Sample records for care based sample

  1. Paper-based sample-to-answer molecular diagnostic platform for point-of-care diagnostics. (United States)

    Choi, Jane Ru; Tang, Ruihua; Wang, ShuQi; Wan Abas, Wan Abu Bakar; Pingguan-Murphy, Belinda; Xu, Feng


    Nucleic acid testing (NAT), as a molecular diagnostic technique, including nucleic acid extraction, amplification and detection, plays a fundamental role in medical diagnosis for timely medical treatment. However, current NAT technologies require relatively high-end instrumentation, skilled personnel, and are time-consuming. These drawbacks mean conventional NAT becomes impractical in many resource-limited disease-endemic settings, leading to an urgent need to develop a fast and portable NAT diagnostic tool. Paper-based devices are typically robust, cost-effective and user-friendly, holding a great potential for NAT at the point of care. In view of the escalating demand for the low cost diagnostic devices, we highlight the beneficial use of paper as a platform for NAT, the current state of its development, and the existing challenges preventing its widespread use. We suggest a strategy involving integrating all three steps of NAT into one single paper-based sample-to-answer diagnostic device for rapid medical diagnostics in the near future.

  2. Unsatisfactory rate in liquid-based cervical samples as compared to conventional smears: A study from tertiary care hospital

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    Nalini Gupta


    Full Text Available Background: Developed countries adopted liquid-based cytology (LBC cervical cytology, partly because of its lower proportions of unsatisfactory (U/S/inadequate samples. This study was carried out to evaluate effect on the rate of U/S samples after introduction of LBC in our laboratory. Materials and Methods: An audit of U/S cervical samples was performed, which included split samples (n = 1000, only conventional Pap smear (CPS smears (n = 1000, and only LBC samples (n = 1000. The smears were reviewed by two observers independently, and adequacy for the samples was assessed as per The Bethesda System 2001. The reasons for U/S rate in split samples were categorized into various cytologic and/or technical reasons. Results: U/S rate was far less in only LBC samples (1.2% as compared to only CPS (10.5% cases. Cases in the satisfactory but limited category were also less in only LBC (0.4% as compared to only CPS (3.2% samples. The main reasons for U/S smears in split samples were low cell count (37.2% in CPS; 58.8% in LBC. The second main reason was low cellularity with excess blood and only excess blood in CPS samples. Conclusion: There was a significant reduction of U/S rate in LBC samples as compared to CPS samples, and the difference was statistically significant. The main cause of U/S samples in LBC was low cellularity indicating a technical fault in sample collection. The main cause of U/S rate in CPS was low cellularity followed by low cellularity with excess blood. Adequate training of sample takers and cytologists for the precise cell count to determine adequacy in smears can be of great help in reducing U/S rate.

  3. Sampling considerations for health care improvement. (United States)

    Perla, Rocco J; Provost, Lloyd P; Murray, Sandra K


    Sampling in improvement work can pose challenges. How is it different from the sampling strategies many use with research, clinical trials, or regulatory programs? What should improvement teams consider when determining a useful approach to sampling and a useful sample size? The aim of this article is to introduce some of the concepts related to sampling for improvement. We give specific guidance related to determining a useful sample size to a wider health care audience so that it can be applied to improvement projects in hospitals and health systems.

  4. Judgment sampling: a health care improvement perspective. (United States)

    Perla, Rocco J; Provost, Lloyd P


    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.

  5. Caring in context: caring practices in a sample of Hong Kong nurses. (United States)

    Arthur, D; Pang, S; Wong, T


    In an effort to place the international literature and research in nursing in a Chinese cultural context a study was commenced to examine the caring practices of nurses in Hong Kong. In view of a recent study (Wilkes & Wallis, 1993) which utilised Roach's 5Cs of caring (Roach, 1987, 1992), a pilot study was commenced on a sample of 77 Hong Kong Registered Nurses studying a Diploma of Nursing. An open ended questionnaire was designed which asked nurses to respond to questions about caring in general and the 5Cs: compassion, competence, confidence, conscience and commitment. The questions asked what each of the concepts meant to them as a nurse. Data was analysed into themes based on key words for each of the six areas revealing that the sample of Hong Kong nurses viewed caring in a similar light to those in overseas studies. The sample highlighted compassion and competence as their major features and it is suggested that methodological problems may have inhibited a deeper analysis of their caring attributes and behaviours. When asked to expand on the 5 Cs in terms of their own practice they were able to supply themes which were closely related to Roach's definitions but which may have been more 'textbook' in their origin and certainly lacked a richness of response. The paucity of responses in terms of clarity and richness of data, followed by discussions with the participants led to conclusions about the methodological issues of cross-cultural research and recommendations for future research are made. Highlighted are the problems with attempting to use concepts such as the 5 Cs across cultures and the problems encountered with translation of concepts related to caring from Chinese into English, and vice-versa. The study has provided some insights into the concepts of caring in Hong Kong Chinese nurses. In the light of advances in China and unification of previously separate countries these findings provide and offer insights into nursing in China and are encouraging

  6. Eosinophilia in routine blood samples as a biomarker for solid tumor development - A study based on the Copenhagen Primary Care Differential Count (CopDiff) Database

    DEFF Research Database (Denmark)

    Andersen, Christen Lykkegaard; Siersma, Volkert Dirk; Hasselbalch, Hans Carl;


    eosinophilia in routine blood samples as a potential biomarker of solid tumor development in a prospective design. MATERIAL AND METHODS: From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356 196 individuals with at least one differential cell count (DIFF) encompassing...... the eosinophil count during 2000-2007. From these, one DIFF was randomly chosen and categorized according to no (... was increased with mild eosinophilia [OR 1.93 (CI 1.29-2.89), p = 0.0013]. No associations with eosinophilia were observed for the remaining solid cancers. CONCLUSION: We demonstrate that eosinophilia in routine blood samples associates with an increased risk of bladder cancer. Our data emphasize...

  7. Urine sampling techniques in symptomatic primary-care patients

    DEFF Research Database (Denmark)

    Holm, Anne; Aabenhus, Rune


    in primary care. The aim of this study was to determine the accuracy of urine culture from different sampling-techniques in symptomatic non-pregnant women in primary care. Methods: A systematic review was conducted by searching Medline and Embase for clinical studies conducted in primary care using......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...... seven studies investigating urine sampling technique in 1062 symptomatic patients in primary care. Mid-stream-clean-catch had a positive predictive value of 0.79 to 0.95 and a negative predictive value close to 1 compared to sterile techniques. Two randomized controlled trials found no difference...

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

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    Kimber Jo


    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

  9. Montessori-based dementia care. (United States)

    Cline, Janet


    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.

  10. Sampling Based Average Classifier Fusion

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    Jian Hou


    fusion algorithms have been proposed in literature, average fusion is almost always selected as the baseline for comparison. Little is done on exploring the potential of average fusion and proposing a better baseline. In this paper we empirically investigate the behavior of soft labels and classifiers in average fusion. As a result, we find that; by proper sampling of soft labels and classifiers, the average fusion performance can be evidently improved. This result presents sampling based average fusion as a better baseline; that is, a newly proposed classifier fusion algorithm should at least perform better than this baseline in order to demonstrate its effectiveness.

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

    DEFF Research Database (Denmark)

    Losacco, Valentina; Cuttini, Marina; Greisen, Gorm


    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...... 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...... and France were the most likely, and Belgium and Spain the least likely to employ recommended combinations of evidence-based pain management measures. Conclusions Heel puncture is a common procedure in preterm neonates, but pain appears inadequately treated in many units and countries. Better compliance...

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

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    Saeed Mian Qaisar


    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.

  13. Silicon based ultrafast optical waveform sampling

    DEFF Research Database (Denmark)

    Ji, Hua; Galili, Michael; Pu, Minhao


    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...

  14. Reachability Analysis of Sampling Based Planners

    NARCIS (Netherlands)

    Geraerts, R.J.; Overmars, M.H.


    The last decade, sampling based planners like the Probabilistic Roadmap Method have proved to be successful in solving complex motion planning problems. We give a reachability based analysis for these planners which leads to a better understanding of the success of the approach and enhancements of t

  15. Sampling and detection of airborne influenza virus towards point-of-care applications (United States)

    Ladhani, Laila; Meeuws, Hanne; van Wesenbeeck, Liesbeth; Schmidt, Kristiane; Stuyver, Lieven; van der Wijngaart, Wouter


    Airborne transmission of the influenza virus contributes significantly to the spread of this infectious pathogen, particularly over large distances when carried by aerosol droplets with long survival times. Efficient sampling of virus-loaded aerosol in combination with a low limit of detection of the collected virus could enable rapid and early detection of airborne influenza virus at the point-of-care setting. Here, we demonstrate a successful sampling and detection of airborne influenza virus using a system specifically developed for such applications. Our system consists of a custom-made electrostatic precipitation (ESP)-based bioaerosol sampler that is coupled with downstream quantitative polymerase chain reaction (qPCR) analysis. Aerosolized viruses are sampled directly into a miniaturized collector with liquid volume of 150 μL, which constitutes a simple and direct interface with subsequent biological assays. This approach reduces sample dilution by at least one order of magnitude when compared to other liquid-based aerosol bio-samplers. Performance of our ESP-based sampler was evaluated using influenza virus-loaded sub-micron aerosols generated from both cultured and clinical samples. Despite the miniaturized collection volume, we demonstrate a collection efficiency of at least 10% and sensitive detection of a minimum of 3721 RNA copies. Furthermore, we show that an improved extraction protocol can allow viral recovery of down to 303 RNA copies and a maximum sampler collection efficiency of 47%. A device with such a performance would reduce sampling times dramatically, from a few hours with current sampling methods down to a couple of minutes with our ESP-based bioaerosol sampler. PMID:28350811

  16. Factors that affect self-care behaviour of female high school students with dysmenorrhoea: a cluster sampling study. (United States)

    Chang, Shu-Fang; Chuang, Mei-hua


    The purpose of this study was to identify factors that affect the self-care behaviour of female high school students with dysmenorrhoea. This cross-sectional study utilized a questionnaire-based survey to understand the self-care behaviour of female high school students dysmenorrhoeal, along with the factors that affect this behaviour. A cluster random sampling method was adopted and questionnaires were used for data collection. Study participants experienced a moderate level of discomfort from dysmenorrhoea, and perceived dysmenorrhoea as serious. This investigation finds that cues to action raised perceived susceptibility to dysmenorrhoea and the perceived effectiveness of self-care behaviour and, therefore, increased the adoption of self-care behaviour. Hence, school nurses should offer female high school students numerous resources to apply correct self-care behaviour.

  17. Explaining Adaptive Radial-Based Direction Sampling

    NARCIS (Netherlands)

    L. Bauwens (Luc); C.S. Bos (Charles); H.K. van Dijk (Herman); R.D. van Oest (Rutger)


    textabstractIn this short paper we summarize the computational steps of Adaptive Radial-Based Direction Sampling (ARDS), which can be used for Bayesian analysis of ill behaved target densities. We consider one simulation experiment in order to illustrate the good performance of ARDS relative to the

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

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    E Amoran


    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

  19. [Transforming health systems based on primary care]. (United States)

    Durán-Arenas, Luis; Salinas-Escudero, Guillermo; Granados-García, Víctor; Martínez-Valverde, Silvia


    Access to health services is a social basic determinant of health in Mexico unlike what happens in developed countries. The demand for health services is focused on primary care, but the design meets only the supply of hospital care services. So it generates a dissonance between the needs and the effective design of health services. In addition, the term affiliation refers to population contributing or in the recruitment process, that has been counted as members of these social security institutions (SS) and Popular Insurance (SP). In the case of Instituto Mexicano del Seguro Social (IMSS) three of four contributors are in contact with health services; while in the SP, this indicator does not exist. Moreover, the access gap between health services is found in the health care packages so that members of the SS and SP do not have same type of coverage. The question is: which model of health care system want the Mexicans? Primary care represents the first choice for increasing the health systems performance, as well as to fulfill their function of social protection: universal access and coverage based on needs, regardless whether it is a public or private health insurance. A central aspect for development of this component is the definition of the first contact with the health system through the creation of a primary health care team, led by a general practitioner as the responsible of a multidisciplinary health team. The process addresses the concepts of primary care nursing, consumption of inputs (mainly medical drugs), maintenance and general services. Adopting a comprehensive strategy that will benefit all Mexicans equally and without discrimination, this primary care system could be financed with a total operating cost of approximately $ 22,809 million by year.

  20. Sample-Based Vegetation Distribution Information Synthesis.

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    Chanchan Xu

    Full Text Available In constructing and visualizing a virtual three-dimensional forest scene, we must first obtain the vegetation distribution, namely, the location of each plant in the forest. Because the forest contains a large number of plants, the distribution of each plant is difficult to obtain from actual measurement methods. Random approaches are used as common solutions to simulate a forest distribution but fail to reflect the specific biological arrangements among types of plants. Observations show that plants in the forest tend to generate particular distribution patterns due to growth competition and specific habitats. This pattern, which represents a local feature in the distribution and occurs repeatedly in the forest, is in line with the "locality" and "static" characteristics in the "texture data", making it possible to use a sample-based texture synthesis strategy to build the distribution. We propose a vegetation distribution data generation method that uses sample-based vector pattern synthesis. A sample forest stand is obtained first and recorded as a two-dimensional vector-element distribution pattern. Next, the large-scale vegetation distribution pattern is synthesized automatically using the proposed vector pattern synthesis algorithm. The synthesized distribution pattern resembles the sample pattern in the distribution features. The vector pattern synthesis algorithm proposed in this paper adopts a neighborhood comparison technique based on histogram matching, which makes it efficient and easy to implement. Experiments show that the distribution pattern synthesized with this method can sufficiently preserve the features of the sample distribution pattern, making our method meaningful for constructing realistic forest scenes.

  1. Sample to answer visualization pipeline for low-cost point-of-care blood cell counting (United States)

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


    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.

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

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    Latika Nath Sinha


    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.

  3. Reality of evidence-based practice in palliative care

    Institute of Scientific and Technical Information of China (English)

    Claire Visser; Gina Hadley; Bee Wee


    hTere has been a paradigm shitf in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically signiifcant beneifts may be marginal and may not be related to clinical meaningfulness. hTe typical treatmentvs. placebo comparison necessitated by ‘gold standard’ randomised controlled trials (RCTs) is not necessarily applicable. hTe complex multimorbidity of end of life care involves considerations of the patient’s physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be diffcult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. hTis review uses examples of the management of cancer-related fatigue and death rattle (noisy breathing) to demonstrate the current state of EBM in palliative care. hTe future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a ‘mixed methods approach’ are likely to pose the correct clinical questions and derive evidence-based yet clinically relevant outcomes.

  4. Applying activity-based costing in long-term care. (United States)

    Wodchis, W P


    As greater numbers of the elderly use health services, and as health care costs climb, effective financial tracking is essential. Cost management in health care can benefit if costs are linked to the care activities where they are incurred. Activity-based costing (ABC) provides a useful approach. The framework aligns costs (inputs), through activities (process), to outputs and outcomes. It allocates costs based on client care needs rather than management structure. The ABC framework was tested in a residential care facility and in supportive housing apartments. The results demonstrate the feasibility and advantages of ABC for long term care agencies, including community-based care.

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

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    Pim P. Valentijn


    Full Text Available 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 understand the complexity of integrated care.Methods:  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.Results: 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.Discussion:  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.

  6. Refining Approximating Betweenness Centrality Based on Samplings

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    Ji, Shiyu


    Betweenness Centrality (BC) is an important measure used widely in complex network analysis, such as social network, web page search, etc. Computing the exact BC values is highly time consuming. Currently the fastest exact BC determining algorithm is given by Brandes, taking $O(nm)$ time for unweighted graphs and $O(nm+n^2\\log n)$ time for weighted graphs, where $n$ is the number of vertices and $m$ is the number of edges in the graph. Due to the extreme difficulty of reducing the time complexity of exact BC determining problem, many researchers have considered the possibility of any satisfactory BC approximation algorithms, especially those based on samplings. Bader et al. give the currently best BC approximation algorithm, with a high probability to successfully estimate the BC of one vertex within a factor of $1/\\varepsilon$ using $\\varepsilon t$ samples, where $t$ is the ratio between $n^2$ and the BC value of the vertex. However, some of the algorithmic parameters in Bader's work are not yet tightly boun...

  7. Direct Detection of Pharmaceuticals and Personal Care Products from Aqueous Samples with Thermally-Assisted Desorption Electrospray Ionization Mass Spectrometry (United States)

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


    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.

  8. [A Maternal Health Care System Based on Mobile Health Care]. (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


    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.


    Directory of Open Access Journals (Sweden)

    Sh. Salarilak


    Full Text Available To determine the coverage rate, timeliness and quality of ante-natal care in rural areas under the coverage of Health Houses in West Azerbaijan province, 30 Health Houses (HH were randomly selected out of 731 HH in the province. In each HH, using the method of Lot Quality Assurance Sampling (LQAS 28 women having recently born babies was selected. Data were collected using check-list for facilities, and questionnaires and forms to be completed from the files by interview. The study showed that the method of LQAS is quite effective for evaluation of this service at HH level. The weighted total coverage of ante-natal care was 46.2%. Quality of care was acceptable for 53.9% of mothers. The weighted average of time lines of care was 49.8%. Availability of facilities in delivery of this service was 100%, showing there was no short coming in this respect.

  10. Burnout and Engagement: Relative Importance of Predictors and Outcomes in Two Health Care Worker Samples. (United States)

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


    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.


    Directory of Open Access Journals (Sweden)

    Mohammad Ashiqur Rahman Khan


    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.

  12. EURO-CARES: European Roadmap for a Sample Return Curation Facility and Planetary Protection Implications. (United States)

    Brucato, John Robert


    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

  13. Harpoon-based sample Acquisition System (United States)

    Bernal, Javier; Nuth, Joseph; Wegel, Donald


    Acquiring information about the composition of comets, asteroids, and other near Earth objects is very important because they may contain the primordial ooze of the solar system and the origins of life on Earth. Sending a spacecraft is the obvious answer, but once it gets there it needs to collect and analyze samples. Conceptually, a drill or a shovel would work, but both require something extra to anchor it to the comet, adding to the cost and complexity of the spacecraft. Since comets and asteroids are very low gravity objects, drilling becomes a problem. If you do not provide a grappling mechanism, the drill would push the spacecraft off the surface. Harpoons have been proposed as grappling mechanisms in the past and are currently flying on missions such as ROSETTA. We propose to use a hollow, core sampling harpoon, to act as the anchoring mechanism as well as the sample collecting device. By combining these two functions, mass is reduced, more samples can be collected and the spacecraft can carry more propellant. Although challenging, returning the collected samples to Earth allows them to be analyzed in laboratories with much greater detail than possible on a spacecraft. Also, bringing the samples back to Earth allows future generations to study them.

  14. Micro contactor based on isotachophoretic sample transport. (United States)

    Goet, Gabriele; Baier, Tobias; Hardt, Steffen


    It is demonstrated how isotachophoresis (ITP) in a microfluidic device may be utilized to bring two small sample volumes into contact in a well-controlled manner. The ITP contactor serves a similar purpose as micromixers that are designed to mix two species rapidly in a microfluidic channel. In contrast to many micromixers, the ITP contactor does not require complex channel architectures and allows a sample processing in the spirit of "digital microfluidics", i.e. the samples always remain in a compact volume. It is shown that the ITP zone transport through microchannels proceeds in a reproducible and predictable manner, and that the sample trajectories follow simple relationships obtained from Ohm's law. Firstly, the micro contactor can be used to synchronize two ITP zones having reached a channel at different points in time. Secondly, fulfilling its actual purpose it is capable of bringing two samples in molecular contact via an interpenetration of ITP zones. It is demonstrated that the contacting time is proportional to the ITP zone extension. This opens up the possibility of using that type of device as a special type of micromixer with "mixing times" significantly below one second and an option to regulate the duration of contact through specific parameters such as the sample volume. Finally, it is shown how the micro contactor can be utilized to conduct a hybridization reaction between two ITP zones containing complementary DNA strands.

  15. Perceived Organizational Justice in Care Services: creation and multi-sample validation of a measure. (United States)

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


    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.

  16. Sampling maternal care behaviour in domestic dogs: what's the best approach? (United States)

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


    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 96hours over postnatal days 3, 6, 9 and 12 (24hours 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-hour night (1800-0600h), 12-hour 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-minute periods. Two random sets of four 15-minute period were also analysed to ensure reliability. We then determined which of the time sampling methods averaged over the three 24-hour periods best represented the frequency and duration of behaviours. As might be expected, frequently occurring behaviours were adequately represented by short (onehour) sampling periods, however this was not the case with the infrequent behaviour. Thus, we argue that 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.

  17. 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.


    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.......77) and general health scores (EQ-5D +0.03, CI 0.00 to 0.05) improved significantly at 24 months of intervention. Intervention costs summed up to 10 United States dollars per patient per month. Limitations: Limitations included a small number of primary care practices and a low intensity of intervention......: 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...

  18. 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


    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.

  19. Web-Based Statistical Sampling and Analysis (United States)

    Quinn, Anne; Larson, Karen


    Consistent with the Common Core State Standards for Mathematics (CCSSI 2010), the authors write that they have asked students to do statistics projects with real data. To obtain real data, their students use the free Web-based app, Census at School, created by the American Statistical Association (ASA) to help promote civic awareness among school…

  20. Virtual Environment: assistance in nursing care for the deaf based on the protocol of Primary Care

    Directory of Open Access Journals (Sweden)

    Silvia Cristina Martini Rodrigues


    Full Text Available Objective: Presenting a Virtual Environment (VE based on the Protocol of Treatment of Hypertension and Diabetes Mellitus type 2, used in Primary Care for evaluation of dietary habits in nursing consultations. Method: An experimental study applied by two nurses and a nurse manager, in a sample of 30 deaf patients aged between 30 and 60 years. The environment was built in Visual Basic NET and offered eight screens about feeding containing food pictures, videos in Libras (Brazilian sign language and audio. The analysis of the VE was done through questionnaires applied to patients and professionals by the Poisson statistical test. Results: The VE shows the possible diagnostics in red, yellow, green and blue colors, depending on the degree of patients’ need. Conclusion: The environment obtained excellent acceptance by patients and nurses, allowing great interaction between them, even without an interpreter. The time in consultation was reduced to 15 minutes, with the preservation of patient privacy.

  1. Caring relationships in home-based nursing care - registered nurses' experiences. (United States)

    Wälivaara, Britt-Marie; Sävenstedt, Stefan; Axelsson, Karin


    The caring relationship between the nurse and the person in need of nursing care has been described as a key concept in nursing and could facilitate health and healing by involving the person's genuine needs. The aim of this study was to explore registered nurses' experiences of their relationships with persons in need of home-based nursing care. Individual interviews with nurses (n=13 registered nurses and 11 district nurses) working in home-based nursing care were performed. A thematic content analysis was used to analyze the transcribed interviews and resulted in the main theme Good nursing care is built on trusting relationship and five sub-themes, Establishing the relationship in home-based nursing care, Conscious efforts maintains the relationship, Reciprocity is a requirement in the relationship, Working in different levels of relationships and Limitations and boundaries in the relationship. A trusting relationship between the nurse and the person in need of healthcare is a prerequisite for good home-based nursing care whether it is based on face-to-face encounters or remote encounters through distance-spanning technology. A trusting relationship could reduce the asymmetry of the caring relationship which could strengthen the person's position. The relationship requires conscious efforts from the nurse and a choice of level of the relationship. The trusting relationship was reciprocal and meant that the nurse had to communicate something about themself as the person needs to know who is entering the home and who is communicating through distance-spanning technology.

  2. Is liquid heparin comparable to dry balanced heparin for blood gas sampling in intensive care unit?

    Directory of Open Access Journals (Sweden)

    Viswas Chhapola


    Full Text Available Introduction: Blood gas (BG analysis is required for management of critically ill patients in emergency and intensive care units. BG parameters can be affected by the type of heparin formulations used-liquid heparin (LH or dry balanced heparin (DBH. This study was conducted to determine whether blood gas, electrolyte, and metabolite estimations performed by using DBH and LH are comparable. Materials and Methods: A prospective study was conducted at pediatric intensive care unit (PICU of a tertiary care hospital. Paired venous samples were collected from 35 consecutive children in commercially prepared DBH syringes and custom-prepared LH syringes. Samples were immediately analyzed by blood gas analyzer and compared for pH, pCO 2 , pO 2 , HCO 3 - , Na + , K + , Cl - , and lactate. Paired comparisons were done and agreement was assessed by Bland-Altman difference plots. The 95% limits of absolute agreement (LOA were compared with the specifications for total allowable error (TEa. Results: The P values were significant for all measured parameters, with the exception of pCO 2 and K +. Bland-Altman difference plots showed wide LOA for pCO 2 , pO 2 , HCO3 - , Na + , K + , and Cl - when compared against TEa. For pCO 2 , HCO3 - , Na + , K + , and Cl - , 40%, 23%, 77%, 34%, and 54% of samples were outside the TEa limits, respectively, with LH. Conclusion: Our study showed that there is poor agreement between LH and DBH for the BG parameters pCO2, pO2, HCO3 - , K + , Na + , and Cl - and, thus, are not comparable. But for pH and lactate, LH and DBH can be used interchangeably.

  3. Perceived Social Environment and Adolescents' Well-Being and Adjustment: Comparing a Foster Care Sample with a Matched Sample (United States)

    Farruggia, Susan P.; Greenberger, Ellen; Chen, Chuansheng; Heckhausen, Jutta


    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…

  4. Advances in paper-based point-of-care diagnostics. (United States)

    Hu, Jie; Wang, ShuQi; Wang, Lin; Li, Fei; Pingguan-Murphy, Belinda; Lu, Tian Jian; Xu, Feng


    Advanced diagnostic technologies, such as polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA), have been widely used in well-equipped laboratories. However, they are not affordable or accessible in resource-limited settings due to the lack of basic infrastructure and/or trained operators. Paper-based diagnostic technologies are affordable, user-friendly, rapid, robust, and scalable for manufacturing, thus holding great potential to deliver point-of-care (POC) diagnostics to resource-limited settings. In this review, we present the working principles and reaction mechanism of paper-based diagnostics, including dipstick assays, lateral flow assays (LFAs), and microfluidic paper-based analytical devices (μPADs), as well as the selection of substrates and fabrication methods. Further, we report the advances in improving detection sensitivity, quantification readout, procedure simplification and multi-functionalization of paper-based diagnostics, and discuss the disadvantages of paper-based diagnostics. We envision that miniaturized and integrated paper-based diagnostic devices with the sample-in-answer-out capability will meet the diverse requirements for diagnosis and treatment monitoring at the POC.

  5. Evidence Based Dental Care: Integrating Clinical Expertise with Systematic Research



    Clinical dentistry is becoming increasingly complex and our patients more knowledgeable. Evidence-based care is now regarded as the “gold standard” in health care delivery worldwide. The basis of evidence based dentistry is the published reports of research projects. They are, brought together and analyzed systematically in meta analysis, the source for evidence based decisions. Activities in the field of evidence-based dentistry has increased tremendously in the 21st century, more and more p...

  6. Silicon waveguide based 320 Gbit/s optical sampling

    DEFF Research Database (Denmark)

    Ji, Hua; Galili, Michael; Pu, Minhao


    A silicon waveguide-based 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.......A silicon waveguide-based 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....

  7. Older people--recipients but also providers of informal care: an analysis among community samples in the Republic of Ireland and Northern Ireland. (United States)

    McGee, Hannah M; Molloy, Gerard; O'Hanlon, Ann; Layte, Richard; Hickey, Anne


    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.

  8. 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


    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.

  9. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

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


    . Our study highlights the importance of providing hospital-based home care with consideration for the family members' need for the sense of security achieved by home care by experienced paediatric oncology nurses and regular contact with the doctor. In future studies, interviews with children......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...

  10. Function approximation for learning control : a key sample based approach



    Two function approximators are introduced in this thesis for use in learning control. These function approximators identify a relation between input and output based on samples. Two different, but closely related function approximators are introduced: the key sample machine and the recursive key sample machine.

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

    Directory of Open Access Journals (Sweden)

    Meijboom Bert


    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

  12. Health care-associated pneumonia: an evidence-based review. (United States)

    Attridge, Russell T; Frei, Christopher R


    Health care-associated pneumonia is a relatively new classification of pneumonia that includes community-dwelling pneumonia patients having contact with the health care system. Current data indicate that health care-associated pneumonia patients present with more severe disease, are more likely to be infected with drug-resistant pathogens, and suffer increased mortality compared with community-acquired pneumonia patients. Guidelines recommend that these patients receive empiric antibiotics similar to those recommended for nosocomial pneumonia; however, it is not currently known if outcomes are improved when health care-associated pneumonia patients are treated with these therapies. In addition, the individual health care-associated pneumonia risk factors are based on limited data and are a poor predictor of patients likely to be infected with drug-resistant pathogens. Many questions remain on how to most appropriately care for this growing group of pneumonia patients. This review is an evidence-based discussion of current health care-associated pneumonia data, the individual health care-associated pneumonia risk factors, and limitations and additional considerations for the health care-associated pneumonia classification system.

  13. Delayed entry into HIV medical care in a nationally representative sample of HIV-infected adults receiving medical care in the USA. (United States)

    Robertson, McKaylee; Wei, Stanley C; Beer, Linda; Adedinsewo, Demilade; Stockwell, Sandra; Dombrowski, Julia C; Johnson, Christopher; Skarbinski, Jacek


    Before widespread antiretroviral therapy (ART), an estimated 17% of people delayed HIV care. We report national estimates of the prevalence and factors associated with delayed care entry in the contemporary ART era. We used Medical Monitoring Project data collected from June 2009 through May 2011 for 1425 persons diagnosed with HIV from May 2004 to April 2009 who initiated care within 12 months. We defined delayed care as entry >three months from diagnosis. Adjusted prevalence ratios (aPRs) were calculated to identify risk factors associated with delayed care. In this nationally representative sample of HIV-infected adults receiving medical care, 7.0% (95% confidence interval [CI]: 5.3-8.8) delayed care after diagnosis. Black race was associated with a lower likelihood of delay than white race (aPR 0.38). Men who have sex with women versus women who have sex with men (aPR 1.86) and persons required to take an HIV test versus recommended by a provider (aPR 2.52) were more likely to delay. Among those who delayed 48% reported a personal factor as the primary reason. Among persons initially diagnosed with HIV (non-AIDS), those who delayed care were twice as likely (aPR 2.08) to develop AIDS as of May 2011. Compared to the pre-ART era, there was a nearly 60% reduction in delayed care entry. Although relatively few HIV patients delayed care entry, certain groups may have an increased risk. Focus on linkage to care among persons who are required to take an HIV test may further reduce delayed care entry.

