, Dependable' (Department of Health (DoH), 1997) and 'A First Class Service: Quality in the New NHS' (DoH, 1998a). Within these White Papers there is an emphasis on improving quality of care, treatment and services through employing the principles of clinical governance. A major feature of clinical governance is guaranteeing quality to the public and the NHS, and ensuring that clinical, managerial and educational practice is based on scientific evidence. This article also examines what evidence-based practice is and what processes are required to promote effective healthcare interventions. The authors also look at how clinical governance relates to other methods/systems involved in clinical effectiveness. Finally, the importance for nurses and other healthcare professionals of familiarizing themselves with the development of critical appraisal skills, and their implications for developing evidence-based practice, is emphasized.

  2. Selective mutism: a consensus based care pathway of good practice.

    Science.gov (United States)

    Keen, D V; Fonseca, S; Wintgens, A

    2008-10-01

    Selective mutism (SM) now acknowledged as an anxiety condition, tends to be a poorly understood, highly complex and vastly under-recognised clinical entity. Children with SM are a vulnerable group as the condition is not the remit of any one professional group. This inevitably leads to delay in formal diagnosis and management. There is a lack of systematic research on which to base guidelines for management. To develop, agree and validate key principles underlying the management of SM through a consensus process involving international experts, in order to create a local care pathway. A local multi-agency consultation process developed 11 statements, which were felt to be the key principles underpinning a potential care pathway for managing SM. Thirteen recognised experts from North America, Europe and Australia participated in a modified Delphi process involving two rounds using a Likert-scale and free commentary. Both quantitative and qualitative analyses were used in the validation or revision of the statements at each stage. Response rates were 100% for Round 1 and 84.6% for Round 2. Despite the differing professional backgrounds and service contexts, by successive revision and/or revalidation of statements, it was possible to arrive at a consensus about key principles relating to early recognition, assessment and intervention. The agreed key principles are presented together with the resulting local care pathway. Through a Delphi process, agreement was reached by a multidisciplinary group of professionals, on key principles that underpin the timely identification, assessment and management of children with SM. These include the potential for staff in school/preschool settings to identify SM and that intervention programmes should generally be based in these settings. Children with SM should receive assessment for possible coexisting disorders, whether developmental, emotional or behavioural and additional specific intervention given for these. Agreement was

  3. [Governance of primary health-care-based health-care organization].

    Science.gov (United States)

    Báscolo, Ernesto

    2010-01-01

    An analytical framework was developed for explaining the conditions for the effectiveness of different strategies promoting integrated primary health-care (PHC) service-based systems in Latin-America. Different modes of governance (clan, incentives and hierarchy) were characterised from a political economics viewpoint for representing alternative forms of regulation promoting innovation in health-service-providing organisations. The necessary conditions for guaranteeing the modes of governance's effectiveness are presented, as are their implications in terms of posts in play. The institutional construction of an integrated health system is interpreted as being a product of a social process in which different modes of governance are combined, operating with different ways of resolving normative aspects for regulating service provision (with the hierarchical mode), resource distribution (with the incentives mode) and on the social values legitimising such process (with the clan mode).

  4. Autonomous spatially adaptive sampling in experiments based on curvature, statistical error and sample spacing with applications in LDA measurements

    Science.gov (United States)

    Theunissen, Raf; Kadosh, Jesse S.; Allen, Christian B.

    2015-06-01

    Spatially varying signals are typically sampled by collecting uniformly spaced samples irrespective of the signal content. For signals with inhomogeneous information content, this leads to unnecessarily dense sampling in regions of low interest or insufficient sample density at important features, or both. A new adaptive sampling technique is presented directing sample collection in proportion to local information content, capturing adequately the short-period features while sparsely sampling less dynamic regions. The proposed method incorporates a data-adapted sampling strategy on the basis of signal curvature, sample space-filling, variable experimental uncertainty and iterative improvement. Numerical assessment has indicated a reduction in the number of samples required to achieve a predefined uncertainty level overall while improving local accuracy for important features. The potential of the proposed method has been further demonstrated on the basis of Laser Doppler Anemometry experiments examining the wake behind a NACA0012 airfoil and the boundary layer characterisation of a flat plate.

  5. HIV/AIDS and home-based health care

    Directory of Open Access Journals (Sweden)

    Jayne TS

    2008-03-01

    Full Text Available Abstract This paper highlights the socio-economic impacts of HIV/AIDS on women. It argues that the socio-cultural beliefs that value the male and female lives differently lead to differential access to health care services. The position of women is exacerbated by their low financial base especially in the rural community where their main source of livelihood, agricultural production does not pay much. But even their active involvement in agricultural production or any other income ventures is hindered when they have to give care to the sick and bedridden friends and relatives. This in itself is a threat to household food security. The paper proposes that gender sensitive policies and programming of intervention at community level would lessen the burden on women who bear the brunt of AIDS as caregivers and livelihood generators at household level. Improvement of medical facilities and quality of services at local dispensaries is seen as feasible since they are in the rural areas. Other interventions should target freeing women's and girls' time for education and involvement in income generating ventures. Two separate data sets from Western Kenya, one being quantitative and another qualitative data have been used.

  6. Generalized sampling in Julia

    DEFF Research Database (Denmark)

    Jacobsen, Christian Robert Dahl; Nielsen, Morten; Rasmussen, Morten Grud

    2017-01-01

    Generalized sampling is a numerically stable framework for obtaining reconstructions of signals in different bases and frames from their samples. For example, one can use wavelet bases for reconstruction given frequency measurements. In this paper, we will introduce a carefully documented toolbox...... for performing generalized sampling in Julia. Julia is a new language for technical computing with focus on performance, which is ideally suited to handle the large size problems often encountered in generalized sampling. The toolbox provides specialized solutions for the setup of Fourier bases and wavelets....... The performance of the toolbox is compared to existing implementations of generalized sampling in MATLAB....

  7. Review series: Examples of chronic care model: the home-based chronic care model: redesigning home health for high quality care delivery.

    Science.gov (United States)

    Suter, Paula; Hennessey, Beth; Florez, Donna; Newton Suter, W

    2011-01-01

    Individuals with chronic obstructive pulmonary disease (COPD) face significant challenges due to frequent distressing dyspnea and deficits related to activities of daily living. Individuals with COPD are often hospitalized frequently for disease exacerbations, negatively impacting quality of life and healthcare expenditure burden. The home-based chronic care model (HBCCM) was designed to address the needs of patients with chronic diseases. This model facilitates the re-design of chronic care delivery within the home health sector by ensuring patient-centered evidence-based care. This HBCCM foundation is Dr. Edward Wagner s chronic care model and has four additional areas of focus: high touch delivery, theory-based self management, specialist oversight and the use of technology. This article will describe this model in detail and outline how model use for patients with COPD can bring value to stakeholders across the health care continuum.

  8. Exploring information systems outsourcing in U.S. hospital-based health care delivery systems.

    Science.gov (United States)

    Diana, Mark L

    2009-12-01

    The purpose of this study is to explore the factors associated with outsourcing of information systems (IS) in hospital-based health care delivery systems, and to determine if there is a difference in IS outsourcing activity based on the strategic value of the outsourced functions. IS sourcing behavior is conceptualized as a case of vertical integration. A synthesis of strategic management theory (SMT) and transaction cost economics (TCE) serves as the theoretical framework. The sample consists of 1,365 hospital-based health care delivery systems that own 3,452 hospitals operating in 2004. The findings indicate that neither TCE nor SMT predicted outsourcing better than the other did. The findings also suggest that health care delivery system managers may not be considering significant factors when making sourcing decisions, including the relative strategic value of the functions they are outsourcing. It is consistent with previous literature to suggest that the high cost of IS may be the main factor driving the outsourcing decision.

  9. Generic project definitions for improvement of health care delivery: a case-based approach.

    Science.gov (United States)

    Niemeijer, Gerard C; Does, Ronald J M M; de Mast, Jeroen; Trip, Albert; van den Heuvel, Jaap

    2011-01-01

    The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning approach to project definition. Data sources were project documentation and hospital-performance statistics of 271 Lean Six Sigma health care projects from 2002 to 2009 of general, teaching, and academic hospitals in the Netherlands and Belgium. Objectives and operational definitions of improvement projects in the sample, analyzed and structured in a uniform format and terminology. Extraction of reusable elements of earlier project definitions, presented in the form of 9 templates called generic project definitions. These templates function as exemplars for future process improvement projects, making the selection, definition, and operationalization of similar projects more efficient. Each template includes an explicated rationale, an operationalization in the form of metrics, and a prototypical example. Thus, a process of incremental and sustained learning based on case-based reasoning is facilitated. The quality of project definitions is a crucial success factor in pursuits to improve health care delivery. We offer 9 tried and tested improvement themes related to patient safety, patient satisfaction, and business-economic performance of hospitals.

  10. A comparison of home care clients and nursing home residents: can community based care keep the elderly and disabled at home?

    Science.gov (United States)

    Shugarman, L R; Fries, B E; James, M

    1999-01-01

    Admission cohorts from the Michigan Medicaid Home and Community-Based Waiver program and Ohio nursing homes were compared on measures of resource utilization including a modified Resource Utilization Groups (RUG-III) system, Activities of Daily Living (ADLs), and overall case mix. We found that, contrary to previous research, the two samples were remarkably similar across RUG-III categories. However, the nursing home sample was more functionally impaired on measures of ADL functioning and overall case mix. Results of this study may inform policymakers and providers of the potential for maintaining the appropriate population in the home with government-funded home care.

  11. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample.

    Science.gov (United States)

    Prins, Annabel; Bovin, Michelle J; Smolenski, Derek J; Marx, Brian P; Kimerling, Rachel; Jenkins-Guarnieri, Michael A; Kaloupek, Danny G; Schnurr, Paula P; Kaiser, Anica Pless; Leyva, Yani E; Tiet, Quyen Q

    2016-10-01

    Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common. The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure. We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5. A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White. The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences. The PC-PTSD-5 demonstrated excellent diagnostic accuracy (AUC = 0.941; 95 % C.I.: 0.912- 0.969). Whereas a cut score of 3 maximized sensitivity (κ[1]) = 0.93; SE = .041; 95 % C.I.: 0.849-1.00), a cut score of 4 maximized efficiency (κ[0.5] = 0.63; SE = 0.052; 95 % C.I.: 0.527-0.731), and a cut score of 5 maximized specificity (κ[0] = 0.70; SE = 0.077; 95 % C.I.: 0.550-0.853). Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report. The PC-PTSD-5 demonstrated strong preliminary results for diagnostic accuracy, and was broadly acceptable to patients.

  12. Needs assessment for home-based care and the strengthening of social support networks: the role of community care workers in rural South Africa

    Directory of Open Access Journals (Sweden)

    Mosa Moshabela

    2015-12-01

    Full Text Available Background: Community care workers (CCWs in rural South Africa provide medical, personal, household, educational, and social care services to their clients. However, little understanding exists on how provision of services is approached within a household, taking into account available social support networks. Objective: The aim of this study was to generate an understanding of the processes that underpin the provision of care by CCWs in rural households and their engagement with clients, primary caregivers (PCGs, and other members of the social support network. Design: We analysed in-depth interviews conducted in a triad of participants involved in a home-based care (HBC encounter – 32 clients, 32 PCGs, and 17 CCWs. For each triad, a purposefully selected CCW was linked with a purposefully selected client and the corresponding PCG using maximum variation sampling. Three coders used an inductive content analysis method to describe participants’ references to the nuances of processes followed by CCWs in servicing HBC clients. Written informed consent was obtained from all participants. Findings: The results suggest that, by intuition and prior knowledge, CCWs treated each household uniquely, depending on the clients’ care needs, cooperation, availability of a social network, and the reliability and resilience of the social support system for the client. Four distinct processes took place in rural households: needs assessment for care, rationing of care, appraisal of care, and reinforcement of a social support system. However, there was no particular order or sequence established for these processes, and caregivers followed no prescribed or shared standards. Conclusions: CCWs bring a basket of services to a household, but engage in a constant, dynamic, and cyclical process of weighing needs against services provided. The service package is uniquely crafted and tailored for each household, depending on the absorptive capacity of the social

  13. Wiisokotaatiwin: development and evaluation of a community-based palliative care program in Naotkamegwanning First Nation.

    Science.gov (United States)

    Nadin, Shevaun; Crow, Maxine; Prince, Holly; Kelley, Mary Lou

    2018-04-01

    Approximately 474 000 Indigenous people live in 617 First Nations communities across Canada; 125 of those communities are located in Ontario, primarily in rural and remote areas. Common rural health challenges, including for palliative care, involve quality and access. The need for culturally relevant palliative care programs in First Nations communities is urgent because the population is aging with a high burden of chronic and terminal disease. Because local palliative care is lacking, most First Nations people now leave their culture, family and community to receive care in distant hospitals or long-term care homes. Due to jurisdictional issues, a policy gap exists where neither federal nor provincial governments takes responsibility for funding palliative care in First Nations communities. Further, no Canadian program models existed for how different levels of government can collaborate to fund and deliver palliative care in First Nations communities. This article describes an innovative, community-based palliative care program (Wiisokotaatiwin) developed in rural Naotkamegwanning, and presents the results of a process evaluation of its pilot implementation. The evaluation aimed to (i) document the program's pilot implementation, (ii) assess progress toward intended program outcomes and (iii) assess the perceived value of the program. The Wiisokotaatiwin Program was developed and implemented over 5 years using participatory action research (http://www.eolfn.lakeheadu.ca). A mixed-method evaluation approach was adopted. Descriptive data were extracted from program documents (eg client registration forms). Client tracking forms documented service provision data for a 4-month sample period. Quantitative and qualitative data were collected through client and family member questionnaires (n=7) and healthcare provider questionnaires (n=22). A focus group was conducted with the program leadership team responsible for program development. Quantitative data were

  14. DGT Passive Sampling for Quantitative in Situ Measurements of Compounds from Household and Personal Care Products in Waters.

    Science.gov (United States)

    Chen, Wei; Li, Yanying; Chen, Chang-Er; Sweetman, Andrew J; Zhang, Hao; Jones, Kevin C

    2017-11-21

    Widespread use of organic chemicals in household and personal care products (HPCPs) and their discharge into aquatic systems means reliable, robust techniques to monitor environmental concentrations are needed. The passive sampling approach of diffusive gradients in thin-films (DGT) is developed here and demonstrated to provide in situ quantitative and time-weighted average (TWA) measurement of these chemicals in waters. The novel technique is developed for HPCPs, including preservatives, antioxidants and disinfectants, by evaluating the performance of different binding agents. Ultrasonic extraction of binding gels in acetonitrile gave good and consistent recoveries for all test chemicals. Uptake by DGT with HLB (hydrophilic-lipophilic-balanced) as the binding agent was relatively independent of pH (3.5-9.5), ionic strength (0.001-0.1 M) and dissolved organic matter (0-20 mg L -1 ), making it suitable for applications across a wide range of environments. Deployment time and diffusion layer thickness dependence experiments confirmed DGT accumulated chemicals masses are consistent with theoretical predictions. The technique was further tested and applied in the influent and effluent of a wastewater treatment plant. Results were compared with conventional grab-sampling and 24-h-composited samples from autosamplers. DGT provided TWA concentrations over up to 18 days deployment, with minimal effects from biofouling or the diffusive boundary layer. The field application demonstrated advantages of the DGT technique: it gives in situ analyte preconcentration in a simple matrix, with more quantitative measurement of the HPCP analytes.

  15. Intensive care survivors' experiences of ward-based care: Meleis' theory of nursing transitions and role development among critical care outreach services.

    Science.gov (United States)

    Ramsay, Pam; Huby, Guro; Thompson, Andrew; Walsh, Tim

    2014-03-01

    To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.'s mid-range theory on experiencing transitions. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Meleis et al.'s work has resonance in terms of explicating intensive care patients' experiences of psychosocial distress throughout the transition to general ward-based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed

  16. Mothers' Transition Back to Work and Infants' Transition to Child Care: Does Work-Based Child Care Make a Difference?

    Science.gov (United States)

    Skouteris, Helen; McCaught, Simone; Dissanayake, Cheryl

    2007-01-01

    The overall aim in this study was twofold: to compare the use of work-based (WB) and non-work-based (NWB) child care on the transition back to the workplace for women after a period of maternity leave, and on the transition into child care for the infants of these women. Thirty-five mothers with infants in WB centres and 44 mothers with infants in…

  17. Health Care Professionals’ Beliefs About Using Wiki-Based Reminders to Promote Best Practices in Trauma Care

    OpenAIRE

    Archambault, Patrick Michel; Bilodeau, Andrea; Gagnon, Marie-Pierre; Aubin, Karine; Lavoie, André; Lapointe, Jean; Poitras, Julien; Croteau, Sylvain; Pham-Dinh, Martin; Légaré, France

    2012-01-01

    Background Wikis are knowledge translation tools that could help health professionals implement best practices in acute care. Little is known about the factors influencing professionals’ use of wikis. Objectives To identify and compare the beliefs of emergency physicians (EPs) and allied health professionals (AHPs) about using a wiki-based reminder that promotes evidence-based care for traumatic brain injuries. Methods Drawing on the theory of planned behavior, we conducted semistructured int...

  18. Interview-Based Qualitative Research in Emergency Care Part II: Data Collection, Analysis and Results Reporting

    Science.gov (United States)

    Ranney, Megan L.; Meisel, Zachary; Choo, Esther K.; Garro, Aris; Sasson, Comilla; Morrow, Kathleen

    2015-01-01

    Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. PMID:26284572

  19. Interview-based Qualitative Research in Emergency Care Part II: Data Collection, Analysis and Results Reporting.

    Science.gov (United States)

    Ranney, Megan L; Meisel, Zachary F; Choo, Esther K; Garro, Aris C; Sasson, Comilla; Morrow Guthrie, Kate

    2015-09-01

    Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. © 2015 by the Society for Academic Emergency Medicine.

  20. Potential Medicaid Cost Savings from Maternity Care Based..

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce...

  1. The impact of HMOs on hospital-based uncompensated care.

    Science.gov (United States)

    Thorpe, K E; Seiber, E E; Florence, C S

    2001-06-01

    Managed care in general and HMOs in particular have become the vehicle of choice for controlling health care spending in the private sector. By several accounts, managed care has achieved its cost-containment objectives. At the same time, the percentage of Americans without health insurance coverage continues to rise. For-profit and not-for-profit hospitals have traditionally financed care for the uninsured from profits derived from patients with insurance. Thus the relationship between growth in managed care and HMOs, hospital "profits," and care for the uninsured represent an important policy question. Using national data over an eight-year period, we find that a ten-percentage point increase in managed care penetration is associated with a two-percentage point reduction in hospital total profit margin and a 0.6 percentage point decrease in uncompensated care.

  2. Observer-Based Stabilization of Spacecraft Rendezvous with Variable Sampling and Sensor Nonlinearity

    Directory of Open Access Journals (Sweden)

    Zhuoshi Li

    2013-01-01

    Full Text Available This paper addresses the observer-based control problem of spacecraft rendezvous with nonuniform sampling period. The relative dynamic model is based on the classical Clohessy-Wiltshire equation, and sensor nonlinearity and sampling are considered together in a unified framework. The purpose of this paper is to perform an observer-based controller synthesis by using sampled and saturated output measurements, such that the resulting closed-loop system is exponentially stable. A time-dependent Lyapunov functional is developed which depends on time and the upper bound of the sampling period and also does not grow along the input update times. The controller design problem is solved in terms of the linear matrix inequality method, and the obtained results are less conservative than using the traditional Lyapunov functionals. Finally, a numerical simulation example is built to show the validity of the developed sampled-data control strategy.

  3. Design and application of a theory-based case/care management model for home care: advanced practice for nurses as care managers.

    Science.gov (United States)

    Sears, Nancy A

    2002-01-01

    Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.

  4. Defining Primary Care Shortage Areas: Do GIS-based Measures Yield Different Results?

    Science.gov (United States)

    Daly, Michael R; Mellor, Jennifer M; Millones, Marco

    2018-02-12

    To examine whether geographic information systems (GIS)-based physician-to-population ratios (PPRs) yield determinations of geographic primary care shortage areas that differ from those based on bounded-area PPRs like those used in the Health Professional Shortage Area (HPSA) designation process. We used geocoded data on primary care physician (PCP) locations and census block population counts from 1 US state to construct 2 shortage area indicators. The first is a bounded-area shortage indicator defined without GIS methods; the second is a GIS-based measure that measures the populations' spatial proximity to PCP locations. We examined agreement and disagreement between bounded shortage areas and GIS-based shortage areas. Bounded shortage area indicators and GIS-based shortage area indicators agree for the census blocks where the vast majority of our study populations reside. Specifically, 95% and 98% of the populations in our full and urban samples, respectively, reside in census blocks where the 2 indicators agree. Although agreement is generally high in rural areas (ie, 87% of the rural population reside in census blocks where the 2 indicators agree), agreement is significantly lower compared to urban areas. One source of disagreement suggests that bounded-area measures may "overlook" some shortages in rural areas; however, other aspects of the HPSA designation process likely mitigate this concern. Another source of disagreement arises from the border-crossing problem, and it is more prevalent. The GIS-based PPRs we employed would yield shortage area determinations that are similar to those based on bounded-area PPRs defined for Primary Care Service Areas. Disagreement rates were lower than previous studies have found. © 2018 National Rural Health Association.

  5. Providing Culturally Competent Care for LGBTQ Youth in School-Based Health Centers: A Needs Assessment to Guide Quality of Care Improvements.

    Science.gov (United States)

    Garbers, Samantha; Heck, Craig J; Gold, Melanie A; Santelli, John S; Bersamin, Melina

    2017-01-01

    School-based health centers (SBHCs) can take specific steps to provide culturally competent care for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, potentially impacting well-being. A needs assessment survey was conducted among a convenience sample of SBHC administrators and medical directors to assess climates and actions supportive of LGBTQ quality medical care. Half (53%) of the SBHCs surveyed ( N = 66) reviewed print materials for negative LGBTQ stereotypes, and 27.3% conducted exhaustive materials review. Regional differences were detected: 46.2% of Southern SBHCs conducted any materials review compared to 91.3% in the West and all in the East and Midwest (χ 2 , p LGBTQ youth. On intake forms, 85.4% included preferred names, but only 23.5% included preferred pronoun. There are significant gaps in the extent to which SBHCs provide culturally competent care. These findings can guide future training and advocacy.

  6. Adolescent Health Care in School-Based Health Centers. Position Statement

    Science.gov (United States)

    National Assembly on School-Based Health Care, 2008

    2008-01-01

    School-based health centers (SBHCs) are considered one of the most effective strategies for delivering preventive care, including reproductive and mental health care services, to adolescents--a population long considered difficult to reach. National Assembly on School-Based Health Care (NASBHC) recommends practices and policies to assure…

  7. Cost Analysis of Prenatal Care Using the Activity-Based Costing Model: A Pilot Study

    Science.gov (United States)

    Gesse, Theresa; Golembeski, Susan; Potter, Jonell

    1999-01-01

    The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care. PMID:22945985

  8. Cost analysis of prenatal care using the activity-based costing model: a pilot study.

    Science.gov (United States)

    Gesse, T; Golembeski, S; Potter, J

    1999-01-01

    The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.

  9. Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

    Directory of Open Access Journals (Sweden)

    Nishikitani Mariko

    2010-06-01

    Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.

  10. Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: a randomized trial.