  14. The caring relationship in hospice care: an analysis based on the ethics of the caring conversation.

    NARCIS (Netherlands)

    Olthuis, G.J.; Dekkers, W.J.M.; Leget, C.J.W.; Vogelaar, P.J.W.


    Good nursing is more than exercising a specific set of skills. It involves the personal identity of the nurse. The aim of this article is to answer two questions: (1) what kind of person should the hospice nurse be? and (2) how should the hospice nurse engage in caring conversations? To answer these

  15. Textile-based sampling for potentiometric determination of ions. (United States)

    Lisak, Grzegorz; Arnebrant, Thomas; Ruzgas, Tautgirdas; Bobacka, Johan


    Potentiometric sensing utilizing textile-based micro-volume sampling was applied and evaluated for the determination of clinically (Na(+), K(+), Cl(-)) and environmentally (Cd(2+), Pb(2+) and pH) relevant analytes. In this technological design, calibration solutions and samples were absorbed into textiles while the potentiometric cells (ion-selective electrodes and reference electrode) were pressed against the textile. Once the liquid, by wicking action, reached the place where the potentiometric cell was pressed onto the textile, hence closing the electric circuit, the potentiometric response was obtained. Cotton, polyamide, polyester and their blends with elastane were applied for micro-volume sampling. The textiles were found to influence the determination of pH in environmental samples with pH close to neutral and Pb(2+) at low analyte concentrations. On the other hand, textile-based micro-volume sampling was successfully applied in measurements of Na(+) using solid-contact sodium-selective electrodes utilizing all the investigated textiles for sampling. It was found that in order to extend the application of textile-based sampling toward environmental analysis of ions it will be necessary to tailor the physio-chemical properties of the textile materials. In general, textile-based sampling opens new possibilities for direct chemical analysis of small-volume samples and provide a simple and low-cost method to screen various textiles for their effects on samples to identify which textiles are the most suitable for on-body sensing.

  16. Similarity-based denoising of point-sampled surface

    Institute of Scientific and Technical Information of China (English)

    Ren-fang WANG; Wen-zhi CHEN; San-yuan ZHANG; Yin ZHANG; Xiu-zi YE


    A non-local denoising (NLD) algorithm for point-sampled surfaces (PSSs) is presented based on similarities, including geometry intensity and features of sample points. By using the trilateral filtering operator, the differential signal of each sample point is determined and called "geometry intensity". Based on covariance analysis, a regular grid of geometry intensity of a sample point is constructed, and the geometry-intensity similarity of two points is measured according to their grids. Based on mean shift clustering, the PSSs are clustered in terms of the local geometry-features similarity. The smoothed geometry intensity, i.e., offset distance, of the sample point is estimated according to the two similarities. Using the resulting intensity, the noise component from PSSs is finally removed by adjusting the position of each sample point along its own normal direction. Experimental results demonstrate that the algorithm is robust and can produce a more accurate denoising result while having better feature preservation.

  17. Evidence-based medicine in health care reform. (United States)

    Hughes, Gordon B


    The Patient Protection and Affordable Care Act of 2010 mandates a national comparative outcomes research project agenda. Comparative effectiveness research includes both clinical trials and observational studies and is facilitated by electronic health records. A national network of electronic health records will create a vast electronic data "warehouse" with exponential growth of observational data. High-quality associations will identify research topics for pragmatic clinical trials, and systematic reviews of clinical trials will provide optimal evidence-based medicine. Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Thus, health care reform will provide a robust environment for comparative effectiveness research, systematic reviews, and evidence-based medicine, and implementation of evidence-based medicine should lead to improved quality of care.

  18. Stroboscopy for benign laryngeal pathology in evidence based health care


    Printza, A; Triaridis, S; Themelis, C; Constantinidis, J


    Background and Aims: Voice disorders are common. The aim of this study is to evaluate the diagnostic value of stroboscopy for voice disorders related with benign pathology and apply results in evidence based health care.

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

    LENUS (Irish Health Repository)

    O'Kelly, C M


    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.

  20. Principle-based concept analysis: Caring in nursing education (United States)

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


    Introduction 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. Methods 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. Results 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). Conclusion 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

  1. A method for selecting training samples based on camera response (United States)

    Zhang, Leihong; Li, Bei; Pan, Zilan; Liang, Dong; Kang, Yi; Zhang, Dawei; Ma, Xiuhua


    In the process of spectral reflectance reconstruction, sample selection plays an important role in the accuracy of the constructed model and in reconstruction effects. In this paper, a method for training sample selection based on camera response is proposed. It has been proved that the camera response value has a close correlation with the spectral reflectance. Consequently, in this paper we adopt the technique of drawing a sphere in camera response value space to select the training samples which have a higher correlation with the test samples. In addition, the Wiener estimation method is used to reconstruct the spectral reflectance. Finally, we find that the method of sample selection based on camera response value has the smallest color difference and root mean square error after reconstruction compared to the method using the full set of Munsell color charts, the Mohammadi training sample selection method, and the stratified sampling method. Moreover, the goodness of fit coefficient of this method is also the highest among the four sample selection methods. Taking all the factors mentioned above into consideration, the method of training sample selection based on camera response value enhances the reconstruction accuracy from both the colorimetric and spectral perspectives.

  2. Function approximation for learning control : a key sample based approach

    NARCIS (Netherlands)

    Kruif, de Bastiaan Johannes


    Two function approximators are introduced in this thesis for use in learning control. These function approximators identify a relation between input and output based on samples. Two different, but closely related function approximators are introduced: the key sample machine and the recursive key sam

  3. Consistency with evidence-based treatments and perceived effectiveness of children's community-based care. (United States)

    Haine-Schlagel, Rachel; Fettes, Danielle L; Garcia, Antonio R; Brookman-Frazee, Lauren; Garland, Ann F


    This study examined whether delivery of psychotherapeutic strategies consistent with common elements of evidence-based (EB) treatments for child disruptive behavior problems was associated with parents' report of treatment effectiveness. The intensity of delivery of practice elements consistent with EB treatments was coded from a random sample of 538 videotaped psychotherapy sessions with 157 children/families and 75 therapists from six community-based clinics. Multilevel regression analyses tested whether intensity of EB practice elements was associated with parents' report of treatment effectiveness after 4 months, controlling for intensity of other practice elements. Results indicate parents reported greater perceived treatment effectiveness when community-based treatment included more intensive delivery of practice elements consistent with EB treatments to children. These findings may reassure providers about the acceptability of EB practice elements and may motivate efforts to integrate EB practice elements more intensively into community-based care.


    Directory of Open Access Journals (Sweden)

    Partha Sarathi


    Full Text Available CONTEXT: The bacterial load in different air samples from environment of most hospitals remained undetermined. Any direct correlation between such bacterial load and the nosocomial infection are also lacking. Only higher bacterial load in air of a particular hospital environment may indicate higher risk of airborne cross infections. AIMS: The study is to determine the bacterial presence per unit volume of air, and the factors influencing the bioload. SETTINGS AND DESIGN: The air samples were collected from different locations of our tertiary care hospital, during Jul 2011 to June 2012 with information like room space per patient, number of daily average visitors, system of air circulation and house-keeping quality. METHODS: A specific volume of air was impacted on a plastic strips containing nutrient agar by air sampler La200, Hi-Media. Following incubation for 24 hour bacterial colonies were counted and organisms were identified up to genus level. RESULTS: Mostly Gram positive cocci followed by Gram positive and a few Gram negative bacilli were detected. The highest bacterial load was found in general outdoor premises (2456 CFU/cm, followed by some extremely crowded general wards (573 CFU/cm. The lowest count of such was found in nursery area (94 CFU/cm, where special emphasis was given on cleanliness, room ventilation and visitor’s restriction. Similarly variations in bacterial loads were also noted in different times in a day and in different seasons in a year. The bioload in all tested samples were within permissible limits. CONCLUSIONS: By appropriate measures the aerobic bacterial load in hospital environment can be restricted within optimal level

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

    Energy Technology Data Exchange (ETDEWEB)

    Campolina, Daniel; Lima, Paulo Rubens I., E-mail:, E-mail: [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil). Servico de Tecnologia de Reatores; Pereira, Claubia; Veloso, Maria Auxiliadora F., E-mail:, E-mail: [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Dept. de Engenharia Nuclear


    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{sub 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)

  6. Different Random Distributions Research on Logistic-Based Sample Assumption

    Directory of Open Access Journals (Sweden)

    Jing Pan


    Full Text Available Logistic-based sample assumption is proposed in this paper, with a research on different random distributions through this system. It provides an assumption system of logistic-based sample, including its sample space structure. Moreover, the influence of different random distributions for inputs has been studied through this logistic-based sample assumption system. In this paper, three different random distributions (normal distribution, uniform distribution, and beta distribution are used for test. The experimental simulations illustrate the relationship between inputs and outputs under different random distributions. Thereafter, numerical analysis infers that the distribution of outputs depends on that of inputs to some extent, and this assumption system is not independent increment process, but it is quasistationary.

  7. Developing internet-based health services in health care organizations. (United States)

    Leskinen, Salme; Häyrinen, Kristiina; Saranto, Kaija; Ensio, Anneli


    It is often said that we are living in an information society and information technology (IT) is a normal part of life in many fields. But IT is not used effectively in health care. The purpose of this study was to survey what kind of Internet-based health services and related electronic services are offered to clients by the web-pages of health care organizations in Finland.

  8. The health care needs of the physically disabled patient in a home-based care environment: Implications for the training of ancillary health care workers

    Directory of Open Access Journals (Sweden)

    Monica Springe


    Full Text Available According to existing literature, ancillary health care workers (AHCWs often do not meet the health care needs of patients with physical disabilities (physically disabled patients in a homebased environment, because of inadequate training programmes. The purpose of this research study was to explore the health care needs of physically disabled patients in long-term, home-based care in the northern suburbs of Johannesburg and, based on results, to offer recommendations for the training of AHCWs. Qualitative, exploratory, descriptive and contextual means were employed in data collection and analysis. The population consisted of eight physically disabled participants who employed an AHCW to assist them with their long-term home care. Purposive sampling was used with subsequent snowballing to identify further participants for the study. Individual interviews were conducted, where participants had to answer the questions (1‘What are your health care needs?’ and(2 ‘How should these be met?’ Data saturation was ensured, after which Tesch’s method of data analysis was followed. Three categories of health care needs were identified (1 physical health care needs, (2 interpersonal relationship needs and (3 social needs, and 12 themes were derived from these categories. These categories of health care needs should be addressed in the training of AHCWs.From the themes, recommendations were described for the training of AHCWs on the health care needs of the home-based physically disabled patients. The AHCW should assist in the adaptation of the environment to the patient’s individual needs, and should use knowledge and critical thinking skills to ensure a patient-centred care setting.


    Volgens die literatuur kan assistentgesondheidsorgwerkers (AGWs, as gevolg van ontoereikende opleiding, nie altyd aan die behoeftes van fisies gestremde pasiënte in 'n tuisopset voldoen nie.Die doel van hierdie navorsingstudie was

  9. From Cure to Care: Assessing the Ethical and Professional Learning Needs of Medical Learners in a Care-Based Facility (United States)

    Hall, Pippa; O'Reilly, Jane; Dojeiji, Sue; Blair, Richard; Harley, Anne


    The purpose of this study was to assess the ethical and professional learning needs of medical trainees on clinical placements at a care-based facility, as they shifted from acute care to care-based philosophy. Using qualitative data analysis and grounded theory techniques, 12 medical learners and five clinical supervisors were interviewed. Five…

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

    Directory of Open Access Journals (Sweden)

    Suzanne Smith


    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.

  11. Establishment of a Representative Practice-based Research Network (PBRN) for the Monitoring of Primary Care in Switzerland. (United States)

    Selby, Kevin; Cornuz, Jacques; Senn, Nicolas


    Data are urgently needed to better understand processes of care in Swiss primary care (PC). A total of 2027 PC physicians, stratified by canton, were invited to participate in the Swiss Primary care Active Monitoring network, of whom 200 accepted to join. There were no significant differences between participants and a random sample drawn from the same physician databases based on sex, year of obtaining medical school diploma, or location. The Swiss Primary care Active Monitoring network represents the first large-scale, nationally representative practice-based research network in Switzerland and will provide a unique opportunity to better understand the functioning of Swiss PC.

  12. Multi-class determination of personal care products and pharmaceuticals in environmental and wastewater samples by ultra-high performance liquid-chromatography-tandem mass spectrometry. (United States)

    Gracia-Lor, Emma; Martínez, Marian; Sancho, Juan V; Peñuela, Gustavo; Hernández, Félix


    In this work, a multi-class method for the simultaneous determination of 17 emerging contaminants, including pharmaceuticals and personal care products, has been developed. Target analytes were two anti-inflammatories, a lipid regulator agent, two angiotensin II antagonists, two antiepileptic drugs and a diuretic. Among personal care products, four preservatives and five UV filters were included. The method is based on solid-phase extraction (SPE) using Oasis HLB cartridges followed by ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Up to three simultaneous transitions per compound were acquired to assure a reliable identification. A detailed study of the extraction process efficiency and matrix effects was carried out in surface water and effluent wastewater. The use of isotope-labeled internal standards (ILIS) was tested to compensate both potential SPE losses during sample extraction and signal suppression/enhancement observed, especially in EWW. Satisfactory correction in all water samples was only ensured when the own analyte ILIS was used. The use of analogues ILIS was a rather useful approach for correction in the majority of the samples tested when analyte ILIS was unavailable. The method was successfully validated in five different surface water (SW) samples and five effluent wastewater (EWW) samples spiked at two concentration levels (0.05 and 0.5 μg/L in SW; 0.1 and 0.5 μg/L in EWW). The developed method was applied to the analysis of 22 samples (SW and EWW) from the Spanish Mediterranean area and 51 reservoir water samples from Colombia. Personal care products were frequently detected, with the highest concentrations corresponding to benzophenone and benzophenone-4 (samples from Spain), and methylparaben (samples from Colombia). Several pharmaceuticals were detected in the Spanish samples, where irbesartan and valsartan - two Angiotensin II antagonists that are not commonly monitored in the aquatic environment

  13. Sampling

    CERN Document Server

    Thompson, Steven K


    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

  14. Home-based care, technology, and the maintenance of selves. (United States)

    Parks, Jennifer A


    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.

  15. The logic of tax-based financing for health care. (United States)

    Bodenheimer, T; Sullivan, K


    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.

  16. Variance optimal sampling based estimation of subset sums

    CERN Document Server

    Cohen, Edith; Kaplan, Haim; Lund, Carsten; Thorup, Mikkel


    From a high volume stream of weighted items, we want to maintain a generic sample of a certain limited size $k$ that we can later use to estimate the total weight of arbitrary subsets. This is the classic context of on-line reservoir sampling, thinking of the generic sample as a reservoir. We present a reservoir sampling scheme providing variance optimal estimation of subset sums. More precisely, if we have seen $n$ items of the stream, then for any subset size $m$, our scheme based on $k$ samples minimizes the average variance over all subsets of size $m$. In fact, the optimality is against any off-line sampling scheme tailored for the concrete set of items seen: no off-line scheme based on $k$ samples can perform better than our on-line scheme when it comes to average variance over any subset size. Our scheme has no positive covariances between any pair of item estimates. Also, our scheme can handle each new item of the stream in $O(\\log k)$ time, which is optimal even on the word RAM.

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

    Directory of Open Access Journals (Sweden)

    Joanna Kobza


    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

  18. [Time based management in health care system: the chosen aspects]. (United States)

    Kobza, Joanna; Syrkiewicz-Świtała, Magdalena


    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.

  19. Improving the evidence base in palliative care to inform practice and policy: thinking outside the box. (United States)

    Aoun, Samar M; Nekolaichuk, Cheryl


    The adoption of evidence-based hierarchies and research methods from other disciplines may not completely translate to complex palliative care settings. The heterogeneity of the palliative care population, complexity of clinical presentations, and fluctuating health states present significant research challenges. The aim of this narrative review was to explore the debate about the use of current evidence-based approaches for conducting research, such as randomized controlled trials and other study designs, in palliative care, and more specifically to (1) describe key myths about palliative care research; (2) highlight substantive challenges of conducting palliative care research, using case illustrations; and (3) propose specific strategies to address some of these challenges. Myths about research in palliative care revolve around evidence hierarchies, sample heterogeneity, random assignment, participant burden, and measurement issues. Challenges arise because of the complex physical, psychological, existential, and spiritual problems faced by patients, families, and service providers. These challenges can be organized according to six general domains: patient, system/organization, context/setting, study design, research team, and ethics. A number of approaches for dealing with challenges in conducting research fall into five separate domains: study design, sampling, conceptual, statistical, and measures and outcomes. Although randomized controlled trials have their place whenever possible, alternative designs may offer more feasible research protocols that can be successfully implemented in palliative care. Therefore, this article highlights "outside the box" approaches that would benefit both clinicians and researchers in the palliative care field. Ultimately, the selection of research designs is dependent on a clearly articulated research question, which drives the research process.

  20. SAMURAI: Polar AUV-Based Autonomous Dexterous Sampling (United States)

    Akin, D. L.; Roberts, B. J.; Smith, W.; Roderick, S.; Reves-Sohn, R.; Singh, H.


    While autonomous undersea vehicles are increasingly being used for surveying and mapping missions, as of yet there has been little concerted effort to create a system capable of performing physical sampling or other manipulation of the local environment. This type of activity has typically been performed under teleoperated control from ROVs, which provides high-bandwidth real-time human direction of the manipulation activities. Manipulation from an AUV will require a completely autonomous sampling system, which implies both advanced technologies such as machine vision and autonomous target designation, but also dexterous robot manipulators to perform the actual sampling without human intervention. As part of the NASA Astrobiology Science and Technology for Exploring the Planets (ASTEP) program, the University of Maryland Space Systems Laboratory has been adapting and extending robotics technologies developed for spacecraft assembly and maintenance to the problem of autonomous sampling of biologicals and soil samples around hydrothermal vents. The Sub-polar ice Advanced Manipulator for Universal Sampling and Autonomous Intervention (SAMURAI) system is comprised of a 6000-meter capable six-degree-of-freedom dexterous manipulator, along with an autonomous vision system, multi-level control system, and sampling end effectors and storage mechanisms to allow collection of samples from vent fields. SAMURAI will be integrated onto the Woods Hole Oceanographic Institute (WHOI) Jaguar AUV, and used in Arctic during the fall of 2007 for autonomous vent field sampling on the Gakkel Ridge. Under the current operations concept, the JAGUAR and PUMA AUVs will survey the water column and localize on hydrothermal vents. Early mapping missions will create photomosaics of the vents and local surroundings, allowing scientists on the mission to designate desirable sampling targets. Based on physical characteristics such as size, shape, and coloration, the targets will be loaded into the

  1. Comparison of metatranscriptomic samples based on k-tuple frequencies.

    Directory of Open Access Journals (Sweden)

    Ying Wang

    Full Text Available BACKGROUND: The comparison of samples, or beta diversity, is one of the essential problems in ecological studies. Next generation sequencing (NGS technologies make it possible to obtain large amounts of metagenomic and metatranscriptomic short read sequences across many microbial communities. De novo assembly of the short reads can be especially challenging because the number of genomes and their sequences are generally unknown and the coverage of each genome can be very low, where the traditional alignment-based sequence comparison methods cannot be used. Alignment-free approaches based on k-tuple frequencies, on the other hand, have yielded promising results for the comparison of metagenomic samples. However, it is not known if these approaches can be used for the comparison of metatranscriptome datasets and which dissimilarity measures perform the best. RESULTS: We applied several beta diversity measures based on k-tuple frequencies to real metatranscriptomic datasets from pyrosequencing 454 and Illumina sequencing platforms to evaluate their effectiveness for the clustering of metatranscriptomic samples, including three d2-type dissimilarity measures, one dissimilarity measure in CVTree, one relative entropy based measure S2 and three classical 1p-norm distances. Results showed that the measure d2(S can achieve superior performance on clustering metatranscriptomic samples into different groups under different sequencing depths for both 454 and Illumina datasets, recovering environmental gradients affecting microbial samples, classifying coexisting metagenomic and metatranscriptomic datasets, and being robust to sequencing errors. We also investigated the effects of tuple size and order of the background Markov model. A software pipeline to implement all the steps of analysis is built and is available at CONCLUSIONS: The k-tuple based sequence signature measures can effectively reveal major groups and

  2. Innovative solutions: sample financial management business plan: neurosurgical intensive care unit. (United States)

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


    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.

  3. Medical Researchers' Ancillary Care Obligations: The Relationship-Based Approach. (United States)

    Olson, Nate W


    In this article, I provide a new account of the basis of medical researchers' ancillary care obligations. Ancillary care in medical research, or medical care that research participants need but that is not required for the validity or safety of a study or to redress research injuries, is a topic that has drawn increasing attention in research ethics over the last ten years. My view, the relationship-based approach, improves on the main existing theory, Richardson and Belsky's 'partial-entrustment model', by avoiding its problematic restriction on the scope of health needs for which researchers could be obligated to provide ancillary care. Instead, it grounds ancillary care obligations in a wide range of morally relevant features of the researcher-participant relationship, including the level of engagement between researchers and participants, and weighs these factors against each other. I argue that the level of engagement, that is, the duration and intensity of interactions, between researchers and participants matters for ancillary care because of its connection to the meaningfulness of a relationship, and I suggest that other morally relevant features can be grounded in researchers' role obligations.

  4. Sampling-based Algorithms for Optimal Motion Planning

    CERN Document Server

    Karaman, Sertac


    During the last decade, sampling-based path planning algorithms, such as Probabilistic RoadMaps (PRM) and Rapidly-exploring Random Trees (RRT), have been shown to work well in practice and possess theoretical guarantees such as probabilistic completeness. However, little effort has been devoted to the formal analysis of the quality of the solution returned by such algorithms, e.g., as a function of the number of samples. The purpose of this paper is to fill this gap, by rigorously analyzing the asymptotic behavior of the cost of the solution returned by stochastic sampling-based algorithms as the number of samples increases. A number of negative results are provided, characterizing existing algorithms, e.g., showing that, under mild technical conditions, the cost of the solution returned by broadly used sampling-based algorithms converges almost surely to a non-optimal value. The main contribution of the paper is the introduction of new algorithms, namely, PRM* and RRT*, which are provably asymptotically opti...

  5. Sample Size Requirements for Traditional and Regression-Based Norms. (United States)

    Oosterhuis, Hannah E M; van der Ark, L Andries; Sijtsma, Klaas


    Test norms enable determining the position of an individual test taker in the group. The most frequently used approach to obtain test norms is traditional norming. Regression-based norming may be more efficient than traditional norming and is rapidly growing in popularity, but little is known about its technical properties. A simulation study was conducted to compare the sample size requirements for traditional and regression-based norming by examining the 95% interpercentile ranges for percentile estimates as a function of sample size, norming method, size of covariate effects on the test score, test length, and number of answer categories in an item. Provided the assumptions of the linear regression model hold in the data, for a subdivision of the total group into eight equal-size subgroups, we found that regression-based norming requires samples 2.5 to 5.5 times smaller than traditional norming. Sample size requirements are presented for each norming method, test length, and number of answer categories. We emphasize that additional research is needed to establish sample size requirements when the assumptions of the linear regression model are violated.

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

    Directory of Open Access Journals (Sweden)

    Kayser Gian


    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

  7. Reliability analysis method for slope stability based on sample weight

    Directory of Open Access Journals (Sweden)

    Zhi-gang YANG


    Full Text Available The single safety factor criteria for slope stability evaluation, derived from the rigid limit equilibrium method or finite element method (FEM, may not include some important information, especially for steep slopes with complex geological conditions. This paper presents a new reliability method that uses sample weight analysis. Based on the distribution characteristics of random variables, the minimal sample size of every random variable is extracted according to a small sample t-distribution under a certain expected value, and the weight coefficient of each extracted sample is considered to be its contribution to the random variables. Then, the weight coefficients of the random sample combinations are determined using the Bayes formula, and different sample combinations are taken as the input for slope stability analysis. According to one-to-one mapping between the input sample combination and the output safety coefficient, the reliability index of slope stability can be obtained with the multiplication principle. Slope stability analysis of the left bank of the Baihetan Project is used as an example, and the analysis results show that the present method is reasonable and practicable for the reliability analysis of steep slopes with complex geological conditions.

  8. An Investigation into the Situation of the Elderly Care in Shunde:Based on the Sampling Survey of the Elderly Population%顺德老年人养老状况的调查分析--基于顺德老年人口状况抽样调查分析

    Institute of Scientific and Technical Information of China (English)

    刘刚桥; 张良桥; 吴卓


    顺德老年人口状况抽样调查涉及老年人居住意愿、经济保障与收支、健康与医疗、居家服务、社会参与以及生活满意度等,本文通过对调查数据的剖析,揭示了顺德老年人养老保障与服务需求的动态变化,以及老龄事业发展过程中存在的问题,并提出了针对性的发展建议。%The sampling survey of the elderly population in Shunde involves willingness to reside, economic security and income and expenses, health and medical care, home services, community participation and life satisfaction. An analysis of the survey data reveals that there are dynamic changes in the elderly care security and service demand, and there are problems existing in the elderly care programs. Finally, certain specific suggestions are put forward.

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


    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

  10. Implementing a community-based self care training initiative: a process evaluation. (United States)

    South, Jane; Darby, Frances; Bagnall, Anne-Marie; White, Alan


    Within the UK, there is growing recognition that individuals will need to take increased responsibility for managing their own health for there to be improvements in population health. The current evidence base on self care interventions reflects an interest in enhancing self care knowledge, skills and behaviour in relation to the management of long-term conditions. In contrast, this paper reports on a community-based self care initiative that was designed to promote self care approaches in the general population. The principal component was a self care skills training course delivered to groups of lay people in community and workplace settings. Self Care for People was piloted in three primary care trusts and a process evaluation was undertaken. The aim of this paper is to examine the feasibility, relevance and acceptability of the initiative. Qualitative interviews were conducted with a sample of stakeholders involved in implementation including coordinators, trainers and key informants from organisations hosting the course. In total 40 interviews and two focus groups were conducted from 2006 to 2008 and the data were analysed thematically. The evaluation found that implementation was relatively straightforward with few major barriers reported. Recruitment to the self care skills training course took place in both workplace and community group settings, including in organisations supporting socially excluded groups. The course was seen to provide a valuable space for contemplation on personal health, however, participation could raise sensitive issues that needed to be dealt with by skilled facilitators. Motivations for involvement differed markedly in host organisations and different strategies for marketing were adopted. The paper concludes by suggesting that while Self Care for People was both feasible and relevant to different stakeholder groups, there needs to be flexibility in responding to the needs of participants in different settings.

  11. Cloud based emergency health care information service in India. (United States)

    Karthikeyan, N; Sukanesh, R


    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

  12. A sampling-based approach to probabilistic pursuit evasion

    KAUST Repository

    Mahadevan, Aditya


    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.

  13. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Helena; Hallström, Inger; Kjaergaard, Hanne


    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...

  14. ATTEND: Toward a Mindfulness-Based Bereavement Care Model (United States)

    Cacciatore, Joanne; Flint, Melissa


    Few, if any, mindfulness-based bereavement care models exist. The ATTEND (attunement, trust, touch, egalitarianism, nuance, and death education) model is an interdisciplinary paradigm for providers, including physicians, social workers, therapists, nursing staff, and others. Using a case example to enhance the breadth and depth of understanding,…

  15. Evidence-based care: 3. Measuring performance: how are we managing this problem? Evidence-Based Care Resource Group.



    The authors have frequently been surprised by discrepancies between what they perceived they were doing and what they found when they audited their medical records. Because these discrepancies are common it is important to measure physician performance to ensure that effective care is being provided. To measure clinical performance physicians must decide what to measure, whether the needed information is available, how to select an appropriate sample of patients, how to collect the informatio...

  16. Evidence-based medicine and quality of care. (United States)

    Dickenson, Donna; Vineis, Paolo


    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.

  17. Integrating care coordination home telehealth and home based primary care in rural Oklahoma: a pilot study. (United States)

    Sorocco, Kristen H; Bratkovich, Kristi L; Wingo, Rita; Qureshi, Saleem M; Mason, Patrick J


    The purpose of this program was to evaluate the benefits of integrating VA Care Coordination Home Telehealth and Telemental health within HBPC. A case study design was used to determine quality assurance and quality improvement of incorporating additional home telehealth equipment within Home Based Primary Care (HBPC). Veterans with complex medical conditions and their caregivers living in rural Oklahoma were enrolled. Veterans received the same care other HBPC patients received with the addition of home telehealth equipment. Members from the interdisciplinary treatment team were certified to use the telehealth equipment. Veterans and their caregivers were trained on use of the equipment in their homes. Standard HBPC program measures were used to assess the program success. Assessments from all disciplines on the HBPC team were at baseline, 3, and 6 months, and participants provided satisfaction and interview data to assess the benefits of integrating technology into standard care delivery within an HBPC program. Six veterans were enrolled (mean age = 72 yrs) with a range of physical health conditions including: chronic obstructive pulmonary disease, cerebrovascular accident, spinal cord injury, diabetes, hypertension, and syncope. Primary mental health conditions included depression, dementia, anxiety, and PTSD. Scores on the Mini-Mental State Examination ranged from 18 to 30. Over a 6-month period, case studies indicated improvements in strength, social functioning, decreased caregiver burden, and compliance with treatment plan. This integration of CCHT and HBPC served previously underserved rural veterans having complex medical conditions and appears both feasible and clinically beneficial to veterans and their caregivers.

  18. SVM Intrusion Detection Model Based on Compressed Sampling

    Directory of Open Access Journals (Sweden)

    Shanxiong Chen


    Full Text Available Intrusion detection needs to deal with a large amount of data; particularly, the technology of network intrusion detection has to detect all of network data. Massive data processing is the bottleneck of network software and hardware equipment in intrusion detection. If we can reduce the data dimension in the stage of data sampling and directly obtain the feature information of network data, efficiency of detection can be improved greatly. In the paper, we present a SVM intrusion detection model based on compressive sampling. We use compressed sampling method in the compressed sensing theory to implement feature compression for network data flow so that we can gain refined sparse representation. After that SVM is used to classify the compression results. This method can realize detection of network anomaly behavior quickly without reducing the classification accuracy.

  19. A research on fast FCM algorithm based on weighted sample

    Institute of Scientific and Technical Information of China (English)

    KUANG Ping; ZHU Qing-xin; WANG Ming-wen; CHEN Xu-dong; QING Li


    To improve the computational performance of the fuzzy C-means (FCM) algorithm used in dataset clustering with large numbers,the concepts of the equivalent samples and the weighting samples based on eigenvalue distribution of the samples in the feature space were introduced and a novel fast cluster algorithm named weighted fuzzy C-means (WFCM) algorithm was put forward,which came from the traditional FCM algorithm.It was proved that the duster results were equivalent in dataset with two different cluster algorithms:WFCM and FCM.Furthermore,the WFCM algorithm had better computational performance than the ordinary FCM algorithm.The experiment of the gray image segmentation showed that the WFCM algorithm is a fast and effective cluster algorithm.

  20. The magnitude, share and determinants of unpaid care costs for home-based palliative care service provision in Toronto, Canada. (United States)

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


    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.


    Institute of Scientific and Technical Information of China (English)

    NI Zhongxin; FEI Heliang


    In reliability theory and survival analysis,the problem of point estimation based on the censored sample has been discussed in many literatures.However,most of them are focused on MLE,BLUE etc;little work has been done on the moment-method estimation in censoring case.To make the method of moment estimation systematic and unifiable,in this paper,the moment-method estimators(abbr.MEs) and modified momentmethod estimators(abbr.MMEs) of the parameters based on type I and type Ⅱ censored samples are put forward involving mean residual lifetime. The strong consistency and other properties are proved. To be worth mentioning,in the exponential distribution,the proposed moment-method estimators are exactly MLEs. By a simulation study,in the view point of bias and mean square of error,we show that the MEs and MMEs are better than MLEs and the "pseudo complete sample" technique introduced in Whitten et al.(1988).And the superiority of the MEs is especially conspicuous,when the sample is heavily censored.

  2. DNA barcoding: error rates based on comprehensive sampling.

    Directory of Open Access Journals (Sweden)

    Christopher P Meyer


    Full Text Available DNA barcoding has attracted attention with promises to aid in species identification and discovery; however, few well-sampled datasets are available to test its performance. We provide the first examination of barcoding performance in a comprehensively sampled, diverse group (cypraeid marine gastropods, or cowries. We utilize previous methods for testing performance and employ a novel phylogenetic approach to calculate intraspecific variation and interspecific divergence. Error rates are estimated for (1 identifying samples against a well-characterized phylogeny, and (2 assisting in species discovery for partially known groups. We find that the lowest overall error for species identification is 4%. In contrast, barcoding performs poorly in incompletely sampled groups. Here, species delineation relies on the use of thresholds, set to differentiate between intraspecific variation and interspecific divergence. Whereas proponents envision a "barcoding gap" between the two, we find substantial overlap, leading to minimal error rates of approximately 17% in cowries. Moreover, error rates double if only traditionally recognized species are analyzed. Thus, DNA barcoding holds promise for identification in taxonomically well-understood and thoroughly sampled clades. However, the use of thresholds does not bode well for delineating closely related species in taxonomically understudied groups. The promise of barcoding will be realized only if based on solid taxonomic foundations.

  3. Missile trajectory shaping using sampling-based path planning


    Pharpatara, Pawit; Pepy, Romain; Hérissé, Bruno; Bestaoui, Yasmina


    International audience; This paper presents missile guidance as a complex robotic problem: a hybrid non-linear system moving in a heterogeneous environment. The proposed solution to this problem combines a sampling-based path planner, Dubins' curves and a locally-optimal guidance law. This algorithm aims to find feasible trajectories that anticipate future flight conditions, especially the loss of manoeuverability at high altitude. Simulated results demonstrate the substantial performance imp...

  4. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

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


    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, an...... and the psychosocial burden on the family does not increase. Pediatr Blood Cancer © 2013 Wiley Periodicals, Inc.......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......, and cost. A controlled trial was conducted to assess children's health-related quality of life (HRQOL) using the parent-reported and self-reported PedsQL Generic Core Scale and PedsQL Cancer Module, and the psychosocial impact on the family by PedsQL Family Impact Module comprising a subsample of 28...

  5. An outcomes approach to stroke care: the importance of teamwork and evidence-based nursing care. (United States)

    Middleton, Sandy


    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.

  6. Standardized mortality ratio analysis on a sample of severely injured patients from a large Canadian city without regionalized trauma care. (United States)

    Sampalis, J S; Lavoie, A; Williams, J I; Mulder, D S; Kalina, M


    Flora's Z statistic and standardized mortality ratios (SMRs) as indicators of excess mortality were calculated for a sample of 355 patients with major trauma. A statistically significant overall excess mortality was observed in this sample (Z = 6.77, SMR = 1.81, p less than 0.05). Advanced life support provided by physicians at the scene (MD-ALS) was not associated with reduced excess mortality. A significant trend toward lower excess mortality was associated with a higher level of trauma care at the receiving hospital (p less than 0.05). Total prehospital time over 60 minutes was associated with a significant increase in excess mortality (p less than 0.001). These results support regionalization of trauma care and failed to show any benefit associated with MD-ALS.

  7. Evaluation of the integrated community based home care model

    Directory of Open Access Journals (Sweden)

    LR Uys


    Full Text Available In 1999-2000 the Integrated Community-Based Home Care model for the care of people with AIDS in communities were implemented in seven sites across the country. The post-implementation evaluation showed that most respondents felt that the model could be replicated if a functioning and informed network including all partners, and a strong management team were in place. The effects of the project were mainly positive for all stakeholders (hospice, clinic, hospital, PWA and their carers, professionals and other community members. Hospitals and community- based services became more aware of and involved in the needs of PWA and felt that the model enabled them to address these needs. PWA and their carers felt supported and respected.

  8. Smartphone based point-of-care detector of urine albumin (United States)

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


    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.

  9. Improved pulse laser ranging algorithm based on high speed sampling (United States)

    Gao, Xuan-yi; Qian, Rui-hai; Zhang, Yan-mei; Li, Huan; Guo, Hai-chao; He, Shi-jie; Guo, Xiao-kang


    Narrow pulse laser ranging achieves long-range target detection using laser pulse with low divergent beams. Pulse laser ranging is widely used in military, industrial, civil, engineering and transportation field. In this paper, an improved narrow pulse laser ranging algorithm is studied based on the high speed sampling. Firstly, theoretical simulation models have been built and analyzed including the laser emission and pulse laser ranging algorithm. An improved pulse ranging algorithm is developed. This new algorithm combines the matched filter algorithm and the constant fraction discrimination (CFD) algorithm. After the algorithm simulation, a laser ranging hardware system is set up to implement the improved algorithm. The laser ranging hardware system includes a laser diode, a laser detector and a high sample rate data logging circuit. Subsequently, using Verilog HDL language, the improved algorithm is implemented in the FPGA chip based on fusion of the matched filter algorithm and the CFD algorithm. Finally, the laser ranging experiment is carried out to test the improved algorithm ranging performance comparing to the matched filter algorithm and the CFD algorithm using the laser ranging hardware system. The test analysis result demonstrates that the laser ranging hardware system realized the high speed processing and high speed sampling data transmission. The algorithm analysis result presents that the improved algorithm achieves 0.3m distance ranging precision. The improved algorithm analysis result meets the expected effect, which is consistent with the theoretical simulation.

  10. A haplotype inference algorithm for trios based on deterministic sampling

    Directory of Open Access Journals (Sweden)

    Iliadis Alexandros


    Full Text Available Abstract Background In genome-wide association studies, thousands of individuals are genotyped in hundreds of thousands of single nucleotide polymorphisms (SNPs. Statistical power can be increased when haplotypes, rather than three-valued genotypes, are used in analysis, so the problem of haplotype phase inference (phasing is particularly relevant. Several phasing algorithms have been developed for data from unrelated individuals, based on different models, some of which have been extended to father-mother-child "trio" data. Results We introduce a technique for phasing trio datasets using a tree-based deterministic sampling scheme. We have compared our method with publicly available algorithms PHASE v2.1, BEAGLE v3.0.2 and 2SNP v1.7 on datasets of varying number of markers and trios. We have found that the computational complexity of PHASE makes it prohibitive for routine use; on the other hand 2SNP, though the fastest method for small datasets, was significantly inaccurate. We have shown that our method outperforms BEAGLE in terms of speed and accuracy for small to intermediate dataset sizes in terms of number of trios for all marker sizes examined. Our method is implemented in the "Tree-Based Deterministic Sampling" (TDS package, available for download at Conclusions Using a Tree-Based Deterministic sampling technique, we present an intuitive and conceptually simple phasing algorithm for trio data. The trade off between speed and accuracy achieved by our algorithm makes it a strong candidate for routine use on trio datasets.


    Directory of Open Access Journals (Sweden)

    Kristjana Ýr Jónsdóttir


    Full Text Available In the present paper, Lévy-based error prediction in circular systematic sampling is developed. A model-based statistical setting as in Hobolth and Jensen (2002 is used, but the assumption that the measurement function is Gaussian is relaxed. The measurement function is represented as a periodic stationary stochastic process X obtained by a kernel smoothing of a Lévy basis. The process X may have an arbitrary covariance function. The distribution of the error predictor, based on measurements in n systematic directions is derived. Statistical inference is developed for the model parameters in the case where the covariance function follows the celebrated p-order covariance model.

  12. Cooperative Sequential Spectrum Sensing Based on Level-triggered Sampling

    CERN Document Server

    Yilmaz, Yasin; Wang, Xiaodong


    We propose a new framework for cooperative spectrum sensing in cognitive radio networks, that is based on a novel class of non-uniform samplers, called the event-triggered samplers, and sequential detection. In the proposed scheme, each secondary user computes its local sensing decision statistic based on its own channel output; and whenever such decision statistic crosses certain predefined threshold values, the secondary user will send one (or several) bit of information to the fusion center. The fusion center asynchronously receives the bits from different secondary users and updates the global sensing decision statistic to perform a sequential probability ratio test (SPRT), to reach a sensing decision. We provide an asymptotic analysis for the above scheme, and under different conditions, we compare it against the cooperative sensing scheme that is based on traditional uniform sampling and sequential detection. Simulation results show that the proposed scheme, using even 1 bit, can outperform its uniform ...

  13. Dense mesh sampling for video-based facial animation (United States)

    Peszor, Damian; Wojciechowska, Marzena


    The paper describes an approach for selection of feature points on three-dimensional, triangle mesh obtained using various techniques from several video footages. This approach has a dual purpose. First, it allows to minimize the data stored for the purpose of facial animation, so that instead of storing position of each vertex in each frame, one could store only a small subset of vertices for each frame and calculate positions of others based on the subset. Second purpose is to select feature points that could be used for anthropometry-based retargeting of recorded mimicry to another model, with sampling density beyond that which can be achieved using marker-based performance capture techniques. Developed approach was successfully tested on artificial models, models constructed using structured light scanner, and models constructed from video footages using stereophotogrammetry.

  14. Home-based Palliative Care: A Strategy for Keeping Intensive Care Unit Beds Vacant

    Directory of Open Access Journals (Sweden)

    Heshmatolah Heydari


    Full Text Available The increasing prevalence of chronic diseases throughout the world is an undeniable phenomenon; 395,000 deaths occurred in Iran in 2014 and about 76% of them were related to chronic diseases.1 Cancer is one of the chronic diseases that are progressing rapidly. In Iran, cancer is known as the third cause of death. Adult morbidity rate of cancer in different regions of Iran is estimated 48-112 cases per million people among the females and 51-144 cases per million people among the males.2 Also, mortality rate related to cancer was about 53500 people in 2014.3 In fact, 13% of all deaths related to chronic diseases are caused by cancer1 and the majority of cancer patients expire in the intensive care units (ICU, whereas bed occupancy of ICUs is in crises, being about 100% in Iran. For each ICU bed, 4 people are applicants. In this situation, firstly, a number of patients do not have access to the ICU beds, and secondly, because of the need to ICU beds, the admitted patients in ICU wards are discharged earlier than the standard time for each disease. According to the head of the Intensive Care association, the shortage of ICU beds is about ten thousand in Iran, whereas setting up each ICU bed requires a high cost.4 In the current condition, due to the high cost and shortage of nurses in Iran, setting up of ICU beds is a challenge for the health system. WHO introduced home-based palliative care to improve the quality of life, quality of care, quality of death and patient satisfaction; decrease burnout in staffing and mortality in hospitals; reduce the cost, accept end of life as live days; neither accelerate death nor prolong life; consider all dimensions of human; help the patients to be active until the time of death; help the patient’s family to cope with the disease and loss of patient; and release the beds in hospitals.5 Although hospital beds are considered for healing the patients not a hospice for them, the majority of cancer patients die in

  15. At-risk drinking in an HMO primary care sample: prevalence and health policy implications. (United States)

    Fleming, M F; Manwell, L B; Barry, K L; Johnson, K


    OBJECTIVES: This study was designed to determine the prevalence of at-risk drinking using varying alcohol use criteria. METHODS: A period prevalence survey was conducted in 22 primary care practices (n = 19372 adults). RESULTS: The frequency of at-risk alcohol use varied from 7.5% (World Health Organization criteria) to 19.7% (National Institute on Alcohol Abuse and Alcoholism criteria). A stepwise logistic model using National Institute on Alcohol Abuse and Alcoholism criteria found male gender, current tobacco use, never married status, retirement, and unemployment to be significant predictors of at-risk alcohol use. CONCLUSIONS: Public health policy needs to move to a primary care paradigm focusing on identification and treatment of at-risk drinkers. PMID:9584040

  16. Microfluidic Paper-Based Sample Concentration Using Ion Concentration Polarization with Smartphone Detection

    Directory of Open Access Journals (Sweden)

    Xue Li


    Full Text Available A simple method for microfluidic paper-based sample concentration using ion concentration polarization (ICP with smartphone detection is developed. The concise and low-cost microfluidic paper-based ICP analytical device, which consists of a black backing layer, a nitrocellulose membrane, and two absorbent pads, is fabricated with the simple lamination method which is widely used for lateral flow strips. Sample concentration on the nitrocellulose membrane is monitored in real time by a smartphone whose camera is used to collect the fluorescence images from the ICP device. A custom image processing algorithm running on the smartphone is used to track the concentrated sample and obtain its fluorescence signal intensity for quantitative analysis. Two different methods for Nafion coating are evaluated and their performances are compared. The characteristics of the ICP analytical device especially with intentionally adjusted physical properties are fully evaluated to optimize its performance as well as to extend its potential applications. Experimental results show that significant concentration enhancement with fluorescence dye sample is obtained with the developed ICP device when a fast depletion of fluorescent dye is observed. The platform based on the simply laminated ICP device with smartphone detection is desired for point-of-care testing in settings with poor resources.

  17. Recognition of human face based on improved multi-sample

    Institute of Scientific and Technical Information of China (English)

    LIU Xia; LI Lei-lei; LI Ting-jun; LIU Lu; ZHANG Ying


    In order to solve the problem caused by variation illumination in human face recognition, we bring forward a face recognition algorithm based on the improved muhi-sample. In this algorithm, the face image is processed with Retinex theory, meanwhile, the Gabor filter is adopted to perform the feature extraction. The experimental results show that the application of Retinex theory improves the recognition accuracy, and makes the algorithm more robust to the variation illumination. The Gabor filter is more effective and accurate for extracting more useable facial local features. It is proved that the proposed algorithm has good recognition accuracy and it is stable under variation illumination.

  18. Managing evidence-based health care: a diagnostic framework. (United States)

    Newman, K; Pyne, T; Cowling, A


    This paper proposes a diagnostic framework useful to Trust managers who are faced with the task of devising and implementing strategies for improvements in clinical effectiveness, and is based on a recent study incorporating clinicians, managers, and professional staff in four NHS Trusts in the North Thames Region. The gap framework is inspired by the gap model developed by Zeithaml, Parasuraman and Berry from their research into service quality and incorporates Dave Sackett's schema as well as a personal competency profile needed for the practice of evidence based health-care (EBHC). The paper highlights the four organisational and personal failures (gaps) which contribute to the fifth gap, namely the discrepancy between clinically relevant research evidence and its implementation in health care. To close the gaps, Trusts need to set the goal and tackle the cultural, organisational, attitudinal and more material aspects such as investment in the information infrastructure, education and training of doctors. Doctors need to go through a process from awareness to action facilitated through a combination of personal and organisational incentives and rewards as well as training in the requisite skills. Researchers should take steps to improve the quality of the evidence and its accessibility and purchasers should reinforce the use of EBHC by withdrawing funding for care which has proved to be ineffective, inappropriate or inferior.

  19. Variational level set segmentation for forest based on MCMC sampling (United States)

    Yang, Tie-Jun; Huang, Lin; Jiang, Chuan-xian; Nong, Jian


    Environmental protection is one of the themes of today's world. The forest is a recycler of carbon dioxide and natural oxygen bar. Protection of forests, monitoring of forest growth is long-term task of environmental protection. It is very important to automatically statistic the forest coverage rate using optical remote sensing images and the computer, by which we can timely understand the status of the forest of an area, and can be freed from tedious manual statistics. Towards the problem of computational complexity of the global optimization using convexification, this paper proposes a level set segmentation method based on Markov chain Monte Carlo (MCMC) sampling and applies it to forest segmentation in remote sensing images. The presented method needs not to do any convexity transformation for the energy functional of the goal, and uses MCMC sampling method with global optimization capability instead. The possible local minima occurring by using gradient descent method is also avoided. There are three major contributions in the paper. Firstly, by using MCMC sampling, the convexity of the energy functional is no longer necessary and global optimization can still be achieved. Secondly, taking advantage of the data (texture) and knowledge (a priori color) to guide the construction of Markov chain, the convergence rate of Markov chains is improved significantly. Finally, the level set segmentation method by integrating a priori color and texture for forest is proposed. The experiments show that our method can efficiently and accurately segment forest in remote sensing images.

  20. CdTe detector based PIXE mapping of geological samples

    Energy Technology Data Exchange (ETDEWEB)

    Chaves, P.C., E-mail: [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)


    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.

  1. [De-institutionalization of mental health and care practices in the context of home-based care]. (United States)

    Amorim, Ana Karenina de Melo Arraes; Dimenstein, Magda


    In Brazil, the home-based care services (HCS) are considered strategic and essential in the de-institutionalization process of patients who passed years in psychiatric hospitals and lost their family and social links. However, this service faces a series of problems and challenges in the wider context of health care. This article seeks to analyze some of these problems and challenges based on the experience of the home-based care service in Natal RN and on the literature in this field. Proposed on the basis of the idea that the encounters between insanity and city are potent destructors of the ' asylum logic' , these home-based care services put in question the current healthcare model, claiming to destruct the rigid and hegemonic forms of residence and care. The aim of this article is to discuss this ' asylum logic' that surpasses the limits of the concrete insane asylum penetrating some daily practices of the substitute services, taking advantage of the weak articulation between the mental health services. The lack of a strong connection between the home-based care service and the psychosocial care center allows this logic to operate through day-by-day bio-political devices. Thus, we discuss the risks of this logic taking over and indicate some possibilities of avoiding this, defending a care model allowing for potent meetings with the city and for the construction of ' affectionate networks' producing life and liberty.

  2. Evidence-based Health Care via Multi-Criteria Decision Analytic decision

    DEFF Research Database (Denmark)

    Kjer Kaltoft, Mette; Dowie, Jack

    ’Evidence-based Health Care via Multi-Criteria Decision Analytic decision support: a Danish case study......’Evidence-based Health Care via Multi-Criteria Decision Analytic decision support: a Danish case study...

  3. A framework to support team-based models of primary care within the Australian health care system. (United States)

    Naccarella, Lucio; Greenstock, Louise N; Brooks, Peter M


    Health systems with strong primary care orientations are known to be associated with improved equity, better access for patients to appropriate services at lower costs, and improved population health. Team-based models of primary care have emerged in response to health system challenges due to complex patient profiles, patient expectations and health system demands. Successful team-based models of primary care require a combination of interprofessional education and learning; organisational and management policies and systems; and practice support systems. To ensure evidence is put into practice, we propose a framework comprising five domains (theory, implementation, infrastructure, sustainability and evaluation) to assist policymakers, educators, researchers, managers and health professionals in supporting team-based models of primary care within the Australian health care system.

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

    Directory of Open Access Journals (Sweden)

    Kelly Concannon


    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.

  5. 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


    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

  6. Practice based research networks impacting periodontal care: PEARL Initiative. (United States)

    Curro, Frederick A; Thompson, Van P; Grill, Ashley; Vena, Don; Terracio, Louis; Naftolin, Frederick


    In 2005, the National Institute of Dental and Craniofacial Research /National Institutes of Health funded the largest initiative to date to affect change in the delivery of oral care. This commentary provides the background for the first study related to periodontics in a Practice Based Research Network (PBRN). It was conducted in the Practitioners Engaged in Applied Research & Learning (PEARL) Network. The PEARL Network is headquartered at New York University College of Dentistry. The basic tenet of the PBRN initiative is to engage clinicians to participate in clinical studies, where they will be more likely to accept the results and to incorporate the findings into their practices. This process may reduce the translational gap that exists between new findings and the time it takes for them to be incorporated into clinical practice. The cornerstone of the PBRN studies is to conduct comparative effectiveness research studies to disseminate findings to the profession and improve care. This is particularly important because the majority of dentists practice independently. Having practitioners generate clinical data allows them to contribute in the process of knowledge development and incorporate the results in their practice to assist in closing the translational gap. With the advent of electronic health systems on the horizon, dentistry may be brought into the mainstream health care paradigm and the PBRN concept can serve as the skeletal framework for advancing the profession provided there is consensus on the terminology used.

  7. Work-based learning in health care environments. (United States)

    Spouse, J


    In reviewing contemporary literature and theories about work-based learning, this paper explores recent trends promoting life-long learning. In the process the paper reviews and discusses some implications of implementing recent policies and fostering le arning in health care practice settings. Recent Government policies designed to provide quality health care services and to improve staffing levels in the nursing workforce, have emphasized the importance of life-long learning whilst learning-on-the-job and the need to recognize and credit experiential learning. Such calls include negotiation of personal development plans tailored to individual educational need and context-sensitive learning activities. To be implemented effectively, this policy cann ot be seen as a cheap option but requires considerable financial resourcing for preparation of staff and the conduct of such activities. Successful work-based learning requires investment in staff at all levels as well as changes to staffing structures in organizations and trusts; changes designed to free people up to work and learn collaboratively. Creating an organizational environment where learning is prized depends upon a climate of trust; a climate where investigation and speculation are fostered and where time is protected for engaging in discussions about practice. Such a change may be radical for many health care organizations and may require a review of current policies and practices ensuring that they include education at all levels. The nature of such education also requires reconceptualizing. In the past, learning in practice settings was seen as formal lecturing or demonstration, and relied upon behaviourist principles of learning. Contemporary thinking suggests effective learning in work-settings is multi-faceted and draws on previously acquired formal knowledge, contextualizes it and moulds it according to situations at hand. Thinking about work-based learning in this way raises questions about how such

  8. Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings (United States)

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


    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…

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

    Directory of Open Access Journals (Sweden)

    Shearer Aiden


    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.

  10. Factor structure of the SOCRATES in a sample of primary care patients. (United States)

    Maisto, S A; Conigliaro, J; McNeil, M; Kraemer, K; O'Connor, M; Kelley, M E


    Motivation or readiness to change has been studied intensively in recent years in research on the use of brief interventions to change alcohol problems in the primary care setting. The purpose of this study was to investigate the factor structure and concurrent and predictive evidence for validity of the short Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), a 19-item self-report instrument developed to measure readiness to change alcohol problems in individuals presenting for specialized alcohol treatment. The participants were 210 men and 91 women who were identified as "at-risk" drinkers in 13 community primary care clinics. These individuals completed the SOCRATES and a number of other assessments as part of a preintervention evaluation. A principal components analysis of the SOCRATES data revealed a two-factor structure: a confirmatory factor analysis showed that this structure was a better fit to the data than the three-factor structure that Miller and Tonigan (1996) identified for the SOCRATES. The two factors (9 and 6 items, respectively), seemed to measure perceived degree of severity of an existing alcohol problem (called "Amrec" because it consisted of Miller and Tonigan's ambivalence and recognition items) and taking action to change or to maintain changes in one that exists (called "Taking Steps"). Predictions of significant and nonsignificant correlations between the two derived factors and other baseline variables (alcohol consumption, related problems and symptoms, and demographic factors) generally were confirmed. In addition, baseline Amrec scores were related in predicted directions to 6-month alcohol consumption and related problems data, but the magnitude of these relationships were reduced when other variables that correlated with Amrec or when the 6-month data were taken into account. In general, Taking Steps showed little or no relationship to the 6-month data. The results are compared to previous work with the SOCRATES

  11. Preview-based sampling for controlling gaseous simulations

    KAUST Repository

    Huang, Ruoguan


    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.

  12. Methods for point-of-care detection of nucleic acid in a sample (United States)

    Bearinger, Jane P.; Dugan, Lawrence C.


    Provided herein are methods and apparatus for detecting a target nucleic acid in a sample and related methods and apparatus for diagnosing a condition in an individual. The condition is associated with presence of nucleic acid produced by certain pathogens in the individual.

  13. Apparatus for point-of-care detection of nucleic acid in a sample (United States)

    Bearinger, Jane P.; Dugan, Lawrence C.


    Provided herein are methods and apparatus for detecting a target nucleic acid in a sample and related methods and apparatus for diagnosing a condition in an individual. The condition is associated with presence of nucleic acid produced by certain pathogens in the individual.

  14. Design-based Sample and Probability Law-Assumed Sample: Their Role in Scientific Investigation. (United States)

    Ojeda, Mario Miguel; Sahai, Hardeo


    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.…

  15. 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...... bonded by ultrasonic welding. In the sub-projects of this PhD, improvements have been made to multiple aspects of fabricating and conducting droplet (or multiphase) microfluidics: • Design phase: Numerical prediction of the capillary burst pressure of a multiphase system. • Fabrication: Two new types...... here were fabricated exclusive using commercially relevant fabrication methods such as injection moulding and ultrasonic welding. Further, to reduce the complexity of the final system, I have worked towards an all-in-one device which includes sample loading, priming (removal of air), droplet formation...

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

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle, Pharm.D.


    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

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

    Directory of Open Access Journals (Sweden)

    Peng Qingchao


    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.

  18. Full-cost determination of different levels of care in the intensive care unit. An activity-based costing approach. (United States)

    Doyle, J J; Casciano, J P; Arikian, S R; Mauskopf, J; Paul, J E


    We applied an activity-based costing methodology to determine the full cost of intensive care service at a community hospital, a university hospital and a health maintenance organisation (HMO)-affiliated hospital. A total of 5 patient care units were analysed: the intensive care unit (ICU) and surgical ICU (SICU) at the university setting, the ICU at the community setting, and the SICU and cardiac care unit at the HMO setting. The selection of the different ICU types was based on the types of critical care units that were found in each setting (e.g. the HMO did not have an ICU). Institution-specific cost data and clinical management parameters were collected through surveys and site visits from the 3 respective organisation types. The analysis revealed a marked increase in patient-minute cost associated with mechanical ventilation. Higher costs associated with prolonged neuromuscular blockade have important economic implications with respect to selection of an appropriate neuromuscular blocking agent.

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

    NARCIS (Netherlands)

    C. de Blok; K. Luijkx; B. Meijboom; J. Schols


    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 d

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

    LENUS (Irish Health Repository)

    Fitzsimons, Mary


    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.

  1. SAR imaging method based on coprime sampling and nested sparse sampling

    Institute of Scientific and Technical Information of China (English)

    Hongyin Shi; Baojing Jia


    As the signal bandwidth and the number of channels increase, the synthetic aperture radar (SAR) imaging system pro-duces huge amount of data according to the Shannon-Nyquist theorem, causing a huge burden for data transmission. This pa-per concerns the coprime sampling and nested sparse sampling, which are proposed recently but have never been applied to real world for target detection, and proposes a novel way which uti-lizes these new sub-Nyquist sampling structures for SAR sam-pling in azimuth and reconstructs the data of SAR sampling by compressive sensing (CS). Both the simulated and real data are processed to test the algorithm, and the results indicate the way which combines these new undersampling structures and CS is able to achieve the SAR imaging effectively with much less data than regularly ways required. Final y, the influence of a little sam-pling jitter to SAR imaging is analyzed by theoretical analysis and experimental analysis, and then it concludes a little sampling jitter have no effect on image quality of SAR.

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

    Directory of Open Access Journals (Sweden)

    Xiaomeng Zhang


    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.

  3. Space Group Debris Imaging Based on Sparse Sample

    Directory of Open Access Journals (Sweden)

    Zhu Jiang


    Full Text Available Space group debris imaging is difficult with sparse data in low Pulse Repetition Frequency (PRF spaceborne radar. To solve this problem in the narrow band system, we propose a method for space group debris imaging based on sparse samples. Due to the diversity of mass, density, and other factors, space group debris typically rotates at a high speed in different ways. We can obtain angular velocity through the autocorrelation function based on the diversity in the angular velocity. The scattering field usually presents strong sparsity, so we can utilize the corresponding measurement matrix to extract the data of different debris and then combine it using the sparse method to reconstruct the image. Furthermore, we can solve the Doppler ambiguity with the measurement matrix in low PRF systems and suppress some energy of other debris. Theoretical analysis confirms the validity of this methodology. Our simulation results demonstrate that the proposed method can achieve high-resolution Inverse Synthetic Aperture Radar (ISAR images of space group debris in low PRF systems.

  4. Incorporating Mobile Phone Technologies to Expand Evidence-Based Care. (United States)

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


    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.

  5. Value-based health care for inflammatory bowel diseases. (United States)

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


    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.