    Science.gov (United States)

    Schroedl, Clara J; Corbridge, Thomas C; Cohen, Elaine R; Fakhran, Sherene S; Schimmel, Daniel; McGaghie, William C; Wayne, Diane B

    2012-04-01

    The purpose of this study is to determine the effect of simulation-based education on the knowledge and skills of internal medicine residents in the medical intensive care unit (MICU). From January 2009 to January 2010, 60 first-year residents at a tertiary care teaching hospital were randomized by month of rotation to an intervention group (simulator-trained, n = 26) and a control group (traditionally trained, n = 34). Simulator-trained residents completed 4 hours of simulation-based education before their medical intensive care unit (MICU) rotation. Topics included circulatory shock, respiratory failure, and mechanical ventilation. After their rotation, residents completed a standardized bedside skills assessment using a 14-item checklist regarding respiratory mechanics, ventilator settings, and circulatory parameters. Performance of simulator-trained and traditionally trained residents was compared using a 2-tailed independent-samples t test. Simulator-trained residents scored significantly higher on the bedside skills assessment compared with traditionally trained residents (82.5% ± 10.6% vs 74.8% ± 14.1%, P = .027). Simulator-trained residents were highly satisfied with the simulation curriculum. Simulation-based education significantly improved resident knowledge and skill in the MICU. Knowledge acquired in the simulated environment was transferred to improved bedside skills caring for MICU patients. Simulation-based education is a valuable adjunct to standard clinical training for residents in the MICU. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Use of Language Sample Analysis by School-Based SLPs: Results of a Nationwide Survey

    Science.gov (United States)

    Pavelko, Stacey L.; Owens, Robert E., Jr.; Ireland, Marie; Hahs-Vaughn, Debbie L.

    2016-01-01

    Purpose: This article examines use of language sample analysis (LSA) by school-based speech-language pathologists (SLPs), including characteristics of language samples, methods of transcription and analysis, barriers to LSA use, and factors affecting LSA use, such as American Speech-Language-Hearing Association certification, number of years'…

  12. Adaptive list sequential sampling method for population-based observational studies

    NARCIS (Netherlands)

    Hof, Michel H.; Ravelli, Anita C. J.; Zwinderman, Aeilko H.

    2014-01-01

    In population-based observational studies, non-participation and delayed response to the invitation to participate are complications that often arise during the recruitment of a sample. When both are not properly dealt with, the composition of the sample can be different from the desired

  13. Eating Disorders among a Community-Based Sample of Chilean Female Adolescents

    Science.gov (United States)

    Granillo, M. Teresa; Grogan-Kaylor, Andrew; Delva, Jorge; Castillo, Marcela

    2011-01-01

    The purpose of this study was to explore the prevalence and correlates of eating disorders among a community-based sample of female Chilean adolescents. Data were collected through structured interviews with 420 female adolescents residing in Santiago, Chile. Approximately 4% of the sample reported ever being diagnosed with an eating disorder.…

  14. Out-of-pocket costs, primary care frequent attendance and sample selection: Estimates from a longitudinal cohort design.

    Science.gov (United States)

    Pymont, Carly; McNamee, Paul; Butterworth, Peter

    2018-03-20

    This paper examines the effect of out-of-pocket costs on subsequent frequent attendance in primary care using data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study from Canberra, Australia. The analysis sample comprised 1197 respondents with two or more GP consultations, and uses survey data linked to administrative health service use (Medicare) data which provides data on the number of consultations and out-of-pocket costs. Respondents identified in the highest decile of GP use in a year were defined as Frequent Attenders (FAs). Logistic regression models that did not account for potential selection effects showed that out-of-pocket costs incurred during respondents' prior two consultations were significantly associated with subsequent FA status. Respondents who incurred higher costs ($15-$35; or >$35) were less likely to become FAs than those who incurred no or low (attenders. Copyright © 2018. Published by Elsevier B.V.

  15. Antibiotic Susceptibility Patterns of Bacterial Isolates from Pus Samples in a Tertiary Care Hospital of Punjab, India

    Directory of Open Access Journals (Sweden)

    Rugira Trojan

    2016-01-01

    Full Text Available We determined the prevalence and antibiotic susceptibilities patterns of bacterial isolates from pus samples collected from patients in a tertiary care hospital of Punjab, India. E. coli was the most prevalent pathogen (51.2% followed by Staphylococcus aureus (21%, Klebsiella pneumoniae (11.6%, Pseudomonas aeruginosa (5.8%, Citrobacter spp. (3.5%, Acinetobacter baumannii (2.3%, Proteus mirabilis (2.3%, and Streptococcus spp. (2.3%. E. coli, K. pneumoniae, A. baumannii, and Citrobacter isolates were resistant to multiple antibiotics including higher generation cephalosporins. S. aureus and Streptococcus isolates were sensitive to cloxacillin and vancomycin. However, P. aeruginosa, P. mirabilis, and Streptococcus isolates were found to be less resistant to the spectrum of antibiotics tested. Overall, our findings indicate the prevalence of resistance to different classes of antibiotics in bacterial isolates from pus infections and hence highlight the need for effective surveillance, regulator reporting, and antibiogram-guided antibiotic prescription.

  16. Patient activation and disparate health care outcomes in a racially diverse sample of chronically ill older adults.

    Science.gov (United States)

    Ryvicker, Miriam; Peng, Timothy R; Feldman, Penny Hollander

    2012-11-01

    The Patient Activation Measure (PAM) assesses people's ability to self-manage their health. Variations in PAM score have been linked with health behaviors, outcomes, and potential disparities. This study assessed the relative impacts of activation, socio-demographic and clinical factors on health care outcomes in a racially diverse sample of chronically ill, elderly homecare patients. Using survey and administrative data from 249 predominantly non-White patients, logistic regression was conducted to examine the effects of activation level and patient characteristics on the likelihood of subsequent hospitalization and emergency department (ED) use. Activation was not a significant predictor of hospitalization or ED use in adjusted models. Non-Whites were more likely than Whites to have a hospitalization or ED visit. Obesity was a strong predictor of both outcomes. Further research should examine potential sources of disadvantage among chronically ill homecare patients to design effective interventions to reduce health disparities in this population.

  17. How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study.

    Science.gov (United States)

    Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki

    2016-07-01

    To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

  18. Team-Based Models for End-of-Life Care: An Evidence-Based Analysis

    Science.gov (United States)

    2014-01-01

    Background End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. Objectives Our objective was to determine whether an optimal team-based model of care exists for service delivery at end of life. In systematically reviewing such models, we considered their core components: team membership, services offered, modes of patient contact, and setting. Data Sources A literature search was performed on October 14, 2013, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to October 14, 2013. Review Methods Abstracts were reviewed by a single reviewer and full-text articles were obtained that met the inclusion criteria. Studies were included if they evaluated a team model of care compared with usual care in an end-of-life adult population. A team was defined as having at least 2 health care disciplines represented. Studies were limited to English publications. A meta-analysis was completed to obtain pooled effect estimates where data permitted. The GRADE quality of the evidence was evaluated. Results Our literature search located 10 randomized controlled trials which, among them, evaluated the following 6 team-based models of care: hospital, direct contact home, direct contact home, indirect contact comprehensive, indirect contact comprehensive, direct contact comprehensive, direct, and early contact Direct contact is when team members see the patient; indirect contact is when they advise another health care practitioner (e.g., a family doctor) who sees

  19. Robotic, MEMS-based Multi Utility Sample Preparation Instrument for ISS Biological Workstation, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — This project will develop a multi-functional, automated sample preparation instrument for biological wet-lab workstations on the ISS. The instrument is based on a...

  20. Dental care and children with special health care needs: a population-based perspective.

    Science.gov (United States)

    Lewis, Charlotte W

    2009-01-01

    This paper grew out of a project reviewing progress in children's oral health after Oral Health in America: A Report of the Surgeon General was published in 2000. It includes a summary of advances in national surveillance of children with special health care needs (CSHCN), and presents more recent data on unmet dental care need among CSHCN. To that end, we used the 2006 National Survey of Children with Special Health Care Needs to determine the prevalence of unmet dental care need among CSHCN and to compare this within subgroups of CSHCN, as well as to children without special health care needs, and to results from the previous iteration of this survey. Dental care remains the most frequently cited unmet health need for CSHCN. More CSHCN had unmet needs for nonpreventive than preventive dental care. CSHCN who are teens, poorer, uninsured, had insurance lapses, or are more severely affected by their condition had higher adjusted odds of unmet dental care needs. CSHCN who were both low income and severely affected had 13.4 times the adjusted odds of unmet dental care need. In summary, CSHCN are more likely to be insured and to receive preventive dental care at equal or higher rates than children without special health care needs. Nevertheless, CSHCN, particularly lower income and severely affected, are more likely to report unmet dental care need compared with unaffected children. Despite advances in knowledge about dental care among CSHCN, unanswered questions remain. Recommendations are provided toward obtaining additional data and facilitating dental care access for this vulnerable population.

  1. Performance-based contracting in home-care work in The Netherlands: professionalism under pressure?

    Science.gov (United States)

    Oomkens, Rosanne; Hoogenboom, Marcel; Knijn, Trudie

    2016-07-01

    Our aim was to improve the understanding of the relationships between performance-based contracting, management supportiveness and professionalism in home care. Using path analysis, this article explores the relationships between home-care workers' perceptions of management support, implementation of performance-based contracting (i.e. use of strict time registration rules and cost-efficiency measures) and autonomy and intrinsic job satisfaction. We hypothesised that: use of strict time registration rules and cost-efficiency measures relates to lower levels of autonomy and intrinsic job satisfaction (H1); there is an indirect relationship between use of strict time registration rules and use of cost-efficiency measures and intrinsic job satisfaction via autonomy (H2); higher levels of management support relate to the use of looser time registration rules and less use of cost-efficiency measures (H3); and higher levels of management support relate to higher levels of autonomy and intrinsic job satisfaction (H4). We used data from a cross-sectional survey conducted in 2010 of a sample of Dutch home-care workers (N = 156, response rate = 34%). Overall, our study suggests that the consequences of performance-based contracting for professionalism are ambiguous. More specifically, using strict time registration rules is related to lower levels of autonomy, whereas using cost-efficiency measures does not seem to affect autonomy (H1). Performance-based contracting has no consequences for the level of fulfilment home-care workers find in their job, as neither of the two contracting dimensions measured was directly or indirectly related to intrinsic job satisfaction (H1, H2). The role of managers must be taken into account when studying performance-based contracting, because perceived higher management support is related to managers' less frequent use of both strict time registration rules and of cost-efficiency measures (H3). The insight we gained into the importance of

  2. Health economic evaluation of home and hospital-based care in ...

    African Journals Online (AJOL)

    ... diabetes treatment satisfaction, diabetes knowledge and costs during three months ... Results: The cost of home-based care in insulin therapy diabetes was 61% ... Conclusions: The care at home approach for type 2 diabetic patients can be ...

  3. Electronic Health Record for Intensive Care based on Usual Windows Based Software.

    Science.gov (United States)

    Reper, Arnaud; Reper, Pascal

    2015-08-01

    In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed an EHR based on usual software and components. The software was designed as a client-server architecture running on the Windows operating system and powered by the access data base system. The client software was developed using Visual Basic interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in September 2004, the EHR was used to care more than five thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of basic functionalities communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on usual software components was able to respond to the medical needs of the local ICU environment. The use of Windows for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

  4. Co- and multimorbidity patterns in primary care based on episodes of care: results from the German CONTENT project

    Directory of Open Access Journals (Sweden)

    Rosemann Thomas

    2008-01-01

    Full Text Available Abstract Background Due to technological progress and improvements in medical care and health policy the average age of patients in primary care is continuously growing. In equal measure, an increasing proportion of mostly elderly primary care patients presents with multiple coexisting medical conditions. To properly assess the current situation of co- and multimorbidity, valid scientific data based on an appropriate data structure are indispensable. CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork is an ambitious project in Germany to establish a system for adequate record keeping and analysis in primary care based on episodes of care. An episode is defined as health problem from its first presentation by a patient to a doctor until the completion of the last encounter for it. The study aims to describe co- and multimorbidity as well as health care utilization based on episodes of care for the study population of the first participating general practices. Methods The analyses were based on a total of 39,699 patients in a yearly contact group (YCG out of 17 general practices in Germany for which data entry based on episodes of care using the International Classification of Primary Care (ICPC was performed between 1.1.2006 and 31.12.2006. In order to model the relationship between the explanatory variables (age, gender, number of chronic conditions and the response variables of interest (number of different prescriptions, number of referrals, number of encounters that were applied to measure health care utilization, we used multiple linear regression. Results In comparison to gender, patients' age had a manifestly stronger impact on the number of different prescriptions, the number of referrals and number of encounters. In comparison to age (β = 0.043, p Conclusion Documentation in primary care on the basis of episodes of care facilitates an insight to concurrently existing health problems and related medical procedures

  5. An Integrated Web-Based Mental Health Intervention of Assessment-Referral-Care to Reduce Stress, Anxiety, and Depression in Hospitalized Pregnant Women With Medically High-Risk Pregnancies: A Feasibility Study Protocol of Hospital-Based Implementation

    OpenAIRE

    Kingston, Dawn; Janes-Kelley, Selikke; Tyrrell, Janie; Clark, Lorna; Hamza, Deena; Holmes, Penny; Parkes, Cheryl; Moyo, Nomagugu; McDonald, Sheila; Austin, Marie-Paule

    2015-01-01

    Background At prevalence rates of up to 40%, rates of depression and anxiety among women with medically complex pregnancies are 3 times greater than those in community-based samples of pregnant women. However, mental health care is not a component of routine hospital-based antenatal care for medically high-risk pregnant women. Objective The purpose of this study is to evaluate the effectiveness and feasibility of the hospital-based implementation of a Web-based integrated mental health interv...

  6. Data splitting for artificial neural networks using SOM-based stratified sampling.

    Science.gov (United States)

    May, R J; Maier, H R; Dandy, G C

    2010-03-01

    Data splitting is an important consideration during artificial neural network (ANN) development where hold-out cross-validation is commonly employed to ensure generalization. Even for a moderate sample size, the sampling methodology used for data splitting can have a significant effect on the quality of the subsets used for training, testing and validating an ANN. Poor data splitting can result in inaccurate and highly variable model performance; however, the choice of sampling methodology is rarely given due consideration by ANN modellers. Increased confidence in the sampling is of paramount importance, since the hold-out sampling is generally performed only once during ANN development. This paper considers the variability in the quality of subsets that are obtained using different data splitting approaches. A novel approach to stratified sampling, based on Neyman sampling of the self-organizing map (SOM), is developed, with several guidelines identified for setting the SOM size and sample allocation in order to minimize the bias and variance in the datasets. Using an example ANN function approximation task, the SOM-based approach is evaluated in comparison to random sampling, DUPLEX, systematic stratified sampling, and trial-and-error sampling to minimize the statistical differences between data sets. Of these approaches, DUPLEX is found to provide benchmark performance with good model performance, with no variability. The results show that the SOM-based approach also reliably generates high-quality samples and can therefore be used with greater confidence than other approaches, especially in the case of non-uniform datasets, with the benefit of scalability to perform data splitting on large datasets. Copyright 2009 Elsevier Ltd. All rights reserved.

  7. Magnitude of 14C/12C variations based on archaeological samples

    International Nuclear Information System (INIS)

    Kusumgar, S.; Agrawal, D.P.

    1977-01-01

    The magnitude of 14 C/ 12 C variations in the period A.D. 5O0 to 200 B.C. and 370 B.C. to 2900 B.C. is discussed. The 14 C dates of well-dated archaeological samples from India and Egypt do not show any significant divergence from the historical ages. On the other hand, the corrections based on dendrochronological samples show marked deviations for the same time period. A plea is, therefore, made to study old tree samples from Anatolia and Irish bogs and archaeological samples from west Asia to arrive at a more realistic calibration curve. (author)

  8. A Method for Microalgae Proteomics Analysis Based on Modified Filter-Aided Sample Preparation.

    Science.gov (United States)

    Li, Song; Cao, Xupeng; Wang, Yan; Zhu, Zhen; Zhang, Haowei; Xue, Song; Tian, Jing

    2017-11-01

    With the fast development of microalgal biofuel researches, the proteomics studies of microalgae increased quickly. A filter-aided sample preparation (FASP) method is widely used proteomics sample preparation method since 2009. Here, a method of microalgae proteomics analysis based on modified filter-aided sample preparation (mFASP) was described to meet the characteristics of microalgae cells and eliminate the error caused by over-alkylation. Using Chlamydomonas reinhardtii as the model, the prepared sample was tested by standard LC-MS/MS and compared with the previous reports. The results showed mFASP is suitable for most of occasions of microalgae proteomics studies.

  9. ON SAMPLING BASED METHODS FOR THE DUBINS TRAVELING SALESMAN PROBLEM WITH NEIGHBORHOODS

    Directory of Open Access Journals (Sweden)

    Petr Váňa

    2015-12-01

    Full Text Available In this paper, we address the problem of path planning to visit a set of regions by Dubins vehicle, which is also known as the Dubins Traveling Salesman Problem Neighborhoods (DTSPN. We propose a modification of the existing sampling-based approach to determine increasing number of samples per goal region and thus improve the solution quality if a more computational time is available. The proposed modification of the sampling-based algorithm has been compared with performance of existing approaches for the DTSPN and results of the quality of the found solutions and the required computational time are presented in the paper.

  10. Teaching evidence-based medical care: description and evaluation.

    Science.gov (United States)

    Grad, R; Macaulay, A C; Warner, M

    2001-09-01

    This paper describes and evaluates several years of a seminar series designed to stimulate residents to seek evidence-based answers to their clinical questions and incorporate this evidence into practice. At the first session, 86 of 89 (97%) residents completed a baseline needs assessment questionnaire. Post-course self-assessment questionnaires measured change from the first to the final seminar session in six domains of interest and skill, as well as residents' preferred sources of information for clinical problem solving up to 2 years after the course. Before the seminars, 48% of residents reported that textbooks were their most important source of information for solving clinical problems. A total of 58 of 75 (77%) residents completed the first post-course questionnaire. Residents reported significant increases in skill at formulating clinical questions and searching for evidence-based answers, appraising reviews, and deciding when and how to incorporate new findings into practice. Use of secondary sources of information such as "Best Evidence," moved up in importance from before the course to after the course. First-year family practice residents who completed our seminar series have reported increased skill at blending consideration of a clinical problem with the use of secondary sources of information to access evidence to support their health care decisions.

  11. Sample Entropy-Based Approach to Evaluate the Stability of Double-Wire Pulsed MIG Welding

    Directory of Open Access Journals (Sweden)

    Ping Yao

    2014-01-01

    Full Text Available According to the sample entropy, this paper deals with a quantitative method to evaluate the current stability in double-wire pulsed MIG welding. Firstly, the sample entropy of current signals with different stability but the same parameters is calculated. The results show that the more stable the current, the smaller the value and the standard deviation of sample entropy. Secondly, four parameters, which are pulse width, peak current, base current, and frequency, are selected for four-level three-factor orthogonal experiment. The calculation and analysis of desired signals indicate that sample entropy values are affected by welding current parameters. Then, a quantitative method based on sample entropy is proposed. The experiment results show that the method can preferably quantify the welding current stability.

  12. Screen Space Ambient Occlusion Based Multiple Importance Sampling for Real-Time Rendering

    Science.gov (United States)

    Zerari, Abd El Mouméne; Babahenini, Mohamed Chaouki

    2018-03-01

    We propose a new approximation technique for accelerating the Global Illumination algorithm for real-time rendering. The proposed approach is based on the Screen-Space Ambient Occlusion (SSAO) method, which approximates the global illumination for large, fully dynamic scenes at interactive frame rates. Current algorithms that are based on the SSAO method suffer from difficulties due to the large number of samples that are required. In this paper, we propose an improvement to the SSAO technique by integrating it with a Multiple Importance Sampling technique that combines a stratified sampling method with an importance sampling method, with the objective of reducing the number of samples. Experimental evaluation demonstrates that our technique can produce high-quality images in real time and is significantly faster than traditional techniques.

  13. A support vector density-based importance sampling for reliability assessment

    International Nuclear Information System (INIS)

    Dai, Hongzhe; Zhang, Hao; Wang, Wei

    2012-01-01

    An importance sampling method based on the adaptive Markov chain simulation and support vector density estimation is developed in this paper for efficient structural reliability assessment. The methodology involves the generation of samples that can adaptively populate the important region by the adaptive Metropolis algorithm, and the construction of importance sampling density by support vector density. The use of the adaptive Metropolis algorithm may effectively improve the convergence and stability of the classical Markov chain simulation. The support vector density can approximate the sampling density with fewer samples in comparison to the conventional kernel density estimation. The proposed importance sampling method can effectively reduce the number of structural analysis required for achieving a given accuracy. Examples involving both numerical and practical structural problems are given to illustrate the application and efficiency of the proposed methodology.

  14. From end of life to chronic care: the provision of community home-based care for HIV and the adaptation to new health care demands in Zambia.

    Science.gov (United States)

    Aantjes, Carolien J; Simbaya, Joseph; Quinlan, Tim K C; Bunders, Joske F G

    2016-11-01

    Aim We present the evolution of primary-level HIV and AIDS services, shifting from end of life to chronic care, and draw attention to the opportunities and threats for the future of Zambia's nascent chronic care system. Although African governments struggled to provide primary health care services in the context of a global economic crisis, civil society organisations (CSO) started mobilising settlement residents to respond to another crisis: the HIV and AIDS pandemic. These initiatives actively engaged patients, families and settlement residents to provide home-based care to HIV-infected patients. After 30 years, CHBC programmes continue to be appropriate in the context of changing health care needs in the population. The study took place in 2011 and 2012 and was part of a multi-country study. It used a mixed method approach involving semi-structured interviews, focus group discussions, structured interviews, service observations and a questionnaire survey. Findings Our research revealed long-standing presence of extensive mutual support amongst residents in many settlements, the invocation of cultural values that emphasise social relationships and organisation of people by CSO in care and support programmes. This laid the foundation for a locally conceived model of chronic care capable of addressing the new care demands arising from the country's changing burden of disease. However, this capacity has come under threat as the reduction in donor funding to community home-based care programmes and donor and government interventions, which have changed the nature of these programmes in the country. Zambia's health system risks losing valuable capacity for fulfilling its vision 'to bring health care as close to the family as possible' if government strategies do not acknowledge the need for transformational approaches to community participation and continuation of the brokering role by CSO in primary health care.

  15. Forgoing dental care for economic reasons in Switzerland: a six-year cross-sectional population-based study.

    Science.gov (United States)

    Guessous, Idris; Theler, Jean-Marc; Durosier Izart, Claire; Stringhini, Silvia; Bodenmann, Patrick; Gaspoz, Jean-Michel; Wolff, Hans

    2014-09-30

    While oral health is part of general health and well-being, oral health disparities nevertheless persist. Potential mechanisms include socioeconomic factors that may influence access to dental care in the absence of universal dental care insurance coverage. We investigated the evolution, prevalence and determinants (including socioeconomic) of forgoing of dental care for economic reasons in a Swiss region, over the course of six years. Repeated population-based surveys (2007-2012) of a representative sample of the adult population of the Canton of Geneva, Switzerland. Forgone dental care, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods. A total of 4313 subjects were included, 10.6% (457/4313) of whom reported having forgone dental care for economic reasons in the previous 12 months. The crude percentage varied from 2.4% in the wealthiest group (monthly income ≥ 13,000 CHF, 1 CHF ≈ 1$) to 23.5% among participants with the lowest income (reasons was independently associated with lower income, younger age, female gender, current smoking, having dependent children, divorced status and not living with a partner, not having a supplementary health insurance, and receipt of a health insurance premium cost-subsidy. In a Swiss region without universal dental care insurance coverage, prevalence of forgoing dental care for economic reasons was high and highly dependent on income. Efforts should be made to prevent high-risk populations from forgoing dental care.

  16. Final LDRD report : development of sample preparation methods for ChIPMA-based imaging mass spectrometry of tissue samples.

    Energy Technology Data Exchange (ETDEWEB)

    Maharrey, Sean P.; Highley, Aaron M.; Behrens, Richard, Jr.; Wiese-Smith, Deneille

    2007-12-01

    The objective of this short-term LDRD project was to acquire the tools needed to use our chemical imaging precision mass analyzer (ChIPMA) instrument to analyze tissue samples. This effort was an outgrowth of discussions with oncologists on the need to find the cellular origin of signals in mass spectra of serum samples, which provide biomarkers for ovarian cancer. The ultimate goal would be to collect chemical images of biopsy samples allowing the chemical images of diseased and nondiseased sections of a sample to be compared. The equipment needed to prepare tissue samples have been acquired and built. This equipment includes an cyro-ultramicrotome for preparing thin sections of samples and a coating unit. The coating unit uses an electrospray system to deposit small droplets of a UV-photo absorbing compound on the surface of the tissue samples. Both units are operational. The tissue sample must be coated with the organic compound to enable matrix assisted laser desorption/ionization (MALDI) and matrix enhanced secondary ion mass spectrometry (ME-SIMS) measurements with the ChIPMA instrument Initial plans to test the sample preparation using human tissue samples required development of administrative procedures beyond the scope of this LDRD. Hence, it was decided to make two types of measurements: (1) Testing the spatial resolution of ME-SIMS by preparing a substrate coated with a mixture of an organic matrix and a bio standard and etching a defined pattern in the coating using a liquid metal ion beam, and (2) preparing and imaging C. elegans worms. Difficulties arose in sectioning the C. elegans for analysis and funds and time to overcome these difficulties were not available in this project. The facilities are now available for preparing biological samples for analysis with the ChIPMA instrument. Some further investment of time and resources in sample preparation should make this a useful tool for chemical imaging applications.

  17. [Study of spatial stratified sampling strategy of Oncomelania hupensis snail survey based on plant abundance].

    Science.gov (United States)

    Xun-Ping, W; An, Z

    2017-07-27

    Objective To optimize and simplify the survey method of Oncomelania hupensis snails in marshland endemic regions of schistosomiasis, so as to improve the precision, efficiency and economy of the snail survey. Methods A snail sampling strategy (Spatial Sampling Scenario of Oncomelania based on Plant Abundance, SOPA) which took the plant abundance as auxiliary variable was explored and an experimental study in a 50 m×50 m plot in a marshland in the Poyang Lake region was performed. Firstly, the push broom surveyed data was stratified into 5 layers by the plant abundance data; then, the required numbers of optimal sampling points of each layer through Hammond McCullagh equation were calculated; thirdly, every sample point in the line with the Multiple Directional Interpolation (MDI) placement scheme was pinpointed; and finally, the comparison study among the outcomes of the spatial random sampling strategy, the traditional systematic sampling method, the spatial stratified sampling method, Sandwich spatial sampling and inference and SOPA was performed. Results The method (SOPA) proposed in this study had the minimal absolute error of 0.213 8; and the traditional systematic sampling method had the largest estimate, and the absolute error was 0.924 4. Conclusion The snail sampling strategy (SOPA) proposed in this study obtains the higher estimation accuracy than the other four methods.

  18. 40 CFR 761.298 - Decisions based on PCB concentration measurements resulting from sampling.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Decisions based on PCB concentration... Cleanup and On-Site Disposal of Bulk PCB Remediation Waste and Porous Surfaces in Accordance With § 761.61(a)(6) § 761.298 Decisions based on PCB concentration measurements resulting from sampling. (a) For...

  19. Reducing Barriers to Care in the Office-Based Health Care Setting for Children With Autism.

    Science.gov (United States)

    Bultas, Margaret W; McMillin, Stephen Edward; Zand, Debra H

    2016-01-01

    The purpose of this survey-design research study was to evaluate the usefulness of a researcher-developed tool designed to improve office-based health care services and to assess the barriers and resources affecting office-based health care services for children with autism spectrum disorder. Fifty-four health care providers (HCPs) and 59 parents participated in the study. HCPs reported child behaviors, communication, and fears as barriers to providing care, whereas parents reported child behavior, sensory issues, and feelings of a disconnect with the HCP as barriers. HCPs identified the parent as a key resource. Parent-identified resources included provider adaptations to the patient, including slowing down the delivery of care and environmental adaptations to the office. In addition, both HCPs and parents indicated that the researcher-developed tool would be useful in reducing barriers during the HCE. Reducing barriers and improving health care interactions during delivery of care for children with autism spectrum disorder has the potential to improve health outcomes. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  20. Community Palliative Care Nurses' Challenges and Coping Strategies on Delivering Home-Based Pediatric Palliative Care.

    Science.gov (United States)

    Chong, LeeAi; Abdullah, Adina

    2017-03-01

    The aim of this study was to explore the experience of community palliative care nurses providing home care to children. A qualitative study was conducted at the 3 community palliative care provider organizations in greater Kuala Lumpur from August to October 2014. Data were collected with semistructured interviews with 16 nurses who have provided care to children and was analyzed using thematic analysis. Two categories were identified: (1) challenges nurses faced and (2) coping strategies. The themes identified from the categories are (1) communication challenges, (2) inadequate training and knowledge, (3) personal suffering, (4) challenges of the system, (5) intrapersonal coping skills, (6) interpersonal coping strategies, and (7) systemic supports. These results reinforces the need for integration of pediatric palliative care teaching and communication skills training into all undergraduate health care programs. Provider organizational support to meet the specific needs of the nurses in the community can help retain them in their role. It will also be important to develop standards for current and new palliative care services to ensure delivery of quality pediatric palliative care.

  1. Nutrition and dementia care: developing an evidence-based model for nutritional care in nursing homes.

    Science.gov (United States)

    Murphy, Jane L; Holmes, Joanne; Brooks, Cindy

    2017-02-14

    There is a growing volume of research to offer improvements in nutritional care for people with dementia living in nursing homes. Whilst a number of interventions have been identified to support food and drink intake, there has been no systematic research to understand the factors for improving nutritional care from the perspectives of all those delivering care in nursing homes. The aim of this study was to develop a research informed model for understanding the complex nutritional problems associated with eating and drinking for people with dementia. We conducted nine focus groups and five semi-structured interviews with those involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (nurses, care workers, catering assistants, dietitians, speech and language therapists) and family carers. The resulting conceptual model was developed by eliciting care-related processes, thus supporting credibility from the perspective of the end-users. The seven identified domain areas were person-centred nutritional care (the overarching theme); availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information. This collaboratively developed, person-centred model can support the design of new education and training tools and be readily translated into existing programmes. Further research is needed to evaluate whether these evidence-informed approaches have been implemented successfully and adopted into practice and policy contexts and can demonstrate effectiveness for people living with dementia.

  2. Sample selection based on kernel-subclustering for the signal reconstruction of multifunctional sensors

    International Nuclear Information System (INIS)

    Wang, Xin; Wei, Guo; Sun, Jinwei

    2013-01-01

    The signal reconstruction methods based on inverse modeling for the signal reconstruction of multifunctional sensors have been widely studied in recent years. To improve the accuracy, the reconstruction methods have become more and more complicated because of the increase in the model parameters and sample points. However, there is another factor that affects the reconstruction accuracy, the position of the sample points, which has not been studied. A reasonable selection of the sample points could improve the signal reconstruction quality in at least two ways: improved accuracy with the same number of sample points or the same accuracy obtained with a smaller number of sample points. Both ways are valuable for improving the accuracy and decreasing the workload, especially for large batches of multifunctional sensors. In this paper, we propose a sample selection method based on kernel-subclustering distill groupings of the sample data and produce the representation of the data set for inverse modeling. The method calculates the distance between two data points based on the kernel-induced distance instead of the conventional distance. The kernel function is a generalization of the distance metric by mapping the data that are non-separable in the original space into homogeneous groups in the high-dimensional space. The method obtained the best results compared with the other three methods in the simulation. (paper)

  3. Asymptotic Effectiveness of the Event-Based Sampling According to the Integral Criterion

    Directory of Open Access Journals (Sweden)

    Marek Miskowicz

    2007-01-01

    Full Text Available A rapid progress in intelligent sensing technology creates new interest in a development of analysis and design of non-conventional sampling schemes. The investigation of the event-based sampling according to the integral criterion is presented in this paper. The investigated sampling scheme is an extension of the pure linear send-on- delta/level-crossing algorithm utilized for reporting the state of objects monitored by intelligent sensors. The motivation of using the event-based integral sampling is outlined. The related works in adaptive sampling are summarized. The analytical closed-form formulas for the evaluation of the mean rate of event-based traffic, and the asymptotic integral sampling effectiveness, are derived. The simulation results verifying the analytical formulas are reported. The effectiveness of the integral sampling is compared with the related linear send-on-delta/level-crossing scheme. The calculation of the asymptotic effectiveness for common signals, which model the state evolution of dynamic systems in time, is exemplified.

  4. Survey of sampling-based methods for uncertainty and sensitivity analysis

    International Nuclear Information System (INIS)

    Helton, J.C.; Johnson, J.D.; Sallaberry, C.J.; Storlie, C.B.

    2006-01-01

    Sampling-based methods for uncertainty and sensitivity analysis are reviewed. The following topics are considered: (i) definition of probability distributions to characterize epistemic uncertainty in analysis inputs (ii) generation of samples from uncertain analysis inputs (iii) propagation of sampled inputs through an analysis (iv) presentation of uncertainty analysis results, and (v) determination of sensitivity analysis results. Special attention is given to the determination of sensitivity analysis results, with brief descriptions and illustrations given for the following procedures/techniques: examination of scatterplots, correlation analysis, regression analysis, partial correlation analysis, rank transformations, statistical tests for patterns based on gridding, entropy tests for patterns based on gridding, nonparametric regression analysis, squared rank differences/rank correlation coefficient test, two-dimensional Kolmogorov-Smirnov test, tests for patterns based on distance measures, top down coefficient of concordance, and variance decomposition

  5. Survey of sampling-based methods for uncertainty and sensitivity analysis.

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Jay Dean; Helton, Jon Craig; Sallaberry, Cedric J. PhD. (.; .); Storlie, Curt B. (Colorado State University, Fort Collins, CO)

    2006-06-01

    Sampling-based methods for uncertainty and sensitivity analysis are reviewed. The following topics are considered: (1) Definition of probability distributions to characterize epistemic uncertainty in analysis inputs, (2) Generation of samples from uncertain analysis inputs, (3) Propagation of sampled inputs through an analysis, (4) Presentation of uncertainty analysis results, and (5) Determination of sensitivity analysis results. Special attention is given to the determination of sensitivity analysis results, with brief descriptions and illustrations given for the following procedures/techniques: examination of scatterplots, correlation analysis, regression analysis, partial correlation analysis, rank transformations, statistical tests for patterns based on gridding, entropy tests for patterns based on gridding, nonparametric regression analysis, squared rank differences/rank correlation coefficient test, two dimensional Kolmogorov-Smirnov test, tests for patterns based on distance measures, top down coefficient of concordance, and variance decomposition.

  6. Perceived importance of caring behaviors to Swedish psychiatric inpatients and staff, with comparisons to somatically-ill samples.

    Science.gov (United States)

    von Essen, L; Sjödén, P O

    1993-08-01

    The present study identified psychiatric inpatient (N = 61) and staff (N = 63) perceptions of most and least important nurse caring behaviors using a modified Swedish version of the CARE-Q instrument (Larson, 1981) and compared the results with data from somatic care (von Essen & Sjödén, 1991a, 1991b). The results demonstrated 13 significant mean between-group differences in the rating of 50 specific CARE-Q behaviors. Two significant mean value differences out of six subscales combining individual items were demonstrated between groups. Psychiatric inpatients considered the cognitive aspect, and somatic inpatients the task-oriented aspect of caring as the most important. Staff, in psychiatric as well as somatic care, considered the emotional aspect of caring as the most important. The results suggest that staff has a relatively invariant, human-oriented perception of caring, irrespective of subdisciplines, while patients' perceptions of caring vary more over specialties.

  7. Immunophenotype Discovery, Hierarchical Organization, and Template-based Classification of Flow Cytometry Samples

    Directory of Open Access Journals (Sweden)

    Ariful Azad

    2016-08-01

    Full Text Available We describe algorithms for discovering immunophenotypes from large collections of flow cytometry (FC samples, and using them to organize the samples into a hierarchy based on phenotypic similarity. The hierarchical organization is helpful for effective and robust cytometry data mining, including the creation of collections of cell populations characteristic of different classes of samples, robust classification, and anomaly detection. We summarize a set of samples belonging to a biological class or category with a statistically derived template for the class. Whereas individual samples are represented in terms of their cell populations (clusters, a template consists of generic meta-populations (a group of homogeneous cell populations obtained from the samples in a class that describe key phenotypes shared among all those samples. We organize an FC data collection in a hierarchical data structure that supports the identification of immunophenotypes relevant to clinical diagnosis. A robust template-based classification scheme is also developed, but our primary focus is in the discovery of phenotypic signatures and inter-sample relationships in an FC data collection. This collective analysis approach is more efficient and robust since templates describe phenotypic signatures common to cell populations in several samples, while ignoring noise and small sample-specific variations.We have applied the template-base scheme to analyze several data setsincluding one representing a healthy immune system, and one of Acute Myeloid Leukemia (AMLsamples. The last task is challenging due to the phenotypic heterogeneity of the severalsubtypes of AML. However, we identified thirteen immunophenotypes corresponding to subtypes of AML, and were able to distinguish Acute Promyelocytic Leukemia from other subtypes of AML.

  8. Performance of local information-based link prediction: a sampling perspective

    Science.gov (United States)

    Zhao, Jichang; Feng, Xu; Dong, Li; Liang, Xiao; Xu, Ke

    2012-08-01

    Link prediction is pervasively employed to uncover the missing links in the snapshots of real-world networks, which are usually obtained through different kinds of sampling methods. In the previous literature, in order to evaluate the performance of the prediction, known edges in the sampled snapshot are divided into the training set and the probe set randomly, without considering the underlying sampling approaches. However, different sampling methods might lead to different missing links, especially for the biased ways. For this reason, random partition-based evaluation of performance is no longer convincing if we take the sampling method into account. In this paper, we try to re-evaluate the performance of local information-based link predictions through sampling method governed division of the training set and the probe set. It is interesting that we find that for different sampling methods, each prediction approach performs unevenly. Moreover, most of these predictions perform weakly when the sampling method is biased, which indicates that the performance of these methods might have been overestimated in the prior works.

  9. Reachable Distance Space: Efficient Sampling-Based Planning for Spatially Constrained Systems

    KAUST Repository

    Xinyu Tang,

    2010-01-25

    Motion planning for spatially constrained robots is difficult due to additional constraints placed on the robot, such as closure constraints for closed chains or requirements on end-effector placement for articulated linkages. It is usually computationally too expensive to apply sampling-based planners to these problems since it is difficult to generate valid configurations. We overcome this challenge by redefining the robot\\'s degrees of freedom and constraints into a new set of parameters, called reachable distance space (RD-space), in which all configurations lie in the set of constraint-satisfying subspaces. This enables us to directly sample the constrained subspaces with complexity linear in the number of the robot\\'s degrees of freedom. In addition to supporting efficient sampling of configurations, we show that the RD-space formulation naturally supports planning and, in particular, we design a local planner suitable for use by sampling-based planners. We demonstrate the effectiveness and efficiency of our approach for several systems including closed chain planning with multiple loops, restricted end-effector sampling, and on-line planning for drawing/sculpting. We can sample single-loop closed chain systems with 1,000 links in time comparable to open chain sampling, and we can generate samples for 1,000-link multi-loop systems of varying topologies in less than a second. © 2010 The Author(s).

  10. A region-based palliative care intervention trial using the mixed-method approach: Japan OPTIM study

    Directory of Open Access Journals (Sweden)

    Morita Tatsuya

    2012-01-01

    populations are a nearly representative sample of advanced cancer patients, bereaved family members, physicians, and nurses in the region. Qualitative process studies consist of 3 studies with each aim: 1 to describe the process in developing regional palliative care in each local context, 2 to understand how and why the regional palliative care program led to changes in the region and to propose a model for shaping regional palliative care, and 3 to systemically collect the barriers of palliative care at a regional level and potential resolutions. The study methodology is a case descriptive study, a grounded theory approach based on interviews, and a content analysis based on systemically collected data, respectively. Discussion This study is, to our knowledge, one of the most comprehensive evaluations of a region-based palliative care intervention program. This study has 3 unique aspects: 1 it measures a wide range of outcomes, including quality of care and quality of life measures specifically designed for palliative care populations, whether patients died where they actually preferred, the changes in physicians and nurses at a regional level; 2 adopts qualitative studies along with quantitative evaluations; and 3 the intervention is without a fundamental change in health care systems. A comprehensive understanding of the findings in this study will contribute to a deeper insight into how to develop community palliative care. Trial Registration UMIN Clinical Trials Registry (UMIN-CTR, Japan, UMIN000001274.

  11. Predictors of Timely Prenatal Care Initiation and Adequate Utilization in a Sample of Late Adolescent Texas Latinas.

    Science.gov (United States)

    Torres, Rosamar; Kehoe, Priscilla; Heilemann, MarySue V

    2018-03-01

    Little is known of late adolescent Texas Latinas' prenatal care perceptions or how these perceptions predict timely prenatal care initiation or adequate utilization. Hence, the purpose of this study is to describe and compare these perceptions between participants with timely versus late prenatal care initiation and adequate, intermediate, and inadequate prenatal care utilization; and to determine predictors of timely prenatal care initiation and adequate utilization. Fifty-four postpartum Latinas were recruited through social media. Eligibility criteria were 18 to 21 years old, Texas-born, primiparous, uncomplicated pregnancy/delivery, and English literate. Prenatal care perceptions were measured with the Revised Better Babies Survey and Access Barriers to Care Index. Participants had favorable views of prenatal care benefits; however, not living with the baby's father predicted inadequate prenatal care, Wald χ 2 (1) = 4.93, p = .026. Perceived benefits of timely and adequate prenatal care predicted timely prenatal care initiation, χ 2 (1) = 7.47, p = .006. Self-reported depression during pregnancy predicted timely entry into prenatal care, χ 2 (1) = 4.73, p = .03. Participants' positive prenatal care perceptions did not predict adequate prenatal care utilization, indicating that barriers serve as powerful obstacles in late adolescent Texas Latinas.

  12. Revisiting random walk based sampling in networks: evasion of burn-in period and frequent regenerations.

    Science.gov (United States)

    Avrachenkov, Konstantin; Borkar, Vivek S; Kadavankandy, Arun; Sreedharan, Jithin K

    2018-01-01

    In the framework of network sampling, random walk (RW) based estimation techniques provide many pragmatic solutions while uncovering the unknown network as little as possible. Despite several theoretical advances in this area, RW based sampling techniques usually make a strong assumption that the samples are in stationary regime, and hence are impelled to leave out the samples collected during the burn-in period. This work proposes two sampling schemes without burn-in time constraint to estimate the average of an arbitrary function defined on the network nodes, for example, the average age of users in a social network. The central idea of the algorithms lies in exploiting regeneration of RWs at revisits to an aggregated super-node or to a set of nodes, and in strategies to enhance the frequency of such regenerations either by contracting the graph or by making the hitting set larger. Our first algorithm, which is based on reinforcement learning (RL), uses stochastic approximation to derive an estimator. This method can be seen as intermediate between purely stochastic Markov chain Monte Carlo iterations and deterministic relative value iterations. The second algorithm, which we call the Ratio with Tours (RT)-estimator, is a modified form of respondent-driven sampling (RDS) that accommodates the idea of regeneration. We study the methods via simulations on real networks. We observe that the trajectories of RL-estimator are much more stable than those of standard random walk based estimation procedures, and its error performance is comparable to that of respondent-driven sampling (RDS) which has a smaller asymptotic variance than many other estimators. Simulation studies also show that the mean squared error of RT-estimator decays much faster than that of RDS with time. The newly developed RW based estimators (RL- and RT-estimators) allow to avoid burn-in period, provide better control of stability along the sample path, and overall reduce the estimation time. Our

  13. Association between Health Care Utilization with Asthma Control Levels among a Sample of Adult Patients in Puerto Rico.

    Science.gov (United States)

    Marín-Centeno, Heriberto A; Ramos-Valencia, Gilberto; Rodríguez-Sánchez, Mario; González-Gavillán, Jesús; Díaz-Toro, Elba C; Torres-Cintrón, Mariela

    2016-06-01

    Asthma is an important and serious public health problem in Puerto Rico; however, very few studies measuring the association between health care utilization and asthma control levels in adult asthma patients in Puerto Rico have been done. This study is secondary analysis of an observational and cross-sectional database generated by the Latin American Asthma Insights and Management (LA AIM) survey. Our sub-sample consisted of adults 18 years or older living with asthma, representing a total of 343 individuals. This study determined the numbers of ambulatory physician visits, emergency visits to a physician or an emergency room, and hospitalizations that took place the 12 months prior to the survey. Patients were characterized as having well-controlled, partly controlled, or uncontrolled asthma. Descriptive and inferential statistics were performed to detect differences in the mean and number of events for physician visits, emergency visits, and hospitalizations by asthma control groups. After adjusting for age, sex, and chronic health conditions (other than asthma), adult asthma patients with controlled asthma had 92.0% fewer physician visits, 82.5% fewer emergency visits, and 92.2% fewer hospitalizations than did those with uncontrolled asthma. Interventions geared toward controlling asthma symptoms and clinical manifestations in adults asthma patients-which interventions might include strategies for controlling environmental risk factors, increasing patient and family education with regard to asthma management, and boosting the use of appropriate and effective medications-may have significant potential in terms of reducing the direct and indirect costs of asthma, costs that have a critical impact on the whole health care system.

  14. The Appreciative Pedagogy of Palliative Care: Arts-Based or Evidence-Based?

    OpenAIRE

    Lander, Dorothy A.; Graham-Pole, John R

    2006-01-01

    The authors integrate poetry and narrative into their self-study application of the research methodology known as Appreciative Inquiry (AI) focused on: (a) their personal and professional practice and development; (b) their teaching practice in universities and informal/popular education settings; and, (c) their educational research in the area of hospice and palliative care giving. AI is both an arts-based participatory philosophy of practice and a qualitative research methodology.

  15. Qigong in Cancer Care: Theory, Evidence-Base, and Practice

    Directory of Open Access Journals (Sweden)

    Penelope Klein

    2017-01-01

    Full Text Available Background: The purpose of this discussion is to explore the theory, evidence base, and practice of Qigong for individuals with cancer. Questions addressed are: What is qigong? How does it work? What evidence exists supporting its practice in integrative oncology? What barriers to wide-spread programming access exist? Methods: Sources for this discussion include a review of scholarly texts, the Internet, PubMed, field observations, and expert opinion. Results: Qigong is a gentle, mind/body exercise integral within Chinese medicine. Theoretical foundations include Chinese medicine energy theory, psychoneuroimmunology, the relaxation response, the meditation effect, and epigenetics. Research supports positive effects on quality of life (QOL, fatigue, immune function and cortisol levels, and cognition for individuals with cancer. There is indirect, scientific evidence suggesting that qigong practice may positively influence cancer prevention and survival. No one Qigong exercise regimen has been established as superior. Effective protocols do have common elements: slow mindful exercise, easy to learn, breath regulation, meditation, emphasis on relaxation, and energy cultivation including mental intent and self-massage. Conclusions: Regular practice of Qigong exercise therapy has the potential to improve cancer-related QOL and is indirectly linked to cancer prevention and survival. Wide-spread access to quality Qigong in cancer care programming may be challenged by the availability of existing programming and work force capacity.

  16. Nurses' perceptions of spiritual care and attitudes toward the principles of dying with dignity: A sample from Turkey.

    Science.gov (United States)

    Gurdogan, Eylem Pasli; Kurt, Duygu; Aksoy, Berna; Kınıcı, Ezgi; Şen, Ayla

    2017-03-01

    Spiritual care is vital for holistic care and dying with dignity. The aim of this study was to determine nurses' perceptions of spiritual care and their attitudes toward dying with dignity. This study was conducted with 289 nurses working at a public hospital. Results showed three things. First, spiritual care perceptions and attitudes toward dying with dignity were more positive in female participants than in male participants. Second, there was a correlation between participants' education levels and their perceptions of spiritual care. Third, there was also a correlation between participants' attitudes toward dying with dignity and their perceptions of spiritual care.