  6. Infrared imaging-based combat casualty care system (United States)

    Davidson, James E., Sr.


    A Small Business Innovative Research (SBIR) contract was recently awarded to a start up company for the development of an infrared (IR) image based combat casualty care system. The company, Medical Thermal Diagnostics, or MTD, is developing a light weight, hands free, energy efficient uncooled IR imaging system based upon a Texas Instruments design which will allow emergency medical treatment of wounded soldiers in complete darkness without any type of light enhancement equipment. The principal investigator for this effort, Dr. Gene Luther, DVM, Ph.D., Professor Emeritus, LSU School of Veterinary Medicine, will conduct the development and testing of this system with support from Thermalscan, Inc., a nondestructive testing company experienced in IR thermography applications. Initial research has been done with surgery on a cat for feasibility of the concept as well as forensic research on pigs as a close representation of human physiology to determine time of death. Further such studies will be done later as well as trauma studies. IR images of trauma injuries will be acquired by imaging emergency room patients to create an archive of emergency medical situations seen with an infrared imaging camera. This archived data will then be used to develop training material for medical personnel using the system. This system has potential beyond military applications. Firefighters and emergency medical technicians could directly benefit from the capability to triage and administer medical care to trauma victims in low or no light conditions.

  7. 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


    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.

  8. Trends in monitoring pharmaceuticals and personal-care products in the aquatic environment by use of passive sampling devices (United States)

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


    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.

  9. Using the GAD-Q-IV to identify generalized anxiety disorder in psychiatric treatment seeking and primary care medical samples. (United States)

    Moore, Michael T; Anderson, Nicholas L; Barnes, Jill M; Haigh, Emily A P; Fresco, David M


    The fourth edition of the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV) is a self-report measure that is commonly used to screen for the presence of generalized anxiety disorder (GAD). The current investigation attempted to identify an optimal cut score using samples obtained from an outpatient psychiatric (n=163) and primary care clinic (n=99). Results indicated that a cut score of 7.67 provided an optimal balance of sensitivity (.85) and specificity (.74) comparable to a previously identified cut score (5.7) across both samples (sensitivity=.90, specificity=.66). However, both cut scores were consistently outperformed by a score representing the criteria for GAD described in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (sensitivity=.89, specificity=.82).

  10. An Optimization-Based Sampling Scheme for Phylogenetic Trees (United States)

    Misra, Navodit; Blelloch, Guy; Ravi, R.; Schwartz, Russell

    Much modern work in phylogenetics depends on statistical sampling approaches to phylogeny construction to estimate probability distributions of possible trees for any given input data set. Our theoretical understanding of sampling approaches to phylogenetics remains far less developed than that for optimization approaches, however, particularly with regard to the number of sampling steps needed to produce accurate samples of tree partition functions. Despite the many advantages in principle of being able to sample trees from sophisticated probabilistic models, we have little theoretical basis for concluding that the prevailing sampling approaches do in fact yield accurate samples from those models within realistic numbers of steps. We propose a novel approach to phylogenetic sampling intended to be both efficient in practice and more amenable to theoretical analysis than the prevailing methods. The method depends on replacing the standard tree rearrangement moves with an alternative Markov model in which one solves a theoretically hard but practically tractable optimization problem on each step of sampling. The resulting method can be applied to a broad range of standard probability models, yielding practical algorithms for efficient sampling and rigorous proofs of accurate sampling for some important special cases. We demonstrate the efficiency and versatility of the method in an analysis of uncertainty in tree inference over varying input sizes. In addition to providing a new practical method for phylogenetic sampling, the technique is likely to prove applicable to many similar problems involving sampling over combinatorial objects weighted by a likelihood model.

  11. Cost analysis of prenatal care using the activity-based costing model: a pilot study. (United States)

    Gesse, T; Golembeski, S; Potter, J


    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.

  12. The Baryonic Tully-Fisher Relation cares about the Galaxy Sample

    CERN Document Server

    G., Sorce Jenny


    The Baryonic Tully-Fisher relation (BTFR) is a clear manifestation of the underlying physics of galaxy formation. As such, it is used to constrain and test galaxy formation and evolution models. Of particular interest, apart from the slope of the relation, is its intrinsic scatter. In this paper, we use the EAGLE simulation to study the dependence of the BTFR on the size of the simulated galaxy sample. The huge number of datapoint available in the simulation is indeed not available with current observations. Observational studies that computed the BTFR used various (small) size samples with the only obligation to have galaxies spanning over a large range of masses and rotation rates. Accordingly, to compare observational and theoretical results, we build a large number of various size datasets using the same criterion and derive the BTFR for all of them. Unmistakably, their is an effect of the number of galaxies used to derive the relation. The smaller the number, the larger the standard deviation around the ...

  13. Exploring information systems outsourcing in U.S. hospital-based health care delivery systems. (United States)

    Diana, Mark L


    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.

  14. Interview-based Qualitative Research in Emergency Care Part II: Data Collection, Analysis and Results Reporting. (United States)

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


    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.

  15. What matters most for end-of-life care? Perspectives from community-based palliative care providers and administrators (United States)

    Mistry, Bina; Bainbridge, Daryl; Bryant, Deanna; Tan Toyofuku, Sue; Seow, Hsien


    Objectives There has been little research conducted to understand the essential meaning of quality, community-based, end-of-life (EOL) care, despite the expansion of these services. The purpose of this study was to define what matters most for EOL care from the perspective of a diverse range of palliative care providers in the community who have daily encounters with death and dying. Methods We used interviews to explore the perceptions of providers and administrators from 14 specialised palliative care teams in Ontario, Canada. Participants were prompted with the question ‘What matters most for EOL care?’ Responses were analysed using a phenomenological approach to derive themes depicting the universal essence of EOL care. Results Data from 107 respondents were obtained and analysed, from which 40 formulated concepts emerged; these were further grouped into 9 themes. Of the respondents, 39% were nurses, 19% physicians, 27% were supervisors or executives and 15% other. The most predominate concept was that Patient's Wishes are Fulfilled, cited by almost half the respondents. The most prominent themes were Addressing the Non-physical Needs, Healthcare Teams’ Nature of Palliative Care Delivery, Patient Wishes are Honoured, Addressing the Physical Needs, Preparing for and Accepting Death, Communication and Relationship Development, and Involving and Supporting the Family. Conclusions 9 critical domains of EOL care evolved from the interviews, indicating that quality EOL care extends beyond managing physical pain, but includes a holistic perspective of care, a healthcare team dedicated to the EOL journey and a patient-centred pathway. Tailoring the provision of care to consider these important elements plays a critical role in supporting a positive EOL experience for patients and families. PMID:26124510

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

    KAUST Repository

    Denny, Jory


    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.

  17. Potential Medicaid Cost Savings from Maternity Care Based.. (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...

  18. Evaluation of Health Care System Model Based on Collaborative Algorithms



    The rapid development and use of information and communication technologies in the last two decades has influenced a dramatic transformation of public health and health care, changing the roles of the health care support systems and services. Recent trends in health care support systems are focused on developing patient-centric pervasive environments and the use of mobile devices and technologies in medical monitoring and health care systems [1].

  19. The HackensackUMC Value-Based Care Model: Building Essentials for Value-Based Purchasing. (United States)

    Douglas, Claudia; Aroh, Dianne; Colella, Joan; Quadri, Mohammed


    The Affordable Care Act, 2010, and the subsequent shift from a quantity-focus to a value-centric reimbursement model led our organization to create the HackensackUMC Value-Based Care Model to improve our process capability and performance to meet and sustain the triple aims of value-based purchasing: higher quality, lower cost, and consumer perception. This article describes the basics of our model and illustrates how we used it to reduce the costs of our patient sitter program.

  20. Reducing Barriers to Care in the Office-Based Health Care Setting for Children With Autism. (United States)

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


    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.

  1. Consistency with evidence-based treatments and perceived effectiveness of children’s community-based care (United States)

    Fettes, Danielle L.; Garcia, Antonio R.; Brookman-Frazee, Lauren; Garland, Ann F.


    This study examined whether delivery of psychotherapeutic strategies consistent with common elements of evidence-based (EB) treatments for child disruptive behavior problems was associated with parents' report of treatment effectiveness. The intensity of delivery of practice elements consistent with EB treatments was coded from a random sample of 538 videotaped psychotherapy sessions with 157 children/families and 75 therapists from six community-based clinics. Multilevel regression analyses tested whether intensity of EB practice elements was associated with parents' report of treatment effectiveness after four months, controlling for intensity of other practice elements. Results indicate parents reported greater perceived treatment effectiveness when community-based treatment included more intensive delivery of practice elements consistent with EB treatments to children. These findings may reassure providers about the acceptability of EB practice elements and may motivate efforts to integrate EB practice elements more intensively into community-based care. PMID:23296551

  2. New approach based on compressive sampling for sample rate enhancement in DASs for low-cost sensing nodes. (United States)

    Bonavolontà, Francesco; D'Apuzzo, Massimo; Liccardo, Annalisa; Vadursi, Michele


    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.

  3. 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


    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.

  4. Efficacy of a Morinda citrifolia Based Skin Care Regimen

    Directory of Open Access Journals (Sweden)

    Brett J. West


    Full Text Available A six week clinical trial of a Morinda citrifolia (noni based skin care regimen was conducted with 49 women, ages 38 to 55 years. Daily application of three product formulations to the face and neck resulted in significant reductions in lateral canthal fine lines and wrinkles (crow’s feet, as measured by technician scoring and digital image analysis. Use of the regimen also improved skin elasticity and firmness Cutometer® measurements. No evidence of skin irritation was present in any participant at any time during the trial. A study questionnaire revealed that the measured improvements were visibly perceptible to more than 90% of the participants. The trial results substantiate traditional uses of the noni plant to improve skin health.

  5. Periodontal self-care: evidence-based support. (United States)

    Drisko, Connie L


    The focus of this review on periodontal self-care will be based primarily on the results of systematic reviews and meta-analyses. Based on the evidence gleaned from systematic reviews, it is notable that most authors of these reviews commented on the relatively small number of trials that could pass the quality-assessment inclusion in the systematic review. Interproximal devices, namely interproximal brushes, are more effective for reducing interproximal plaque and gingivitis than are flossing or brushing alone. Some added benefit may be attributed to the use of rotational oscillation powered toothbrushes over manual toothbrushes. Recommendations by the dentist and dental hygienist to add one or more chemotherapeutic agents to the typical oral hygiene regimen has been shown, in systematic reviews and meta-analyses, to reduce the level of plaque and gingival inflammation in patients. Oral irrigation does not seem to reduce visible plaque but does tend to reduce inflammation, determined by the presence of bleeding on probing, the gingival index score and probing depth measurements. To date, high-quality evidence is either lacking or weak in some areas regarding the efficacy of self-care and periodontal disease. Low educational attainment, smoking and socio-economic status are related to adverse periodontal health outcomes. Variation in self-esteem, self-confidence and perfectionism are associated with oral health status and oral health behaviors. Better understanding of the psychological factors associated with oral hygiene would be of benefit in further developing strategies to help patients improve their oral hygiene in addition to helping professionals design better programs on prevention and education.

  6. A region-based palliative care intervention trial using the mixed-method approach: Japan OPTIM study

    Directory of Open Access Journals (Sweden)

    Morita Tatsuya


    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.

  7. Social care as first work experience in England: a secondary analysis of the profile of a national sample of migrant workers. (United States)

    Hussein, Shereen; Manthorpe, Jill; Stevens, Martin


    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.

  8. On the Estimation of Heritability with Family-Based and Population-Based Samples

    Directory of Open Access Journals (Sweden)

    Youngdoe Kim


    Full Text Available For a family-based sample, the phenotypic variance-covariance matrix can be parameterized to include the variance of a polygenic effect that has then been estimated using a variance component analysis. However, with the advent of large-scale genomic data, the genetic relationship matrix (GRM can be estimated and can be utilized to parameterize the variance of a polygenic effect for population-based samples. Therefore narrow sense heritability, which is both population and trait specific, can be estimated with both population- and family-based samples. In this study we estimate heritability from both family-based and population-based samples, collected in Korea, and the heritability estimates from the pooled samples were, for height, 0.60; body mass index (BMI, 0.32; log-transformed triglycerides (log TG, 0.24; total cholesterol (TCHL, 0.30; high-density lipoprotein (HDL, 0.38; low-density lipoprotein (LDL, 0.29; systolic blood pressure (SBP, 0.23; and diastolic blood pressure (DBP, 0.24. Furthermore, we found differences in how heritability is estimated—in particular the amount of variance attributable to common environment in twins can be substantial—which indicates heritability estimates should be interpreted with caution.

  9. Relevant sampling applied to event-based state-estimation

    NARCIS (Netherlands)

    Marck, J.W.; Sijs, J.


    To reduce the amount of data transfer in networked control systems and wireless sensor networks, measurements are usually sampled only when an event occurs, rather than synchronous in time. Today's event sampling methodologies are triggered by the current value of the sensor. State-estimators are de

  10. Development of a field sampling method based on magnetic nanoparticles for the enrichment of pesticides in aqueous samples. (United States)

    Zhang, Lingyi; Sheng, Xiaoling; Zhang, Runsheng; Xiong, Zhichao; Wu, Zhongping; Yan, Songmao; Zhang, Yurong; Zhang, Weibing


    A field sampling method based on magnetic core-shell silica nanoparticles was developed for field sampling and the enrichment of low concentrations of pesticides in aqueous samples. The magnetic nanoparticles could be easily extracted from water samples by a custom-made magnetic nanoparticle collector. The recovery of 15 mg of magnetic particles from a 500 mL water sample was 90.8%. Mixtures of seven pesticides spiked into pure water and pond water were used as marker samples to evaluate the field sampling method. The average recoveries at three levels of spiking were in the range 60.0-104.7% with relative standard deviations method has good linearity with a correlation coefficient >0.9990 in the concentration range 0.5-15 μg L(-1). The results of the analysis of a sample of poisoned pond water indicate that this method is fast, convenient and efficient for the field sampling and enrichment of pesticides in aqueous samples.

  11. Optical biosensor system with integrated microfluidic sample preparation and TIRF based detection (United States)

    Gilli, Eduard; Scheicher, Sylvia R.; Suppan, Michael; Pichler, Heinz; Rumpler, Markus; Satzinger, Valentin; Palfinger, Christian; Reil, Frank; Hajnsek, Martin; Köstler, Stefan


    There is a steadily growing demand for miniaturized bioanalytical devices allowing for on-site or point-of-care detection of biomolecules or pathogens in applications like diagnostics, food testing, or environmental monitoring. These, so called labs-on-a-chip or micro-total analysis systems (μ-TAS) should ideally enable convenient sample-in - result-out type operation. Therefore, the entire process from sample preparation, metering, reagent incubation, etc. to detection should be performed on a single disposable device (on-chip). In the early days such devices were mainly fabricated using glass or silicon substrates and adapting established fabrication technologies from the electronics and semiconductor industry. More recently, the development focuses on the use of thermoplastic polymers as they allow for low-cost high volume fabrication of disposables. One of the most promising materials for the development of plastic based lab-on-achip systems are cyclic olefin polymers and copolymers (COP/COC) due to their excellent optical properties (high transparency and low autofluorescence) and ease of processing. We present a bioanalytical system for whole blood samples comprising a disposable plastic chip based on TIRF (total internal reflection fluorescence) optical detection. The chips were fabricated by compression moulding of COP and microfluidic channels were structured by hot embossing. These microfluidic structures integrate several sample pretreatment steps. These are the separation of erythrocytes, metering of sample volume using passive valves, and reagent incubation for competitive bioassays. The surface of the following optical detection zone is functionalized with specific capture probes in an array format. The plastic chips comprise dedicated structures for simple and effective coupling of excitation light from low-cost laser diodes. This enables TIRF excitation of fluorescently labeled probes selectively bound to detection spots at the microchannel surface

  12. An agent-based simulation model of patient choice of health care providers in accountable care organizations. (United States)

    Alibrahim, Abdullah; Wu, Shinyi


    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.

  13. Large Group Problem-Based Learning: A Revision from Traditional to Pharmaceutical Care-Based Therapeutics. (United States)

    Winslade, Nancy


    The process of revising a University of Toronto (Canada) final-year undergraduate pharmacy therapeutics course to incorporate the principles of pharmaceutical care and problem-based learning is detailed. The final course outline and results of a course evaluation are also included. (MSE)

  14. A BRDF Measurement Apparatus for Lab-based Samples (United States)

    Gunderson, K.; Whitby, J.; Thomas, N.


    We have constructed an instrument to make full-hemisphere bidirectional reflectance distribution function (BRDF) laboratory measurements of terrestrial samples in order to validate BRDF models and help interpret data of solar system objects.

  15. Health care expenditure for hospital-based delivery care in Lao PDR

    Directory of Open Access Journals (Sweden)

    Douangvichit Daovieng


    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

  16. A Concept Analysis of Spiritual Care Based on Islamic Sources

    Directory of Open Access Journals (Sweden)

    Rahmatollah Marzband


    Full Text Available The cultural and religious resources of every community influence the definition of spiritual care. This paper discusses a concept analysis of spiritual care in an Islamic context. The Quran, narrations (Shie’h and commentarial books were searched, for information data. The data was used to provide a comprehensive definition of the concept of spiritual care from Islamic literature. We identified the attributes, antecedents and consequences of spiritual care according to Roger’s concept analysis approach. The review of the Islamic text showed that spiritual care is a series of spiritual skills or competencies that help patients to achieve excellent life. It is grouped into categories and has numerous positive effects on patients and caregivers. This study will be useful to Muslim clinicians and nurse educators as they strive to understand and incorporate spiritual care within their practice for Muslim patients.

  17. Efficiency of Event-Based Sampling According to Error Energy Criterion


    Marek Miskowicz


    The paper belongs to the studies that deal with the effectiveness of the particular event-based sampling scheme compared to the conventional periodic sampling as a reference. In the present study, the event-based sampling according to a constant energy of sampling error is analyzed. This criterion is suitable for applications where the energy of sampling error should be bounded (i.e., in building automation, or in greenhouse climate monitoring and control). Compared to the integral sampling c...

  18. Evidence-based surgical wound care on surgical wound infection. (United States)

    Reilly, Jaqueline


    Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

  19. Framework of sensor-based monitoring for pervasive patient care. (United States)

    Triantafyllidis, Andreas K; Koutkias, Vassilis G; Chouvarda, Ioanna; Adami, Ilia; Kouroubali, Angelina; Maglaveras, Nicos


    Sensor-based health systems can often become difficult to use, extend and sustain. The authors propose a framework for designing sensor-based health monitoring systems aiming to provide extensible and usable monitoring services in the scope of pervasive patient care. The authors' approach relies on a distributed system for monitoring the patient health status anytime-anywhere and detecting potential health complications, for which healthcare professionals and patients are notified accordingly. Portable or wearable sensing devices measure the patient's physiological parameters, a smart mobile device collects and analyses the sensor data, a Medical Center system receives notifications on the detected health condition, and a Health Professional Platform is used by formal caregivers in order to review the patient condition and configure monitoring schemas. A Service-oriented architecture is utilised to provide extensible functional components and interoperable interactions among the diversified system components. The framework was applied within the REMOTE ambient-assisted living project in which a prototype system was developed, utilising Bluetooth to communicate with the sensors and Web services for data exchange. A scenario of using the REMOTE system and preliminary usability results show the applicability, usefulness and virtue of our approach.

  20. Evidence-Based Care for Couples With Infertility. (United States)

    Stevenson, Eleanor L; Hershberger, Patricia E; Bergh, Paul A


    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.

  1. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities. (United States)

    Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen


    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.

  2. Evidence-based medicine in primary care: qualitative study of family physicians

    Directory of Open Access Journals (Sweden)

    Dantas Guilherme


    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.

  3. Traffic Prediction Based on SVM Training Sample Divided by Time

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    Lingli Li


    Full Text Available In recent years, the volume of traffic is rapidly increasing. When vehicles running through the tunnel are more intensive or move slowly, the tunnel environment occurs deteriorated sharply, which affects the normal operation of the vehicle in the tunnel. This paper uses the result of previous mining association rules to select feature items and to establish four training samples divided by time. Then the training samples are utilized to create the SVM classification model. Finally the trained SVM model is used to prediction the tunnel traffic situation. Through traffic situation prediction, effective decisions can be made before traffic jams, and ensure that the tunnel traffic is normal.  

  4. Criteria for Sample Selection to Maximize Planet Sensitivity and Yield from Space-Based Microlens Parallax Surveys

    CERN Document Server

    Yee, Jennifer C; Beichman, Charles; Novati, Sebastiano Calchi; Carey, Sean; Gaudi, B Scott; Henderson, Calen; Nataf, David; Penny, Matthew; Shvartzvald, Yossi; Zhu, Wei


    Space-based microlens parallax measurements are a powerful tool for understanding planet populations, especially their distribution throughout the Galaxy. However, if space-based observations of the microlensing events must be specifically targeted, it is crucial that microlensing events enter the parallax sample without reference to the known presence or absence of planets. Hence, it is vital to define objective criteria for selecting events where possible and to carefully consider and minimize the selection biases where not possible so that the final sample represents a controlled experiment. We present objective criteria for initiating observations and determining their cadence for a subset of events, and we define procedures for isolating subjective decision making from information about detected planets for the remainder of events. We also define procedures to resolve conflicts between subjective and objective selections. These procedures maximize planet sensitivity of the sample as a whole by allowing f...

  5. Findings From a Nursing Care Audit Based on the Nursing Process: A Descriptive Study

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    Full Text Available 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.

  6. Personal Continuity of Care in a University-Based Primary Care Practice: Impact on Blood Pressure Control.

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    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.

  7. Qigong in Cancer Care: Theory, Evidence-Base, and Practice

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    Penelope Klein


    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.

  8. 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


    of community - based programs and continued intervention with the families in order to improve the quality of care.

  9. 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


    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

  10. Home-based chronic care. An expanded integrative model for home health professionals. (United States)

    Suter, Paula; Hennessey, Beth; Harrison, Gregory; Fagan, Martha; Norman, Barbara; Suter, W Newton


    The Chronic Care Model (CCM) developed by is an influential and accepted guide for the care of patients with chronic disease. Wagner acknowledges a current healthcare focus on acute care needs that often circumvents chronic care coordination. He identifies the need for a "division of labor" to assist the primary care physician with this neglected function. This article posits that the role of chronic care coordination assistance and disease management fits within the purview of home healthcare and should be central to home health chronic care delivery. An expanded Home-Based Chronic Care Model (HBCCM) is described that builds on Wagner's model and integrates salient theories from fields beyond medicine. The expanded model maximizes the potential for disease self-management success and is intended to provide a foundation for home health's integral role in chronic disease management.

  11. A careful look at ECG sampling frequency and R-peak interpolation on short-term measures of heart rate variability. (United States)

    Ellis, Robert J; Zhu, Bilei; Koenig, Julian; Thayer, Julian F; Wang, Ye


    As the literature on heart rate variability (HRV) continues to burgeon, so too do the challenges faced with comparing results across studies conducted under different recording conditions and analysis options. Two important methodological considerations are (1) what sampling frequency (SF) to use when digitizing the electrocardiogram (ECG), and (2) whether to interpolate an ECG to enhance the accuracy of R-peak detection. Although specific recommendations have been offered on both points, the evidence used to support them can be seen to possess a number of methodological limitations. The present study takes a new and careful look at how SF influences 24 widely used time- and frequency-domain measures of HRV through the use of a Monte Carlo-based analysis of false positive rates (FPRs) associated with two-sample tests on independent sets of healthy subjects. HRV values from the first sample were calculated at 1000 Hz, and HRV values from the second sample were calculated at progressively lower SFs (and either with or without R-peak interpolation). When R-peak interpolation was applied prior to HRV calculation, FPRs for all HRV measures remained very close to 0.05 (i.e. the theoretically expected value), even when the second sample had an SF well below 100 Hz. Without R-peak interpolation, all HRV measures held their expected FPR down to 125 Hz (and far lower, in the case of some measures). These results provide concrete insights into the statistical validity of comparing datasets obtained at (potentially) very different SFs; comparisons which are particularly relevant for the domains of meta-analysis and mobile health.

  12. Efficiency of event-based sampling according to error energy criterion. (United States)

    Miskowicz, Marek


    The paper belongs to the studies that deal with the effectiveness of the particular event-based sampling scheme compared to the conventional periodic sampling as a reference. In the present study, the event-based sampling according to a constant energy of sampling error is analyzed. This criterion is suitable for applications where the energy of sampling error should be bounded (i.e., in building automation, or in greenhouse climate monitoring and control). Compared to the integral sampling criteria, the error energy criterion gives more weight to extreme sampling error values. The proposed sampling principle extends a range of event-based sampling schemes and makes the choice of particular sampling criterion more flexible to application requirements. In the paper, it is proved analytically that the proposed event-based sampling criterion is more effective than the periodic sampling by a factor defined by the ratio of the maximum to the mean of the cubic root of the signal time-derivative square in the analyzed time interval. Furthermore, it is shown that the sampling according to energy criterion is less effective than the send-on-delta scheme but more effective than the sampling according to integral criterion. On the other hand, it is indicated that higher effectiveness in sampling according to the selected event-based criterion is obtained at the cost of increasing the total sampling error defined as the sum of errors for all the samples taken.

  13. [Nursing care systematization at the intensive care unit (ICU) based on Wanda Horta's theory]. (United States)

    Amante, Lúcia Nazareth; Rossetto, Annelise Paula; Schneider, Dulcinéia Ghizoni


    The purpose of this study was to implement the Nursing Care Systematization--Sistematização da Assistência de Enfermagem (SAE)--with Wanda Aguiar Horta's Theory of Basic Human Necessities and the North American Nursing Diagnosis Association's (NANDA) Nursing Diagnosis as its references. The starting point was the evaluation of the knowledge of the nursing team about the SAE, including their participation in this process. This is a qualitative study, performed in the Intensive Care Unit in a hospital in the city of Brusque, Santa Catarina, from October, 2006 to March, 2007. It was observed that the nursing professionals know little about SAE, but they are greatly interested in learning and developing it in their daily practice. In conclusion, it was possible to execute the healthcare systematization in an easy way, with the use of simple brochures that provided all the necessary information for the qualified development of nursing care.

  14. The Performance Analysis Based on SAR Sample Covariance Matrix

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    Esra Erten


    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.

  15. 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.;


    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....... Besides, 18% were using insulin, 31% had a history of cardiovascular disease, mean HbA1c was 7.1% (range 6.6-8.0), mean systolic blood pressure was 133.7 mmHg (range 126.1-144.4) and mean total cholesterol was 4.9 mmol/l (range 4.0-6.2). CONCLUSION: A European study on care and complications in a random......) 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...

  16. Randomization-Based Inference about Latent Variables from Complex Samples: The Case of Two-Stage Sampling (United States)

    Li, Tiandong


    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…

  17. Associations between birth health, maternal employment, and child care arrangement among a community sample of mothers with young children. (United States)

    Chiao, Chi; Chyu, Laura; Ksobiech, Kate


    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.

  18. [Sociability networks: approaches based on home-based therapeutic care services]. (United States)

    Argiles, Carmen Terezinha Leal; Kantorski, Luciane Prado; Willrich, Janaína Quinzen; Antonacci, Milena Hohmann; Coimbra, Valéria Cristina Christello


    Home-based therapeutic services emerge in the context of psychiatric reform in Brazil, as a step forward in the policy of de-institutionalization, as well as being essential services to overcome custody practices, typical of the asylum model. These services provide spaces for care, welcome and decent housing for people whose family and social ties have been affected by internment in psychiatric hospitals. The article seeks to evaluate the sociability network of users of home-based therapeutic services in Alegrete in the State of Rio Grande do Sul, based on a case report. This study is part of the research on 'Networks that Rehabilitate'--evaluating innovative experiments in the composition of psychosocial care networks. Data from semi-structured interviews with the six workers of the service were used. It was observed that the service provides unique and innovative experience to find solutions that bring people with long periods of psychiatric hospitalization back together with their family, the community and city life, thereby eliminating the segregation to which they were subjected. Coaching residents and workers in the creation of home-based therapeutic care services reveals the potential to reintegrate mentally handicapped patients into society.

  19. Market-Based Health Care in Specialty Surgery: Finding Patient-Centered Shared Value. (United States)

    Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R


    : The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients.

  20. An Asset Based Approach to Health Care and Wider Public Sector Reform in the Wigan Borough


    Wilson, Robert Lee; Blandamer, Will


    Introduction: The Wigan Borough’s system wide approach is based on the fastest and greatest improvement in the health of the population of the Borough. The way services are delivered to citizens are being reformed to include improved access, standardisation to best practice, technology deployment, integrated approaches to care, shifts to community and primary care orientated service delivery.Description: Wigan Borough has developed integrated care based on populations’ assets and is actively ...


    Institute of Scientific and Technical Information of China (English)


    A practical approach of measurement calibration is presented for obtaining the true area of the photographed objects projected in the 2-D image scene. The calibration is performed using three circular samples with given diameters. The process is first to obtain the ratio mm/pixel in two orthogonal directions, and then use the obtained ratios with the total number of pixels scanned within projected area of the object of interest to compute the desired area. Compared the optically measured areas with their corresponding true areas, the results show that the proposed method is quite encouraging and the relevant application also proves the approach adequately accurate.

  2. Developing evidence-based maternity care in Iran: a quality improvement study

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    Mohammad Kazem


    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.

  3. Community-based rehabilitation: working in partnership with eye care

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    Joerg Weber


    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.

  4. Arteriovenous fistula: An evidence based practice in nursing care



    The arteriovenous fistula (AVF) is the most frequent form of vascular access for patients undergoing haemodialysis because it ensures good quality of dialysis and reduce haemodialysis mortality. For this reason, the nephrology nurse plays an important role in the appropriate care of fistula with a view to promoting the longevity and prevention of complications. Purpose: The purpose of this review was to investigate the role of Nephrology nurse in the appropriate care of fistula, promoting lon...

  5. Four proposals for market-based health care system reform. (United States)

    Sumner, W


    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.