  17. Case Study: Evidence-Based Interventions Enhancing Diabetic Foot Care Behaviors among Hospitalized DM Patients

    Directory of Open Access Journals (Sweden)

    Titis Kurniawan

    2011-01-01

    Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients

  18. Evidence-based medicine in primary care: qualitative study of family physicians

    Directory of Open Access Journals (Sweden)

    Dantas Guilherme

    2003-05-01

    Full Text Available Abstract Background The objectives of this study were: a to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM in primary care; b to investigate the influence of patient preferences on clinical decision-making; and c to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

  19. Evidence-based medicine in primary care: qualitative study of family physicians.

    Science.gov (United States)

    Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross E G

    2003-05-09

    The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

  20. Can Team-Based Care Improve Patient Satisfaction? A Systematic Review of Randomized Controlled Trials

    Science.gov (United States)

    Wen, Jin; Schulman, Kevin A.

    2014-01-01

    Background Team-based approaches to patient care are a relatively recent innovation in health care delivery. The effectiveness of these approaches on patient outcomes has not been well documented. This paper reports a systematic review of the relationship between team-based care and patient satisfaction. Methods We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, and PSYCHOINFO for eligible studies dating from inception to October 8, 2012. Eligible studies reported (1) a randomized controlled trial, (2) interventions including both team-based care and non-team-based care (or usual care), and (3) outcomes including an assessment of patient satisfaction. Articles with different settings between intervention and control were excluded, as were trial protocols. The reference lists of retrieved papers were also evaluated for inclusion. Results The literature search yielded 319 citations, of which 77 were screened for further full-text evaluation. Of these, 27 articles were included in the systematic review. The 26 trials with a total of 15,526 participants were included in this systematic review. The pooling result of dichotomous data (number of studies: 10) showed that team-based care had a positive effect on patient satisfaction compared with usual care (odds ratio, 2.09; 95% confidence interval, 1.54 to 2.84); however, combined continuous data (number of studies: 7) demonstrated that there was no significant difference in patient satisfaction between team-based care and usual care (standardized mean difference, −0.02; 95% confidence interval, −0.40 to 0.36). Conclusions Some evidence showed that team-based care is better than usual care in improving patient satisfaction. However, considering the pooling result of continuous data, along with the suboptimal quality of included trials, further large-scale and high-quality randomized controlled trials comparing team-based care and usual care are needed. PMID:25014674

  1. Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia

    Directory of Open Access Journals (Sweden)

    Zahid Muhammad A

    2010-09-01

    of community - based programs and continued intervention with the families in order to improve the quality of care.

  2. Computer-based intervention in HIV clinical care setting improves antiretroviral adherence: the LifeWindows Project.

    Science.gov (United States)

    Fisher, Jeffrey D; Amico, K Rivet; Fisher, William A; Cornman, Deborah H; Shuper, Paul A; Trayling, Cynthia; Redding, Caroline; Barta, William; Lemieux, Anthony F; Altice, Frederick L; Dieckhaus, Kevin; Friedland, Gerald

    2011-11-01

    We evaluated the efficacy of LifeWindows, a theory-based, computer-administered antiretroviral (ARV) therapy adherence support intervention, delivered to HIV + patients at routine clinical care visits. 594 HIV + adults receiving HIV care at five clinics were randomized to intervention or control arms. Intervention vs. control impact in the intent-to-treat sample (including participants whose ARVs had been entirely discontinued, who infrequently attended care, or infrequently used LifeWindows) did not reach significance. Intervention impact in the On Protocol sample (328 intervention and control arm participants whose ARVs were not discontinued, who attended care and were exposed to LifeWindows regularly) was significant. On Protocol intervention vs. control participants achieved significantly higher levels of perfect 3-day ACTG-assessed adherence over time, with sensitivity analyses maintaining this effect down to 70% adherence. This study supports the utility of LifeWindows and illustrates that patients on ARVs who persist in care at clinical care sites can benefit from adherence promotion software.

  3. A Web-Based Model for Diabetes Education and Decision Support for the Home Care Nurse

    OpenAIRE

    Hill, Michelle; Kirby, Judy

    1998-01-01

    Diabetes education for the home care population requires expert knowledge to be available at the point-of-care, the patient's home. This poster displays a model for Web-based diabetes education and decision support for the home care nurse. The system utilizes the line of reasoning (LOR) model to organize and represent expert decision-making thought processes.

  4. Home Care Quality Indicators (HCQIS) Based on the MDS-HC

    Science.gov (United States)

    Hirdes, John P.; Fries, Brant E.; Morris, John N.; Ikegami, Naoki; Zimmerman, David; Dalby, Dawn M.; Aliaga, Pablo; Hammer, Suzanne; Jones, Richard

    2004-01-01

    Purpose: This study aimed to develop home care quality indicators (HCQIs) to be used by a variety of audiences including consumers, agencies, regulators, and policy makers to support evidence-based decision making related to the quality of home care services. Design and Methods: Data from 3,041 Canadian and 11,252 U.S. home care clients assessed…

  5. Collaborating while competing? The substainability of community-based integrated care initiatives through a health partnership.

    NARCIS (Netherlands)

    Plochg, T.; Delnoij, D.M.J.; Hoogedoorn, N.P.C.; Klazinga, N.S.

    2006-01-01

    BACKGROUND: To improve health-care delivery, care providers must base their services on community health needs and create a seamless continuum of care in which these needs can be met. Though, it is not obvious that providers apply this vision. Experiments with regulated competition in the health

  6. Collaborating while competing? The sustainability of community-based integrated care initiatives through a health partnership

    NARCIS (Netherlands)

    Plochg, Thomas; Delnoij, Diana M. J.; Hoogedoorn, Nelleke P. C.; Klazinga, Niek S.

    2006-01-01

    BACKGROUND: To improve health-care delivery, care providers must base their services on community health needs and create a seamless continuum of care in which these needs can be met. Though, it is not obvious that providers apply this vision. Experiments with regulated competition in the health

  7. Collaborating while competing? The sustainability of community-based integrated care initiatives through a health partnership

    NARCIS (Netherlands)

    Plochg, T.; Delnoij, D.M.J.; Hoogedoorn, N.P.C.; Klazinga, N.S.

    2006-01-01

    Background: To improve health-care delivery, care providers must base their services on community health needs and create a seamless continuum of care in which these needs can be met. Though, it is not obvious that providers apply this vision. Experiments with regulated competition in the health

  8. A PDA based Point of Care E-Health Solution for Ambulatory Care

    Directory of Open Access Journals (Sweden)

    Daniel Walsh

    2005-11-01

    Full Text Available The adoption of PDAs and mobile communication is expected to provide a solution to the use of computer technology by healthcare workers at the point-of-care. The Australian National Health Information Strategy, Health Online, is providing national leadership for approaches to address the quality and availability of information to assist in the planning and delivery of care. One area for potential growth is the availability and capture of information at the point of care by healthcare providers. A key factor in the lack of adoption of systems, is that traditionally health care information systems have been designed for desktop computing whereas many healthcare workers are highly mobile. This paper discusses phase one of a larger, four-phase project which aims to develop information access applications at point-of-care for Ambulatory Care Services. The initial phase of the research (phase one involves workflow analysis, requirements specification and the development and testing of a system prototype to assess the feasibility of achieving increased efficiencies in workflow at the Ambulatory Care Service.

  9. Failure Probability Calculation Method Using Kriging Metamodel-based Importance Sampling Method

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seunggyu [Korea Aerospace Research Institue, Daejeon (Korea, Republic of); Kim, Jae Hoon [Chungnam Nat’l Univ., Daejeon (Korea, Republic of)

    2017-05-15

    The kernel density was determined based on sampling points obtained in a Markov chain simulation and was assumed to be an important sampling function. A Kriging metamodel was constructed in more detail in the vicinity of a limit state. The failure probability was calculated based on importance sampling, which was performed for the Kriging metamodel. A pre-existing method was modified to obtain more sampling points for a kernel density in the vicinity of a limit state. A stable numerical method was proposed to find a parameter of the kernel density. To assess the completeness of the Kriging metamodel, the possibility of changes in the calculated failure probability due to the uncertainty of the Kriging metamodel was calculated.

  10. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

    Science.gov (United States)

    Spoorenberg, Sophie L W; Wynia, Klaske; Fokkens, Andrea S; Slotman, Karin; Kremer, Hubertus P H; Reijneveld, Sijmen A

    2015-01-01

    Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2) Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

  11. Stochastic bounded consensus tracking of leader-follower multi-agent systems with measurement noises based on sampled data with general sampling delay

    International Nuclear Information System (INIS)

    Wu Zhi-Hai; Peng Li; Xie Lin-Bo; Wen Ji-Wei

    2013-01-01

    In this paper we provide a unified framework for consensus tracking of leader-follower multi-agent systems with measurement noises based on sampled data with a general sampling delay. First, a stochastic bounded consensus tracking protocol based on sampled data with a general sampling delay is presented by employing the delay decomposition technique. Then, necessary and sufficient conditions are derived for guaranteeing leader-follower multi-agent systems with measurement noises and a time-varying reference state to achieve mean square bounded consensus tracking. The obtained results cover no sampling delay, a small sampling delay and a large sampling delay as three special cases. Last, simulations are provided to demonstrate the effectiveness of the theoretical results. (interdisciplinary physics and related areas of science and technology)

  12. The impact of team-based primary care on health care services utilization and costs: Quebec's family medicine groups.

    Science.gov (United States)

    Strumpf, Erin; Ammi, Mehdi; Diop, Mamadou; Fiset-Laniel, Julie; Tousignant, Pierre

    2017-09-01

    We investigate the effects on health care costs and utilization of team-based primary care delivery: Quebec's Family Medicine Groups (FMGs). FMGs include extended hours, patient enrolment and multidisciplinary teams, but they maintain the same remuneration scheme (fee-for-service) as outside FMGs. In contrast to previous studies, we examine the impacts of organizational changes in primary care settings in the absence of changes to provider payment and outside integrated care systems. We built a panel of administrative data of the population of elderly and chronically ill patients, characterizing all individuals as FMG enrollees or not. Participation in FMGs is voluntary and we address potential selection bias by matching on GP propensity scores, using inverse probability of treatment weights at the patient level, and then estimating difference-in-differences models. We also use appropriate modelling strategies to account for the distributions of health care cost and utilization data. We find that FMGs significantly decrease patients' health care services utilization and costs in outpatient settings relative to patients not in FMGs. The number of primary care visits decreased by 11% per patient per year among FMG enrolees and specialist visits declined by 6%. The declines in costs were of roughly equal magnitude. We found no evidence of an effect on hospitalizations, their associated costs, or the costs of ED visits. These results provide support for the idea that primary care organizational reforms can have impacts on the health care system in the absence of changes to physician payment mechanisms. The extent to which the decline in GP visits represents substitution with other primary care providers warrants further investigation. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  13. 350 keV accelerator based PGNAA setup to detect nitrogen in bulk samples

    Energy Technology Data Exchange (ETDEWEB)

    Naqvi, A.A., E-mail: aanaqvi@kfupm.edu.sa [Department of Physics and King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia); Al-Matouq, Faris A.; Khiari, F.Z.; Gondal, M.A.; Rehman, Khateeb-ur [Department of Physics and King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia); Isab, A.A. [Department of Chemistry, King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia); Raashid, M.; Dastageer, M.A. [Department of Physics and King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia)

    2013-11-21

    Nitrogen concentration was measured in explosive and narcotics proxy material, e.g. anthranilic acid, caffeine, melamine, and urea samples, bulk samples through thermal neutron capture reaction using 350 keV accelerator based prompt gamma ray neutron activation (PGNAA) setup. Intensity of 2.52, 3.53–3.68, 4.51, 5.27–5.30 and 10.38 MeV prompt gamma rays of nitrogen from the bulk samples was measured using a cylindrical 100 mm×100 mm (diameter×height ) BGO detector. Inspite of interference of nitrogen gamma rays from bulk samples with capture prompt gamma rays from BGO detector material, an excellent agreement between the experimental and calculated yields of nitrogen gamma rays has been obtained. This is an indication of the excellent performance of the PGNAA setup for detection of nitrogen in bulk samples.

  14. Imaging a Large Sample with Selective Plane Illumination Microscopy Based on Multiple Fluorescent Microsphere Tracking

    Science.gov (United States)

    Ryu, Inkeon; Kim, Daekeun

    2018-04-01

    A typical selective plane illumination microscopy (SPIM) image size is basically limited by the field of view, which is a characteristic of the objective lens. If an image larger than the imaging area of the sample is to be obtained, image stitching, which combines step-scanned images into a single panoramic image, is required. However, accurately registering the step-scanned images is very difficult because the SPIM system uses a customized sample mount where uncertainties for the translational and the rotational motions exist. In this paper, an image registration technique based on multiple fluorescent microsphere tracking is proposed in the view of quantifying the constellations and measuring the distances between at least two fluorescent microspheres embedded in the sample. Image stitching results are demonstrated for optically cleared large tissue with various staining methods. Compensation for the effect of the sample rotation that occurs during the translational motion in the sample mount is also discussed.

  15. 350 keV accelerator based PGNAA setup to detect nitrogen in bulk samples

    International Nuclear Information System (INIS)

    Naqvi, A.A.; Al-Matouq, Faris A.; Khiari, F.Z.; Gondal, M.A.; Rehman, Khateeb-ur; Isab, A.A.; Raashid, M.; Dastageer, M.A.

    2013-01-01

    Nitrogen concentration was measured in explosive and narcotics proxy material, e.g. anthranilic acid, caffeine, melamine, and urea samples, bulk samples through thermal neutron capture reaction using 350 keV accelerator based prompt gamma ray neutron activation (PGNAA) setup. Intensity of 2.52, 3.53–3.68, 4.51, 5.27–5.30 and 10.38 MeV prompt gamma rays of nitrogen from the bulk samples was measured using a cylindrical 100 mm×100 mm (diameter×height ) BGO detector. Inspite of interference of nitrogen gamma rays from bulk samples with capture prompt gamma rays from BGO detector material, an excellent agreement between the experimental and calculated yields of nitrogen gamma rays has been obtained. This is an indication of the excellent performance of the PGNAA setup for detection of nitrogen in bulk samples

  16. 350 keV accelerator based PGNAA setup to detect nitrogen in bulk samples

    Science.gov (United States)

    Naqvi, A. A.; Al-Matouq, Faris A.; Khiari, F. Z.; Gondal, M. A.; Rehman, Khateeb-ur; Isab, A. A.; Raashid, M.; Dastageer, M. A.

    2013-11-01

    Nitrogen concentration was measured in explosive and narcotics proxy material, e.g. anthranilic acid, caffeine, melamine, and urea samples, bulk samples through thermal neutron capture reaction using 350 keV accelerator based prompt gamma ray neutron activation (PGNAA) setup. Intensity of 2.52, 3.53-3.68, 4.51, 5.27-5.30 and 10.38 MeV prompt gamma rays of nitrogen from the bulk samples was measured using a cylindrical 100 mm×100 mm (diameter×height ) BGO detector. Inspite of interference of nitrogen gamma rays from bulk samples with capture prompt gamma rays from BGO detector material, an excellent agreement between the experimental and calculated yields of nitrogen gamma rays has been obtained. This is an indication of the excellent performance of the PGNAA setup for detection of nitrogen in bulk samples.

  17. Findings From a Nursing Care Audit Based on the Nursing Process: A Descriptive Study

    Science.gov (United States)

    Poortaghi, Sarieh; Salsali, Mahvash; Ebadi, Abbas; Rahnavard, Zahra; Maleki, Farzaneh

    2015-01-01

    Background: Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally. Objectives: This study aimed to audit nursing care based on a nursing process model. Patients and Methods: This was a cross-sectional descriptive study in which a nursing audit checklist was designed and validated for assessing nurses’ compliance with nursing process. A total of 300 nurses from various clinical settings of Tehran university of medical sciences were selected. Data were analyzed using descriptive and inferential statistics, including frequencies, Pearson correlation coefficient and independent samples t-tests. Results: The compliance rate of nursing process indicators was 79.71 ± 0.87. Mean compliance scores did not significantly differ by education level and gender. However, overall compliance scores were correlated with nurses’ age (r = 0.26, P = 0.001) and work experience (r = 0.273, P = 0.001). Conclusions: Nursing process indicators can be used to audit nursing care. Such audits can be used as quality assurance tools. PMID:26576448

  18. Findings From a Nursing Care Audit Based on the Nursing Process: A Descriptive Study.

    Science.gov (United States)

    Poortaghi, Sarieh; Salsali, Mahvash; Ebadi, Abbas; Rahnavard, Zahra; Maleki, Farzaneh

    2015-09-01

    Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally. This study aimed to audit nursing care based on a nursing process model. This was a cross-sectional descriptive study in which a nursing audit checklist was designed and validated for assessing nurses' compliance with nursing process. A total of 300 nurses from various clinical settings of Tehran university of medical sciences were selected. Data were analyzed using descriptive and inferential statistics, including frequencies, Pearson correlation coefficient and independent samples t-tests. The compliance rate of nursing process indicators was 79.71 ± 0.87. Mean compliance scores did not significantly differ by education level and gender. However, overall compliance scores were correlated with nurses' age (r = 0.26, P = 0.001) and work experience (r = 0.273, P = 0.001). Nursing process indicators can be used to audit nursing care. Such audits can be used as quality assurance tools.

  19. Health care expenditure for hospital-based delivery care in Lao PDR

    Directory of Open Access Journals (Sweden)

    Douangvichit Daovieng

    2012-01-01

    Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family

  20. Influence of Freezing and Storage Procedure on Human Urine Samples in NMR-Based Metabolomics

    OpenAIRE

    Rist, Manuela; Muhle-Goll, Claudia; Görling, Benjamin; Bub, Achim; Heissler, Stefan; Watzl, Bernhard; Luy, Burkhard

    2013-01-01

    It is consensus in the metabolomics community that standardized protocols should be followed for sample handling, storage and analysis, as it is of utmost importance to maintain constant measurement conditions to identify subtle biological differences. The aim of this work, therefore, was to systematically investigate the influence of freezing procedures and storage temperatures and their effect on NMR spectra as a potentially disturbing aspect for NMR-based metabolomics studies. Urine sample...

  1. A design-based approximation to the Bayes Information Criterion in finite population sampling

    Directory of Open Access Journals (Sweden)

    Enrico Fabrizi

    2014-05-01

    Full Text Available In this article, various issues related to the implementation of the usual Bayesian Information Criterion (BIC are critically examined in the context of modelling a finite population. A suitable design-based approximation to the BIC is proposed in order to avoid the derivation of the exact likelihood of the sample which is often very complex in a finite population sampling. The approximation is justified using a theoretical argument and a Monte Carlo simulation study.

  2. Is there a survival benefit within a German primary care-based disease management program?

    Science.gov (United States)

    Miksch, Antje; Laux, Gunter; Ose, Dominik; Joos, Stefanie; Campbell, Stephen; Riens, Burgi; Szecsenyi, Joachim

    2010-01-01

    To compare the mortality rate of patients with type 2 diabetes who were enrolled in the German diabetes disease management program (DMP) with the mortality rate of those who were not enrolled. This observational study was part of the ELSID study (Evaluation of a Large Scale Implementation of disease management programs) in Germany. Participants had type 2 diabetes and were either enrolled or not enrolled in the DMP. The DMP provides systems-based, multifaceted, and patient-centered interventions. To reduce imbalances between the groups, a matched sample was created using sex, age, retirement status, federal state, pharmacy-based cost groups, and diagnostic-cost groups as matching criteria. Cox proportional hazards regression model and the Kaplan-Meier method were used to assess overall mortality. The observation period was 3 years beginning on January 1, 2006. A total of 11,079 patients were included in the analysis. As of January 1, 2006, 2300 patients were enrolled in the DMP and 8779 were receiving routine care. There were 1927 matched pairs of patients in the DMP group and the non-DMP group. The overall mortality rate was 11.3% in the DMP and 14.4% in the non-DMP group (log-rank test P German diabetes DMP and reduced mortality. This reduced mortality cannot be attributed directly to the DMP. However, further research should evaluate whether a primary care-based DMP contributes to increased life expectancy in patients with diabetes.

  3. Multistrategy childcare-based intervention to improve compliance with nutrition guidelines versus usual care in long day care services: a study protocol for a randomised controlled trial

    Science.gov (United States)

    Seward, Kirsty; Finch, Meghan; Wiggers, John; Wyse, Rebecca; Jones, Jannah; Gillham, Karen; Yoong, Sze Lin

    2016-01-01

    Introduction Interventions to improve child diet are recommended as dietary patterns developed in childhood track into adulthood and influence the risk of chronic disease. For child health, childcare services are required to provide foods to children consistent with nutrition guidelines. Research suggests that foods and beverages provided by services to children are often inconsistent with nutrition guidelines. The primary aim of this study is to assess, relative to a usual care control group, the effectiveness of a multistrategy childcare-based intervention in improving compliance with nutrition guidelines in long day care services. Methods and analysis The study will employ a parallel group randomised controlled trial design. A sample of 58 long day care services that provide all meals (typically includes 1 main and 2 mid-meals) to children while they are in care, in the Hunter New England region of New South Wales, Australia, will be randomly allocated to a 6-month intervention to support implementation of nutrition guidelines or a usual care control group in a 1:1 ratio. The intervention was designed to overcome barriers to the implementation of nutrition guidelines assessed using the theoretical domains framework. Intervention strategies will include the provision of staff training and resources, audit and feedback, ongoing support and securing executive support. The primary outcome of the trial will be the change in the proportion of long day care services that have a 2-week menu compliant with childcare nutrition guidelines, measured by comprehensive menu assessments. As a secondary outcome, child dietary intake while in care will also be assessed. To assess the effectiveness of the intervention, the measures will be undertaken at baseline and ∼6 months postbaseline. Ethics and dissemination The study was approved by the Hunter New England Human Research Ethics Committee. Study findings will be disseminated widely through peer-reviewed publications. PMID

  4. Sample preparation techniques based on combustion reactions in closed vessels - A brief overview and recent applications

    International Nuclear Information System (INIS)

    Flores, Erico M.M.; Barin, Juliano S.; Mesko, Marcia F.; Knapp, Guenter

    2007-01-01

    In this review, a general discussion of sample preparation techniques based on combustion reactions in closed vessels is presented. Applications for several kinds of samples are described, taking into account the literature data reported in the last 25 years. The operational conditions as well as the main characteristics and drawbacks are discussed for bomb combustion, oxygen flask and microwave-induced combustion (MIC) techniques. Recent applications of MIC techniques are discussed with special concern for samples not well digested by conventional microwave-assisted wet digestion as, for example, coal and also for subsequent determination of halogens

  5. Acceptance Sampling Plans Based on Truncated Life Tests for Sushila Distribution

    Directory of Open Access Journals (Sweden)

    Amer Ibrahim Al-Omari

    2018-03-01

    Full Text Available An acceptance sampling plan problem based on truncated life tests when the lifetime following a Sushila distribution is considered in this paper. For various acceptance numbers, confidence levels and values of the ratio between fixed experiment time and particular mean lifetime, the minimum sample sizes required to ascertain a specified mean life were found. The operating characteristic function values of the suggested sampling plans and the producer’s risk are presented. Some tables are provided and the results are illustrated by an example of a real data set.

  6. The effect of a supportive educational intervention developed based on the Orem's self-care theory on the self-care ability of patients with myocardial infarction: a randomised controlled trial.