  6. Toward a More Complete Picture of Outpatient, Office-Based Health Care in the U.S. (United States)

    Lau, Denys T; McCaig, Linda F; Hing, Esther


    The healthcare system in the U.S., particularly outpatient, office-based care, has been shifting toward service delivery by advanced practice providers, particularly nurse practitioners (NPs) and physician assistants (PAs). The National Ambulatory Medical Care Survey (NAMCS), conducted by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention, is the leading source of nationally representative data on care delivered by office-based physicians. This paper first describes NAMCS, then discusses key NAMCS expansion efforts, and finally presents major findings from two exploratory studies that assess the feasibility of collecting data from NPs and PAs as sampled providers in NAMCS. The first NAMCS expansion effort began in 2006 when the NAMCS sample was expanded to include community health centers and started collecting and disseminating data on physicians, NPs, PAs, and nurse midwives in these settings. Then, in 2013, NCHS included workforce questions in NAMCS on the composition and clinical tasks of all healthcare staff in physician offices. Finally, in 2013-2014, NCHS conducted two exploratory studies and found that collecting data from NPs and PAs as sampled providers in NAMCS is feasible. However, modifications to the current NAMCS procedures may be necessary, for example, changing recruitment strategies, visit sampling procedures, and physician-centric survey items. Collectively, these NCHS initiatives are important for healthcare research, practice, and policy communities in their efforts toward providing a more complete picture of the changing outpatient, office-based workforce, team-based care approach, and service utilization in the U.S.

  7. Rapid detection of Vancomycin-Resistant Enterococci (VRE in rectal samples from patients admitted to intensive care units

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    Pedro Alves d'Azevedo


    Full Text Available The reduction in time required to identify vancomycin-resistant enterococci (VRE has gained increased importance during hospital outbreaks. In the present study, we implemented a laboratory protocol to speed up the VRE screening from rectal samples. The protocol combines a medium for selective VRE isolation (VREBAC®, Probac, São Paulo and a multiplex PCR for detection and identification of vanA and vanB resistance genes. The screening performance was analyzed in 114 specimens collected from four intensive care units. The swabs were collected at two periods: (1 during a VRE outbreak (February 2006, n=83 patients and (2 at the post-outbreak period, after adoption of infection control measures (June 2006, n=31 patients. Forty-one/83 VRE (49.4% and 3/31(9.7% VRE were found at the first and second period, respectively. All isolates harbored the vanA gene. In both periods, detection of the gene vanA parallels to the minimum inhibitory concentration values of >256 µg/mL and >48 µg/mL for vancomycin and teicoplanin, respectively. Multiplex PCR and conventional methods agreed in 90.2% for enterococci identification. Besides this accuracy, we also found a remarkable reduction in time to obtain results. Detection of enterococcal species and identification of vancomycin resistance genes were ready in 29.5 hours, in comparison to 72 hours needed by the conventional methods. In conclusion, our protocol identified properly and rapidly enterococci species and vancomycin-resistance genes. The results strongly encourage its adoption by microbiology laboratories for VRE screenning in rectal samples.

  8. Adaptive sampling for nonlinear dimensionality reduction based on manifold learning

    DEFF Research Database (Denmark)

    Franz, Thomas; Zimmermann, Ralf; Goertz, Stefan


    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 approximately isometric to the manifold that is assumed to be formed by the high-fidelity Navier-Stokes flow solutions under smooth variations of the inflow conditions. The focus of the work at hand is the adaptive construction and refinement of the Isomap emulator: We exploit the non-Euclidean Isomap metric...... 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....

  9. Learning algorithms for feedforward networks based on finite samples

    Energy Technology Data Exchange (ETDEWEB)

    Rao, N.S.V.; Protopopescu, V.; Mann, R.C.; Oblow, E.M.; Iyengar, S.S.


    Two classes of convergent algorithms for learning continuous functions (and also regression functions) that are represented by feedforward networks, are discussed. The first class of algorithms, applicable to networks with unknown weights located only in the output layer, is obtained by utilizing the potential function methods of Aizerman et al. The second class, applicable to general feedforward networks, is obtained by utilizing the classical Robbins-Monro style stochastic approximation methods. Conditions relating the sample sizes to the error bounds are derived for both classes of algorithms using martingale-type inequalities. For concreteness, the discussion is presented in terms of neural networks, but the results are applicable to general feedforward networks, in particular to wavelet networks. The algorithms can be directly adapted to concept learning problems.

  10. Interprofessional primary care protocols: a strategy to promote an evidence-based approach to teamwork and the delivery of care. (United States)

    Goldman, Joanne; Meuser, Jamie; Lawrie, Lynne; Rogers, Jess; Reeves, Scott


    Primary care reform involving interprofessional team-based care is a global phenomenon. In Ontario, Canada, 150 Family Health Teams (FHTs) have been approved in the past few years. The transition to a FHT is complex involving many changes and the processes for collaborative teamwork are not clearly delineated. To support the transition to team-based care in FHTs, a project was undertaken to develop and implement a series of interprofessional protocols in four clinical areas. These interprofessional protocols would contain relevant and evidence-based resources to support both a team and evidence-based approach to care. This paper reports on a qualitative study to examine the process of interprofessional protocol development and pilot implementation. Adopting an exploratory case study approach (Robson, 2002 ), 36 interviews were conducted with health professionals and community group members who participated in the creation and piloting of the protocols, and with project managers. In addition, observational and documentary data were gathered on the protocol development and implementation processes. The findings from the protocol development stage demonstrate the value of the focus on evidence and team, the process of assessing and targeting FHT needs, inter-organizational and interprofessional sharing, the importance of facilitation and support, and expectations for implementation. The findings from the pilot implementation stage report on the importance of champions and leaders, the implementation strategies used, FHT and organizational factors affecting implementation, and outcomes achieved. Findings are discussed in relation to the knowledge translation and interprofessional literature. Research is ongoing to examine the effectiveness of dissemination of the protocols to FHTs across the province of Ontario and its impact on health care outcomes.

  11. [Molecular epidemiology and antifungal susceptibility of Candida species isolated from urine samples of patients in intensive care unit]. (United States)

    Yüksekkaya, Serife; Fındık, Duygu; Arslan, Uğur


    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

  12. Feature-Based Digital Modulation Recognition Using Compressive Sampling

    Directory of Open Access Journals (Sweden)

    Zhuo Sun


    Full Text Available Compressive sensing theory can be applied to reconstruct the signal with far fewer measurements than what is usually considered necessary, while in many scenarios, such as spectrum detection and modulation recognition, we only expect to acquire useful characteristics rather than the original signals, where selecting the feature with sparsity becomes the main challenge. With the aim of digital modulation recognition, the paper mainly constructs two features which can be recovered directly from compressive samples. The two features are the spectrum of received data and its nonlinear transformation and the compositional feature of multiple high-order moments of the received data; both of them have desired sparsity required for reconstruction from subsamples. Recognition of multiple frequency shift keying, multiple phase shift keying, and multiple quadrature amplitude modulation are considered in our paper and implemented in a unified procedure. Simulation shows that the two identification features can work effectively in the digital modulation recognition, even at a relatively low signal-to-noise ratio.

  13. Agarose-based microfluidic device for point-of-care concentration and detection of pathogen. (United States)

    Li, Yiwei; Yan, Xinghua; Feng, Xiaojun; Wang, Jie; Du, Wei; Wang, Yachao; Chen, Peng; Xiong, Liang; Liu, Bi-Feng


    Preconcentration of pathogens from patient samples represents a great challenge in point-of-care (POC) diagnostics. Here, a low-cost, rapid, and portable agarose-based microfluidic device was developed to concentrate biological fluid from micro- to picoliter volume. The microfluidic concentrator consisted of a glass slide simply covered by an agarose layer with a binary tree-shaped microchannel, in which pathogens could be concentrated at the end of the microchannel due to the capillary effect and the strong water permeability of the agarose gel. The fluorescent Escherichia coli strain OP50 was used to demonstrate the capacity of the agarose-based device. Results showed that 90% recovery efficiency could be achieved with a million-fold volume reduction from 400 μL to 400 pL. For concentration of 1 × 10(3) cells mL(-1) bacteria, approximately ten million-fold enrichment in cell density was realized with volume reduction from 100 μL to 1.6 pL. Urine and blood plasma samples were further tested to validate the developed method. In conjugation with fluorescence immunoassay, we successfully applied the method to the concentration and detection of infectious Staphylococcus aureus in clinics. The agarose-based microfluidic concentrator provided an efficient approach for POC detection of pathogens.

  14. Analysis of a novel field dilution method for testing samples that exceed the analytic range of point-of-care blood lead analyzers. (United States)

    Neri, Antonio James; Roy, Joannie; Jarrett, Jeffery; Pan, Yi; Dooyema, Carrie; Caldwell, Kathleen; Umar-Tsafe, Nasir Tsafe; Olubiyo, Ruth; Brown, Mary Jean


    Investigators developed and evaluated a dilution method for the LeadCare II analyzer (LCII) for blood lead levels >65 μg/dL, the analyzer's maximum reporting value. Venous blood samples from lead-poisoned children were initially analyzed in the field using the dilution method. Split samples were analyzed at the US Centers for Disease Control and Prevention (CDC) laboratory using both the dilution method and inductively coupled plasma-mass spectrometry (ICP-MS). The concordance correlation coefficient of CDC LCII vs. ICP-MS values (N = 211) was 0.976 (95 % confidence interval (CI) 0.970-0.981); of Field LCII vs. ICP-MS (N = 68) was 0.910 (95% CI 0.861-0.942), and CDC LCII vs. Field LCII (N = 53) was 0.721 (95% CI 0.565-0.827). Sixty percent of CDC and 54% of Field LCII values were within ±10% of the ICP-MS value. Results from the dilution method approximated ICP-MS values and were useful for field-based decision-making. Specific recommendations for additional evaluation are provided.

  15. How we implemented a classroom-based educational intervention for ward-based diabetes care. (United States)

    Taylor, Charles G; Atherley, Anique; George, Colette; Morris, Clare


    Abstract Background: Junior doctors require training to adequately manage the increasing numbers of adult, hospitalized patients with diabetes whom they encounter. Aims: Junior doctors experiencing the intervention acquire knowledge and skills that improve their management of inpatients with diabetes. Methods: We designed and administered, a one-hour, classroom-based, educational intervention to 242 juniors doctors. This resulted in a 49% reduction in insulin prescription errors and an increase in their confidence in the delivery of care. A number of key steps were taken to develop the intervention. First, aims, objectives, methods and assessment were carefully aligned with learning objectives at the appropriate level of Bloom's Taxonomy. Clarity was enhanced through the structuring of the introduction, body and conclusion. Clinically authentic active learning methods were used to increase engagement and provide an opportunity for junior doctors to reflect and make connections with their own clinical practice. Additionally, refinement was integrated into the process of administration. Results: Qualitative analysis from 205 trainees (85%) revealed that trainees liked a number of design features, their ability to be interactive, and immediacy behaviors of facilitators. Conclusion: Classroom-based training can impact clinically delivered care. Achieving this goal requires well-thought-out content design and evaluation.

  16. Integrated microdroplet-based system for enzyme synthesis and sampling (United States)

    Lapierre, Florian; Best, Michel; Stewart, Robert; Oakeshott, John; Peat, Thomas; Zhu, Yonggang


    Microdroplet-based microfluidic devices are emerging as powerful tools for a wide range of biochemical screenings and analyses. Monodispersed aqueous microdroplets from picoliters to nanoliters in volume are generated inside microfluidic channels within an immiscible oil phase. This results in the formation of emulsions which can contain various reagents for chemical reactions and can be considered as discrete bioreactors. In this paper an integrated microfluidic platform for the synthesis, screening and sorting of libraries of an organophosphate degrading enzyme is presented. The variants of the selected enzyme are synthesized from a DNA source using in-vitro transcription and translation method. The synthesis occurs inside water-in-oil emulsion droplets, acting as bioreactors. Through a fluorescence based detection system, only the most efficient enzymes are selected. All the necessary steps from the enzyme synthesis to selection of the best genes (producing the highest enzyme activity) are thus integrated inside a single and unique device. In the second part of the paper, an innovative design of the microfluidic platform is presented, integrating an electronic prototyping board for ensuring the communication between the various components of the platform (camera, syringe pumps and high voltage power supply), resulting in a future handheld, user-friendly, fully automated device for enzyme synthesis, screening and selection. An overview on the capabilities as well as future perspectives of this new microfluidic platform is provided.

  17. The generalization ability of online SVM classification based on Markov sampling. (United States)

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


    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.

  18. A Context-Aware Interactive Health Care System Based on Ontology and Fuzzy Inference. (United States)

    Chiang, Tzu-Chiang; Liang, Wen-Hua


    In the present society, most families are double-income families, and as the long-term care is seriously short of manpower, it contributes to the rapid development of tele-homecare equipment, and the smart home care system gradually emerges, which assists the elderly or patients with chronic diseases in daily life. This study aims at interaction between persons under care and the system in various living spaces, as based on motion-sensing interaction, and the context-aware smart home care system is proposed. The system stores the required contexts in knowledge ontology, including the physiological information and environmental information of the person under care, as the database of decision. The motion-sensing device enables the person under care to interact with the system through gestures. By the inference mechanism of fuzzy theory, the system can offer advice and rapidly execute service, thus, implementing the EHA. In addition, the system is integrated with the functions of smart phone, tablet PC, and PC, in order that users can implement remote operation and share information regarding the person under care. The health care system constructed in this study enables the decision making system to probe into the health risk of each person under care; then, from the view of preventive medicine, and through a composing system and simulation experimentation, tracks the physiological trend of the person under care, and provides early warning service, thus, promoting smart home care.

  19. Assessing the acceptability of community pharmacy based pharmaceutical care services in Karachi


    Muhammad Amir, B.Pharmacy, MSc. MBA, Assistant Professor/Clinical Pharmacist


    Provision of pharmaceutical care services in community pharmacies is a new trend in pharmacy practice worldwide. Published literature from developed countries is available showing benefits of pharmaceutical care services provided in community pharmacies. However, relatively little published literature is available from developing countries in which unique market environments are encountered. This study was conducted to assess the acceptability of community pharmacy based pharmaceutical care s...

  20. Teaching Chinese health care professionals about community-based long-term care (CBLTC) in China. (United States)

    Wu, Bei


    Academic exchanges between the U.S. and other countries around the world are increasing and teaching students abroad is part of this trend. China is in its initial stage of developing gerontology education and is in great need of new concepts and ideas for dealing with its rapidly aging population. This paper discusses the challenges and rewards of teaching gerontology to health care professionals in China. To achieve the desired learning outcomes in another country requires culturally appropriate course materials and teaching methods; drawing on students' knowledge and expertise by using an interactive format and gaining students' respect.

  1. Who Shall Not Be Treated: Public Attitudes on Setting Health Care Priorities by Person-Based Criteria in 28 Nations. (United States)

    Rogge, Jana; Kittel, Bernhard


    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.

  2. Comparison of the PSC-17 and Alternative Mental Health Screens in an At-Risk Primary Care Sample (United States)

    Gardner, William; Lucas, Amanda; Kolko, David J.; Campo, John V.


    Objective: To validate the 17-item version of the Pediatric Symptom Checklist (PSC-17) as a screen for common pediatric mental disorders in primary care. Method: Patients were 269 children and adolescents (8-15 years old) whose parents completed the PSC-17 in primary care waiting rooms. Children were later assessed using the Schedule for Affective…

  3. Development of an evaporation-based microfluidic sample concentrator (United States)

    Sharma, Nigel R.; Lukyanov, Anatoly; Bardell, Ron L.; Seifried, Lynn; Shen, Mingchao


    MicroPlumbers Microsciences LLC, has developed a relatively simple concentrator device based on isothermal evaporation. The device allows for rapid concentration of dissolved or dispersed substances or microorganisms (e.g. bacteria, viruses, proteins, toxins, enzymes, antibodies, etc.) under conditions gentle enough to preserve their specific activity or viability. It is capable of removing of 0.8 ml of water per minute at 37°C, and has dimensions compatible with typical microfluidic devices. The concentrator can be used as a stand-alone device or integrated into various processes and analytical instruments, substantially increasing their sensitivity while decreasing processing time. The evaporative concentrator can find applications in many areas such as biothreat detection, environmental monitoring, forensic medicine, pathogen analysis, and agricultural industrial monitoring. In our presentation, we describe the design, fabrication, and testing of the concentrator. We discuss multiphysics simulations of the heat and mass transport in the device that we used to select the design of the concentrator and the protocol of performance testing. We present the results of experiments evaluating water removal performance.

  4. A Model for Community-Based Pediatric Oral Heath: Implementation of an Infant Oral Care Program

    Directory of Open Access Journals (Sweden)

    Francisco J. Ramos-Gomez


    Full Text Available The Affordable Care Act (ACA mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0–5 and their caregivers. In collaboration with the Venice Family Clinic's Simms/Mann Health and Wellness Center, UCLA Pediatrics, Women, Infants, and Children (WIC, and Early Head Start and Head Start programs, the IOCP increases family-centered care access and promotes early utilization of dental services in nontraditional, primary care settings. Emphasizing disease prevention, management, and care that is sensitive to cultural, language, and oral health literacy challenges, IOCP patients achieve better oral health maintenance “in health” not in “disease modality”. IOCP uses interprofessional education to promote pediatric oral health across multiple disciplines and highlights the necessity for the “age-one visit”. This innovative clinical model facilitates early intervention and disease management. It sets a new standard of minimally invasive dental care that is widely available and prevention focused, with high retention rates due to strong collaborations with the community-based organizations serving these vulnerable, high-risk children.

  5. Development of a sample preparation procedure of sewage sludge samples for the determination of polycyclic aromatic hydrocarbons based on selective pressurized liquid extraction. (United States)

    Pena, Maria Teresa; Casais, Maria Carmen; Mejuto, Maria Carmen; Cela, Rafael


    An automated, simple and sensitive method based on selective pressurized liquid extraction (SPLE) was developed for the analysis of polycyclic aromatic hydrocarbons in sewage sludge samples. The new sample preparation procedure consists of on-line clean-up by inclusion of sorbents in the extraction cell, and combines elevated temperatures and pressures with liquid solvents to achieve fast and efficient removal of target analytes from complex sewage sludge matrices. The effects of various operational parameters (e.g. sample pretreatment, extraction solvent, temperature, pressure, static time, etc.) on the performance of SPLE procedure were carefully investigated, obtaining the best results when SPLE conditions were fixed at 140 degrees C, 1500 psi, static time of 5 min and n-hexane as extraction solvent. A new programmed temperature vaporization-gas chromatography-tandem mass spectrometry method based on large volume injection (PTV-LVI-GC-MS/MS) was also developed and analytical determinations were performed by high performance liquid chromatography coupled with fluorescence detection and GC-MS/MS. The extraction yields for the different compounds obtained by SPLE ranged from 84.8% to 106.6%. Quantification limits obtained for all of these studied compounds (between 0.0001 and 0.005 microg g(-1), dry mass) were well below the regulatory limits for all compounds considered. To test the accuracy of the SPLE technique, the optimized methodology was applied to the analysis of a certified reference material (sewage sludge (BCR088)) and a reference material (sewage sludge (RTC-CNS312-04)), with excellent results.

  6. Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh

    Directory of Open Access Journals (Sweden)

    Ali Mohammed


    Full Text Available Abstract Background Poor neonatal health is a major contributor to under-five mortality in developing countries. A major constraint to effective neonatal survival programme has been the lack of population level data in developing countries. This study investigated the consultation patterns of caregivers during neonatal fatal illness episodes in the rural Matlab sub-district of eastern Bangladesh. Methods Neonatal deaths were identified through a population-based demographic surveillance system in Matlab ICDDR,B maternal and child health (MCH project area and an adjoining government service area. Trained project staff administered a structured questionnaire on care seeking to mothers at home who had experienced a neonatal death. Univariate, bivariate and binary multivariate logistic regressions were performed to describe care seeking during the fatal illness episode. Results Of the 365 deaths recorded during 2003 and 2004, 84% died in the early (0-7 days neonatal period, with the remaining deaths occurring over the subsequent 8 to 28 days. The first resort of care by parents was a qualified doctor or paramedic in 37% of cases, followed by traditional and unqualified health care providers in 25%, while 38% sought no care. Thus, almost two thirds (63% of neonates who died received only traditional and unqualified care or no care at all during their final illness episode. About 22% sought care from more than one provider, including 6% from 3 or more providers. Such plurality in care seeking was more likely among male infants, in the late neonatal period, and in the MCH project area. Conclusions The high proportion of neonatal deaths that had received traditional care or no medical care in a rural area of Bangladesh highlights the need to develop community awareness about prompt medical care seeking for neonatal illnesses and to improve access to effective health care. Integration of traditional care providers into mainstream health programs should

  7. Treatment-Based Classification versus Usual Care for Management of Low Back Pain (United States)


    Back Pain PRINCIPAL INVESTIGATOR: Dr. Daniel Rhon RECIPIENT: The Geneva Foundation Tacoma, WA 98402-4437 REPORT DATE: August 2015 TYPE OF...DATES COVERED 1Aug2014 - 31Jul2015 4. TITLE AND SUBTITLE Treatment-Based Classification versus Usual Care for Management of Low Back Pain 5a. CONTRACT...the effectiveness of two management strategies for patients with a recent onset of low back pain . One is based on usual care and the other is based on

  8. Predictors of quality of life of people receiving intensive community-based care

    NARCIS (Netherlands)

    Emmerink, P.M.J.; Roeg, Diana


    Purpose Intensive community-based care (ICBC) is a home-treatment approach aiming to support people ‘living in the community’ with severe psychiatric and addiction problems. Although subjective quality of life (SQOL) is an increasingly important outcome measure in health care, little is known on ICB

  9. An Empirical Typology of Residential Care/Assisted Living Based on a Four-State Study (United States)

    Park, Nan Sook; Zimmerman, Sheryl; Sloane, Philip D.; Gruber-Baldini, Ann L.; Eckert, J. Kevin


    Purpose: Residential care/assisted living describes diverse facilities providing non-nursing home care to a heterogeneous group of primarily elderly residents. This article derives typologies of assisted living based on theoretically and practically grounded evidence. Design and Methods: We obtained data from the Collaborative Studies of Long-Term…

  10. Developing Memory Clinics in Primary Care: An Evidence-Based Interprofessional Program of Continuing Professional Development (United States)

    Lee, Linda; Weston, W. Wayne; Hillier, Loretta M.


    Introduction: Primary care is challenged to meet the needs of patients with dementia. A training program was developed to increase capacity for dementia care through the development of Family Health Team (FHT)-based interprofessional memory clinics. The interprofessional training program consisted of a 2-day workshop, 1-day observership, and 2-day…

  11. New Practices of Farm-Based Community-Oriented Social Care Services in The Netherlands

    NARCIS (Netherlands)

    Hassink, Jan; Grin, John; Hulsink, Willem


    Social care services provided by farmers provide a community-based collaboration that can empower people and improve their quality of life. The objective of this study was to increase understanding of the collaboration between care organizations and farmers. The study involves 4 cases, and all st

  12. Performance-based contracting in home-care work in The Netherlands : Professionalism under pressure?

    NARCIS (Netherlands)

    Oomkens, Rosanne; Hoogenboom, Marcel; Knijn, Trudie


    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 o

  13. A Randomized Controlled Trial of Hospital-based Case Management in Cancer Care

    DEFF Research Database (Denmark)

    Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens


    BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital......-based CM on (i) GPs' evaluation of information from the hospital and collaboration with the hospital staff and (ii) patients' contacts with GPs during daytime and out of hours. DESIGN: A randomized controlled trial allocated 280 colorectal cancer patients 1:1 to either a control group or CM intervention...

  14. FEAMAC/CARES Stochastic-Strength-Based Damage Simulation Tool for Ceramic Matrix Composites (United States)

    Nemeth, Noel; Bednarcyk, Brett; Pineda, Evan; Arnold, Steven; Mital, Subodh; Murthy, Pappu; Bhatt, Ramakrishna


    Reported here is a coupling of two NASA developed codes: CARES (Ceramics Analysis and Reliability Evaluation of Structures) with the MAC/GMC (Micromechanics Analysis Code/ Generalized Method of Cells) composite material analysis code. The resulting code is called FEAMAC/CARES and is constructed as an Abaqus finite element analysis UMAT (user defined material). Here we describe the FEAMAC/CARES code and an example problem (taken from the open literature) of a laminated CMC in off-axis loading is shown. FEAMAC/CARES performs stochastic-strength-based damage simulation response of a CMC under multiaxial loading using elastic stiffness reduction of the failed elements.

  15. A case-base sampling method for estimating recurrent event intensities. (United States)

    Saarela, Olli


    Case-base sampling provides an alternative to risk set sampling based methods to estimate hazard regression models, in particular when absolute hazards are also of interest in addition to hazard ratios. The case-base sampling approach results in a likelihood expression of the logistic regression form, but instead of categorized time, such an expression is obtained through sampling of a discrete set of person-time coordinates from all follow-up data. In this paper, in the context of a time-dependent exposure such as vaccination, and a potentially recurrent adverse event outcome, we show that the resulting partial likelihood for the outcome event intensity has the asymptotic properties of a likelihood. We contrast this approach to self-matched case-base sampling, which involves only within-individual comparisons. The efficiency of the case-base methods is compared to that of standard methods through simulations, suggesting that the information loss due to sampling is minimal.

  16. A randomized clinical trial of home-based telepsychiatric outpatient care via videoconferencing: design, methodology, and implementation

    Directory of Open Access Journals (Sweden)

    Ines Hungerbuehler


    Full Text Available Background Healthcare providers are continuously challenged to find innovative, cost-effective alternatives and to scale up existent services to meet the growing demand upon mental health care delivery. Due to continuous advances in technologies, telepsychiatry has become an effective tool for psychiatric care. In 2012, the Institute of Psychiatry of the University of São Paulo Medical School started a randomized clinical trial of home-based telepsychiatric outpatient care via videoconferencing. Objective The objective of this article is to describe the design, methodology and implementation of a pilot project, which aimed to verify the applicability and efficiency of psychiatric attendance via Internet-based videoconferencing in a resource-constrained environment. Methods The project consisted of a 12 months follow-up study with a randomized clinical trial, which compared various quality indicators between home-based telepsychiatric aftercare via videoconferencing and face-to-face aftercare. Results The final sample comprised 107 outpatients (53 in the telepsychiatry group and 54 in the control group. Among 1,227 realized consultations, 489 were held by videoconferencing. Satisfaction with the aftercare by videoconferencing and the medication delivery was high among patients. Attending psychiatrists were satisfied with the assistance by videoconferencing. Discussion The experiences during this pilot project have overall been very positive and psychiatric outpatient care by videoconferencing seems viable to treat patients even in a resource-constrained environment.

  17. [Evidence-based clinical practice guidelines in oral care 2: process and content of evidence-based guideline development

    NARCIS (Netherlands)

    Mettes, T.G.P.H.; Loveren, C. van; Oirschot, B.A.J.A. van; Maanen-Schakel, N.W. van; Weijden, F.G. van der; Bruers, J.J.


    In 2014, an advisory report was published by a national working committee concerning how the current, applied method of evidence-based guideline development in healthcare can be used in oral care in a national guideline programme. In an independent Institute of Knowledge Translation in Oral Care, as

  18. Managed care or managed inequality? A call for critiques of market-based medicine. (United States)

    Rylko-Bauer, Barbara; Farmer, Paul


    This review article critiques the growing dominance of market-based medicine in the United States against the background of existing problems with quality of care, rising costs, devaluation of doctor-patient relationships, and, especially, persistent inequalities of access and outcomes. It summarizes the present state of health care delivery by focusing on the concurrent trends of growth in managed care, expanding profits, increasing proportion of those uninsured, and widening racial, ethnic, and class disparities in access to care. Allowing market forces to dictate the shape of health care delivery in this country ensures that inequalities will continue to grow and modern medicine will become increasingly adept at managing inequality rather than managing (providing) care. The article challenges anthropology to become more involved in critiquing these developments and suggests how anthropologists can expand on and contextualize debates surrounding the market's role in medicine, here and abroad.

  19. Anaesthesia care for emergency endoscopy for peptic ulcer bleeding. A nationwide population-based cohort study

    DEFF Research Database (Denmark)

    Duch, Patricia; Haahr Raunkjær, Camilla; Møller, Morten Hylander;


    describe the prevalence and inter-hospital variation of anaesthesia care in Denmark and identify clinical predictors for choosing anaesthesia care. MATERIAL AND METHODS: This population-based cohort study included all emergency EGDs for PUB in adults during 2012-2013. About 90-day all-cause mortality after...... of the endoscopist. Some 16.7% of the patients undergoing EGD with anaesthesia care died within 90 days after the procedure, compared to 9.8% of the patients who had no anaesthesia care, adjusted OR = 1.51 (95% CI = 1.25-1.83). Comparing the two hospitals with the most frequent (98.6% of al EGDs) and least frequent...... EGD was estimated by crude and adjusted logistic regression. Clinical predictors of anaesthesia care were identified in another logistic regression model. RESULTS: Some 3.056 EGDs performed at 21 hospitals were included; 2074 (68%) received anaesthesia care and 982 (32%) were managed under supervison...

  20. The Affordable Care Act: the ethical call for value-based leadership to transform quality. (United States)

    Piper, Llewellyn E


    Hospitals in America face a daunting and historical challenge starting in 2013 as leadership navigates their organizations toward a new port of call-the Patient Protection and Affordable Care Act. Known as the Affordable Care Act (ACA) was signed into law in March 2010 and held in abeyance waiting on 2 pivotal points-the Supreme Court's June 2012 ruling upholding the constitutionality of the ACA and the 2012 presidential election of Barack Obama bringing to reality to health care organizations that leadership now must implement the mandates of health care delivery under the ACA. This article addresses the need for value-based leadership to transform the culture of health care organizations in order to be successful in navigating uncharted waters under the unprecedented challenges for change in the delivery of quality health care.

  1. Exploring the phenomenon of spiritual care between hospital chaplains and hospital based healthcare providers. (United States)

    Taylor, Janie J; Hodgson, Jennifer L; Kolobova, Irina; Lamson, Angela L; Sira, Natalia; Musick, David


    Hospital chaplaincy and spiritual care services are important to patients' medical care and well-being; however, little is known about healthcare providers' experiences receiving spiritual support. A phenomenological study examined the shared experience of spiritual care between hospital chaplains and hospital-based healthcare providers (HBHPs). Six distinct themes emerged from the in-depth interviews: Awareness of chaplain availability, chaplains focus on building relationships with providers and staff, chaplains are integrated in varying degrees on certain hospital units, chaplains meet providers' personal and professional needs, providers appreciate chaplains, and barriers to expanding hospital chaplains' services. While HBHPs appreciated the care received and were able to provide better patient care as a result, participants reported that administrators may not recognize the true value of the care provided. Implications from this study are applied to hospital chaplaincy clinical, research, and training opportunities.