    Science.gov (United States)

    Mohammadpour, Ali; Rahmati Sharghi, Narjes; Khosravan, Shahla; Alami, Ali; Akhond, Majid

    2015-06-01

    The aim of this study was to assess the effect of a supportive educational intervention developed based on the Orem's self-care theory on the self-care ability of patients with myocardial infarction. Patients with cardiovascular disease suffer from the lack of knowledge about the disease and consequently are not able to fulfil their own self-care needs. This was a randomised controlled trial conducted in 2012. We recruited a random sample of 66 patients with myocardial infarction who had been recently discharged from coronary care unit. The study setting was two university hospitals located in Khorasan, Iran. Patients were randomly allocated to either the experimental or the control groups. Patients in the experimental group received education, support, and counselling while patients in the control group received no intervention. We employed a demographic questionnaire and the Myocardial Infarction Self-Care Ability Questionnaire for data collection and spss version 16.00 for data analysis. After the study, patients in the experimental group had higher levels of self-care knowledge, motivation and skills compared to the prestudy readings and the control group. The supportive educational intervention developed based on the Orem's self-care theory can improve nonhospitalised patients' self-care ability and positively affect public health outcomes. Consequently, using the developed programme for providing follow-up care to nonhospitalised patients is recommended. Having the ability to develop caring systems based on the nursing theories is a prerequisite to standard nursing practice. Identifying patients' educational needs is a fundamental prerequisite to patient education. Our findings revealed that the supportive educational intervention developed based on the Orem's self-care theory can help health care providers identify and fulfil patients' self-care needs. © 2015 John Wiley & Sons Ltd.

  7. Task-role-based Access Control Model in Smart Health-care System

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

    As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for...

  8. Associations between birth health, maternal employment, and child care arrangement among a community sample of mothers with young children.

    Science.gov (United States)

    Chiao, Chi; Chyu, Laura; Ksobiech, Kate

    2014-01-01

    Although a large body of literature exists on how different types of child care arrangements affect a child's subsequent health and sociocognitive development, little is known about the relationship between birth health and subsequent decisions regarding type of nonparental child care as well as how this relationship might be influenced by maternal employment. This study used data from the Los Angeles Families and Neighborhoods Survey (L.A.FANS). Mothers of 864 children (ages 0-5) provided information regarding birth weight, maternal evaluation of a child's birth health, child's current health, maternal employment, type of child care arrangement chosen, and a variety of socioeconomic variables. Child care options included parental care, relative care, nonrelative care, and daycare center. Multivariate analyses found that birth weight and subjective rating of birth health had similar effects on child care arrangement. After controlling for a child's age and current health condition, multinomial logit analyses found that mothers with children with poorer birth health are more likely to use nonrelative and daycare centers than parental care when compared to mothers with children with better birth health. The magnitude of these relationships diminished when adjusting for maternal employment. Working mothers were significantly more likely to use nonparental child care than nonemployed mothers. Results suggest that a child's health early in life is significantly but indirectly related to subsequent decisions regarding child care arrangements, and this association is influenced by maternal employment. Development of social policy aimed at improving child care service should take maternal and family backgrounds into consideration.

  9. Nano-Calorimetry based point of care biosensor for metabolic disease management.

    Science.gov (United States)

    Kazura, Evan; Lubbers, Brad R; Dawson, Elliott; Phillips, John A; Baudenbacher, Franz

    2017-09-01

    Point of care (POC) diagnostics represents one of the fastest growing health care technology segments. Developments in microfabrication have led to the development of highly-sensitive nanocalorimeters ideal for directly measuring heat generated in POC biosensors. Here we present a novel nano-calorimeter-based biosensor design with differential sensing to eliminate common mode noise and capillary microfluidic channels for sample delivery to the thermoelectric sensor. The calorimeter has a resolution of 1.4 ± 0.2 nJ/(Hz) 1/2 utilizing a 27 junction bismuth/titanium thermopile, with a total Seebeck coefficient of 2160 μV/K. Sample is wicked to the calorimeter through a capillary channel making it suitable for monitoring blood obtained through a finger prick (performance in a model assay using catalase, achieving a threshold for hydrogen peroxide quantification of 50 μM. The potential for our device as a POC blood test for metabolic diseases is shown through the quantification of phenylalanine (Phe) in serum, an unmet necessary service in the management of Phenylketonuria (PKU). Pegylated phenylalanine ammonia-lyase (PEG-PAL) was utilized to react with Phe, but reliable detection was limited to <5 mM due to low enzymatic activity. The POC biosensor concept can be multiplexed and adapted to a large number of metabolic diseases utilizing different immobilized enzymes.

  10. Mental health treatment associated with community-based depression screening: considerations for planning multidisciplinary collaborative care.

    Science.gov (United States)

    Winchester, Bruce R; Watkins, Sarah C; Brahm, Nancy C; Harrison, Donald L; Miller, Michael J

    2013-06-01

    Depression places a large economic burden on the US health care system. Routine screening has been recognized as a fundamental step in the effective treatment of depression, but should be undertaken only when support systems are available to ensure proper diagnosis, treatment, and follow-up. To estimate differences in prescribing new antidepressants and referral to stress management, psychotherapy, and other mental health (OMH) counseling at physician visits when documented depression screening was and was not performed. Cross-sectional physician visit data for adults from the 2005-2007 National Ambulatory Medical Care Survey were used. The final analytical sample included 55,143 visits, representing a national population estimate of 1,741,080,686 physician visits. Four dependent variables were considered: (1) order for new antidepressant(s), and referral to (2) stress management, (3) psycho therapy, or (4) OMH counseling. Bivariable and multivariable associations between depression screening and each measure of depression follow-up care were evaluated using the design-based F statistic and multivariable logistic regression models. New antidepressant prescribing increased significantly (2.12% of visits without depression screening vs 10.61% with depression screening resulted in a new prescription of an antidepressant). Referral to stress management was the behavioral treatment with the greatest absolute change (3.31% of visits without depression screening vs 33.10% of visits with depression screening resulted in a referral to stress management). After controlling for background sociodemographic characteristics, the adjusted odds ratio of a new antidepressant order remained significantly higher at visits involving depression screening (AOR 5.36; 99.9% CI 2.92-9.82), as did referrals for all behavioral health care services (ie, stress management, psychotherapy, and OMH counseling). At the national level, depression screening was associated with increased new

  11. Hospital-based palliative care: A case for integrating care with cure

    Directory of Open Access Journals (Sweden)

    Priya Darshini Kulkarni

    2011-01-01

    Full Text Available The reason that probably prompted Dame Cicely Saunders to launch the palliative care movement was the need to move away from the impersonal, technocratic approach to death that had become the norm in hospitals after the Second World War. Palliative care focuses on relieving the suffering of patients and families. Not limited to just management of pain, it includes comprehensive management of any symptom, which affects the quality of life. Care is optimized through early initiation and comprehensive implementation throughout the disease trajectory. Effective palliative care at the outset can help accelerate a positive clinical outcome. At the end of life, it can enhance the opportunity for the patient and family to achieve a sense of growth, resolve differences, and find a comfortable closure. It helps to reduce the suffering and fear associated with dying and prepares the family for bereavement.

  12. Combat and peacekeeping operations in relation to prevalence of mental disorders and perceived need for mental health care: findings from a large representative sample of military personnel.

    Science.gov (United States)

    Sareen, Jitender; Cox, Brian J; Afifi, Tracie O; Stein, Murray B; Belik, Shay-Lee; Meadows, Graham; Asmundson, Gordon J G

    2007-07-01

    Although military personnel are trained for combat and peacekeeping operations, accumulating evidence indicates that deployment-related exposure to traumatic events is associated with mental health problems and mental health service use. To examine the relationships between combat and peacekeeping operations and the prevalence of mental disorders, self-perceived need for mental health care, mental health service use, and suicidality. Cross-sectional, population-based survey. Canadian military. A total of 8441 currently active military personnel (aged 16-54 years). The DSM-IV mental disorders (major depressive disorder, posttraumatic stress disorder, generalized anxiety disorder, panic disorder, social phobia, and alcohol dependence) were assessed using the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, a fully structured lay-administered psychiatric interview. The survey included validated measures of self-perceived need for mental health treatment, mental health service use, and suicidal ideation. Lifetime exposure to peacekeeping and combat operations and witnessing atrocities or massacres (ie, mutilated bodies or mass killings) were assessed. The prevalences of any past-year mental disorder assessed in the survey and self-perceived need for care were 14.9% and 23.2%, respectively. Most individuals meeting the criteria for a mental disorder diagnosis did not use any mental health services. Deployment to combat operations and witnessing atrocities were associated with increased prevalence of mental disorders and perceived need for care. After adjusting for the effects of exposure to combat and witnessing atrocities, deployment to peacekeeping operations was not associated with increased prevalence of mental disorders. This is the first study to use a representative sample of active military personnel to examine the relationship between deployment-related experiences and mental health problems. It provides

  13. ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore.

    Science.gov (United States)

    Mittal, Chikul; Lee, Hsien Chieh Daniel; Goh, Kiat Sern; Lau, Cheng Kiang Adrian; Tay, Leeanna; Siau, Chuin; Loh, Yik Hin; Goh, Teck Kheng Edward; Sandi, Chit Lwin; Lee, Chien Earn

    2018-05-30

    To test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital. The ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program. Clinical outcome data on consecutive hip fracture patients seen in 12 months pre-intervention were then compared with the post-intervention group. Both pre- and post-intervention groups were followed up across the continuum of care for a period of 12 months. VC patients showed significant improvement in median time to surgery (97 to 50.5 h), as well as proportion of patients operated within 48 h from hospital admission (48% from 18.8%) as compared to baseline pre-intervention data. These patients also had significant reduction (p value based care for hip fracture patients at Changi General Hospital. This has also reflected successful change management and interdisciplinary collaboration within the organization through the program. There is potential for testing this methodology as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system.

  14. An agent-based simulation model of patient choice of health care providers in accountable care organizations.

    Science.gov (United States)

    Alibrahim, Abdullah; Wu, Shinyi

    2018-03-01

    Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.

  15. A cache-friendly sampling strategy for texture-based volume rendering on GPU

    Directory of Open Access Journals (Sweden)

    Junpeng Wang

    2017-06-01

    Full Text Available The texture-based volume rendering is a memory-intensive algorithm. Its performance relies heavily on the performance of the texture cache. However, most existing texture-based volume rendering methods blindly map computational resources to texture memory and result in incoherent memory access patterns, causing low cache hit rates in certain cases. The distance between samples taken by threads of an atomic scheduling unit (e.g. a warp of 32 threads in CUDA of the GPU is a crucial factor that affects the texture cache performance. Based on this fact, we present a new sampling strategy, called Warp Marching, for the ray-casting algorithm of texture-based volume rendering. The effects of different sample organizations and different thread-pixel mappings in the ray-casting algorithm are thoroughly analyzed. Also, a pipeline manner color blending approach is introduced and the power of warp-level GPU operations is leveraged to improve the efficiency of parallel executions on the GPU. In addition, the rendering performance of the Warp Marching is view-independent, and it outperforms existing empty space skipping techniques in scenarios that need to render large dynamic volumes in a low resolution image. Through a series of micro-benchmarking and real-life data experiments, we rigorously analyze our sampling strategies and demonstrate significant performance enhancements over existing sampling methods.

  16. Evidence-Based Care for Couples With Infertility.

    Science.gov (United States)

    Stevenson, Eleanor L; Hershberger, Patricia E; Bergh, Paul A

    2016-01-01

    When couples cannot achieve pregnancy, they often seek health care from medical and nursing specialists. The care the couple receives begins with a thorough assessment to determine the possible cause of infertility and to plan appropriate care to ensure the best chance for the couple to have a biological child. In this article, we provide an overview of the etiology and evaluation of infertility, the various treatment options available, and the appropriate clinical implications. Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  17. Evidence, Engagement, and Technology: Themes of and the State of Primary Care Practice-based Network Research.

    Science.gov (United States)

    Nease, Donald E

    2016-01-01

    Practice-based research supported by practice-based research network (PBRN) infrastructure has historically provided an important method for challenging guidelines and evidence arising from secondary and tertiary care settings. This sample of current practice-based research in this issue of the JABFM provides an opportunity to ask whether practice-based research continues to address questions relevant to primary care practices and clinicians and whether a PBRN infrastructure is instrumental to maintaining the relevance and feasibility of practice-based research. Based on this issue's articles, the current state of practice-based research seems to be good, at face value addressing relevant issues for primary care practices. Less clear is the degree to which PBRN infrastructures and relationships informed the questions asked and facilitated the implementation of the studies presented. Practice-based research-related articles that routinely report about how study questions arose-from practices and their clinicians, staff and communities, or elsewhere-could help directly answer questions of relevance. In addition, reporting how practices are recruited to practice-based research studies could inform the degree to which ongoing relationships central to PBRNs facilitate the recruitment and conduct of practice-based research. © Copyright 2016 by the American Board of Family Medicine.

  18. eSensor: an electrochemical detection-based DNA microarray technology enabling sample-to-answer molecular diagnostics

    Science.gov (United States)

    Liu, Robin H.; Longiaru, Mathew

    2009-05-01

    DNA microarrays are becoming a widespread tool used in life science and drug screening due to its many benefits of miniaturization and integration. Microarrays permit a highly multiplexed DNA analysis. Recently, the development of new detection methods and simplified methodologies has rapidly expanded the use of microarray technologies from predominantly gene expression analysis into the arena of diagnostics. Osmetech's eSensor® is an electrochemical detection platform based on a low-to- medium density DNA hybridization array on a cost-effective printed circuit board substrate. eSensor® has been cleared by FDA for Warfarin sensitivity test and Cystic Fibrosis Carrier Detection. Other genetic-based diagnostic and infectious disease detection tests are under development. The eSensor® platform eliminates the need for an expensive laser-based optical system and fluorescent reagents. It allows one to perform hybridization and detection in a single and small instrument without any fluidic processing and handling. Furthermore, the eSensor® platform is readily adaptable to on-chip sample-to-answer genetic analyses using microfluidics technology. The eSensor® platform provides a cost-effective solution to direct sample-to-answer genetic analysis, and thus have a potential impact in the fields of point-of-care genetic analysis, environmental testing, and biological warfare agent detection.

  19. Point-of-care blood gases, electrolytes, chemistries, hemoglobin, and hematocrit measurement in venous samples from pet rabbits.

    Science.gov (United States)

    Selleri, Paolo; Di Girolamo, Nicola

    2014-01-01

    Point-of-care testing is an attractive option in rabbit medicine, because it permits rapid analysis of a panel of electrolytes, chemistries, blood gases, hemoglobin, and hematocrit, requiring only 65 μL of blood. The purpose of this study was to evaluate the performance of a portable clinical analyzer for measurement of pH, partial pressure of CO2, Na, chloride, potassium, blood urea nitrogen, glucose, hematocrit, and hemoglobin in healthy and diseased rabbits. Blood samples obtained from 30 pet rabbits were analyzed immediately after collection by the portable clinical analyzer (PCA) and immediately thereafter (time <20 sec) by a reference analyzer. Bland-Altman plots and Passing-Bablok regression analysis were used to compare the results. Limits of agreement were wide for all the variables studied, with the exception of pH. Most variables presented significant proportional and/or constant bias. The current study provides sufficient evidence that the PCA presents reliability for pH, although its low agreement with a reference analyzer for the other variables does not support their interchangeability. Limits of agreement provided for each variable allow researchers to evaluate if the PCA is reliable enough for their scope. To the authors' knowledge, the present is the first report evaluating a PCA in the rabbit.

  20. Rapid filtration separation-based sample preparation method for Bacillus spores in powdery and environmental matrices.

    Science.gov (United States)

    Isabel, Sandra; Boissinot, Maurice; Charlebois, Isabelle; Fauvel, Chantal M; Shi, Lu-E; Lévesque, Julie-Christine; Paquin, Amélie T; Bastien, Martine; Stewart, Gale; Leblanc, Eric; Sato, Sachiko; Bergeron, Michel G

    2012-03-01

    Authorities frequently need to analyze suspicious powders and other samples for biothreat agents in order to assess environmental safety. Numerous nucleic acid detection technologies have been developed to detect and identify biowarfare agents in a timely fashion. The extraction of microbial nucleic acids from a wide variety of powdery and environmental samples to obtain a quality level adequate for these technologies still remains a technical challenge. We aimed to develop a rapid and versatile method of separating bacteria from these samples and then extracting their microbial DNA. Bacillus atrophaeus subsp. globigii was used as a simulant of Bacillus anthracis. We studied the effects of a broad variety of powdery and environmental samples on PCR detection and the steps required to alleviate their interference. With a benchmark DNA extraction procedure, 17 of the 23 samples investigated interfered with bacterial lysis and/or PCR-based detection. Therefore, we developed the dual-filter method for applied recovery of microbial particles from environmental and powdery samples (DARE). The DARE procedure allows the separation of bacteria from contaminating matrices that interfere with PCR detection. This procedure required only 2 min, while the DNA extraction process lasted 7 min, for a total of sample preparation procedure allowed the recovery of cleaned bacterial spores and relieved detection interference caused by a wide variety of samples. Our procedure was easily completed in a laboratory facility and is amenable to field application and automation.

  1. Does case-mix based reimbursement stimulate the development of process-oriented care delivery?

    Science.gov (United States)

    Vos, Leti; Dückers, Michel L A; Wagner, Cordula; van Merode, Godefridus G

    2010-11-01

    Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix based reimbursement leads to more efficiency, it remains unclear whether care coordination improved as well. This study aims to explore whether case-mix based reimbursement stimulates development of care coordination by the use of care programmes, and a process-oriented way of working. Data for this study were gathered during the winter of 2007/2008 in a survey involving all Dutch hospitals. Descriptive and structural equation modelling (SEM) analyses were conducted. SEM reveals that adoption of the case-mix reimbursement within hospitals' budgeting processes stimulates hospitals to establish care programmes by the use of process-oriented performance measures. However, the implementation of care programmes is not (yet) accompanied by a change in focus from function (the delivery of independent care activities) to process (the delivery of care activities as being connected to a chain of interdependent care activities). This study demonstrates that hospital management can stimulate the development of care programmes by the adoption of case-mix reimbursement within hospitals' budgeting processes. Future research is recommended to confirm this finding and to determine whether the establishment of care programmes will in time indeed lead to a more process-oriented view of professionals. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  2. 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.

  3. National Survey of Emergency Physicians Concerning Home-Based Care Options as Alternatives to Emergency Department-Based Hospital Admissions.

    Science.gov (United States)

    Stuck, Amy R; Crowley, Christopher; Killeen, James; Castillo, Edward M

    2017-11-01

    Emergency departments (EDs) in the United States play a prominent role in hospital admissions, especially for the growing population of older adults. Home-based care, rather than hospital admission from the ED, provides an important alternative, especially for older adults who have a greater risk of adverse events, such as hospital-acquired infections, falls, and delirium. The objective of the survey was to understand emergency physicians' (EPs) perspectives on home-based care alternatives to hospitalization from the ED. Specific goals included determining how often EPs ordered home-based care, what they perceive as the barriers and motivators for more extensive ordering of home-based care, and the specific conditions and response times most appropriate for such care. A group of 1200 EPs nationwide were e-mailed a six-question survey. Participant response was 57%. Of these, 55% reported ordering home-based care from the ED within the past year as an alternative to hospital admission or observation, with most doing so less than once per month. The most common barrier was an "unsafe or unstable home environment" (73%). Home-based care as a "better setting to care for low-acuity chronic or acute disease exacerbation" was the top motivator (79%). Medical conditions EPs most commonly considered for home-based care were cellulitis, urinary tract infection, diabetes, and community-acquired pneumonia. Results suggest that EPs recognize there is a benefit to providing home-based care as an alternative to hospitalization, provided they felt the home was safe and a process was in place for dispositioning the patient to this setting. Better understanding of when and why EPs use home-based care pathways from the ED may provide suggestions for ways to promote wider adoption. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  4. Quality evaluation in health care services based on customer-provider relationships.

    Science.gov (United States)

    Eiriz, Vasco; Figueiredo, José António

    2005-01-01

    To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. Systematic review of the literature. Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non-technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence). This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing-oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.

  5. Integrative health care method based on combined complementary ...

    African Journals Online (AJOL)

    Background: There are various models of health care, such as the ... sociological, economic, systemic of Neuman, cognitive medicine or ecological, ayurvedic, ... 2013, with a comprehensive approach in 64 patients using the clinical method.

  6. Community-based rehabilitation: working in partnership with eye care

    Directory of Open Access Journals (Sweden)

    Joerg Weber

    2013-05-01

    Full Text Available Any response to the needs of people with visual impairment and their families will be more effective if eye care workers and CBR programme staff can work together at the community level.

  7. [Molecular epidemiology and antifungal susceptibility of Candida species isolated from urine samples of patients in intensive care unit].

    Science.gov (United States)

    Yüksekkaya, Serife; Fındık, Duygu; Arslan, Uğur

    2011-01-01

    The aims of this study were to analyse the amphotericin B and fluconazole susceptibility and molecular epidemiology of Candida strains (Candida albicans, Candida tropicalis and Candida glabrata) isolated from the urine samples of patients hospitalized in the intensive care unit. Identification of the isolates was done according to microscopic morphology (chlamydospor, blastospor, pseudohyphae and true hyphae) on cornmeal agar, germ tube formation and carbohydrate assimilation patterns (API ID 32C bioMérieux, France). Antifungal susceptibilities of the isolates were determined by in vitro broth microdilution method recommended by Clinical and Laboratory Standards Institute (CLSI). To investigate the clonal relationship of the isolates, randomly amplified polymorphic DNA (RAPD) analysis was performed by using Cnd3 primer. Of the 56 Candida isolates minimum inhibitory concentration (MIC) ranges, MIC50 and MIC90 values for amphotericin B were 0.125-1 µg/ml, 0.125 and 0.5 µg/ml for C.albicans, 0.125-1 µg/ml, 0.25 and 1 µg/ml for C.tropicalis and 0.125-1 µg/ml, 0.25 and 1 µg/ml for C.glabrata, respectively. Fluconazole MIC ranges, MIC50 and MIC90 values were 0.25-4 µg/ml, 0.25 and 0.5 µg/ml for C.albicans, 0.25-16 µg/ml, 0.5 and 1 µg/ml for C.tropicalis and 0.5-64 µg/ml, 8 and 16 µg/ml for C.glabrata, respectively. For amphotericin B, none of the isolates had high MIC values (MIC > 1 µg/ml). While one of the C.glabrata isolates was resistant to fluconazole (MIC ≥ 64 µg/ml), one C.tropicalis and two C.glabrata isolates were dose-dependent susceptible (MIC: 16-32 µg/ml). The results of RAPD analysis indicated an exogenous spread from two clones for C.albicans, one clone for C.glabrata and one clone for C.tropicalis. This study underlines the importance of molecular epidemiological analysis of clinical samples together with hospital environmental samples in terms of Candida spp. To determine the exogenous origin for the related strains and to prevent

  8. The Experience of Psychiatric Care of Adolescents with Anxiety-based School Refusal and of their Parents: A Qualitative Study.

    Science.gov (United States)

    Sibeoni, Jordan; Orri, Massimiliano; Podlipski, Marc-Antoine; Labey, Mathilde; Campredon, Sophie; Gerardin, Priscille; Revah-Levy, Anne

    2018-01-01

    Anxiety-based school refusal in adolescence is a complex, sometimes difficult to treat disorder that can have serious academic and psychiatric consequences. The objective of this qualitative study was to explore how teens with this problem and their parents experience the psychiatric care received. This qualitative multicenter study took place in France, where we conducted semi-structured interviews with adolescents receiving psychiatric care for anxiety-based school refusal and with their parents. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. This study included 20 adolescents aged 12 to 18 years and 21 parents. Two themes emerged from the analysis: (1) the goals of psychiatric care with two sub-themes, " self-transformation " and problem solving ; and, (2) the therapeutic levers identified as effective with two sub-themes: time and space and relationships . Our results show a divergence between parents and teens in their representations of care and especially of its goals. Therapeutic and research implications about the terms of return to school within psychiatric care and also the temporality of care are discussed.