  2. Student Perceptions of and Confidence in Self-Care Course Concepts Using Team-based Learning. (United States)

    Frame, Tracy R; Gryka, Rebecca; Kiersma, Mary E; Todt, Abby L; Cailor, Stephanie M; Chen, Aleda M H


    Objective. To evaluate changes in student perceptions of and confidence in self-care concepts after completing a team-based learning (TBL) self-care course. Methods. Team-based learning was used at two universities in first professional year, semester-long self-care courses. Two instruments were created and administered before and after the semester. The instruments were designed to assess changes in student perceptions of self-care using the theory of planned behavior (TPB) domains and confidence in learning self-care concepts using Bandura's Social Cognitive Theory. Wilcoxon signed rank tests were used to evaluate pre/post changes, and Mann Whitney U tests were used to evaluate university differences. Results. Fifty-three Cedarville University and 58 Manchester University students completed both instruments (100% and 92% response rates, respectively). Student self-care perceptions with TPB decreased significantly on nine of 13 items for Cedarville and decreased for one of 13 items for Manchester. Student confidence in self-care concepts improved significantly on all questions for both universities. Conclusion. Data indicate TBL self-care courses were effective in improving student confidence about self-care concepts. Establishing students' skill sets prior to entering the profession is beneficial because pharmacists will use self-directed learning to expand their knowledge and adapt to problem-solving situations.

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

  4. Population management, systems-based practice, and planned chronic illness care: integrating disease management competencies into primary care to improve composite diabetes quality measures. (United States)

    Kimura, Joe; DaSilva, Karen; Marshall, Richard


    The increasing prevalence of chronic illnesses in the United States requires a fundamental redesign of the primary care delivery system's structure and processes in order to meet the changing needs and expectations of patients. Population management, systems-based practice, and planned chronic illness care are 3 potential processes that can be integrated into primary care and are compatible with the Chronic Care Model. In 2003, Harvard Vanguard Medical Associates, a multispecialty ambulatory physician group practice based in Boston, Massachusetts, began implementing all 3 processes across its primary care practices. From 2004 to 2006, the overall diabetes composite quality measures improved from 51% to 58% for screening (HgA1c x 2, low-density lipoprotein, blood pressure in 12 months) and from 13% to 17% for intermediate outcomes (HgA1c system integrated these disease management functions into the front lines of primary care and the positive impact of those changes on overall diabetes quality of care.

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

    Directory of Open Access Journals (Sweden)

    van der Weijden Trudy


    Full Text Available 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 data from 83 health care professionals involved in diabetes care from 30 primary care practices in the Netherlands, with a total of 752 diabetes mellitus type II patients participating in an improvement study. We used self-reported measures of team climate (Team Climate Inventory and organizational culture (Competing Values Framework, and measures of quality of diabetes care and clinical patient characteristics from medical records and self-report. We conducted multivariate analyses of the relationship between culture, climate and HbA1c, total cholesterol, systolic blood pressure and a sum score on process indicators for the quality of diabetes care, adjusting for potential patient- and practice level confounders and practice-level clustering. Results A strong group culture was negatively associated to the quality of diabetes care provided to patients (β = -0.04; p = 0.04, whereas a more 'balanced culture' was positively associated to diabetes care quality (β = 5.97; p = 0.03. No associations were found between organizational culture, team climate and clinical patient outcomes. Conclusion Although some significant associations were found between high quality diabetes care in general practice and different organizational cultures, relations were rather marginal. Variation in clinical patient outcomes could not be attributed to organizational culture or teamwork. This study therefore contributes to the discussion about the legitimacy of the widespread idea

  6. Decision making based on single and double acceptance sampling plans for assessing quality of lots

    Directory of Open Access Journals (Sweden)

    Ksenija Dumičic


    Full Text Available Background: Acceptance sampling is a statistical tool of quality control. Sampling plans and operating characteristic (OC curves are very useful for conducting acceptance sampling and provide the quality manager with tools to evaluate the quality of a production run or shipment. There are developed different sampling plans, but common used in practise are single and double acceptance sampling plans. Objectives: The goal of the paper is to test if applying of single and double sampling plan can lead to statistically significant different conclusion about quality level of observed lot. Methods/Approach: Statistical tests of difference in proportions are used to test if there is some statistically significant difference in probabilities of lot fraction defectives between a single and a double sampling plan at the same levels of probability of acceptance. Results: The results of the analysis show that in some cases there is statistically significant difference. Namely, the quality manager should be careful when he chooses to use, instead of the first, the second sampling plan with different parameters because on that way he could make statistically significant different conclusion about quality level of observed lot. Conclusions: The paper shows that some intentional manipulations by using different sampling plans are possible.

  7. Estimation of pyrethroid pesticide intake using regression modeling of food groups based on composite dietary samples (United States)

    Population-based estimates of pesticide intake are needed to characterize exposure for particular demographic groups based on their dietary behaviors. Regression modeling performed on measurements of selected pesticides in composited duplicate diet samples allowed (1) estimation ...

  8. A review of instruments to measure interprofessional team-based primary care. (United States)

    Shoemaker, Sarah J; Parchman, Michael L; Fuda, Kathleen Kerwin; Schaefer, Judith; Levin, Jessica; Hunt, Meaghan; Ricciardi, Richard


    Interprofessional team-based care is increasingly regarded as an important feature of delivery systems redesigned to provide more efficient and higher quality care, including primary care. Measurement of the functioning of such teams might enable improvement of team effectiveness and could facilitate research on team-based primary care. Our aims were to develop a conceptual framework of high-functioning primary care teams to identify and review instruments that measure the constructs identified in the framework, and to create a searchable, web-based atlas of such instruments (available at: ). Our conceptual framework was developed from existing frameworks, the teamwork literature, and expert input. The framework is based on an Input-Mediator-Output model and includes 12 constructs to which we mapped both instruments as a whole, and individual instrument items. Instruments were also reviewed for relevance to measuring team-based care, and characterized. Instruments were identified from peer-reviewed and grey literature, measure databases, and expert input. From nearly 200 instruments initially identified, we found 48 to be relevant to measuring team-based primary care. The majority of instruments were surveys (n = 44), and the remainder (n = 4) were observational checklists. Most instruments had been developed/tested in healthcare settings (n = 30) and addressed multiple constructs, most commonly communication (n = 42), heedful interrelating (n = 42), respectful interactions (n = 40), and shared explicit goals (n = 37). The majority of instruments had some reliability testing (n = 39) and over half included validity testing (n = 29). Currently available instruments offer promise to researchers and practitioners to assess teams' performance, but additional work is needed to adapt these instruments for primary care settings.

  9. Home-Based Hospice Care Reduces End-of-Life Expenditure in Taiwan: A Population-Based Study. (United States)

    Chen, Li-Fu; Chang, Chun-Ming; Huang, Chih-Yuan


    Inpatient hospice care can reduce futile treatment and medical costs. However, the cost trimming effect of home-based hospice care in hospital has yet not been explored. This study evaluates the impact of home-based hospice care on end-of-life expenditure in hospitals with different spending intensity. This is a population-based retrospective study in Taiwan. Cancer decedents were identified in the National Health Insurance Research Database (NHIRD) from 2009 to 2011. They are categorized by hospital spending intensity. A hierarchical linear regression model with a random-intercept model was used to analyze the relationship between end-of-life expenditure (dependent variable) with and without home-based hospice, and both patient-level and hospital-level characteristics. A total of 78,613 cancer decedents were identified in the NHIRD from 2009 to 2011. Of these decedents, 17,638, 43,286, and 17,689 were categorized by hospital spending intensity as high, moderate, and low, respectively. Decedents with home-based hospice care were associated with US$2452 less in expenditure per patient compared with those without home-based hospice care. The majority of savings occurred in the last 3 months of life. These savings with home-based hospice care were consistent in hospitals with different levels of spending intensity. Home-based hospice reduced one-fifth expenditure at the end of life of cancer decedents treated in hospitals with different spending intensity.

  10. Patient centredness in integrated care: results of a qualitative study based on a systems theoretical framework

    Directory of Open Access Journals (Sweden)

    Daniel Lüdecke


    Full Text Available Introduction: Health care providers seek to improve patient-centred care. Due to fragmentation of services, this can only be achieved by establishing integrated care partnerships. The challenge is both to control costs while enhancing the quality of care and to coordinate this process in a setting with many organisations involved. The problem is to establish control mechanisms, which ensure sufficiently consideration of patient centredness. Theory and methods: Seventeen qualitative interviews have been conducted in hospitals of metropolitan areas in northern Germany. The documentary method, embedded into a systems theoretical framework, was used to describe and analyse the data and to provide an insight into the specific perception of organisational behaviour in integrated care. Results: The findings suggest that integrated care partnerships rely on networks based on professional autonomy in the context of reliability. The relationships of network partners are heavily based on informality. This correlates with a systems theoretical conception of organisations, which are assumed autonomous in their decision-making. Conclusion and discussion: Networks based on formal contracts may restrict professional autonomy and competition. Contractual bindings that suppress the competitive environment have negative consequences for patient-centred care. Drawbacks remain due to missing self-regulation of the network. To conclude, less regimentation of integrated care partnerships is recommended.

  11. Patient centredness in integrated care: results of a qualitative study based on a systems theoretical framework

    Directory of Open Access Journals (Sweden)

    Daniel Lüdecke


    Full Text Available Introduction: Health care providers seek to improve patient-centred care. Due to fragmentation of services, this can only be achieved by establishing integrated care partnerships. The challenge is both to control costs while enhancing the quality of care and to coordinate this process in a setting with many organisations involved. The problem is to establish control mechanisms, which ensure sufficiently consideration of patient centredness.Theory and methods: Seventeen qualitative interviews have been conducted in hospitals of metropolitan areas in northern Germany. The documentary method, embedded into a systems theoretical framework, was used to describe and analyse the data and to provide an insight into the specific perception of organisational behaviour in integrated care.Results: The findings suggest that integrated care partnerships rely on networks based on professional autonomy in the context of reliability. The relationships of network partners are heavily based on informality. This correlates with a systems theoretical conception of organisations, which are assumed autonomous in their decision-making.Conclusion and discussion: Networks based on formal contracts may restrict professional autonomy and competition. Contractual bindings that suppress the competitive environment have negative consequences for patient-centred care. Drawbacks remain due to missing self-regulation of the network. To conclude, less regimentation of integrated care partnerships is recommended.

  12. Who Receives Home-Based Perinatal Palliative Care: Experience from Poland

    Directory of Open Access Journals (Sweden)

    Aleksandra Korzeniewska-Eksterowicz


    Full Text Available Context. The current literature suggests that perinatal palliative care (PPC programs should be comprehensive, initiated early, and integrative. So far there have been very few publications on the subject of home-based PC of newborns and neonates. Most publications focus on hospital-based care, mainly in the neonatal intensive care units. Objective. To describe the neonates and infants who received home-based palliative care in Lodz Region between 2005 and 2011. Methods. A retrospective review of medical records. Results. 53 neonates and infants were admitted to a home hospice in Lodz Region between 2005 and 2011. In general, they are a growing group of patients referred to palliative care. Congenital diseases (41% were the primary diagnoses; out of 53 patients 16 died, 20 were discharged home, and 17 stayed under hospice care until 2011. The most common cause of death (56% was cardiac insufficiency. Neurological symptoms (72% and dysphagia (58% were the most common clinical problems. The majority of children (45% had a feeding tube inserted and were oxygen dependent (45%; 39 families received psychological care and 31 social supports. Conclusions. For terminally ill neonates and infants, perinatal palliative care is an option which improves the quality of their lives and provides the family with an opportunity to say goodbye.

  13. Development and validation of a point-of-care test for detecting hantavirus antibodies in human and rodent samples. (United States)

    Koishi, Andrea Cristine; Aoki, Mateus Nóbrega; Jorge, Taissa Ricciardi; Suzukawa, Andréia Akemi; Zanluca, Camila; Levis, Silvana; Duarte Dos Santos, Claudia Nunes


    Hantaviruses are etiologic agents of a zoonotic disease transmitted mainly from wild rodents to humans, causing Hemorrhagic Fever with Renal Syndrome in Eurasia and the Hantavirus Cardiopulmonary Syndrome in the Americas (HCPS), reaching a lethality rate of 40% in Brazil. Hantavirus diagnostic and seroprevalence are often based on the presence of IgM and IgG antibodies against the virus. Here we propose a rapid test assay able to identify hantavirus antibodies with sensibility and specificity similar to ELISA assays. We analyzed five groups of samples, including healthy human population and small mammals of endemic areas, suspected cases of HCPS, patients with non-related infections and a serum panel from a different geographical region. The test presented good rates of sensibility (87-100%) and specificity (97-100%) for all groups, being a promising tool suitable for both rodent and human hantavirus epidemiological surveys.

  14. Evidence that consumers are skeptical about evidence-based health care. (United States)

    Carman, Kristin L; Maurer, Maureen; Yegian, Jill Mathews; Dardess, Pamela; McGee, Jeanne; Evers, Mark; Marlo, Karen O


    We undertook focus groups, interviews, and an online survey with health care consumers as part of a recent project to assist purchasers in communicating more effectively about health care evidence and quality. Most of the consumers were ages 18-64; had health insurance through a current employer; and had taken part in making decisions about health insurance coverage for themselves, their spouse, or someone else. We found many of these consumers' beliefs, values, and knowledge to be at odds with what policy makers prescribe as evidence-based health care. Few consumers understood terms such as "medical evidence" or "quality guidelines." Most believed that more care meant higher-quality, better care. The gaps in knowledge and misconceptions point to serious challenges in engaging consumers in evidence-based decision making.

  15. Treatment and survival in a population-based sample of patients diagnosed with gastroesophageal adenocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Deirdre P Cronin-Fenton; Margaret M Mooney; Limin X Clegg; Linda C Harlan


    AIM:To examine the extent of use of specific therapies in clinical practice,and their relationship to therapies validated in clinical trials.METHODS:The US National Cancer Institutes' Patterns of Care study was used to examine therapies and survival of patients diagnosed in 2001 with histologically-confirmed gastroesophageal adenocarcinoma (n = 1356).The study re-abstracted data and verified therapy with treating physicians for a population-based stratified random sample.RESULTS:Approximately 62% of patients had stomach adenocarcinoma (SAC),while 22% had gastric-cardia adenocarcinoma (GCA),and 16% lower esophageal adenocarcinoma (EAC).Stage IV/ unstaged esophageal cancer patients were most likely and stage I -111 stomach cancer patients least likely to receive chemotherapy as all or part of their therapy;gastric-cardia patients received chemotherapy at a rate between these two.In multivariable analysis by anatomic site,patients 70 years and older were significantly less likely than younger patients to receive chemotherapy alone or chemoradiation for all three anatomic sites.Among esophageal and stomach cancer patients,receipt of chemotherapy was associated with lower mortality;but no association was found among gastric-cardia patients.CONCLUSION:This study highlights the relatively low use of clinical trials-validated anti-cancer therapies in community practice.Use of chemotherapy-based treatment was associated with lower mortality,dependent on anatomic site.Findings suggest that physicians treat lower esophageal and SAC as two distinct entities,while gastric-cardia patients receive a mix of the treatment strategies employed for the two other sites.

  16. Columbia University's Competency and Evidence-based Acute Care Nurse Practitioner Program. (United States)

    Curran, Christine R.; Roberts, W. Dan


    Columbia University's acute care nurse practitioner curriculum incorporates evaluation strategies and standards to assess clinical competence and foster evidence-based practice. The curriculum consists of four core courses, supporting sciences, and specialty courses. (Contains 17 references.) (SK)

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

    DEFF Research Database (Denmark)

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


    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...

  18. Sample Design. (United States)

    Ross, Kenneth N.


    This article considers various kinds of probability and non-probability samples in both experimental and survey studies. Throughout, how a sample is chosen is stressed. Size alone is not the determining consideration in sample selection. Good samples do not occur by accident; they are the result of a careful design. (Author/JAZ)

  19. Acupuncture injection for field amplified sample stacking and glass microchip-based capillary gel electrophoresis. (United States)

    Ha, Ji Won; Hahn, Jong Hoon


    Acupuncture sample injection is a simple method to deliver well-defined nanoliter-scale sample plugs in PDMS microfluidic channels. This acupuncture injection method in microchip CE has several advantages, including minimization of sample consumption, the capability of serial injections of different sample solutions into the same microchannel, and the capability of injecting sample plugs into any desired position of a microchannel. Herein, we demonstrate that the simple and cost-effective acupuncture sample injection method can be used for PDMS microchip-based field amplified sample stacking in the most simplified straight channel by applying a single potential. We achieved the increase in electropherogram signals for the case of sample stacking. Furthermore, we present that microchip CGE of ΦX174 DNA-HaeⅢ digest can be performed with the acupuncture injection method on a glass microchip while minimizing sample loss and voltage control hardware.

  20. Filter-based assay for Escherichia coli in aqueous samples using bacteriophage-based amplification. (United States)

    Derda, Ratmir; Lockett, Matthew R; Tang, Sindy K Y; Fuller, Renee C; Maxwell, E Jane; Breiten, Benjamin; Cuddemi, Christine A; Ozdogan, Aysegul; Whitesides, George M


    This paper describes a method to detect the presence of bacteria in aqueous samples, based on the capture of bacteria on a syringe filter, and the infection of targeted bacterial species with a bacteriophage (phage). The use of phage as a reagent provides two opportunities for signal amplification: (i) the replication of phage inside a live bacterial host and (ii) the delivery and expression of the complementing gene that turns on enzymatic activity and produces a colored or fluorescent product. Here we demonstrate a phage-based amplification scheme with an M13KE phage that delivers a small peptide motif to an F(+), α-complementing strain of Escherichia coli K12, which expresses the ω-domain of β-galactosidase (β-gal). The result of this complementation-an active form of β-gal-was detected colorimetrically, and the high level of expression of the ω-domain of β-gal in the model K12 strains allowed us to detect, on average, five colony-forming units (CFUs) of this strain in 1 L of water with an overnight culture-based assay. We also detected 50 CFUs of the model K12 strain in 1 L of water (or 10 mL of orange juice, or 10 mL of skim milk) in less than 4 h with a solution-based assay with visual readout. The solution-based assay does not require specialized equipment or access to a laboratory, and is more rapid than existing tests that are suitable for use at the point of access. This method could potentially be extended to detect many different bacteria with bacteriophages that deliver genes encoding a full-length enzyme that is not natively expressed in the target bacteria.

  1. Implementation of a Tailored Kiosk-Based Injury Prevention Program in Pediatric Primary Care



    This study identified behavioral and organizational barriers and facilitators related to the implementation of a clinic-based pediatric injury prevention program. Safe N′ Sound (SNS), an evidence-based tailored injury prevention program designed for pediatric primary care, was implemented in five pediatric clinics in North Carolina. Office managers participated in structured interviews; health care providers participated in focus groups. Waiting room observations were conducted in participati...

  2. Web-based Weight Loss in Primary Care: A Randomized Controlled Trial


    Bennett, Gary G.; Herring, Sharon J.; Puleo, Elaine; Stein, Evelyn K.; Emmons, Karen M; Gillman, Matthew W.


    Evidence is lacking regarding effective and sustainable weight loss approaches for use in the primary care setting. We conducted a 12-week randomized controlled trial to evaluate the short-term efficacy of a web-based weight loss intervention among 101 primary care patients with obesity and hypertension. Patients had access to a comprehensive website that used a moderate-intensity weight loss approach designed specifically for web-based implementation. Patients also participated in four (two ...

  3. Paper-based capacitive sensors for identification and quantification of chemicals at the point of care. (United States)

    Hu, Jie; Yew, Chee-Hong Takahiro; Chen, Xiaoshuang; Feng, Shangsheng; Yang, Qu; Wang, Shuqi; Wee, Wei-Hong; Pingguan-Murphy, Belinda; Lu, Tian Jian; Xu, Feng


    The identification and quantification of chemicals play a vital role in evaluation and surveillance of environmental health and safety. However, current techniques usually depend on costly equipment, professional staff, and/or essential infrastructure, limiting their accessibility. In this work, we develop paper-based capacitive sensors (PCSs) that allow simple, rapid identification and quantification of various chemicals from microliter size samples with the aid of a handheld multimeter. PCSs are low-cost parallel-plate capacitors (~$0.01 per sensor) assembled from layers of aluminum foil and filter paper via double-sided tape. The developed PCSs can identify different kinds of fluids (e.g., organic chemicals) and quantify diverse concentrations of substances (e.g., heavy metal ions) based on differences in dielectric properties, including capacitance, frequency spectrum, and dielectric loss tangent. The PCS-based method enables chemical identification and quantification to take place much cheaply, simply, and quickly at the point-of-care (POC), holding great promise for environmental monitoring in resource-limited settings.

  4. Examining "success" in post-hip fracture care transitions: a strengths-based approach. (United States)

    Sims-Gould, Joanie; Byrne, Kerry; Hicks, Elisabeth; Khan, Karim; Stolee, Paul


    Transitions between health care settings are a high-risk period for care quality and patient safety (Coleman, 2003; Picker Institute, 1999), particularly for older patients - such as those with hip fracture - who have complex needs and may undergo multiple care transitions. We sought to understand the key elements of "success" in care transition. Using a strengths-based perspective (Rapp, 1998; Saleebey, 2006), we focused on interprofessional health care providers' perspectives of what constitutes a "good" care transition for elderly hip fracture patients. As part of a larger ethnographic field study, semi-structured interviews were conducted with 17 health providers across a number of disciplines employed across the continuum of post-hip fracture management in British Columbia, Canada. We found two hallmarks of "success" in care transitions: a focus on process - information gathering and communication, and a focus on outcomes - autonomy and care pathways. Strategies for promoting and improving success, such as using practitioner-driven ground-up solutions to address challenges in care transitions, are highlighted.

  5. A web-based care-requiring client and Home Helper mutual support system. (United States)

    Ogawa, Hidekuni; Yonezawa, Yoshiharu; Maki, Hiromichi; Hahn, Allen W; Caldwell, W Morton


    For the improved efficiency of home care of the elderly, a web-based system has been developed to enable faster communications between care-requiring clients, their Home Helper and the care manager. Changes to care items, such as cooking, bathing, washing, cleaning and shopping are usually requested by the elderly client over the telephone. However, the care central office often requires 24 hours to process and respond to such spoken requests. The system we have developed consists of Internet client computers with liquid crystal input tablets, wireless Internet Java enabled mobile phones and a central office server that yields almost instant communication. The care clients enter requests on the liquid crystal tablet at their home and then their computer sends these requests to the server at the Home Helper central office. The server automatically creates a new file of the requested items, and then immediately transfers them to the care manager and Home Helper's mobile phone. With this non-vocal and paperless system, the care-requiring clients, who can easily operate the liquid crystal tablet, can very quickly communicate their needed care change requests to their Home Helper.

  6. Assessing Health Status Differences Between Veterans Affairs Home-Based Primary Care and State Medicaid Waiver Program Clients (United States)

    Wharton, Tracy C.; Nnodim, Joseph; Hogikyan, Robert; Mody, Lona; James, Mary; Montagnini, Marcos; Fries, Brant E.


    Objectives Comprehensive health care for older adults is complex, involving multiple comorbidities and functional impairments of varying degrees and numbers. In response to this complexity and associated barriers to care, home-based care models have become prevalent. The home-based primary care (HBPC) model, based at a Michigan Department of Veterans Affairs Medical Center, and the Michigan Waiver Program (MWP) that includes home-based care are 2 of these. Although both models are formatted to address barriers to effective and efficient health care, there are differences in disease prevalence and functional performance between groups. The objective of this study was to explore the differences between the 2 groups, to shed some light on potential trends that could suggest areas for resource allocation by service providers. Design Using a retrospective analysis of data collected using the interRAI-home care, we examined a cross-sectional representation of clients enrolled in HBPC and MWP in 2008. Participants The HBPC sample had 89 participants. The MWP database contained 9324 participants from across the State of Michigan and were weighted to be comparable to the HBPC population in sex and age, and to simulate the HBPC sample size. Results Veterans were more independent in basic activities of daily living performance, but there was no difference in the rate of reported falls between the 2 groups. Veterans had more pain and a higher prevalence of coronary artery disease (z = 7.0; P <.001), Chronic obstructive pulmonary disease (z = 3.9; P < .001), and cancer (z = 8.5; P < .001). There was no statistically significant difference between the 2 groups in terms of the prevalence of geriatric syndromes. Scores on subscales of the interRAI-home care indicated a lower risk of serious health decline and adverse outcomes for MWP compared with HBPC clients (1.4 ± 1.1 vs 0.9 ± 0.1; z = 2.5; P = .012). Veterans receiving home-based care through the Veterans Affairs Medical

  7. Model-based reinforcement learning for partially observable games with sampling-based state estimation. (United States)

    Fujita, Hajime; Ishii, Shin


    Games constitute a challenging domain of reinforcement learning (RL) for acquiring strategies because many of them include multiple players and many unobservable variables in a large state space. The difficulty of solving such realistic multiagent problems with partial observability arises mainly from the fact that the computational cost for the estimation and prediction in the whole state space, including unobservable variables, is too heavy. To overcome this intractability and enable an agent to learn in an unknown environment, an effective approximation method is required with explicit learning of the environmental model. We present a model-based RL scheme for large-scale multiagent problems with partial observability and apply it to a card game, hearts. This game is a well-defined example of an imperfect information game and can be approximately formulated as a partially observable Markov decision process (POMDP) for a single learning agent. To reduce the computational cost, we use a sampling technique in which the heavy integration required for the estimation and prediction can be approximated by a plausible number of samples. Computer simulation results show that our method is effective in solving such a difficult, partially observable multiagent problem.

  8. A miniaturised image based fluorescence detection system for point-of-care-testing of cocaine abuse (United States)

    Walczak, Rafał; Krüger, Jan; Moynihan, Shane


    In this paper, we describe a miniaturised image-based fluorescence detection system and demonstrate its viability as a highly sensitive tool for point-of-care-analysis of drugs of abuse in human sweat with a focus on monitor individuals for drugs of abuse. Investigations of miniaturised and low power optoelectronic configurations and methodologies for real-time image analysis were successfully carried out. The miniaturised fluorescence detection system was validated against a reference detection system under controlled laboratory conditions by analysing spiked sweat samples in dip stick and then strip with sample pad. As a result of the validation studies, a 1 ng mL-1 limit of detection of cocaine in sweat and full agreement of test results with the reference detection system can be reported. Results of the investigations open the way towards a detection system that integrates a hand-held fluorescence reader and a wearable skinpatch, and which can collect and in situ analyse sweat for the presence of cocaine at any point for up to tenths hours.

  9. The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review (United States)

    Demarzo, Marcelo M.P.; Montero-Marin, Jesús; Cuijpers, Pim; Zabaleta-del-Olmo, Edurne; Mahtani, Kamal R.; Vellinga, Akke; Vicens, Caterina; López-del-Hoyo, Yolanda; García-Campayo, Javier


    PURPOSE Positive effects have been reported after mindfulness-based interventions (MBIs) in diverse clinical and nonclinical populations. Primary care is a key health care setting for addressing common chronic conditions, and an effective MBI designed for this setting could benefit countless people worldwide. Meta-analyses of MBIs have become popular, but little is known about their efficacy in primary care. Our aim was to investigate the application and efficacy of MBIs that address primary care patients. METHODS We performed a meta-analytic review of randomized controlled trials addressing the effect of MBIs in adult patients recruited from primary care settings. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines were followed. Effect sizes were calculated with the Hedges g in random effects models. RESULTS The meta-analyses were based on 6 trials having a total of 553 patients. The overall effect size of MBI compared with a control condition for improving general health was moderate (g = 0.48; P = .002), with moderate heterogeneity (I2 = 59; P .05). CONCLUSIONS Although the number of randomized controlled trials applying MBIs in primary care is still limited, our results suggest that these interventions are promising for the mental health and quality of life of primary care patients. We discuss innovative approaches for implementing MBIs, such as complex intervention and stepped care. PMID:26553897

  10. Screening mammography beliefs and recommendations: a web-based survey of primary care physicians

    Directory of Open Access Journals (Sweden)

    Yasmeen Shagufta


    Full Text Available Abstract Background The appropriateness and cost-effectiveness of screening mammography (SM for women younger than 50 and older than 74 years is debated in the clinical research community, among health care providers, and by the American public. This study explored primary care physicians' (PCPs perceptions of the influence of clinical practice guidelines for SM; the recommendations for SM in response to hypothetical case scenarios; and the factors associated with perceived SM effectiveness and recommendations in the US from June to December 2009 before the United States Preventive Services Task Force (USPSTF recently revised guidelines. Methods A nationally representative sample of 11,922 PCPs was surveyed using a web-based questionnaire. The response rate was 5.7% (684; (41% 271 family physicians (FP, (36% 232 general internal medicine physicians (IM, (23% 150 obstetrician-gynaecologists (OBG, and (0.2% 31 others. Cross-sectional analysis examined PCPs perceived effectiveness of SM, and recommendation for SM in response to hypothetical case scenarios. PCPs responses were measured using 4-5 point adjectival scales. Differences in perceived effectiveness and recommendations for SM were examined after adjusting for PCPs specialty, race/ethnicity, and the US region. Results Compared to IM and FP, OBG considered SM more effective in reducing breast cancer mortality among women aged 40-49 years (p = 0.003. Physicians consistently recommended mammography to women aged 50-69 years with no differences by specialty (p = 0.11. However, 94% of OBG "always recommended" SM to younger and 86% of older women compared to 81% and 67% for IM and 84% and 59% for FP respectively (p = p = Conclusions A majority of physicians, especially OBG, favour aggressive breast cancer screening for women from 40 through 79 years of age, including women with short life expectancy. Policy interventions should focus on educating providers to provide tailored recommendations for

  11. The relation between exercise and glaucoma in a South Korean population-based sample (United States)

    Lin, Shuai-Chun; Wang, Sophia Y.; Pasquale, Louis R.; Singh, Kuldev; Lin, Shan C.


    Purpose To investigate the association between exercise and glaucoma in a South Korean population-based sample. Design Population-based, cross-sectional study. Participants A total of 11,246 subjects, 40 years and older who underwent health care assessment as part of the 2008–2011 Korean National Health and Nutrition Examination Survey. Methods Variables regarding the duration (total minutes per week), frequency (days per week), and intensity of exercise (vigorous, moderate exercise and walking) as well as glaucoma prevalence were ascertained for 11,246 survey participants. Demographic, comorbidity, and health-related behavior information was obtained via interview. Multivariable logistic regression analyses were performed to determine the association between the exercise-related parameters and odds of a glaucoma diagnosis. Main outcome measure(s) Glaucoma defined by International Society for Geographical and Epidemiological Ophthalmology criteria. Results Overall, 336 (2.7%) subjects met diagnostic criteria for glaucomatous disease. After adjustment for potential confounding variables, subjects engaged in vigorous exercise 7 days per week had higher odds of having glaucoma compared with those exercising 3 days per week (Odds Ratio [OR] 3.33, 95% confidence interval [CI] 1.16–9.54). High intensity of exercise, as categorized by the guidelines of the American College of Sports Medicine (ACSM), was also associated with greater glaucoma prevalence compared with moderate intensity of exercise (OR 1.55, 95% CI 1.03–2.33). There was no association between other exercise parameters including frequency of moderate exercise, walking, muscle strength exercise, flexibility training, or total minutes of exercise per week, and the prevalence of glaucoma. In sub-analyses stratifying by gender, the association between frequency of vigorous exercise 7 days per week and glaucoma diagnosis remained significant in men (OR 6.05, 95% CI 1.67–21.94) but not in women (OR 0.96 95

  12. Impact of a home-based social welfare program on care for palliative patients in the Basque Country (SAIATU Program

    Directory of Open Access Journals (Sweden)

    Molina Emilio Herrera


    Full Text Available Abstract Background SAIATU is a program of specially trained in-home social assistance and companionship which, since February 2011, has provided support to end-of-life patients, enabling the delivery of better clinical care by healthcare professionals in Osakidetza (Basque Health Service, in Guipúzcoa (Autonomous Community of the Basque Country. In January 2012, a retrospective observational study was carried out, with the aim of describing the characteristics of the service and determining if the new social service and the associated socio-health co-ordination had produced any effect on the use of healthcare resources by end-of-life patients. The results of a comparison of a cohort of cases and controls demonstrated evidence that the program could reduce the use of hospital resources and promote the continuation of living at home, increasing the home-based activity of primary care professionals. The objective of this study is to analyse whether a program of social intervention in palliative care (SAIATU results in a reduction in the consumption of healthcare resources and cost by end-of-life patients and promotes a shift towards a more community-based model of care. Method/design Comparative prospective cohort study, with randomised selection of patients, which will systematically measure patient characteristics and their consumption of resources in the last 30 days of life, with and without the intervention of a social support team trained to provide in-home end-of-life care. For a sample of approximately 150 patients, data regarding the consumption of public healthcare resources, SAIATU activity, home hospitalisation teams, and palliative care will be recorded. Such data will also include information dealing with the socio-demographic and clinical characteristics of the patients and attending carers, as well as particular characteristics of patient outcomes (Karnofsky Index, and of the outcomes of palliative care received (Palliative

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


    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.

  14. A national survey of home-based care kits for palliative HIV/AIDS care in South Africa. (United States)

    Mabude, Z A; Beksinska, M E; Ramkissoon, A; Wood, S; Folsom, M


    The objective of this study was to assess home-based care (HBC) kits and programs in South Africa to evaluate the feasibility of scaling up kit production and distribution. South African HBC organizations received structured questionnaires; key informant interviews and a literature review were completed to assess systems for production, distribution and supply of HBC kits. Meetings with stakeholders were held in two Provinces to share and analyze the study findings. The study team distributed questionnaires to 466 organizations and conducted interviews with representatives from 45 organizations, the Provincial Department of Health (DoH) and manufacturers of kits. All identifiable HBC organizations in South Africa were included in the survey. As a result 215 HBC organizations returned questionnaires; including non-governmental organizations (56%), community-based organizations (32%) and organizations affiliated with government health departments. Two types of kits were available: a home kit and a professional kit. The demand for HBC kits exceeded availability, kit contents and availability varied considerably and the supply chain was irregular. Kit production and distribution systems were fragmented. Replenishment of kit items was problematic. End-users are mostly caregivers who have not received adequate training on their use. The study shows that substantial work has been done by HBC organizations in South Africa to respond to the need for palliative care supplies within resource constraints. The growing demand for kits exceeds the supply. There is a need to improve the supply chain management of HBC kits, strengthen referral systems and links between community-based organizations and government departments, expand training opportunities for care givers, and develop monitoring and evaluation systems.

  15. Implementation process and challenges for the community-based integrated care system in Japan

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    Takako Tsutsui


    Full Text Available Background: Since 10 years ago, Japan has been creating a long-term vision to face its peak in the number of older people that will be reached in 2025 when baby boomers will turn 75 years of age. In 2003, the government set up a study group called “Caring for older people in 2015” which led to a first reform of the Long-Term Care Insurance System in 2006. This study group was the first to suggest the creation of a community-based integrated care system. Reforms: Three measures were taken in 2006: ‘Building an active ageing society: implementation of preventive care services’, ‘Improve sustainability: revision of the remuneration of facilities providing care’ and ‘Integration: establishment of a new service system’. These reforms are at the core of the community-based integrated care system. Discussion: The socialization of long-term care that came along with the ageing of the population, and the second shift in Japan towards an increased reliance on the community can provide useful information for other ageing societies. As a super ageing society, the attempts from Japan to develop a rather unique system based on the widely spread concept of integrated care should also become an increasing focus of attention.

  16. Practice Based Versus Telemedicine Based Collaborative Care for Depression in Rural Federally Qualified Health Centers: A Pragmatic Randomized Comparative Effectiveness Trial (United States)

    Fortney, John C.; Pyne, Jeffrey M.; Mouden, Sip B.; Mittal, Dinesh; Hudson, Teresa J.; Schroeder, Gary W.; Williams, David K.; Bynum, Carol A.; Mattox, Rhonda; Rost, Kathryn M


    Objective Practice Based Collaborative Care is a complex evidence-based practice that is difficult to implement in smaller primary care practices lacking on-site mental health staff. Telemedicine Based Collaborative Care virtually co-locates and integrates mental health providers into primary care settings. The objective of this multi-site randomized pragmatic comparative effectiveness trial was to compare the outcomes of patients randomized to Practice Based versus Telemedicine Based Collaborative Care. Method From 2007–2009, patients at Federally Qualified Health Centers serving medically underserved populations were screened for depression, and 364 patients screening positive were enrolled and followed for 18 months. Those randomized to Practice Based Collaborative Care received evidence-based care from an on-site primary care provider and nurse care manager. Those randomized to Telemedicine Based Collaborative Care received evidence-based care from an on-site primary care provider and off-site telephone nurse care manager, telephone pharmacist, tele-psychologist and tele-psychiatrist. The primary clinical outcomes were treatment response, remission and changes in depression severity Results There were significant group main effects for both response (OR=7.74, CI95=3.94–15.20, p<0.0001) and remission (OR=12.69, CI95=4.81–33.46, p<0.0001) and a significant overall group by time interaction effect for Hopkins Symptom Checklist depression severity (χ23=40.51, p<0.0001) with greater reductions in depression severity observed over time for those randomized to Telemedicine Based Collaborative Care. Improvements in outcomes appeared to be attributable to higher fidelity to the collaborative care evidence-base in the Telemedicine Based group. Conclusions Contracting with an off-site Telemedicine Based Collaborative Care team yields better outcomes than implementing Practice Based Collaborative Care with locally available staff. PMID:23429924

  17. Sampling uncertainty evaluation for data acquisition board based on Monte Carlo method (United States)

    Ge, Leyi; Wang, Zhongyu


    Evaluating the data acquisition board sampling uncertainty is a difficult problem in the field of signal sampling. This paper analyzes the sources of dada acquisition board sampling uncertainty in the first, then introduces a simulation theory of dada acquisition board sampling uncertainty evaluation based on Monte Carlo method and puts forward a relation model of sampling uncertainty results, sampling numbers and simulation times. In the case of different sample numbers and different signal scopes, the author establishes a random sampling uncertainty evaluation program of a PCI-6024E data acquisition board to execute the simulation. The results of the proposed Monte Carlo simulation method are in a good agreement with the GUM ones, and the validities of Monte Carlo method are represented.

  18. Village-based primary health care in the Central Highlands of Vietnam. (United States)

    Barrett, B; Ladinsky, J; Volk, N


    This paper describes the first year of an ongoing village health care and economic development project in the Krong Buk district of Dak Lak province in Vietnam's Central Highlands. The project serves 21 villages with a total population of just over 15,000. Most belong to ethnic minority groups. Physicians from the province capital of Boun Me Thuot were trained by a multi-disciplinary team of American health care workers to be trainers and supervisors of 21 village health care workers (VHWs). Two months later, a VHW from each village was trained in primary and preventive health care by the physician-supervisors. Since this initial training, each VHW has been provided with materials, medicines and monthly supervision by the physician-supervisors. The health care component has been complemented by an economic development project based on a system of small loans. Data from the first year of monthly reports and from a baseline survey are presented in this paper.

  19. Web-based collaboration in individual care planning challenges the user and the provider roles – toward a power transition in caring relationships

    Directory of Open Access Journals (Sweden)

    Bjerkan J


    Full Text Available Jorunn Bjerkan,1,2 Solfrid Vatne,3 Anne Hollingen4 1Norwegian Research Centre for Electronic Health Records (EHR, Medical Faculty, Norwegian University of Science and Technology, Trondheim, 2Faculty of Health Science, Nord-Trøndelag University College, Levanger, 3Faculty of Health Science, Molde University College, 4Møre og Romsdal Hospital Trust, Molde, Norway Background and objective: The Individual Care Plan (ICP was introduced in Norway to meet new statutory requirements for user participation in health care planning, incorporating multidisciplinary and cross-sector collaboration. A web-based solution (electronic ICP [e-ICP] was used to support the planning and documentation. The aim of this study was to investigate how web-based collaboration challenged user and professional roles. Methods: Data were obtained from 15 semistructured interviews with users and eight with care professionals, and from two focus-group interviews with eight care professionals in total. The data were analyzed using systematic text condensation in a stepwise analysis model. Results: Users and care professionals took either a proactive or a reluctant role in e-ICP collaboration. Where both user and care professionals were proactive, the pairing helped to ensure that the planning worked well; so did pairings of proactive care professionals and reluctant users. Proactive users paired with reluctant care professionals also made care planning work, thanks to the availability of information and the users' own capacity or willingness to conduct the planning. Where both parties were reluctant, no planning activities occurred. Conclusion: Use of the e-ICP challenged the user–professional relationship. In some cases, a power transition took place in the care process, which led to patient empowerment. This knowledge might be used to develop a new understanding of how role function can be challenged when users and care professionals have equal access to health care

  20. Group-based and personalized care in an age of genomic and evidence-based medicine: a reappraisal. (United States)

    Maglo, Koffi N


    This article addresses the philosophical and moral foundations of group-based and individualized therapy in connection with population care equality. The U.S. Food and Drug Administration (FDA) recently modified its public health policy by seeking to enhance the efficacy and equality of care through the approval of group-specific prescriptions and doses for some drugs. In the age of genomics, when individualization of care increasingly has become a major concern, investigating the relationship between population health, stratified medicine, and personalized therapy can improve our understanding of the ethical and biomedical implications of genomic medicine. I suggest that the need to optimize population health through population substructure-sensitive research and the need to individualize care through genetically targeted therapies are not necessarily incompatible. Accordingly, the article reconceptualizes a unified goal for modern scientific medicine in terms of individualized equal care.

  1. Autonomous spatially adaptive sampling in experiments based on curvature, statistical error and sample spacing with applications in LDA measurements (United States)

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


    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.

  2. A Comprehensive Approach in Dissemination of Evidence-Based Care for PTSD (United States)


    clinical competence , the American Board of Medical Specialties and the American Board of Psychiatry and Neurology are implementing multifaceted...Performance in Practice: Sample Tools for the Care of Patients with Major Depressive Disorder Abstract: To facilitate continued clinical competence , the

  3. Work-based learning in health and social care. (United States)

    Phillips, Sue

    This article examines some of the issues encountered in helping to develop and facilitate work-based learning (WBL) in clinical areas from the author's perspective of APEL/WBL co-ordinator. The advantages of work-based learning to both organisations and practitioners are discussed, together with possible drawbacks. The article concludes by identifying the positive aspects, including that of practice development, but suggests caution in attempting to use work-based learning in all circumstances.

  4. Risk-Based Sampling: I Don't Want to Weight in Vain. (United States)

    Powell, Mark R


    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.

  5. Sample injection and electrophoretic separation on a simple laminated paper based analytical device. (United States)

    Xu, Chunxiu; Zhong, Minghua; Cai, Longfei; Zheng, Qingyu; Zhang, Xiaojun


    We described a strategy to perform multistep operations on a simple laminated paper-based separation device by using electrokinetic flow to manipulate the fluids. A laminated crossed-channel paper-based separation device was fabricated by cutting a filter paper sheet followed by lamination. Multiple function units including sample loading, sample injection, and electrophoretic separation were integrated on a single paper based analytical device for the first time, by applying potential at different reservoirs for sample, sample waste, buffer, and buffer waste. As a proof-of-concept demonstration, mixed sample solution containing carmine and sunset yellow were loaded in the sampling channel, and then injected into separation channel followed by electrophoretic separation, by adjusting the potentials applied at the four terminals of sampling and separation channel. The effects of buffer pH, buffer concentration, channel width, and separation time on resolution of electrophoretic separation were studied. This strategy may be used to perform multistep operations such as reagent dilution, sample injection, mixing, reaction, and separation on a single microfluidic paper based analytical device, which is very attractive for building micro total analysis systems on microfluidic paper based analytical devices.

  6. Single-use paper-based hydrogen fuel cells for point-of-care diagnostic applications (United States)

    Esquivel, J. P.; Buser, J. R.; Lim, C. W.; Domínguez, C.; Rojas, S.; Yager, P.; Sabaté, N.


    This work demonstrates a stand-alone power source that integrates a paper-based hydrogen fuel cell with a customized chemical heater that produces hydrogen in-situ upon the addition of a liquid. The presented approach operates by capillary action and takes advantage of the hydrogen released as a by-product of an exothermic reaction used in point-of-care diagnostics. The paper-based fuel cell produces a maximum power of 25.8 mW (103.2 mW cm-2), which is suitable for powering a diversity of electrical devices such as commercially available digital pregnancy tests and glucometers. While device shape and dimensions can be customized, here it is shown that the fuel cell can be designed in a compact form factor and footprint comparable to a lateral flow test while providing a remarkable power output. This approach holds great promise for powering portable diagnostics, as the generated electric power could enable device functionalities required for advanced assays, such as device timing, actuation, and signal quantification. Part of the same liquid sample that is to be analyzed (urine, saliva, water, etc) could be used to trigger the hydrogen generation and start the fuel cell operation.

  7. Automatic training sample selection for a multi-evidence based crop classification approach

    DEFF Research Database (Denmark)

    Chellasamy, Menaka; Ferre, Ty; Greve, Mogens Humlekrog

    three Multi-Layer Perceptron (MLP) neural networks trained separately with spectral, texture and vegetation indices; classification labels were then assigned based on Endorsement Theory. The present study proposes an approach to feed this ensemble classifier with automatically selected training samples...... are classified using the multi-evidence approach. The study is implemented with WorldView-2 multispectral imagery acquired for a study area containing 10 crop classes. The proposed approach is compared with the multi-evidence approach based on training samples selected randomly and border samples based...

  8. Primary care practice-based care management for chronically ill patients (PraCMan: study protocol for a cluster randomized controlled trial [ISRCTN56104508

    Directory of Open Access Journals (Sweden)

    Baldauf Annika


    Full Text Available Abstract Background Care management programmes are an effective approach to care for high risk patients with complex care needs resulting from multiple co-occurring medical and non-medical conditions. These patients are likely to be hospitalized for a potentially "avoidable" cause. Nurse-led care management programmes for high risk elderly patients showed promising results. Care management programmes based on health care assistants (HCAs targeting adult patients with a high risk of hospitalisation may be an innovative approach to deliver cost-efficient intensified care to patients most in need. Methods/Design PraCMan is a cluster randomized controlled trial with primary care practices as unit of randomisation. The study evaluates a complex primary care practice-based care management of patients at high risk for future hospitalizations. Eligible patients either suffer from type 2 diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure or any combination. Patients with a high likelihood of hospitalization within the following 12 months (based on insurance data will be included in the trial. During 12 months of intervention patients of the care management group receive comprehensive assessment of medical and non-medical needs and resources as well as regular structured monitoring of symptoms. Assessment and monitoring will be performed by trained HCAs from the participating practices. Additionally, patients will receive written information, symptom diaries, action plans and a medication plan to improve self-management capabilities. This intervention is addition to usual care. Patients from the control group receive usual care. Primary outcome is the number of all-cause hospitalizations at 12 months follow-up, assessed by insurance claims data. Secondary outcomes are health-related quality of life (SF12, EQ5D, quality of chronic illness care (PACIC, health care utilisation and costs, medication adherence (MARS, depression

  9. Sampling for evaluation. Issues and strategies for community-based HIV prevention programs. (United States)

    O'Connell, A A


    Sampling methods are an important issue in the evaluation of community-based HIV prevention initiatives because it is through responsible sampling procedures that a valid model of the population is produced and reliable estimates of behavior change determined. This article provides an overview on sampling with particular focus on the needs of community-based organizations (CBOs). As these organizations continue to improve their capacity for sampling and program evaluation activities, comparisons across CBOs can become more rigorous, resulting in valuable information collectively regarding the effectiveness of particular HIV prevention initiatives. The author reviews several probability and non-probability sampling designs; discusses bias, cost, and feasibility factors in design selection; and presents six guidelines designed to encourage community organizations to consider these important sampling issues as they plan their program evaluations.

  10. Microwave spectrum sensing based on photonic time stretch and compressive sampling. (United States)

    Chi, Hao; Chen, Ying; Mei, Yuan; Jin, Xiaofeng; Zheng, Shilie; Zhang, Xianmin


    An approach to realizing microwave spectrum sensing based on photonic time stretch and compressive sampling is proposed. The time stretch system is used to slow down the input high-speed signal and the compressive sampling based on random demodulation can further decrease the sampling rate. A spectrally sparse signal in a wide bandwidth can be captured with a sampling rate far lower than the Nyquist rate thanks to both time stretch and compressive sampling. It is demonstrated that a system with a time stretch factor 5 and a compression factor 8 can be used to capture a signal with multiple tones in a 50 GHz bandwidth, which means a sampling rate 40 times lower than the Nyquist rate. In addition, the time stretch of the microwave signal largely decreases the data rate of random data sequence and therefore the speed of the mixer in the random demodulator.

  11. Practical considerations for the interpretation of microbial testing results based on small numbers of samples. (United States)

    Hoelzer, Karin; Pouillot, Régis


    While adequate, statistically designed sampling plans should be used whenever feasible, inference about the presence of pathogens in food occasionally has to be made based on smaller numbers of samples. To help the interpretation of such results, we reviewed the impact of small sample sizes on pathogen detection and prevalence estimation. In particular, we evaluated four situations commonly encountered in practice. The first two examples evaluate the combined impact of sample size and pathogen prevalence (i.e., fraction of contaminated food items in a given lot) on pathogen detection and prevalence estimation. The latter two examples extend the previous example to consider the impact of pathogen concentration and imperfect test sensitivity. The provided examples highlight the difficulties of making inference based on small numbers of samples, and emphasize the importance of using appropriate statistical sampling designs whenever possible.

  12. The cost of universal health care in India: a model based estimate.

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    Full Text Available INTRODUCTION: As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. METHODS: We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. RESULTS: We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73 per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8% of the GDP for universalizing health care services. CONCLUSION: The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

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

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    Zhuoshi Li


    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.

  14. Improving the quality of medical care: the normativity of evidence-based performance standards. (United States)

    Tanenbaum, Sandra J


    Poor quality medical care is sometimes attributed to physicians' unwillingness to act on evidence about what works best. Evidence-based performance standards (EBPSs) are one response to this problem, and they are increasingly employed by health care regulators and payers. Evidence in this instance is judged according to the precepts of evidence-based medicine (EBM); it is probabilistic, and the randomized controlled trial (RCT) is the gold standard. This means that EBPSs suffer all the infirmities of EBM generally-well rehearsed problems with the external validity of research findings as well as the inferential leap from study results in the aggregate to individual patient care. These theoretical weaknesses promise to have a practical impact on the care of patients. To avoid this, EBPSs should be understood as guidelines indicative of average effectiveness rather than standards to be applied in every case.

  15. Connecting teens to caring adults in a school-based health center: a case study. (United States)

    Blacksin, Beth A; Kelly, Patricia J


    The traditional medical care system is generally unable to provide the broad health and wellness services needed by many adolescents, especially those from low-income and racial/ethnic minority communities. Using a theoretical framework adapted from Bronfenbrenner's ecological model of multiple influencers, this case study examined how a school-based health center was able to provide a network of connections for adolescents to caring adults within the school and the local community. Contributors to this network were the creation of a student-centered community with access to adolescent-friendly services, providers acting as connectors, and care of the whole adolescent.

  16. The Role of Liposomal Bupivacaine in Value-Based Care. (United States)

    Iorio, Richard

    Multimodal pain control strategies are crucial in reducing opioid use and delivering effective pain management to facilitate improved surgical outcomes. The utility of liposomal bupivacaine in enabling effective pain control in multimodal strategies has been demonstrated in several studies, but others have found the value of liposomal bupivacaine in such approaches to be insignificant. At New York University Langone Medical Center, liposomal bupivacaine injection and femoral nerve block were compared in their delivery of efficacious and cost-effective multimodal analgesia among patients undergoing total joint arthroplasty (TJA). Retrospective analysis revealed that including liposomal bupivacaine in a multimodal pain control protocol for TJA resulted in improved quality and efficiency metrics, decreased narcotic use, and faster mobilization, all relative to femoral nerve block, and without a significant increase in admission costs. In addition, liposomal bupivacaine use was associated with elimination of the need for patient-controlled analgesia in TJA. Thus, at Langone Medical Center, the introduction of liposomal bupivacaine to TJA has been instrumental in achieving adequate pain control, delivering high-level quality of care, and controlling costs.


    Directory of Open Access Journals (Sweden)



    Full Text Available OBJECTIVES: The purpose of present study was to evaluate the reliability of central venous blood gas monitoring as an alternative to arterial blood gas monitoring and to assess that the central venous catheter is convenient and reliable source of blood for repetitive measurement of pH bicarbonate and PCO2 in critically ill patients admitted in surgical intensive care unit (SICU. METHODS: We took one hundred patients who required ABG analysis between 20 - 60 years of age. The cases were divided in four groups which constituted major admissions in SICU in one year. Out of one hundred patients for the study there were 19 Poisoning patients, 15 Trauma patients, 40 Major abdominal surgery patients, 26 Hypovolemic shock patients and others. Central Venous blood drawn within 5 min of an ABG measurement and the samples analyzed immediately on automated ABG analyzer were compared. RESULTS: Bland Altman plots demonstrated a high degree of agreement between the two corresponding sets of measurements of arterial and venous blood with coefficient of correlation 0.979 for pH. The coefficient of correlation was highly positive i.e. 0.926 for PCO 2 and 0.955 for HCO 3 - which is statistically significant. There was also positive correlation for saturation between arterial and venous blood i.e. 0.57 with clinically acceptable difference and is statistically significant. The difference in pO 2 measurements was however higher with correlation coefficient of 0.259 although the arterial saturation and finger oximetry reveals a good degree of agreement with clinically acceptable bias. CONCLUSION: Venous blood gas (VBG analysis clearly does not replace ABG analysis in determining exact pO 2 status and arterial puncture may still be required for invasive arterial BP monitoring. With positive correlation and regression plots obtained, venous samples can be used as an alternative to arterial samples depending on the significant positive correlation values obtained for

  18. An optimization based sampling approach for multiple metrics uncertainty analysis using generalized likelihood uncertainty estimation (United States)

    Zhou, Rurui; Li, Yu; Lu, Di; Liu, Haixing; Zhou, Huicheng


    This paper investigates the use of an epsilon-dominance non-dominated sorted genetic algorithm II (ɛ-NSGAII) as a sampling approach with an aim to improving sampling efficiency for multiple metrics uncertainty analysis using Generalized Likelihood Uncertainty Estimation (GLUE). The effectiveness of ɛ-NSGAII based sampling is demonstrated compared with Latin hypercube sampling (LHS) through analyzing sampling efficiency, multiple metrics performance, parameter uncertainty and flood forecasting uncertainty with a case study of flood forecasting uncertainty evaluation based on Xinanjiang model (XAJ) for Qing River reservoir, China. Results obtained demonstrate the following advantages of the ɛ-NSGAII based sampling approach in comparison to LHS: (1) The former performs more effective and efficient than LHS, for example the simulation time required to generate 1000 behavioral parameter sets is shorter by 9 times; (2) The Pareto tradeoffs between metrics are demonstrated clearly with the solutions from ɛ-NSGAII based sampling, also their Pareto optimal values are better than those of LHS, which means better forecasting accuracy of ɛ-NSGAII parameter sets; (3) The parameter posterior distributions from ɛ-NSGAII based sampling are concentrated in the appropriate ranges rather than uniform, which accords with their physical significance, also parameter uncertainties are reduced significantly; (4) The forecasted floods are close to the observations as evaluated by three measures: the normalized total flow outside the uncertainty intervals (FOUI), average relative band-width (RB) and average deviation amplitude (D). The flood forecasting uncertainty is also reduced a lot with ɛ-NSGAII based sampling. This study provides a new sampling approach to improve multiple metrics uncertainty analysis under the framework of GLUE, and could be used to reveal the underlying mechanisms of parameter sets under multiple conflicting metrics in the uncertainty analysis process.

  19. Negative thoughts and health: associations among rumination, immunity, and health care utilization in a young and elderly sample

    DEFF Research Database (Denmark)

    Thomsen, Dorthe Kirkegaard; Mehlsen, Mimi Yung; Hokland, Marianne;


    OBJECTIVE: In the present study, it was tested whether rumination-negative, recurrent thoughts-would be associated with immune parameters and health care utilization. Because rumination has been associated with sadness and subjective sleep quality, it was tested whether these factors mediated...... displayed a positive association with total leukocyte count, total lymphocyte count, and number of B cells among the elderly, and this was not mediated by sadness or subjective sleep quality. Rumination was also positively associated with number of telephone consultations during the follow......-up for the elderly, and this was partly mediated by sadness and subjective sleep quality. Although total leukocyte counts correlated with number of telephone consultations at the follow-up, none of the immune parameters mediated the association between rumination and health care utilization. No significant...

  20. Application of a Comprehensive Unit-based Safety Program in critical care: the royal exchange. (United States)

    Smith, Lauren E; Flanders, Sonya A


    This article discusses the history of the Comprehensive Unit-based Safety Program (CUSP) and how it is used to foster a culture of safety. CUSP involves interdisciplinary teamwork and empowers nurses at all levels to pioneer changes and develop leadership skills. A case study is presented to show how CUSP was used effectively in critical care to create a standardized handover of patients from the operating room to the intensive care unit.

  1. Predictors of quality of life of people receiving intensive community-based care



    Purpose Intensive community-based care (ICBC) is a home-treatment approach aiming to support people ‘living in the community’ with severe psychiatric and addiction problems. Although subjective quality of life (SQOL) is an increasingly important outcome measure in health care, little is known on ICBC clients’ SQOL. Methods Clients of three ICBC teams (N = 523) participated in the study. Upon intake, clients filled out a SQOL measure and indicated whether they had a good friend, partner, and c...

  2. Determinants of Self-Care in Diabetic Patients Based on Health Belief Model


    Dehghani-Tafti, Abbasali; Mahmoodabad, Seyed Saeed Mazloomy; Morowatisharifabad, Mohammad Ali; Ardakani, Mohammad Afkhami; Rezaeipandari, Hassan; Lotfi, Mohammad Hassan


    Introduction: The aim of this study was to determine self-care predictors in diabetic patients based on health belief model. Materials and Methods: The cross-sectional study was conducted on 110 diabetic patients referred to health service centers in Ardakan city, Yazd, Iran. The data was collected by a questionnaire including perceived benefits, barriers, severity, susceptibility, self-efficacy, social support, self-care behaviors and demographic variables. Results: Regularly medicine use (m...

  3. Erectile dysfunction among diabetic patients in Saudi Arabia: A hospital-based primary care study

    Directory of Open Access Journals (Sweden)

    Yousef A Al-Turki


    Conclusions: Complete (severe and partial erectile dysfunction was quite common among adult diabetic patients in a hospital-based primary care setting in Saudi Arabia. It is important for primary care physicians to diagnose erectile dysfunction in diabetic patients, and to counsel them early, as most patients are hesitant to discuss their concern during a consultation. Further studies are recommended to evaluate the effect of other risk factors on erectile dysfunction in diabetic patients.