  9. Risk-Based Sampling: I Don't Want to Weight in Vain.

    Science.gov (United States)

    Powell, Mark R

    2015-12-01

    Recently, there has been considerable interest in developing risk-based sampling for food safety and animal and plant health for efficient allocation of inspection and surveillance resources. The problem of risk-based sampling allocation presents a challenge similar to financial portfolio analysis. Markowitz (1952) laid the foundation for modern portfolio theory based on mean-variance optimization. However, a persistent challenge in implementing portfolio optimization is the problem of estimation error, leading to false "optimal" portfolios and unstable asset weights. In some cases, portfolio diversification based on simple heuristics (e.g., equal allocation) has better out-of-sample performance than complex portfolio optimization methods due to estimation uncertainty. Even for portfolios with a modest number of assets, the estimation window required for true optimization may imply an implausibly long stationary period. The implications for risk-based sampling are illustrated by a simple simulation model of lot inspection for a small, heterogeneous group of producers. © 2015 Society for Risk Analysis.

  10. Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project.

    Science.gov (United States)

    Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G

    2017-01-01

    Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

  11. Women’s experience with home-based self-sampling for human papillomavirus testing

    International Nuclear Information System (INIS)

    Sultana, Farhana; Mullins, Robyn; English, Dallas R.; Simpson, Julie A.; Drennan, Kelly T.; Heley, Stella; Wrede, C. David; Brotherton, Julia M. L.; Saville, Marion; Gertig, Dorota M.

    2015-01-01

    Increasing cervical screening coverage by reaching inadequately screened groups is essential for improving the effectiveness of cervical screening programs. Offering HPV self-sampling to women who are never or under-screened can improve screening participation, however participation varies widely between settings. Information on women’s experience with self-sampling and preferences for future self-sampling screening is essential for programs to optimize participation. The survey was conducted as part of a larger trial (“iPap”) investigating the effect of HPV self-sampling on participation of never and under-screened women in Victoria, Australia. Questionnaires were mailed to a) most women who participated in the self-sampling to document their experience with and preference for self-sampling in future, and b) a sample of the women who did not participate asking reasons for non-participation and suggestions for enabling participation. Reasons for not having a previous Pap test were also explored. About half the women who collected a self sample for the iPap trial returned the subsequent questionnaire (746/1521). Common reasons for not having cervical screening were that having Pap test performed by a doctor was embarrassing (18 %), not having the time (14 %), or that a Pap test was painful and uncomfortable (11 %). Most (94 %) found the home-based self-sampling less embarrassing, less uncomfortable (90 %) and more convenient (98 %) compared with their last Pap test experience (if they had one); however, many were unsure about the test accuracy (57 %). Women who self-sampled thought the instructions were clear (98 %), it was easy to use the swab (95 %), and were generally confident that they did the test correctly (81 %). Most preferred to take the self-sample at home in the future (88 %) because it was simple and did not require a doctor’s appointment. Few women (126/1946, 7 %) who did not return a self-sample in the iPap trial returned the questionnaire

  12. Four proposals for market-based health care system reform.

    Science.gov (United States)

    Sumner, W

    1994-08-01

    A perfectly free, competitive medical market would not meet many social goals, such as universal access to health care. Micromanagement of interactions between patients and providers does not guarantee quality care and frequently undermines that relationship, to the frustration of all involved. Furthermore, while some North American health care plans are less expensive than others, none have reduced the medical inflation rate to equal the general inflation rate. Markets have always fixed uneven inflation rates in other domains. The suggested reforms could make elective interactions between patients and providers work more like a free market than did any preceding system. The health and life insurance plan creates cost-sensitive consumers, informed by a corporation with significant research incentives and abilities. The FFEB proposal encourages context-sensitive pricing, established by negotiation processes that weigh labor and benefit. Publication of providers' expected outcomes further enriches the information available to consumers and may reduce defensive medicine incentives. A medical career ladder would ease entry and exit from medical professions. These and complementary reforms do not specifically cap spending yet could have a deflationary impact on elective health care prices, while providing incentives to maintain quality. They accomplish these ends by giving more responsibility, information, incentives, and choice to citizens. We could provide most health care in a marketlike environment. We can incorporate these reforms in any convenient order and allow them to compete with alternative schemes. Our next challenge is to design, implement, and evaluate marketlike health care systems.

  13. Gamut Volume Index: a color preference metric based on meta-analysis and optimized colour samples.

    Science.gov (United States)

    Liu, Qiang; Huang, Zheng; Xiao, Kaida; Pointer, Michael R; Westland, Stephen; Luo, M Ronnier

    2017-07-10

    A novel metric named Gamut Volume Index (GVI) is proposed for evaluating the colour preference of lighting. This metric is based on the absolute gamut volume of optimized colour samples. The optimal colour set of the proposed metric was obtained by optimizing the weighted average correlation between the metric predictions and the subjective ratings for 8 psychophysical studies. The performance of 20 typical colour metrics was also investigated, which included colour difference based metrics, gamut based metrics, memory based metrics as well as combined metrics. It was found that the proposed GVI outperformed the existing counterparts, especially for the conditions where correlated colour temperatures differed.

  14. Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment.

    Science.gov (United States)

    Lehnert, T; Günther, O H; Hajek, A; Riedel-Heller, S G; König, H H

    2018-04-06

    Most people prefer to "age in place" and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care. To investigate preferences for home- and community-based long-term care services packages. Discrete choice experiment conducted in mailed survey. Randomly selected sample of the general population aged 45-64 years in Germany (n = 1.209). Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2-4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment. Quality of care was the most important attribute to respondents and small teams of regular caregivers (1-2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98. Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.

  15. Relationships between duration of practice, educational level, and perception of barriers to implement evidence-based practice among critical care nurses.

    Science.gov (United States)

    Phillips, Carswella

    2015-12-01

    Globally, a greater emphasis has been placed on the delivery of safe, patient-centered, evidence-based nursing care. As point-of-care providers, critical care nurses play a key role in ensuring that patients receive the safest, most effective treatment available. In order to deliver scientific-based care, critical care nurses must stay abreast of the current trends, as well as engage in the evidence-based practice process. This study aimed to describe research activities, to identify barriers to implement evidence-based practice and to explore professional factors related to the use of evidence-based practice among critical care nurses at three teaching hospitals in south-eastern United States. A survey design and convenience sampling method was used. A sample of 30 critical care staff nurses participated in the study. A 61-item online questionnaire composed of a demographic survey - BARRIERS scale - and Evidence-Based Practice Questionnaire was used. Simple descriptive statistics, Pearson's product moment correlations, and independent-sample t test procedures were used to analyze the data. Critical care nurses' reported positive attitudes, but viewed knowledge and use of evidence-based practice less favorably. These results may indicate that having a positive attitude towards evidence-based practice does not necessarily translate to knowledge and use of the evidence-based practice process in clinical practice. An unwillingness to change and time constraints were identified as the top barriers to use evidence-based practice in this study. Perceptions of barriers to use evidence-based practice were higher in those critical care nurses who had less practical experience and educational preparation. The results suggest that critical care nurses possess the foundation to engage in the evidence-based practice process; however, their knowledge, practice, and attitudes just need to be cultivated and strengthened. Understanding the nurses' professional factors, current use

  16. A pilot survey of post-deployment health care needs in small community-based primary care clinics

    Directory of Open Access Journals (Sweden)

    Pugh Mary J

    2011-07-01

    Full Text Available Abstract Background Relatively little is known regarding to what extent community-based primary care physicians are encountering post-deployment health care needs among veterans of the Afghanistan or Iraq conflicts and their family members. Methods This pilot study conducted a cross-sectional survey of 37 primary care physicians working at small urban and suburban clinics belonging to a practice-based research network in the south central region of Texas. Results Approximately 80% of the responding physicians reported caring for patients who have been deployed to the Afghanistan or Iraq war zones, or had a family member deployed. Although these physicians noted a variety of conditions related to physical trauma, mental illnesses and psychosocial disruptions such as marital, family, financial, and legal problems appeared to be even more prevalent among their previously deployed patients and were also noted among family members of deployed veterans. Conclusions Community-based primary care physicians should be aware of common post-deployment health conditions and the resources that are available to meet these needs.

  17. Networked Estimation for Event-Based Sampling Systems with Packet Dropouts

    Directory of Open Access Journals (Sweden)

    Young Soo Suh

    2009-04-01

    Full Text Available This paper is concerned with a networked estimation problem in which sensor data are transmitted over the network. In the event-based sampling scheme known as level-crossing or send-on-delta (SOD, sensor data are transmitted to the estimator node if the difference between the current sensor value and the last transmitted one is greater than a given threshold. Event-based sampling has been shown to be more efficient than the time-triggered one in some situations, especially in network bandwidth improvement. However, it cannot detect packet dropout situations because data transmission and reception do not use a periodical time-stamp mechanism as found in time-triggered sampling systems. Motivated by this issue, we propose a modified event-based sampling scheme called modified SOD in which sensor data are sent when either the change of sensor output exceeds a given threshold or the time elapses more than a given interval. Through simulation results, we show that the proposed modified SOD sampling significantly improves estimation performance when packet dropouts happen.

  18. Development and preliminary validation of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in a psychiatric sample.

    Science.gov (United States)

    Sinclair, Samuel Justin; Slavin-Mulford, Jenelle; Antonius, Daniel; Stein, Michelle B; Siefert, Caleb J; Haggerty, Greg; Malone, Johanna C; O'Keefe, Sheila; Blais, Mark A

    2013-06-01

    Research over the last decade has been promising in terms of the incremental utility of psychometric tools in predicting important clinical outcomes, such as mental health service utilization and inpatient psychiatric hospitalization. The purpose of this study was to develop and validate a new Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI). Logistic regression was initially used in a development sample (n = 253) of psychiatric patients to identify unique PAI indicators associated with inpatient (n = 75) as opposed to outpatient (n = 178) status. Five PAI variables were ultimately retained (Suicidal Ideation, Antisocial Personality-Stimulus Seeking, Paranoia-Persecution, Negative Impression Management, and Depression-Affective) and were then aggregated into a single LOCI and independently evaluated in a second validation sample (n = 252). Results indicated the LOCI effectively differentiated inpatients from outpatients after controlling for demographic variables and was significantly associated with both internalizing and externalizing risk factors for psychiatric admission (range of ds = 0.46 for history of arrests to 0.88 for history of suicidal ideation). The LOCI was additionally found to be meaningfully associated with measures of normal personality, performance-based tests of psychological functioning, and measures of neurocognitive (executive) functioning. The clinical implications of these findings and potential utility of the LOCI are discussed. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  19. Target and suspect screening of psychoactive substances in sewage-based samples by UHPLC-QTOF

    Energy Technology Data Exchange (ETDEWEB)

    Baz-Lomba, J.A., E-mail: jba@niva.no [Norwegian Institute for Water Research, Gaustadalléen 21, NO-0349, Oslo (Norway); Faculty of Medicine, University of Oslo, PO box 1078 Blindern, 0316, Oslo (Norway); Reid, Malcolm J.; Thomas, Kevin V. [Norwegian Institute for Water Research, Gaustadalléen 21, NO-0349, Oslo (Norway)

    2016-03-31

    The quantification of illicit drug and pharmaceutical residues in sewage has been shown to be a valuable tool that complements existing approaches in monitoring the patterns and trends of drug use. The present work delineates the development of a novel analytical tool and dynamic workflow for the analysis of a wide range of substances in sewage-based samples. The validated method can simultaneously quantify 51 target psychoactive substances and pharmaceuticals in sewage-based samples using an off-line automated solid phase extraction (SPE-DEX) method, using Oasis HLB disks, followed by ultra-high performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UHPLC-QTOF) in MS{sup e}. Quantification and matrix effect corrections were overcome with the use of 25 isotopic labeled internal standards (ILIS). Recoveries were generally greater than 60% and the limits of quantification were in the low nanogram-per-liter range (0.4–187 ng L{sup −1}). The emergence of new psychoactive substances (NPS) on the drug scene poses a specific analytical challenge since their market is highly dynamic with new compounds continuously entering the market. Suspect screening using high-resolution mass spectrometry (HRMS) simultaneously allowed the unequivocal identification of NPS based on a mass accuracy criteria of 5 ppm (of the molecular ion and at least two fragments) and retention time (2.5% tolerance) using the UNIFI screening platform. Applying MS{sup e} data against a suspect screening database of over 1000 drugs and metabolites, this method becomes a broad and reliable tool to detect and confirm NPS occurrence. This was demonstrated through the HRMS analysis of three different sewage-based sample types; influent wastewater, passive sampler extracts and pooled urine samples resulting in the concurrent quantification of known psychoactive substances and the identification of NPS and pharmaceuticals. - Highlights: • A novel reiterative workflow

  20. Target and suspect screening of psychoactive substances in sewage-based samples by UHPLC-QTOF

    International Nuclear Information System (INIS)

    Baz-Lomba, J.A.; Reid, Malcolm J.; Thomas, Kevin V.

    2016-01-01

    The quantification of illicit drug and pharmaceutical residues in sewage has been shown to be a valuable tool that complements existing approaches in monitoring the patterns and trends of drug use. The present work delineates the development of a novel analytical tool and dynamic workflow for the analysis of a wide range of substances in sewage-based samples. The validated method can simultaneously quantify 51 target psychoactive substances and pharmaceuticals in sewage-based samples using an off-line automated solid phase extraction (SPE-DEX) method, using Oasis HLB disks, followed by ultra-high performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UHPLC-QTOF) in MS"e. Quantification and matrix effect corrections were overcome with the use of 25 isotopic labeled internal standards (ILIS). Recoveries were generally greater than 60% and the limits of quantification were in the low nanogram-per-liter range (0.4–187 ng L"−"1). The emergence of new psychoactive substances (NPS) on the drug scene poses a specific analytical challenge since their market is highly dynamic with new compounds continuously entering the market. Suspect screening using high-resolution mass spectrometry (HRMS) simultaneously allowed the unequivocal identification of NPS based on a mass accuracy criteria of 5 ppm (of the molecular ion and at least two fragments) and retention time (2.5% tolerance) using the UNIFI screening platform. Applying MS"e data against a suspect screening database of over 1000 drugs and metabolites, this method becomes a broad and reliable tool to detect and confirm NPS occurrence. This was demonstrated through the HRMS analysis of three different sewage-based sample types; influent wastewater, passive sampler extracts and pooled urine samples resulting in the concurrent quantification of known psychoactive substances and the identification of NPS and pharmaceuticals. - Highlights: • A novel reiterative workflow based on three

  1. An investigation of care-based vs. rule-based morality in frontotemporal dementia, Alzheimer's disease, and healthy controls.

    Science.gov (United States)

    Carr, Andrew R; Paholpak, Pongsatorn; Daianu, Madelaine; Fong, Sylvia S; Mather, Michelle; Jimenez, Elvira E; Thompson, Paul; Mendez, Mario F

    2015-11-01

    Behavioral changes in dementia, especially behavioral variant frontotemporal dementia (bvFTD), may result in alterations in moral reasoning. Investigators have not clarified whether these alterations reflect differential impairment of care-based vs. rule-based moral behavior. This study investigated 18 bvFTD patients, 22 early onset Alzheimer's disease (eAD) patients, and 20 healthy age-matched controls on care-based and rule-based items from the Moral Behavioral Inventory and the Social Norms Questionnaire, neuropsychological measures, and magnetic resonance imaging (MRI) regions of interest. There were significant group differences with the bvFTD patients rating care-based morality transgressions less severely than the eAD group and rule-based moral behavioral transgressions more severely than controls. Across groups, higher care-based morality ratings correlated with phonemic fluency on neuropsychological tests, whereas higher rule-based morality ratings correlated with increased difficulty set-shifting and learning new rules to tasks. On neuroimaging, severe care-based reasoning correlated with cortical volume in right anterior temporal lobe, and rule-based reasoning correlated with decreased cortical volume in the right orbitofrontal cortex. Together, these findings suggest that frontotemporal disease decreases care-based morality and facilitates rule-based morality possibly from disturbed contextual abstraction and set-shifting. Future research can examine whether frontal lobe disorders and bvFTD result in a shift from empathic morality to the strong adherence to conventional rules. Published by Elsevier Ltd.

  2. Evaluating the effect of disturbed ensemble distributions on SCFG based statistical sampling of RNA secondary structures

    Directory of Open Access Journals (Sweden)

    Scheid Anika

    2012-07-01

    Full Text Available Abstract Background Over the past years, statistical and Bayesian approaches have become increasingly appreciated to address the long-standing problem of computational RNA structure prediction. Recently, a novel probabilistic method for the prediction of RNA secondary structures from a single sequence has been studied which is based on generating statistically representative and reproducible samples of the entire ensemble of feasible structures for a particular input sequence. This method samples the possible foldings from a distribution implied by a sophisticated (traditional or length-dependent stochastic context-free grammar (SCFG that mirrors the standard thermodynamic model applied in modern physics-based prediction algorithms. Specifically, that grammar represents an exact probabilistic counterpart to the energy model underlying the Sfold software, which employs a sampling extension of the partition function (PF approach to produce statistically representative subsets of the Boltzmann-weighted ensemble. Although both sampling approaches have the same worst-case time and space complexities, it has been indicated that they differ in performance (both with respect to prediction accuracy and quality of generated samples, where neither of these two competing approaches generally outperforms the other. Results In this work, we will consider the SCFG based approach in order to perform an analysis on how the quality of generated sample sets and the corresponding prediction accuracy changes when different degrees of disturbances are incorporated into the needed sampling probabilities. This is motivated by the fact that if the results prove to be resistant to large errors on the distinct sampling probabilities (compared to the exact ones, then it will be an indication that these probabilities do not need to be computed exactly, but it may be sufficient and more efficient to approximate them. Thus, it might then be possible to decrease the worst

  3. Mandatory bundled payment getting into formation for value-based care.

    Science.gov (United States)

    Fink, John

    2015-10-01

    Succeeding under Medicare's enterprise Comprehensive Care for Joint Replacement Model will require collaboration among caregivers and financial arrangements to align incentives Priorities for most organization's transition to becoming a value-based hospitals will be care redesign, supply-purchasing strategy, and post-acute care provider partnering. Pursuing value for your joint replacement program will chart a path for other service lines and lead your organization's transition to becoming a value-based enterprise.

  4. Future Directions of Applying Healthcare Cloud for Home-based Chronic Disease Care

    OpenAIRE

    Hu, Yan; Eriksén, Sara; Lundberg, Jenny

    2017-01-01

    The care of chronic disease has become the main challenge for healthcare institutions around the world. To meet the growing needs of patients, moving the front desk of healthcare from hospital to home is essential. Recently, cloud computing has been applied to healthcare domain; however, adapting to and using this technology effectively for home-based care is still in its initial phase. We have proposed a conceptual hybrid cloud model for home-based chronic disease care, and have evaluated it...

  5. Multidimensional scaling analysis of financial time series based on modified cross-sample entropy methods

    Science.gov (United States)

    He, Jiayi; Shang, Pengjian; Xiong, Hui

    2018-06-01

    Stocks, as the concrete manifestation of financial time series with plenty of potential information, are often used in the study of financial time series. In this paper, we utilize the stock data to recognize their patterns through out the dissimilarity matrix based on modified cross-sample entropy, then three-dimensional perceptual maps of the results are provided through multidimensional scaling method. Two modified multidimensional scaling methods are proposed in this paper, that is, multidimensional scaling based on Kronecker-delta cross-sample entropy (MDS-KCSE) and multidimensional scaling based on permutation cross-sample entropy (MDS-PCSE). These two methods use Kronecker-delta based cross-sample entropy and permutation based cross-sample entropy to replace the distance or dissimilarity measurement in classical multidimensional scaling (MDS). Multidimensional scaling based on Chebyshev distance (MDSC) is employed to provide a reference for comparisons. Our analysis reveals a clear clustering both in synthetic data and 18 indices from diverse stock markets. It implies that time series generated by the same model are easier to have similar irregularity than others, and the difference in the stock index, which is caused by the country or region and the different financial policies, can reflect the irregularity in the data. In the synthetic data experiments, not only the time series generated by different models can be distinguished, the one generated under different parameters of the same model can also be detected. In the financial data experiment, the stock indices are clearly divided into five groups. Through analysis, we find that they correspond to five regions, respectively, that is, Europe, North America, South America, Asian-Pacific (with the exception of mainland China), mainland China and Russia. The results also demonstrate that MDS-KCSE and MDS-PCSE provide more effective divisions in experiments than MDSC.

  6. Sample Data Synchronization and Harmonic Analysis Algorithm Based on Radial Basis Function Interpolation

    Directory of Open Access Journals (Sweden)

    Huaiqing Zhang

    2014-01-01

    Full Text Available The spectral leakage has a harmful effect on the accuracy of harmonic analysis for asynchronous sampling. This paper proposed a time quasi-synchronous sampling algorithm which is based on radial basis function (RBF interpolation. Firstly, a fundamental period is evaluated by a zero-crossing technique with fourth-order Newton’s interpolation, and then, the sampling sequence is reproduced by the RBF interpolation. Finally, the harmonic parameters can be calculated by FFT on the synchronization of sampling data. Simulation results showed that the proposed algorithm has high accuracy in measuring distorted and noisy signals. Compared to the local approximation schemes as linear, quadric, and fourth-order Newton interpolations, the RBF is a global approximation method which can acquire more accurate results while the time-consuming is about the same as Newton’s.

  7. Adaptive sampling rate control for networked systems based on statistical characteristics of packet disordering.

    Science.gov (United States)

    Li, Jin-Na; Er, Meng-Joo; Tan, Yen-Kheng; Yu, Hai-Bin; Zeng, Peng

    2015-09-01

    This paper investigates an adaptive sampling rate control scheme for networked control systems (NCSs) subject to packet disordering. The main objectives of the proposed scheme are (a) to avoid heavy packet disordering existing in communication networks and (b) to stabilize NCSs with packet disordering, transmission delay and packet loss. First, a novel sampling rate control algorithm based on statistical characteristics of disordering entropy is proposed; secondly, an augmented closed-loop NCS that consists of a plant, a sampler and a state-feedback controller is transformed into an uncertain and stochastic system, which facilitates the controller design. Then, a sufficient condition for stochastic stability in terms of Linear Matrix Inequalities (LMIs) is given. Moreover, an adaptive tracking controller is designed such that the sampling period tracks a desired sampling period, which represents a significant contribution. Finally, experimental results are given to illustrate the effectiveness and advantages of the proposed scheme. Copyright © 2015 ISA. Published by Elsevier Ltd. All rights reserved.

  8. Generalized sample entropy analysis for traffic signals based on similarity measure

    Science.gov (United States)

    Shang, Du; Xu, Mengjia; Shang, Pengjian

    2017-05-01

    Sample entropy is a prevailing method used to quantify the complexity of a time series. In this paper a modified method of generalized sample entropy and surrogate data analysis is proposed as a new measure to assess the complexity of a complex dynamical system such as traffic signals. The method based on similarity distance presents a different way of signals patterns match showing distinct behaviors of complexity. Simulations are conducted over synthetic data and traffic signals for providing the comparative study, which is provided to show the power of the new method. Compared with previous sample entropy and surrogate data analysis, the new method has two main advantages. The first one is that it overcomes the limitation about the relationship between the dimension parameter and the length of series. The second one is that the modified sample entropy functions can be used to quantitatively distinguish time series from different complex systems by the similar measure.

  9. Factors related to the provision of home-based end-of-life care among home-care nursing, home help, and care management agencies in Japan.

    Science.gov (United States)

    Igarashi, Ayumi; Kurinobu, Takeshi; Ko, Ayako; Okamoto, Yuko; Matsuura, Shino; Feng, Mei; Yamamoto-Mitani, Noriko

    2015-09-12

    To promote home death, it is necessary to clarify the institutional barriers to conducting end-of-life (EOL) care and consider strategies to deal with this process. This study aims to clarify institution-related factors associated with the provision of home-based EOL care cases, and to compare them among three different types of home-care agencies. We administered a cross-sectional survey throughout Japan to investigate the number and characteristics of EOL cases of home-care nursing (HN), home-help (HH) and care management (CM) agencies. Bivariate and multivariate analyses were performed for each type of agency to examine factors related to the provision of EOL care. 378 HN agencies, 274 HH agencies, and 452 CM agencies responded to the distributed questionnaire. HN agencies had on average 2.1 (SD = 4.0; range 0-60) home-based EOL cases in the last 3 months, while HH agencies had 0.9 (SD = 1.3; range 0-7) and CM agencies had 1.5 (SD = 2.2; range 0-18) in the last 6 months. In a multivariable analysis of HN agencies, a large number of staff (OR: 1.52; p EOL care; in HH agencies, accepting EOL clients in the agency (OR: 3.29; p EOL care; in CM agencies, the number of staff (OR: 1.21; p = 0.037), the number of collaborating HH agencies (OR: 1.07; p = 0.032), and whether home-care nurses and home helpers visit clients together (OR: 1.89; p = 0.007) were positively associated with the provision of EOL care. The agency's size and the inter-agency collaborative system seemed most important among HN agencies and CM agencies, while institutional preparedness for EOL was most important for HH agencies. These findings represent important new information for targeting different effective strategies in the promotion of home-based EOL care, depending on the agency type.

  10. Aleatoric and epistemic uncertainties in sampling based nuclear data uncertainty and sensitivity analyses

    International Nuclear Information System (INIS)

    Zwermann, W.; Krzykacz-Hausmann, B.; Gallner, L.; Klein, M.; Pautz, A.; Velkov, K.

    2012-01-01

    Sampling based uncertainty and sensitivity analyses due to epistemic input uncertainties, i.e. to an incomplete knowledge of uncertain input parameters, can be performed with arbitrary application programs to solve the physical problem under consideration. For the description of steady-state particle transport, direct simulations of the microscopic processes with Monte Carlo codes are often used. This introduces an additional source of uncertainty, the aleatoric sampling uncertainty, which is due to the randomness of the simulation process performed by sampling, and which adds to the total combined output sampling uncertainty. So far, this aleatoric part of uncertainty is minimized by running a sufficiently large number of Monte Carlo histories for each sample calculation, thus making its impact negligible as compared to the impact from sampling the epistemic uncertainties. Obviously, this process may cause high computational costs. The present paper shows that in many applications reliable epistemic uncertainty results can also be obtained with substantially lower computational effort by performing and analyzing two appropriately generated series of samples with much smaller number of Monte Carlo histories each. The method is applied along with the nuclear data uncertainty and sensitivity code package XSUSA in combination with the Monte Carlo transport code KENO-Va to various critical assemblies and a full scale reactor calculation. It is shown that the proposed method yields output uncertainties and sensitivities equivalent to the traditional approach, with a high reduction of computing time by factors of the magnitude of 100. (authors)

  11. Cassette-based in-situ TEM sample inspection in the dual-beam FIB

    International Nuclear Information System (INIS)

    Kendrick, A B; Moore, T M; Zaykova-Feldman, L; Amador, G; Hammer, M

    2008-01-01

    A novel method is presented, combining site-specific TEM sample preparation and in-situ STEM analysis in a dual-beam microscope (FIB/SEM) fitted with a chamber mounted nano-manipulator. TEM samples are prepared using a modified in-situ, lift-out method, whereby the samples are thinned and oriented for immediate in-situ STEM analysis using the tilt, translation, and rotation capabilities of a FIB/SEM sample stage, a nano-manipulator, and a novel cassette. This cassette can provide a second tilt axis, orthogonal to the stage tilt axis, so that the STEM image contrast can be optimized to reveal the structural features of the sample (true STEM imaging in the FIB/SEM). The angles necessary for stage rotation and probe shaft rotation are calculated based on the position of the nano-manipulator relative to the stage and door and the stage tilt angle. A FIB/SEM instrument, equipped with a high resolution scanning electron column, can provide sufficiently high image resolution to enable many failure analysis and process control applications to be successfully carried out without requiring the use of a separate dedicated TEM/STEM instrument. The benefits of this novel approach are increased throughput and reduced cost per sample. Comparative analysis of different sample preparation methods is provided, and the STEM images obtained are shown.

  12. Feasibility and impact of telemonitor-based depression care management for geriatric homecare patients.

    Science.gov (United States)

    Sheeran, Thomas; Rabinowitz, Terry; Lotterman, Jennifer; Reilly, Catherine F; Brown, Suzanne; Donehower, Patricia; Ellsworth, Elizabeth; Amour, Judith L; Bruce, Martha L

    2011-10-01

    The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services. Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. An ethnically diverse sample of 48 English- and Spanish-only-speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the "markedly severe" range at baseline and in the "mild" range at follow-up. Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed.

  13. Personal Continuity of Care in a University-Based Primary Care Practice: Impact on Blood Pressure Control.

    Directory of Open Access Journals (Sweden)

    Nik Sherina Hanafi

    Full Text Available Continuity of care is an important quality outcome of patient care. This study aimed to investigate the relationship between personal continuity and blood pressure (BP control among the patients with hypertension in an academic primary care centre. Between January and May 2012, we conducted a retrospective review of medical records of patients with hypertension who had been followed up for at least 1 year in the Primary Care Clinic, University of Malaya Medical Centre, Malaysia. In this setting, doctors who provided care for hypertension included postgraduate family medicine trainees, non-trainee doctors and academic staff. Systematic random sampling (1:4 was used for patient selection. BP control was defined as less than 130/80 mm Hg for patients with diabetes mellitus, proteinuria and chronic kidney disease and less than 140/90 mm Hg for all other patients. Continuity of care was assessed using the usual provider continuity index (UPCI, which is the ratio of patient visits to the usual provider to the total number of visits to all providers in 1 year. A UPC index of zero denotes no continuity while an index of one reflects perfect continuity with only the usual provider. We reviewed a total of 1060 medical records. The patients' mean age was 62.0 years (SD 10.4. The majority was women (59.2% and married (85.7%. The mean number of visits in a year was 3.85 (SD 1.36. A total of 72 doctors had provided consultations (55 postgraduate family medicine trainees, 8 non-trainee doctors and 9 academic staff. The mean UPCI was 0.43 (SD 0.34. Target BP was achieved in 42% of the patients. There was no significant relationship between BP control and personal continuity after adjustment for total number of visits. Continuity of care was not associated with BP control in our centre. Further studies are needed to explore the reasons for this.

  14. Nitrogen Detection in Bulk Samples Using a D-D Reaction-Based Portable Neutron Generator

    Directory of Open Access Journals (Sweden)

    A. A. Naqvi

    2013-01-01

    Full Text Available Nitrogen concentration was measured via 2.52 MeV nitrogen gamma ray from melamine, caffeine, urea, and disperse orange bulk samples using a newly designed D-D portable neutron generator-based prompt gamma ray setup. Inspite of low flux of thermal neutrons produced by D-D reaction-based portable neutron generator and interference of 2.52 MeV gamma rays from nitrogen in bulk samples with 2.50 MeV gamma ray from bismuth in BGO detector material, an excellent agreement between the experimental and calculated yields of nitrogen gamma rays indicates satisfactory performance of the setup for detection of nitrogen in bulk samples.

  15. A Study of Assimilation Bias in Name-Based Sampling of Migrants

    Directory of Open Access Journals (Sweden)

    Schnell Rainer

    2014-06-01

    Full Text Available The use of personal names for screening is an increasingly popular sampling technique for migrant populations. Although this is often an effective sampling procedure, very little is known about the properties of this method. Based on a large German survey, this article compares characteristics of respondents whose names have been correctly classified as belonging to a migrant population with respondentswho aremigrants and whose names have not been classified as belonging to a migrant population. Although significant differences were found for some variables even with some large effect sizes, the overall bias introduced by name-based sampling (NBS is small as long as procedures with small false-negative rates are employed.

  16. Fabry-Pérot cavity based on chirped sampled fiber Bragg gratings.

    Science.gov (United States)

    Zheng, Jilin; Wang, Rong; Pu, Tao; Lu, Lin; Fang, Tao; Li, Weichun; Xiong, Jintian; Chen, Yingfang; Zhu, Huatao; Chen, Dalei; Chen, Xiangfei

    2014-02-10

    A novel kind of Fabry-Pérot (FP) structure based on chirped sampled fiber Bragg grating (CSFBG) is proposed and demonstrated. In this structure, the regular chirped FBG (CFBG) that functions as reflecting mirror in the FP cavity is replaced by CSFBG, which is realized by chirping the sampling periods of a sampled FBG having uniform local grating period. The realization of such CSFBG-FPs having diverse properties just needs a single uniform pitch phase mask and sub-micrometer precision moving stage. Compared with the conventional CFBG-FP, it becomes more flexible to design CSFBG-FPs of diverse functions, and the fabrication process gets simpler. As a demonstration, based on the same experimental facilities, FPs with uniform FSR (~73 pm) and chirped FSR (varying from 28 pm to 405 pm) are fabricated respectively, which shows good agreement with simulation results.

  17. Inference for multivariate regression model based on multiply imputed synthetic data generated via posterior predictive sampling

    Science.gov (United States)

    Moura, Ricardo; Sinha, Bimal; Coelho, Carlos A.

    2017-06-01

    The recent popularity of the use of synthetic data as a Statistical Disclosure Control technique has enabled the development of several methods of generating and analyzing such data, but almost always relying in asymptotic distributions and in consequence being not adequate for small sample datasets. Thus, a likelihood-based exact inference procedure is derived for the matrix of regression coefficients of the multivariate regression model, for multiply imputed synthetic data generated via Posterior Predictive Sampling. Since it is based in exact distributions this procedure may even be used in small sample datasets. Simulation studies compare the results obtained from the proposed exact inferential procedure with the results obtained from an adaptation of Reiters combination rule to multiply imputed synthetic datasets and an application to the 2000 Current Population Survey is discussed.

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

    Science.gov (United States)

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

    2015-01-01

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

  19. Problems with sampling desert tortoises: A simulation analysis based on field data

    Science.gov (United States)

    Freilich, J.E.; Camp, R.J.; Duda, J.J.; Karl, A.E.

    2005-01-01

    The desert tortoise (Gopherus agassizii) was listed as a U.S. threatened species in 1990 based largely on population declines inferred from mark-recapture surveys of 2.59-km2 (1-mi2) plots. Since then, several census methods have been proposed and tested, but all methods still pose logistical or statistical difficulties. We conducted computer simulations using actual tortoise location data from 2 1-mi2 plot surveys in southern California, USA, to identify strengths and weaknesses of current sampling strategies. We considered tortoise population estimates based on these plots as "truth" and then tested various sampling methods based on sampling smaller plots or transect lines passing through the mile squares. Data were analyzed using Schnabel's mark-recapture estimate and program CAPTURE. Experimental subsampling with replacement of the 1-mi2 data using 1-km2 and 0.25-km2 plot boundaries produced data sets of smaller plot sizes, which we compared to estimates from the 1-mi 2 plots. We also tested distance sampling by saturating a 1-mi 2 site with computer simulated transect lines, once again evaluating bias in density estimates. Subsampling estimates from 1-km2 plots did not differ significantly from the estimates derived at 1-mi2. The 0.25-km2 subsamples significantly overestimated population sizes, chiefly because too few recaptures were made. Distance sampling simulations were biased 80% of the time and had high coefficient of variation to density ratios. Furthermore, a prospective power analysis suggested limited ability to detect population declines as high as 50%. We concluded that poor performance and bias of both sampling procedures was driven by insufficient sample size, suggesting that all efforts must be directed to increasing numbers found in order to produce reliable results. Our results suggest that present methods may not be capable of accurately estimating desert tortoise populations.

  20. Algorithm/Architecture Co-design of the Generalized Sampling Theorem Based De-Interlacer.

    NARCIS (Netherlands)

    Beric, A.; Haan, de G.; Sethuraman, R.; Meerbergen, van J.

    2005-01-01

    De-interlacing is a major determinant of image quality in a modern display processing chain. The de-interlacing method based on the generalized sampling theorem (GST)applied to motion estimation and motion compensation provides the best de-interlacing results. With HDTV interlaced input material

  1. Sociocultural Experiences of Bulimic and Non-Bulimic Adolescents in a School-Based Chinese Sample

    Science.gov (United States)

    Jackson, Todd; Chen, Hong

    2010-01-01

    From a large school-based sample (N = 3,084), 49 Mainland Chinese adolescents (31 girls, 18 boys) who endorsed all DSM-IV criteria for bulimia nervosa (BN) or sub-threshold BN and 49 matched controls (31 girls, 18 boys) completed measures of demographics and sociocultural experiences related to body image. Compared to less symptomatic peers, those…

  2. Using Load Balancing to Scalably Parallelize Sampling-Based Motion Planning Algorithms

    KAUST Repository

    Fidel, Adam; Jacobs, Sam Ade; Sharma, Shishir; Amato, Nancy M.; Rauchwerger, Lawrence

    2014-01-01

    Motion planning, which is the problem of computing feasible paths in an environment for a movable object, has applications in many domains ranging from robotics, to intelligent CAD, to protein folding. The best methods for solving this PSPACE-hard problem are so-called sampling-based planners. Recent work introduced uniform spatial subdivision techniques for parallelizing sampling-based motion planning algorithms that scaled well. However, such methods are prone to load imbalance, as planning time depends on region characteristics and, for most problems, the heterogeneity of the sub problems increases as the number of processors increases. In this work, we introduce two techniques to address load imbalance in the parallelization of sampling-based motion planning algorithms: an adaptive work stealing approach and bulk-synchronous redistribution. We show that applying these techniques to representatives of the two major classes of parallel sampling-based motion planning algorithms, probabilistic roadmaps and rapidly-exploring random trees, results in a more scalable and load-balanced computation on more than 3,000 cores. © 2014 IEEE.

  3. Some advances in importance sampling of reliability models based on zero variance approximation

    NARCIS (Netherlands)

    Reijsbergen, D.P.; de Boer, Pieter-Tjerk; Scheinhardt, Willem R.W.; Juneja, Sandeep

    We are interested in estimating, through simulation, the probability of entering a rare failure state before a regeneration state. Since this probability is typically small, we apply importance sampling. The method that we use is based on finding the most likely paths to failure. We present an

  4. Using Load Balancing to Scalably Parallelize Sampling-Based Motion Planning Algorithms

    KAUST Repository

    Fidel, Adam

    2014-05-01

    Motion planning, which is the problem of computing feasible paths in an environment for a movable object, has applications in many domains ranging from robotics, to intelligent CAD, to protein folding. The best methods for solving this PSPACE-hard problem are so-called sampling-based planners. Recent work introduced uniform spatial subdivision techniques for parallelizing sampling-based motion planning algorithms that scaled well. However, such methods are prone to load imbalance, as planning time depends on region characteristics and, for most problems, the heterogeneity of the sub problems increases as the number of processors increases. In this work, we introduce two techniques to address load imbalance in the parallelization of sampling-based motion planning algorithms: an adaptive work stealing approach and bulk-synchronous redistribution. We show that applying these techniques to representatives of the two major classes of parallel sampling-based motion planning algorithms, probabilistic roadmaps and rapidly-exploring random trees, results in a more scalable and load-balanced computation on more than 3,000 cores. © 2014 IEEE.

  5. Theorical and practical bases for blood sample collection from the heel of newborns for neonatal screening

    Directory of Open Access Journals (Sweden)

    Marcela Vela-Amieva

    2014-07-01

    collected in a special filter paper (Guthrie’s card. Despite its apparent simplicity, NBS laboratories commonly receive a large number of samples collected incorrectly and technically unsuitable for perfor4ming biochemical determinations. The aim of the present paper is to offer recommendations based on scientific evidence, for the properly blood collection on filter paper for NBS programs.

  6. Reinforcing Sampling Distributions through a Randomization-Based Activity for Introducing ANOVA

    Science.gov (United States)

    Taylor, Laura; Doehler, Kirsten

    2015-01-01

    This paper examines the use of a randomization-based activity to introduce the ANOVA F-test to students. The two main goals of this activity are to successfully teach students to comprehend ANOVA F-tests and to increase student comprehension of sampling distributions. Four sections of students in an advanced introductory statistics course…

  7. Students learn systems-based care and facilitate system change as stakeholders in a free clinic experience.

    Science.gov (United States)

    Colbert, Colleen Y; Ogden, Paul E; Lowe, Darla; Moffitt, Michael J

    2010-10-01

    Systems-based practice (SBP) is rarely taught or evaluated during medical school, yet is one of the required competencies once students enter residency. We believe Texas A&M College of Medicine students learn about systems issues informally, as they care for patients at a free clinic in Temple, TX. The mandatory free clinic rotation is part of the Internal Medicine clerkship and does not include formal instruction in SBP. During 2008-2009, a sample of students (n = 31) on the IMED clerkship's free clinic rotation participated in a program evaluation/study regarding their experiences. Focus groups (M = 5 students/group) were held at the end of each outpatient rotation. Students were asked: "Are you aware of any system issues which can affect either the delivery of or access to care at the free clinic?" Data saturation was reached after six focus groups, when investigators noted a repetition of responses. Based upon investigator consensus opinion, data collection was discontinued. Based upon a content analysis, six themes were identified: access to specialists, including OB-GYN, was limited; cost containment; lack of resources affects delivery of care; delays in care due to lack of insurance; understanding of larger healthcare system and free clinic role; and delays in tests due to language barriers. Medical students were able to learn about SBP issues during free clinic rotations. Students experienced how SBP issues affected the health care of uninsured individuals. We believe these findings may be transferable to medical schools with mandatory free clinic rotations.

  8. The impact of sample size on the reproducibility of voxel-based lesion-deficit mappings.

    Science.gov (United States)

    Lorca-Puls, Diego L; Gajardo-Vidal, Andrea; White, Jitrachote; Seghier, Mohamed L; Leff, Alexander P; Green, David W; Crinion, Jenny T; Ludersdorfer, Philipp; Hope, Thomas M H; Bowman, Howard; Price, Cathy J

    2018-07-01

    This study investigated how sample size affects the reproducibility of findings from univariate voxel-based lesion-deficit analyses (e.g., voxel-based lesion-symptom mapping and voxel-based morphometry). Our effect of interest was the strength of the mapping between brain damage and speech articulation difficulties, as measured in terms of the proportion of variance explained. First, we identified a region of interest by searching on a voxel-by-voxel basis for brain areas where greater lesion load was associated with poorer speech articulation using a large sample of 360 right-handed English-speaking stroke survivors. We then randomly drew thousands of bootstrap samples from this data set that included either 30, 60, 90, 120, 180, or 360 patients. For each resample, we recorded effect size estimates and p values after conducting exactly the same lesion-deficit analysis within the previously identified region of interest and holding all procedures constant. The results show (1) how often small effect sizes in a heterogeneous population fail to be detected; (2) how effect size and its statistical significance varies with sample size; (3) how low-powered studies (due to small sample sizes) can greatly over-estimate as well as under-estimate effect sizes; and (4) how large sample sizes (N ≥ 90) can yield highly significant p values even when effect sizes are so small that they become trivial in practical terms. The implications of these findings for interpreting the results from univariate voxel-based lesion-deficit analyses are discussed. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  9. Developing evidence-based maternity care in Iran: a quality improvement study

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  10. Paper membrane-based SERS platform for the determination of glucose in blood samples.

    Science.gov (United States)

    Torul, Hilal; Çiftçi, Hakan; Çetin, Demet; Suludere, Zekiye; Boyacı, Ismail Hakkı; Tamer, Uğur

    2015-11-01

    In this report, we present a paper membrane-based surface-enhanced Raman scattering (SERS) platform for the determination of blood glucose level using a nitrocellulose membrane as substrate paper, and the microfluidic channel was simply constructed by wax-printing method. The rod-shaped gold nanorod particles were modified with 4-mercaptophenylboronic acid (4-MBA) and 1-decanethiol (1-DT) molecules and used as embedded SERS probe for paper-based microfluidics. The SERS measurement area was simply constructed by dropping gold nanoparticles on nitrocellulose membrane, and the blood sample was dropped on the membrane hydrophilic channel. While the blood cells and proteins were held on nitrocellulose membrane, glucose molecules were moved through the channel toward the SERS measurement area. Scanning electron microscopy (SEM) was used to confirm the effective separation of blood matrix, and total analysis is completed in 5 min. In SERS measurements, the intensity of the band at 1070 cm(-1) which is attributed to B-OH vibration decreased depending on the rise in glucose concentration in the blood sample. The glucose concentration was found to be 5.43 ± 0.51 mM in the reference blood sample by using a calibration equation, and the certified value for glucose was 6.17 ± 0.11 mM. The recovery of the glucose in the reference blood sample was about 88 %. According to these results, the developed paper-based microfluidic SERS platform has been found to be suitable for use for the detection of glucose in blood samples without any pretreatment procedure. We believe that paper-based microfluidic systems may provide a wide field of usage for paper-based applications.

  11. Risk adjustment methods for Home Care Quality Indicators (HCQIs based on the minimum data set for home care

    Directory of Open Access Journals (Sweden)

    Hirdes John P

    2005-01-01

    Full Text Available Abstract Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs based on the Minimum Data Set for Home Care (MDS-HC. Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a client covariates only; b client covariates plus an "Agency Intake Profile" (AIP to adjust for ascertainment and selection bias by the agency; and c client covariates plus the intake Case Mix Index (CMI. Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did

  12. Risk adjustment methods for Home Care Quality Indicators (HCQIs) based on the minimum data set for home care

    Science.gov (United States)

    Dalby, Dawn M; Hirdes, John P; Fries, Brant E

    2005-01-01

    Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs) based on the Minimum Data Set for Home Care (MDS-HC). Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA) in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a) client covariates only; b) client covariates plus an "Agency Intake Profile" (AIP) to adjust for ascertainment and selection bias by the agency; and c) client covariates plus the intake Case Mix Index (CMI). Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did substantially affect the

  13. Social care as first work experience in England: a secondary analysis of the profile of a national sample of migrant workers.

    Science.gov (United States)

    Hussein, Shereen; Manthorpe, Jill; Stevens, Martin

    2011-01-01

    Migrant workers are increasingly important to the care sector in England as well as in other developed countries. The profile of migrants is likely to continue changing due to reforms in immigration policy and legislation limiting the range of jobs open to migrants from non-EU countries while facilitating migration from the new European Union accession countries. This article reports on detailed secondary analysis of newly available data on the characteristics of migrants working in the care sector as their first job. The analysis was undertaken in 2009 as part of research investigating the contribution made by migrant care workers in England. The sample was identified from the new National Minimum Data Set for Social Care (NMDSSC), which is completed by social care employers in England. Workers whose ethnicity was identified as not White British and who had their previous job abroad were used as a proxy of recent migrants. The analysis shows that this group of workers has a significantly different profile compared with other workers. Recent migrants in the care sector were significantly younger and held higher qualifications relevant to social care; however, there were no significant gender differences. They were also significantly concentrated in the private and voluntary sectors and in direct care work. There were variations between recent migrants' ethnicity and their job roles, with Asian workers more prevalent in senior care positions. These findings have a number of possible implications for social care workforce and providers, particularly within the current context of changing migration rules and social care reforms. © 2010 Blackwell Publishing Ltd.

  14. Sample preparation prior to the LC-MS-based metabolomics/metabonomics of blood-derived samples.

    Science.gov (United States)

    Gika, Helen; Theodoridis, Georgios

    2011-07-01

    Blood represents a very important biological fluid and has been the target of continuous and extensive research for diagnostic, or health and drug monitoring reasons. Recently, metabonomics/metabolomics have emerged as a new and promising 'omics' platform that shows potential in biomarker discovery, especially in areas such as disease diagnosis, assessment of drug efficacy or toxicity. Blood is collected in various establishments in conditions that are not standardized. Next, the samples are prepared and analyzed using different methodologies or tools. When targeted analysis of key molecules (e.g., a drug or its metabolite[s]) is the aim, enforcement of certain measures or additional analyses may correct and harmonize these discrepancies. In omics fields such as those performed by holistic analytical approaches, no such rules or tools are available. As a result, comparison or correlation of results or data fusion becomes impractical. However, it becomes evident that such obstacles should be overcome in the near future to allow for large-scale studies that involve the assaying of samples from hundreds of individuals. In this case the effect of sample handling and preparation becomes very serious, in order to avoid wasting months of work from experts and expensive instrument time. The present review aims to cover the different methodologies applied to the pretreatment of blood prior to LC-MS metabolomic/metabonomic studies. The article tries to critically compare the methods and highlight issues that need to be addressed.

  15. The critical role of social workers in home-based primary care.

    Science.gov (United States)

    Reckrey, Jennifer M; Gettenberg, Gabrielle; Ross, Helena; Kopke, Victoria; Soriano, Theresa; Ornstein, Katherine

    2014-01-01

    The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers' individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.

  16. Value-based resource management: a model for best value nursing care.

    Science.gov (United States)

    Caspers, Barbara A; Pickard, Beth

    2013-01-01

    With the health care environment shifting to a value-based payment system, Catholic Health Initiatives nursing leadership spearheaded an initiative with 14 hospitals to establish best nursing care at a lower cost. The implementation of technology-enabled business processes at point of care led to a new model for best value nursing care: Value-Based Resource Management. The new model integrates clinical patient data from the electronic medical record and embeds the new information in care team workflows for actionable real-time decision support and predictive forecasting. The participating hospitals reported increased patient satisfaction and cost savings in the reduction of overtime and improvement in length of stay management. New data generated by the initiative on nursing hours and cost by patient and by population (Medicare severity diagnosis-related groups), and patient health status outcomes across the acute care continuum expanded business intelligence for a value-based population health system.

  17. Neurologic continuum of care: Evidence-based model of a post-hospital system of care.

    Science.gov (United States)

    Lewis, Frank D; Horn, Gordon J

    2015-01-01

    There is increasing need for a well-organized continuum of post-hospital rehabilitative care to reduce long term disability resulting from acquired brain injury. This study examined the effectiveness of four levels of post-hospital care (active neurorehabilitation, neurobehavioral intensive, day treatment, and supported living) and the functional variables most important to their success. Participants were 1276 adults with acquired brain injury who were being treated in one of the four program levels. A Repeated Measures MANOVA was used to evaluate change from admission to discharge on the Mayo Portland Adaptability Inventory-4 T-scores. Regression analyses were used to identify predictors of outcome. Statistical improvement on the MPAI-4 was observed at each program level. Self-care and Initiation were the strongest predictors of outcome. The results support the effectiveness of a continuum of care for acquired brain injury individuals beyond hospitalization and acute in-hospital rehabilitation. It is particularly noteworthy that reduction in disability was achieved for all levels of programming even with participants whose onset to admission exceeded 7 years post-injury.

  18. Application of In-Segment Multiple Sampling in Object-Based Classification

    Directory of Open Access Journals (Sweden)

    Nataša Đurić

    2014-12-01

    Full Text Available When object-based analysis is applied to very high-resolution imagery, pixels within the segments reveal large spectral inhomogeneity; their distribution can be considered complex rather than normal. When normality is violated, the classification methods that rely on the assumption of normally distributed data are not as successful or accurate. It is hard to detect normality violations in small samples. The segmentation process produces segments that vary highly in size; samples can be very big or very small. This paper investigates whether the complexity within the segment can be addressed using multiple random sampling of segment pixels and multiple calculations of similarity measures. In order to analyze the effect sampling has on classification results, statistics and probability value equations of non-parametric two-sample Kolmogorov-Smirnov test and parametric Student’s t-test are selected as similarity measures in the classification process. The performance of both classifiers was assessed on a WorldView-2 image for four land cover classes (roads, buildings, grass and trees and compared to two commonly used object-based classifiers—k-Nearest Neighbor (k-NN and Support Vector Machine (SVM. Both proposed classifiers showed a slight improvement in the overall classification accuracies and produced more accurate classification maps when compared to the ground truth image.

  19. Sample size for post-marketing safety studies based on historical controls.

    Science.gov (United States)

    Wu, Yu-te; Makuch, Robert W

    2010-08-01

    As part of a drug's entire life cycle, post-marketing studies are an important part in the identification of rare, serious adverse events. Recently, the US Food and Drug Administration (FDA) has begun to implement new post-marketing safety mandates as a consequence of increased emphasis on safety. The purpose of this research is to provide exact sample size formula for the proposed hybrid design, based on a two-group cohort study with incorporation of historical external data. Exact sample size formula based on the Poisson distribution is developed, because the detection of rare events is our outcome of interest. Performance of exact method is compared to its approximate large-sample theory counterpart. The proposed hybrid design requires a smaller sample size compared to the standard, two-group prospective study design. In addition, the exact method reduces the number of subjects required in the treatment group by up to 30% compared to the approximate method for the study scenarios examined. The proposed hybrid design satisfies the advantages and rationale of the two-group design with smaller sample sizes generally required. 2010 John Wiley & Sons, Ltd.

  20. Evaluation of a Telephone-Delivered, Community-Based Collaborative Care Management Program for Caregivers of Older Adults with Dementia.

    Science.gov (United States)

    Mavandadi, Shahrzad; Wray, Laura O; DiFilippo, Suzanne; Streim, Joel; Oslin, David

    2017-09-01

    To evaluate whether a community-based, telephone-delivered, brief patient/caregiver-centered collaborative dementia care management intervention is associated with improved caregiver and care recipient (CR) outcomes. Longitudinal program evaluation of a clinical intervention; assessments at baseline and 3- and 6-month follow-up. General community. Caregivers (N = 440) of older, community-dwelling, low-income CRs prescribed a psychotropic medication by a primary care provider who met criteria for dementia and were enrolled in the SUpporting Seniors Receiving Treatment And INtervention (SUSTAIN) program for older adults. Dementia care management versus clinical evaluation only. Perceived caregiving burden and caregiver general health (primary outcomes); CR neuropsychiatric symptoms and caregiver distress in response to CRs' challenging dementia-related behaviors (secondary outcomes). Caregivers were, on average, 64.0 (SD: 11.8) years old and 62.6% provided care for the CR for 20 or more hours per week. The majority of the sample was female (73.2%), non-Hispanic White (90.2%), and spousal caregivers (72.5%). Adjusted longitudinal models of baseline and 3- and 6-month data suggest that compared with caregivers receiving clinical evaluation only, caregivers receiving care management reported greater reductions in burden over time. Subgroup analyses also showed statistically significant reductions in caregiver-reported frequency of CR dementia-related behaviors and caregiver distress in response to those symptoms at 3-month follow-up. A community-based, telephone-delivered care management program for caregivers of individuals with dementia is associated with favorable caregiver and CR-related outcomes. Findings support replication and further research in the impact of tailored, collaborative dementia care management programs that address barriers to access and engagement. Published by Elsevier Inc.

  1. Nurses' beliefs and values about doing cue-based care in an NICU in Taiwan.

    Science.gov (United States)

    Liaw, Jen-Jiuan; Chen, Shu-Yueh; Yin, Ying-Ti

    2004-12-01

    Although advances in medical technology have increased the survival rate of preterm infants, science is no cure-all for these high-risk patients. A growing number of studies report that caregiving interventions cause physiological and behavioral distress in such infants. The results have prompted changes in caregiving practices, attempting to reduce stress and strengthen protection for the infants, in order to promote their stability and development in the neonatal intensive care unit (NICU) . This study uses qualitative research methods to grasp the richness and diversity of nurses' beliefs and experience in the taking care of preterm infants. Ten groups of questions explore how NICU nurses take care of premature infants, nurses' perspectives on cue-based care, and the extent to which NICU nurses practice cue-based care. The results generated three themes: (1) timely and skillful management of the preterm infants; (2) compassionate and holistic care for the infants and their highly stressed families; and (3) the relationship between good nursing care and meeting the needs of preterm infants, families, physicians, units, and the environment. It is apparent that the approach to care delivery in NICU practice is still clinical-based, and that there are some obstacles to the delivery of cue-based care. The reasons for this include lack of knowledge, incomplete collaboration with team members, and insufficient support from the administrative systems. To improve the quality of nursing care and preterm infant outcomes, it will be necessary to educate NICU nurses on cue-based care, to enhance collaboration among all team members, to reduce their non-nursing workload, and to re-design NICUs for optimal cue-based care.

  2. Contamination of apple orchard soils and fruit trees with copper-based fungicides: sampling aspects.

    Science.gov (United States)

    Wang, Quanying; Liu, Jingshuang; Liu, Qiang

    2015-01-01

    Accumulations of copper in orchard soils and fruit trees due to the application of Cu-based fungicides have become research hotspots. However, information about the sampling strategies, which can affect the accuracy of the following research results, is lacking. This study aimed to determine some sampling considerations when Cu accumulations in the soils and fruit trees of apple orchards are studied. The study was conducted in three apple orchards from different sites. Each orchard included two different histories of Cu-based fungicides usage, varying from 3 to 28 years. Soil samples were collected from different locations varying with the distances from tree trunk to the canopy drip line. Fruits and leaves from the middle heights of tree canopy at two locations (outer canopy and inner canopy) were collected. The variation in total soil Cu concentrations between orchards was much greater than the variation within orchards. Total soil Cu concentrations had a tendency to increase with the increasing history of Cu-based fungicides usage. Moreover, total soil Cu concentrations had the lowest values at the canopy drip line, while the highest values were found at the half distances between the trunk and the canopy drip line. Additionally, Cu concentrations of leaves and fruits from the outer parts of the canopy were significantly higher than from the inner parts. Depending on the findings of this study, not only the between-orchard variation but also the within-orchard variation should be taken into consideration when conducting future soil and tree samplings in apple orchards.

  3. The hybrid model for sampling multiple elastic scattering angular deflections based on Goudsmit-Saunderson theory

    Directory of Open Access Journals (Sweden)

    Wasaye Muhammad Abdul

    2017-01-01

    Full Text Available An algorithm for the Monte Carlo simulation of electron multiple elastic scattering based on the framework of SuperMC (Super Monte Carlo simulation program for nuclear and radiation process is presented. This paper describes efficient and accurate methods by which the multiple scattering angular deflections are sampled. The Goudsmit-Saunderson theory of multiple scattering has been used for sampling angular deflections. Differential cross-sections of electrons and positrons by neutral atoms have been calculated by using Dirac partial wave program ELSEPA. The Legendre coefficients are accurately computed by using the Gauss-Legendre integration method. Finally, a novel hybrid method for sampling angular distribution has been developed. The model uses efficient rejection sampling method for low energy electrons (500 mean free paths. For small path lengths, a simple, efficient and accurate analytical distribution function has been proposed. The later uses adjustable parameters determined from the fitting of Goudsmith-Saunderson angular distribution. A discussion of the sampling efficiency and accuracy of this newly developed algorithm is given. The efficiency of rejection sampling algorithm is at least 50 % for electron kinetic energies less than 500 keV and longer path lengths (>500 mean free paths. Monte Carlo Simulation results are then compared with measured angular distributions of Ross et al. The comparison shows that our results are in good agreement with experimental measurements.

  4. Determination of optimal samples for robot calibration based on error similarity

    Directory of Open Access Journals (Sweden)

    Tian Wei

    2015-06-01

    Full Text Available Industrial robots are used for automatic drilling and riveting. The absolute position accuracy of an industrial robot is one of the key performance indexes in aircraft assembly, and can be improved through error compensation to meet aircraft assembly requirements. The achievable accuracy and the difficulty of accuracy compensation implementation are closely related to the choice of sampling points. Therefore, based on the error similarity error compensation method, a method for choosing sampling points on a uniform grid is proposed. A simulation is conducted to analyze the influence of the sample point locations on error compensation. In addition, the grid steps of the sampling points are optimized using a statistical analysis method. The method is used to generate grids and optimize the grid steps of a Kuka KR-210 robot. The experimental results show that the method for planning sampling data can be used to effectively optimize the sampling grid. After error compensation, the position accuracy of the robot meets the position accuracy requirements.

  5. Nonmelanoma skin cancer visits and procedure patterns in a nationally representative sample: national ambulatory medical care survey 1995-2007.

    Science.gov (United States)

    Wysong, Ashley; Linos, Eleni; Hernandez-Boussard, Tina; Arron, Sarah T; Gladstone, Hayes; Tang, Jean Y

    2013-04-01

    The rising incidence of nonmelanoma skin cancer (NMSC) is well documented, but data are limited on the number of visits and treatment patterns of NMSC in the outpatient setting. To evaluate practice and treatment patterns of NMSC in the United States over the last decade and to characterize differences according to sex, age, race, insurance type, and physician specialty. Adults with an International Classification of Diseases, Ninth Revision, diagnosis of NMSC were included in this cross-sectional survey study of the National Ambulatory Medical Care Survey between 1995 and 2007. Primary outcomes included population-adjusted NMSC visit rates and odds ratios of receiving a procedure for NMSC using logistic regression. Rates of NMSC visits increased between 1995 and 2007. The number of visits was significantly higher in men, particularly those aged 65 and older. Fifty-nine percent of NMSC visits were associated with a procedure, and the individuals associated with that visit were more likely to be male, to be seen by a dermatologist, and to have private-pay insurance. Nonmelanoma skin cancer visit rates increased from 1995 to 2007 and were higher in men than women. Visits to a dermatologist are more likely to be associated with a procedure for NMSC, and there may be discrepancies in treatment patterns based on insurance type and sex. © 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

  6. A GMM-Based Test for Normal Disturbances of the Heckman Sample Selection Model

    Directory of Open Access Journals (Sweden)

    Michael Pfaffermayr

    2014-10-01

    Full Text Available The Heckman sample selection model relies on the assumption of normal and homoskedastic disturbances. However, before considering more general, alternative semiparametric models that do not need the normality assumption, it seems useful to test this assumption. Following Meijer and Wansbeek (2007, the present contribution derives a GMM-based pseudo-score LM test on whether the third and fourth moments of the disturbances of the outcome equation of the Heckman model conform to those implied by the truncated normal distribution. The test is easy to calculate and in Monte Carlo simulations it shows good performance for sample sizes of 1000 or larger.

  7. Plane-Based Sampling for Ray Casting Algorithm in Sequential Medical Images

    Science.gov (United States)

    Lin, Lili; Chen, Shengyong; Shao, Yan; Gu, Zichun

    2013-01-01

    This paper proposes a plane-based sampling method to improve the traditional Ray Casting Algorithm (RCA) for the fast reconstruction of a three-dimensional biomedical model from sequential images. In the novel method, the optical properties of all sampling points depend on the intersection points when a ray travels through an equidistant parallel plan cluster of the volume dataset. The results show that the method improves the rendering speed at over three times compared with the conventional algorithm and the image quality is well guaranteed. PMID:23424608

  8. Eating Disorders Among a Community-based Sample of Chilean Female Adolescents

    Science.gov (United States)

    Granillo, M. Teresa; Grogan-Kaylor, Andrew; Delva, Jorge; Castillo, Marcela

    2010-01-01

    The purpose of this study was to explore the prevalence and correlates of eating disorders among a community-based sample of female Chilean adolescents. Data were collected through structured interviews with 420 female adolescents residing in Santiago, Chile. Approximately 4% of the sample reported ever being diagnosed with an eating disorder. Multivariate logistic regression analyses revealed that those with higher symptoms of anxiety and who had tried cigarettes were significantly more likely to have been diagnosed with an eating disorder. Findings indicate that Chilean female adolescents are at risk of eating disorders and that eating disorders, albeit maladaptive, may be a means to cope with negative affect, specifically anxiety. PMID:22121329

  9. Using lot quality assurance sampling to assess measurements for growth monitoring in a developing country's primary health care system.

    Science.gov (United States)

    Valadez, J J; Brown, L D; Vargas, W V; Morley, D

    1996-04-01

    Local supervisors used lot quality assurance sampling (LQAS) during routine household visits to assess the technical quality of Costa Rican community-based health workers (CHW): measuring and recording weights of children, interpreting their growth trend and providing nutrition education to mothers. Supervisors sampled 10 households in each of 12 Health Areas (4-8 hours per area). No more than two performance errors were allowed for each CHW. This LQAS decision rule resulted in judgments with a sensitivity and specificity of about 95 percent. Three categories of results are reported: (1) CHW adequately weighed children, calculated ages, identified children requiring nutritional services, and used the growth chart. (2) They needed to improve referral, education, and documentation skills. (3) The lack of system support to regularly provide growth cards, supplementary feeding to identified malnourished children, and other essential materials may have discouraged some CHW resulting in them not applying their skills. Supervisors regularly using LQAS should, by the sixth round of supervision, identify at least 90 percent of inadequately performing CHW. This paper demonstrates the strength of LQAS, namely, to be used easily by low level local health workers to identify poorly functioning components of growth monitoring and promotion.

  10. Long-term care-service use and increases in care-need level among home-based elderly people in a Japanese urban area.

    Science.gov (United States)

    Koike, Soichi; Furui, Yuji

    2013-04-01

    The objective of this study was to examine the effects of home-based long-term care insurance services on an increase in care need levels and discuss its policy implications. We analyzed care need certification and long-term care service use data for 3006 non-institutionalized elderly persons in a Tokyo ward effective as of October 2009 and 2010. Individual care need assessment intervals and their corresponding changes in care need level were calculated from data at two data acquisition points of care need assessment. Those who had been certified but did not use any long-term care insurance service were defined as the control group. The Cox proportionate hazard model was used to determine whether the use of a long-term care insurance service is associated with increased care need level. After adjusting for sex, age, and care need level, the hazard ratio for the probability of increased care need level among service users was calculated as 0.75 (95% confidence interval, 0.64-0.88; p Home-based long-term care service use may prevent an increase in care need level. Administrative data on care need certification and services use could be an effective tool for evaluating the long-term care insurance system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. Home Based Care | Chukwukelu | Nigerian Journal of Family Practice

    African Journals Online (AJOL)

    Cost considerations thus tend to shift the burden of both acute and long-term care to the family. In the very poor countries, health centres are overwhelmed, staff are not paid for months, drugs and equipment are often unavailable, patients' expectations of service quality are not met, etc. Most common ailments are therefore ...

  12. Evidence-Based Clinical Decision: Key to Improved Patients Care ...

    African Journals Online (AJOL)

    ... materials remain limited to mostly developed countries. There is need to adopt measures to further facilitate dissemination of current information of effective health to care providers and policymakers in resource-poor countries. This review is aimed at re-enforcing the need for applying best-evidence into clinical practice

  13. HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS ...

    African Journals Online (AJOL)

    Results: 103 Family Care givers participated in this study; 73(71%) were female and 30(29%) were male. The mean age of participants was. 38 years. The study revealed that 17% believed that they were knowledgeable, 65(63%) had inadequate knowledge and 21( 20%) had no knowledge whatsoever of HBC for PLWHA.

  14. Field-based random sampling without a sampling frame: control selection for a case-control study in rural Africa.

    Science.gov (United States)

    Crampin, A C; Mwinuka, V; Malema, S S; Glynn, J R; Fine, P E

    2001-01-01

    Selection bias, particularly of controls, is common in case-control studies and may materially affect the results. Methods of control selection should be tailored both for the risk factors and disease under investigation and for the population being studied. We present here a control selection method devised for a case-control study of tuberculosis in rural Africa (Karonga, northern Malawi) that selects an age/sex frequency-matched random sample of the population, with a geographical distribution in proportion to the population density. We also present an audit of the selection process, and discuss the potential of this method in other settings.

  15. Activity-based funding model provides foundation for province-wide best practices in renal care.

    Science.gov (United States)

    Levin, Adeera; Lo, Clifford; Noel, Kevin; Djurdjev, Ogjnenka; Amano, Erlyn C

    2013-01-01

    British Columbia has a unique funding model for renal care in Canada. Patient care is delivered through six health authorities, while funding is administered by the Provincial Renal Agency using an activity-based funding model. The model allocates funding based on a schedule of costs for every element of renal care, excluding physician fees. Accountability, transparency of allocation and tracking of outcomes are key features that ensure successful implementation. The model supports province-wide best practices and equitable care and fosters innovation. Since its introduction, the outpatient renal services budget has grown less than the population, while maintaining or improving clinical outcomes. Copyright © 2013 Longwoods Publishing.

  16. Exploring interprofessional, interagency multimorbidity care: case study based observational research

    Science.gov (United States)

    McKinlay, Eileen M.; Morgan, Sonya J.; Gray, Ben V.; Macdonald, Lindsay M.; Pullon, Susan R.H.

    2017-01-01

    Background The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. PMID

  17. Paper based diagnostics for personalized health care: Emerging technologies and commercial aspects.

    Science.gov (United States)

    Mahato, Kuldeep; Srivastava, Ananya; Chandra, Pranjal

    2017-10-15

    Personalized health care (PHC) is being appreciated globally to combat clinical complexities underlying various metabolic or infectious disorders including diabetes, cardiovascular, communicable diseases etc. Effective diagnoses majorly depend on initial identification of the causes which are nowadays being practiced in disease-oriented approach, where personal health profile is often overlooked. The adoption of PHC has shown significantly improved diagnoses in various conditions including emergency, ambulatory, and remote area. PHC includes personalized health monitoring (PHM), which is its integral part and may provide valuable information's on various clinical conditions. In PHC, bio-fluids are analyzed using various diagnostic devices including lab based equipment and biosensors. Among all types of biosensing systems, paper based biosensors are commercially attracted due to its portability, easy availability, cheaper manufacturing cost, and transportability. Not only these, various intrinsic properties of paper has facilitated the development of paper based miniaturized sensors, which has recently gained ASSURED (Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment free, Deliverable to all end-users) status for point of care diagnosis in miniaturized settings. In this review, importance of paper based biosensors and their compatibility for affordable and low cost diagnostics has been elaborated with various examples. Limitations and strategies to overcome the challenges of paper biosensor have also been discussed. We have provided elaborated tables which describe the types, model specifications, sensing mechanisms, target biomarkers, and analytical performance of the paper biosensors with their respective applications in real sample matrices. Different commercial aspects of paper biosensor have also been explained using SWOT (Strength, Weakness, Opportunities, Threats) analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care.

    Science.gov (United States)

    Closa, Conxita; Mas, Miquel À; Santaeugènia, Sebastià J; Inzitari, Marco; Ribera, Aida; Gallofré, Miquel

    2017-09-01

    To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Quasi-experimental longitudinal study. An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  19. Who Shall Not Be Treated: Public Attitudes on Setting Health Care Priorities by Person-Based Criteria in 28 Nations.

    Science.gov (United States)

    Rogge, Jana; Kittel, Bernhard

    2016-01-01

    The principle of distributing health care according to medical need is being challenged by increasing costs. As a result, many countries have initiated a debate on the introduction of explicit priority regulations based on medical, economic and person-based criteria, or have already established such regulations. Previous research on individual attitudes towards setting health care priorities based on medical and economic criteria has revealed consistent results, whereas studies on the use of person-based criteria have generated controversial findings. This paper examines citizens' attitudes towards three person-based priority criteria, patients' smoking habits, age and being the parent of a young child. Using data from the ISSP Health Module (2011) in 28 countries, logistic regression analysis demonstrates that self-interest as well as socio-demographic predictors significantly influence respondents' attitudes towards the use of person-based criteria for health care prioritization. This study contributes to resolving the controversial findings on person-based criteria by using a larger country sample and by controlling for country-level differences with fixed effects models.

  20. Who Shall Not Be Treated: Public Attitudes on Setting Health Care Priorities by Person-Based Criteria in 28 Nations.

    Directory of Open Access Journals (Sweden)

    Jana Rogge

    Full Text Available The principle of distributing health care according to medical need is being challenged by increasing costs. As a result, many countries have initiated a debate on the introduction of explicit priority regulations based on medical, economic and person-based criteria, or have already established such regulations. Previous research on individual attitudes towards setting health care priorities based on medical and economic criteria has revealed consistent results, whereas studies on the use of person-based criteria have generated controversial findings. This paper examines citizens' attitudes towards three person-