  4. Academic-practice partnerships to promote evidence-based practice in long-term care: oral hygiene care practices as an exemplar. (United States)

    McConnell, Eleanor Schildwachter; Lekan, Deborah; Hebert, Catherine; Leatherwood, Lisa


    Learning in practice disciplines suffers when gaps exist between classroom instruction and students' observations of routine clinical practices.(1) Academic institutions, therefore, have a strong interest in fostering the rapid and effective translation of evidence-based care techniques into routine practice. Long-term care (LTC) practice sites are particularly vulnerable to gaps between classroom teaching and how daily care is implemented, owing to the recent rapid advances in the scientific bases of care for frail older adults, the relative isolation of most LTC sites from academic settings,(2) and the relatively small number of registered nurses (RNs) available in LTC settings who can facilitate translation of research-based practices into care.(3) The aim of this project was to demonstrate the feasibility and value of an academic practice partnership to implement evidence-based approaches to solving resident care problems in LTC, as many scientifically proven practices hold promise for improving resident outcomes yet adoption is often slow.(4) We developed and implemented a clinical practice improvement process, based on diffusion of innovations theory and research,(5-8) to serve as a new model of academic-practice collaboration between a university school of nursing, LTC facility management and direct-care staff, as a means of developing high quality clinical sites for student rotations. The goal was to implement a sustainable evidence-based oral care program as an exemplar of how scientific evidence can be translated into LTC practice. This project focused on oral hygiene because the staff was dissatisfied with their existing resident oral care program, and an evidence-base for oral care in LTC existed that had not yet been incorporated into care routines. This article describes a systematic, replicable process for linking advanced practice registered nurse expertise with staff insights about care systems to reduce the gap between teaching and practice in

  5. Eating Disorders among a Community-Based Sample of Chilean Female Adolescents (United States)

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


    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.…

  6. Divorce, divorce rates, and professional care seeking for mental health problems in Europe: a cross-sectional population-based study

    Directory of Open Access Journals (Sweden)

    Symoens Sara AA


    Full Text Available Abstract Background Little is known about differences in professional care seeking based on marital status. The few existing studies show more professional care seeking among the divorced or separated compared to the married or cohabiting. The aim of this study is to determine whether, in a sample of the European general population, the divorced or separated seek more professional mental health care than the married or cohabiting, regardless of self-reported mental health problems. Furthermore, we examine whether two country-level features--the supply of mental health professionals and the country-level divorce rates--contribute to marital status differences in professional care-seeking behavior. Methods We use data from the Eurobarometer 248 on mental well-being that was collected via telephone interviews. The unweighted sample includes 27,146 respondents (11,728 men and 15,418 women. Poisson hierarchical regression models were estimated to examine whether the divorced or separated have higher professional health care use for emotional or psychological problems, after controlling for mental and somatic health, sociodemographic characteristics, support from family and friends, and degree of urbanization. We also considered country-level divorce rates and indicators of the supply of mental health professionals, and applied design and population weights. Results We find that professional care seeking is strongly need based. Moreover, the divorced or separated consult health professionals for mental health problems more often than people who are married or who cohabit do. In addition, we find that the gap between the divorced or separated and the married or cohabiting is highest in countries with low divorce rates. Conclusions The higher rates of professional care seeking for mental health problems among the divorced or separated only partially correlates with their more severe mental health problems. In countries where marital dissolution is more

  7. Investigating unmet health needs in primary health care services in a representative sample of the Greek population. (United States)

    Pappa, Evelina; Kontodimopoulos, Nick; Papadopoulos, Angelos; Tountas, Yannis; Niakas, Dimitris


    Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the socioeconomic and health status factors that are associated with unmet needs. A cross-sectional study was conducted in Greece in 2010 and involved data from 1,000 consenting subjects (>18 years old). Multiple binary logistic regression analysis was applied to investigate the predictors of unmet needs and to determine the relation between the socio-demographic characteristics and the accessibility, availability and acceptability barriers. Ninety nine participants (9.9%) reported unmet health needs during the 12 months prior to the research. The most frequently self-reported reasons were cost and lack of time. Youth, parenthood, physician consultations, and poor mental health increased the likelihood of unmet needs. Women were less likely to report accessibility and availability than acceptability barriers. Educational differences were evident and individuals with primary and secondary education were associated with significantly more accessibility and availability barriers compared with those with tertiary education. Unmet health needs pose a significant challenge to the health care system, especially given the difficult current financial situation in Greece. It is believed that unmet health needs will continue to increase, which will widen inequalities in health and health care access.

  8. Osteoarthritis: quality of life, comorbidities, medication and health service utilization assessed in a large sample of primary care patients

    Directory of Open Access Journals (Sweden)

    Szecsenyi Joachim


    Full Text Available Abstract Objective To assess the gender related impact of osteoarthritis (OA on quality of life (QoL and health service utilization (HSU of primary care patients in Germany. Methods Cross sectional study with 1250 OA patients attending 75 primary care practices from March to May 2005. QoL was assessed using the GERMAN-AIMS2-SF. Data about comorbidities, prescriptions, health service utilization, and physical activity were obtained by questioning patients or from the patients' medical files. Depression was assessed by means of the Patient Health Questionnaire (PHQ-9. Results 1021 (81.7% questionnaires were returned. 347 (34% patients were male. Impact of OA on QoL was different between gender: women achieved significantly higher scores in the AIMS 2-SF dimensions lower body (p Conclusion The extent to which OA impacts men and women differs in primary care patients. This might have resulted in the revealed differences in the pharmacological treatment and the HSU. Further research is needed to confirm our findings and to assess causality.

  9. Robotic, MEMS-based Multi Utility Sample Preparation Instrument for ISS Biological Workstation Project (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...

  10. A qualitative study: Mothers of late preterm infants relate their experiences of community-based care (United States)

    Dosani, Aliyah; Oliver, Lynnette May; Lodha, Abhay K; Young, Marilyn


    Purpose In Alberta, the high occurrence of late preterm infants and early hospital discharge of mother-infant dyads has implications for postpartum care in the community. Shortened hospital stay and complexities surrounding the care of biologically and developmentally immature late preterm infants heighten anxiety and fears. Our descriptive phenomenological study explores mothers’ experience of caring for their late preterm infants in the community. Methods Eleven mothers were interviewed using a semi-structured interview guide. Interview transcripts were analysed using an interpretive thematic approach. Findings The mothers’ hospital experience informed their perspective that being a late preterm infant was not a “big deal,” and they tended to treat their infant as normal. “Feeding was really problem,” especially the variability in feeding effectiveness, which was not anticipated. Failing to recognize late preterm infants’ feeding distress exemplified lack of knowledge of feeding cues and tendencies to either rationalize or minimize feeding concerns. Public health nurses represent a source of informational support for managing neonatal morbidities associated with being late preterm; however, maternal experiences with public health nurses varied. Some nurses used a directive style that overwhelmed certain mothers. Seeing multiple public health nurses and care providers was not always effective, given inconsistent and contradictory guidance to care. These new and changing situations increased maternal anxiety and stress and influenced maternal confidence in care. Fathers, family, and friends were important sources of emotional support. Conclusion After discharge, mothers report their lack of preparation to meet the special needs of their late preterm infants. Current approaches to community-based care can threaten maternal confidence in care. New models and pathways of care for late preterm infants and their families need to be responsive to the

  11. Task-role-based Access Control Model in Smart Health-care System

    Directory of Open Access Journals (Sweden)

    Wang Peng


    Full Text Available 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 the medical health-care environment, task-role-based access control model, which overcomes the disadvantages of traditional access control models. The task-role-based access control (T-RBAC model introduces a task concept, dividing tasks into four categories. It also supports supervision role hierarchy. T-RBAC is a proper access control model for Smart Health-care System, and it improves the management of access rights. This paper also proposes an implementation of T-RBAC, a binary two-key-lock pair access control scheme using prime factorization.

  12. A resource-based view of partnership strategies in health care organizations. (United States)

    Yarbrough, Amy K; Powers, Thomas L


    The distribution of management structures in health care has been shifting from independent ownership to interorganizational relationships with other firms. A shortage of resources has been cited as one cause for such collaboration among health care entities. The resource- based view of the firm suggests that organizations differentiate between strategic alliances and acquisition strategies based on a firm's internal resources and the types of resources a potential partner organization possesses. This paper provides a review of the literature using the resource-based theory of the firm to understand what conditions foster different types of health care partnerships. A model of partnership alliances using the resource-based view is presented, strategic linkages are presented, managerial implications are outlined, and directions for future research are given.

  13. A methodological approach based on indirect sampling to survey the homeless people


    Claudia De Vitiis; Stefano Falorsi; Francesca Inglese; Alessandra Masi; Nicoletta Pannuzi; Monica Russo


    The Italian National Institute of Statistics carried out the first survey on homeless population. The survey aims at estimating the unknown size and some demographic and social characteristics of this population. The methodological strategy used to investigate homeless population could not follow the standard approaches of official statistics usually based on the use of population lists. The sample strategy for the homeless survey refers to the theory of indirect sampling, based on the use of...

  14. Mechanism-based classification of pain for physical therapy management in palliative care: A clinical commentary

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar


    Full Text Available Pain relief is a major goal for palliative care in India so much that most palliative care interventions necessarily begin first with pain relief. Physical therapists play an important role in palliative care and they are regarded as highly proficient members of a multidisciplinary healthcare team towards management of chronic pain. Pain necessarily involves three different levels of classification-based upon pain symptoms, pain mechanisms and pain syndromes. Mechanism-based treatments are most likely to succeed compared to symptomatic treatments or diagnosis-based treatments. The objective of this clinical commentary is to update the physical therapists working in palliative care, on the mechanism-based classification of pain and its interpretation, with available therapeutic evidence for providing optimal patient care using physical therapy. The paper describes the evolution of mechanism-based classification of pain, the five mechanisms (central sensitization, peripheral neuropathic, nociceptive, sympathetically maintained pain and cognitive-affective are explained with recent evidence for physical therapy treatments for each of the mechanisms.

  15. Does capillary racetrack-based enrichment reflect the diversity of uncultivated magnetotactic cocci in environmental samples? (United States)

    Lin, Wei; Tian, Lanxiang; Li, Jinhua; Pan, Yongxin


    The racetrack-based PCR approach is widely used in phylogenetic analysis of magnetotactic bacteria (MTB), which are isolated from environmental samples using the capillary racetrack method. To evaluate whether the capillary racetrack-based enrichment can truly reflect the diversity of MTB in the targeted environmental sample, phylogenetic diversity studies of MTB enriched from the Miyun lake near Beijing were carried out, using both the capillary racetrack-based PCR and a modified metagenome-based PCR approach. Magnetotactic cocci were identified in the studied sample using both approaches. Comparative studies showed that three clusters of magnetotactic cocci were revealed by the modified metagenome-based PCR approach, while only one of them (e.g. MYG-22 sequence) was detected by the racetrack-based PCR approach from the studied sample. This suggests that the result of capillary racetrack-based enrichment might have been biased by the magnetotaxis of magnetotactic bacteria. It appears that the metagenome-based PCR approach better reflects the original diversity of MTB in the environmental sample.

  16. Web-Based Self-Management in Chronic Care: A Study of Change in Patient Activation (United States)

    Solomon, Michael R.


    Web-based self-management interventions (W-SMIs) are designed to help a large number of chronically ill people become more actively engaged in their health care. Despite the potential to engage more patients in self-managing their health, the use of W-SMIs by patients and their clinicians is low. Using a self-management conceptual model based on…

  17. A Nonlinear Lagrange Algorithm for Stochastic Minimax Problems Based on Sample Average Approximation Method

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    Suxiang He


    Full Text Available An implementable nonlinear Lagrange algorithm for stochastic minimax problems is presented based on sample average approximation method in this paper, in which the second step minimizes a nonlinear Lagrange function with sample average approximation functions of original functions and the sample average approximation of the Lagrange multiplier is adopted. Under a set of mild assumptions, it is proven that the sequences of solution and multiplier obtained by the proposed algorithm converge to the Kuhn-Tucker pair of the original problem with probability one as the sample size increases. At last, the numerical experiments for five test examples are performed and the numerical results indicate that the algorithm is promising.

  18. Scaling up the DBSCAN Algorithm for Clustering Large Spatial Databases Based on Sampling Technique

    Institute of Scientific and Technical Information of China (English)


    Clustering, in data mining, is a useful technique for discoveringinte resting data distributions and patterns in the underlying data, and has many app lication fields, such as statistical data analysis, pattern recognition, image p rocessing, and etc. We combine sampling technique with DBSCAN alg orithm to cluster large spatial databases, and two sampling-based DBSCAN (SDBSC A N) algorithms are developed. One algorithm introduces sampling technique inside DBSCAN, and the other uses sampling procedure outside DBSCAN. Experimental resul ts demonstrate that our algorithms are effective and efficient in clustering lar ge-scale spatial databases.

  19. Designing a multiple dependent state sampling plan based on the coefficient of variation. (United States)

    Yan, Aijun; Liu, Sanyang; Dong, Xiaojuan


    A multiple dependent state (MDS) sampling plan is developed based on the coefficient of variation of the quality characteristic which follows a normal distribution with unknown mean and variance. The optimal plan parameters of the proposed plan are solved by a nonlinear optimization model, which satisfies the given producer's risk and consumer's risk at the same time and minimizes the sample size required for inspection. The advantages of the proposed MDS sampling plan over the existing single sampling plan are discussed. Finally an example is given to illustrate the proposed plan.

  20. Prevalence and Antimicrobial Susceptibility of Enterococcus Species Isolated from Different Clinical Samples in a Tertiary Care Hospital of North India

    Directory of Open Access Journals (Sweden)

    Preeti Srivastava


    Result: Among the 100 isolates of Enterococcus from various clinical samples maximum isolates were from urine sample 70% and E. faecalis 92% constituted the predominant isolate. They were found to be susceptible to linezolid and vancomycin with least sensitive to ciprofloxacin and tetracycline. Conclusion: Routine speciation and in vitro antimicrobial susceptibility testing of Enterococcus in various clinical samples is emphasized due to the prevalence of wide variety of Enterococcus species and also appearance of high resistant strains. [Natl J Med Res 2013; 3(4.000: 389-391

  1. The influence of sampling design on tree-ring-based quantification of forest growth. (United States)

    Nehrbass-Ahles, Christoph; Babst, Flurin; Klesse, Stefan; Nötzli, Magdalena; Bouriaud, Olivier; Neukom, Raphael; Dobbertin, Matthias; Frank, David


    Tree-rings offer one of the few possibilities to empirically quantify and reconstruct forest growth dynamics over years to millennia. Contemporaneously with the growing scientific community employing tree-ring parameters, recent research has suggested that commonly applied sampling designs (i.e. how and which trees are selected for dendrochronological sampling) may introduce considerable biases in quantifications of forest responses to environmental change. To date, a systematic assessment of the consequences of sampling design on dendroecological and-climatological conclusions has not yet been performed. Here, we investigate potential biases by sampling a large population of trees and replicating diverse sampling designs. This is achieved by retroactively subsetting the population and specifically testing for biases emerging for climate reconstruction, growth response to climate variability, long-term growth trends, and quantification of forest productivity. We find that commonly applied sampling designs can impart systematic biases of varying magnitude to any type of tree-ring-based investigations, independent of the total number of samples considered. Quantifications of forest growth and productivity are particularly susceptible to biases, whereas growth responses to short-term climate variability are less affected by the choice of sampling design. The world's most frequently applied sampling design, focusing on dominant trees only, can bias absolute growth rates by up to 459% and trends in excess of 200%. Our findings challenge paradigms, where a subset of samples is typically considered to be representative for the entire population. The only two sampling strategies meeting the requirements for all types of investigations are the (i) sampling of all individuals within a fixed area; and (ii) fully randomized selection of trees. This result advertises the consistent implementation of a widely applicable sampling design to simultaneously reduce uncertainties in

  2. Validating evidence based decision making in health care

    DEFF Research Database (Denmark)

    Nüssler, Emil Karl; Eskildsen, Jacob Kjær; Håkonsson, Dorthe Døjbak;

    of Gynecological Surgery we examine factors related to decisions to use mesh. Our results indicate that decisions to use mesh are not evidence based, and cannot be explained neither by FDA safety communications, nor by medical conditions usually assumed to predict its usage. Instead, decisions to use mesh...

  3. Models for Delivering School-Based Dental Care. (United States)

    Albert, David A.; McManus, Joseph M.; Mitchell, Dennis A.


    School-based health centers (SBHCs) often are located in high-need schools and communities. Dental service is frequently an addition to existing comprehensive services, functioning in a variety of models, configurations, and locations. SBHCs are indicated when parents have limited financial resources or inadequate health insurance, limiting…

  4. Mental Health Care in a High School Based Health Service. (United States)

    Jepson, Lisa; Juszczak, Linda; Fisher, Martin


    Describes the mental-health and medical services provided at a high-school-based service center. Five years after the center's inception mental health visits had quadrupled. One third of students utilizing the center reported substance abuse within their family. Other reasons for center use included pregnancy, suicidal ideation, obesity,…

  5. Development of a primary care-based complex care management intervention for chronically ill patients at high risk for hospitalization: a study protocol

    Directory of Open Access Journals (Sweden)

    Beyer Martin


    Full Text Available Abstract Background Complex care management is seen as an approach to face the challenges of an ageing society with increasing numbers of patients with complex care needs. The Medical Research Council in the United Kingdom has proposed a framework for the development and evaluation of complex interventions that will be used to develop and evaluate a primary care-based complex care management program for chronically ill patients at high risk for future hospitalization in Germany. Methods and design We present a multi-method procedure to develop a complex care management program to implement interventions aimed at reducing potentially avoidable hospitalizations for primary care patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, or chronic heart failure and a high likelihood of hospitalization. The procedure will start with reflection about underlying precipitating factors of hospitalizations and how they may be targeted by the planned intervention (pre-clinical phase. An intervention model will then be developed (phase I based on theory, literature, and exploratory studies (phase II. Exploratory studies are planned that entail the recruitment of 200 patients from 10 general practices. Eligible patients will be identified using two ways of 'case finding': software based predictive modelling and physicians' proposal of patients based on clinical experience. The resulting subpopulations will be compared regarding healthcare utilization, care needs and resources using insurance claims data, a patient survey, and chart review. Qualitative studies with healthcare professionals and patients will be undertaken to identify potential barriers and enablers for optimal performance of the complex care management program. Discussion This multi-method procedure will support the development of a primary care-based care management program enabling the implementation of interventions that will potentially reduce avoidable

  6. Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with advanced heart failure. (United States)

    McDougall, A; Goldszmidt, M; Kinsella, E A; Smith, S; Lingard, L


    Despite calls for more interprofessional and intraprofessional team-based approaches in healthcare, we lack sufficient understanding of how this happens in the context of patient care teams. This multi-perspective, team-based interview study examined how medical teams negotiated collaborative tensions. From 2011 to 2013, 50 patients across five sites in three Canadian provinces were interviewed about their care experiences and were asked to identify members of their health care teams. Patient-identified team members were subsequently interviewed to form 50 "Team Sampling Units" (TSUs), consisting of 209 interviews with patients, caregivers and healthcare providers. Results are gathered from a focused analysis of 13 TSUs where intraprofessional collaborative tensions involved treating fluid overload, or edema, a common HF symptom. Drawing on actor-network theory (ANT), the analysis focused on intraprofessional collaboration between specialty care teams in cardiology and nephrology. The study found that despite a shared narrative of common purpose between cardiology teams and nephrology teams, fluid management tools and techniques formed sites of collaborative tension. In particular, care activities involved asynchronous clinical interpretations, geographically distributed specialist care, fragmented forms of communication, and uncertainty due to clinical complexity. Teams 'disentangled' fluid in order to focus on its physiological function and mobilisation. Teams also used distinct 'framings' of fluid management that created perceived collaborative tensions. This study advances collaborative entanglement as a conceptual framework for understanding, teaching, and potentially ameliorating some of the tensions that manifest during intraprofessional care for patients with complex, chronic disease.

  7. General practice based teaching exchanges in Europe. Experiences from the EU Socrates programme 'primary health care'. (United States)

    van Weel, Chris; Mattsson, Bengt; Freeman, George K; de Meyere, Marc; von Fragstein, Martin


    This paper reviews the experience of international exchange of medical students for general practice. The experience is based on the EU Socrates programme 'Primary Health Care' that offers, since 1992, clinical attachments and research electives in primary care. This programme involves 11 university departments of general practice/primary care in eight countries: Austria - Vienna; Belgium - Gent; Germany Düsseldorf; Italy - Monza, Udine; Netherlands Nijmegen; Slovenia - Ljubljana; Sweden - Göteborg; and the UK - Edinburgh, Imperial College London and Nottingham. More than 150 students have taken part in the programme, most in the last four years. For clinical attachment communication to patients is essential, and students should be able to speak the language of the host university. A research elective in primary care is less demanding and requires students' ability to communicate in English. Despite marked differences in health care structure in the countries involved, it is quite possible to provide a valuable teaching environment in general practice, and the experience gained by students in the exchanges more than equals that what they would gain at home. The added value is in experiencing the influence of another health care system and of working in another academic primary care centre. A substantial number of research electives have been published in international peer reviewed scientific journals with the student as first (occasionally second) author and staff members of the student's host and home university as co-authors. A further benefit of the exchange programme lies in the transfer teaching innovations between universities.

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

    Directory of Open Access Journals (Sweden)

    Ping Yao


    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.

  9. [Random sampling according to section 17 c KHG--report on the experience of maximal care hospitals in Hesse]. (United States)

    van Essen, J; Hübner, M; von Mittelstaedt, G


    Hospital billing converted to "German diagnosis-related groups" (G-DRG) for in-patient treatment in Germany is reviewed, except in psychiatry where per-diems are still in use. Currently thousands of bills are sent to the Medical Service for scrutiny. In addition, the law relating to Hospital Financing (Krankenhausfinanzierungsgesetz, para. 17 c) provides for systematic checks on a random sample of bills from a given hospital. The Medical Service of the Social Security Health Insurance reports on the experience in the State of Hessen. Present regulations exclude from the random sample those bills that have already been presented for a check on a case by case basis. Excluding these cases from the random sample introduces a bias in an avoidable way. The present rule is contrary to valid conclusions from the random sampling and should be abolished.

  10. DSP based lunar sampling control system for the coiling-type sampler (United States)

    Ling, Yun; Song, Aiguo; Lu, Wei


    The paper develops a control system based on DSP28334 for lunar sampling, and provides the main structure of it. The critical hardware and software design of the system are introduced in detail. The emphasis is placed on the design and realization of the vibration control of the coiling-type sampler in the process of lunar sampling. A control strategy which combines manual-control and local autonomous control is applied for the lunar sampling control. And the sampling mechanism being controlled can realizes multi-motor units working at time-sharing, which reduces the power comsumption and increases the stability of the sampling system greatly. The practical application of the control strategy used for the coiling-type sampler is verified by the finite element analysis. The experiments results show that the system works with low power consumption and high efficiency, and the proposed strategy enables greater depth and better efficiency during sampling.

  11. Differentials-Based Segmentation and Parameterization for Point-Sampled Surfaces

    Institute of Scientific and Technical Information of China (English)

    Yong-Wei Miao; Jie-Qing Feng; Chun-Xia Xiao; Qun-Sheng Peng; A.R. Forrest


    Efficient parameterization of point-sampled surfaces is a fundamental problem in the field of digital geometry processing. In order to parameterize a given point-sampled surface for minimal distance distortion, a differentials-based segmentation and parameterization approach is proposed in this paper. Our approach partitions the point-sampled geometry based on two criteria: variation of Euclidean distance between sample points, and angular difference between surface differential directions. According Co the analysis of normal curvatures for some specified directions, a new projection approach is adopted to estimate the local surface differentials. Then a k-means clustering (k-MC) algorithm is used for partitioning the model into a set of charts based on the estimated local surface attributes. Finally, each chart is parameterized with a statistical method - multidimensional scaling (MDS) approach, and the parameterizaCion results of all charts form an atlas for compact storage.

  12. Evaluation of an Interdisciplinary Curriculum Teaching Team-Based Palliative Care Integration in Oncology. (United States)

    Head, Barbara A; Schapmire, Tara; Earnshaw, Lori; Faul, Anna; Hermann, Carla; Jones, Carol; Martin, Amy; Shaw, Monica Ann; Woggon, Frank; Ziegler, Craig; Pfeiffer, Mark


    For students of the health care professions to succeed in today's health care environment, they must be prepared to collaborate with other professionals and practice on interdisciplinary teams. As most will care for patients with cancer, they must also understand the principles of palliative care and its integration into oncology. This article reports the success of one university's effort to design and implement an interdisciplinary curriculum teaching team-based palliative care in oncology which was mandatory for medical, nursing, social work, and chaplaincy students. Quantitative evaluation indicated that students made significant improvements related to palliative care knowledge and skills and readiness for interprofessional education. Qualitative feedback revealed that students appreciated the experiential aspects of the curriculum most, especially the opportunity to observe palliative teams at work and practice team-based skills with other learners. While there exist many obstacles to interprofessional education and hands-on learning, the value of such experiences to the learners justifies efforts to initiate and continue similar programs in the health sciences.

  13. Calibration belt for quality-of-care assessment based on dichotomous outcomes.

    Directory of Open Access Journals (Sweden)

    Stefano Finazzi

    Full Text Available Prognostic models applied in medicine must be validated on independent samples, before their use can be recommended. The assessment of calibration, i.e., the model's ability to provide reliable predictions, is crucial in external validation studies. Besides having several shortcomings, statistical techniques such as the computation of the standardized mortality ratio (SMR and its confidence intervals, the Hosmer-Lemeshow statistics, and the Cox calibration test, are all non-informative with respect to calibration across risk classes. Accordingly, calibration plots reporting expected versus observed outcomes across risk subsets have been used for many years. Erroneously, the points in the plot (frequently representing deciles of risk have been connected with lines, generating false calibration curves. Here we propose a methodology to create a confidence band for the calibration curve based on a function that relates expected to observed probabilities across classes of risk. The calibration belt allows the ranges of risk to be spotted where there is a significant deviation from the ideal calibration, and the direction of the deviation to be indicated. This method thus offers a more analytical view in the assessment of quality of care, compared to other approaches.

  14. Plastic-Chip-Based Magnetophoretic Immunoassay for Point-of-Care Diagnosis of Tuberculosis. (United States)

    Kim, Jeonghyo; Jang, Minji; Lee, Kyoung G; Lee, Kil-Soo; Lee, Seok Jae; Ro, Kyung-Won; Kang, In Sung; Jeong, Byung Do; Park, Tae Jung; Kim, Hwa-Jung; Lee, Jaebeom


    Tuberculosis (TB) remains a relevant infectious disease in the 21st century, and its extermination is still far from being attained. Due to the extreme infectivity of incipient TB patients, a rapid sensing system for proficient point-of-care (POC) diagnostics is required. In our study, a plastic-chip-based magnetophoretic immunoassay (pcMPI) is introduced using magnetic and gold nanoparticles (NPs) modified with Mycobacterium tuberculosis (MTB) antibodies. This pcMPI offers an ultrasensitive limit of detection (LOD) of 1.8 pg·ml(-1) for the detection of CFP-10, an MTB-secreted antigen, as a potential TB biomarker with high specificity. In addition, by combining the plastic chip with an automated spectrophotometer setup, advantages include ease of operation, rapid time to results (1 h), and cost-effectiveness. Furthermore, the pcMPI results using clinical sputum culture filtrate samples are competitively compared with and integrated with clinical data collected from conventional tools such as the acid-fast bacilli (AFB) test, mycobacteria growth indicator tube (MGIT), polymerase chain reaction (PCR), and physiological results. CFP-10 concentrations were consistently higher in patients diagnosed with MTB infection than those seen in patients infected with nontuberculosis mycobacteria (NTM) (P < 0.05), and this novel test can distinguish MTB and NTM while MGIT cannot. All these results indicate that this pcMPI has the potential to become a new commercial TB diagnostic POC platform in view of its sensitivity, portability, and affordability.

  15. Multi-Agent-Based Simulation of a Complex Ecosystem of Mental Health Care. (United States)

    Kalton, Alan; Falconer, Erin; Docherty, John; Alevras, Dimitris; Brann, David; Johnson, Kyle


    This paper discusses the creation of an Agent-Based Simulation that modeled the introduction of care coordination capabilities into a complex system of care for patients with Serious and Persistent Mental Illness. The model describes the engagement between patients and the medical, social and criminal justice services they interact with in a complex ecosystem of care. We outline the challenges involved in developing the model, including process mapping and the collection and synthesis of data to support parametric estimates, and describe the controls built into the model to support analysis of potential changes to the system. We also describe the approach taken to calibrate the model to an observable level of system performance. Preliminary results from application of the simulation are provided to demonstrate how it can provide insights into potential improvements deriving from introduction of care coordination technology.

  16. Primary care doctors' perceptions towards evidence-based medicine in Melaka State: a questionnaire study. (United States)

    Chan, G C; Teng, C L


    A cross sectional study using a self-administered questionnaire to determine the perceptions of primary care doctors towards evidence-based medicine (EBM) was conclucted in Melaka state. About 78% of the primary care doctors were aware of EBM and agreed it could improve patient care. Only 6.7% of them had ever conducted a Medline literature search. They had a low level of awareness of review publications and databases relevant to EBM; only about 33% of them were aware of the Cochrane Database of Systemic Reviews. Over half of the respondents had at least some understanding of the technical terms used in EBM. Ninety percent of the respondents had Internet access and the majority of them used it at home. The main barriers to practicing EBM were lack of personal time and lack of Internet access in the primary care clinics.

  17. Discovering the dementia evidence base: Tools to support knowledge to action in dementia care (innovative practice). (United States)

    Hayman, Sarah L; Tieman, Jennifer J


    Dementia requires expert care and decision making, based on sound evidence. Reliable evidence is difficult for busy dementia care professionals to find quickly. This study developed an experimentally tested search filter as an innovative tool to retrieve literature on dementia. It has a known retrieval performance and can be provided as an open access web link directly to current literature. The Dementia Search Filter was developed using validated methodology. An Expert Advisory Group of dementia care practitioners and researchers ratified a representative set of relevant studies and undertook post hoc relevance assessment, to ensure the usefulness of the search filter. The Dementia Search Filter is published on two websites and combined with expert searches to link to evidence on dementia, at end of life in aged care settings and more generally. Evidence accessed by the Dementia Search Filter will help overcome barriers to finding current relevant research in the field, for practitioners, researchers and decision makers.

  18. Application of ATP-based bioluminescence for bioaerosol quantification: effect of sampling method. (United States)

    Han, Taewon; Wren, Melody; DuBois, Kelsey; Therkorn, Jennifer; Mainelis, Gediminas


    An adenosine triphosphate (ATP)-based bioluminescence has potential to offer a quick and affordable method for quantifying bioaerosol samples. Here we report on our investigation into how different bioaerosol aerosolization parameters and sampling methods affect bioluminescence output per bacterium, and implications of that effect for bioaerosol research. Bacillus atrophaeus and Pseudomonas fluorescens bacteria were aerosolized by using a Collison nebulizer (BGI Inc., Waltham, MA) with a glass or polycarbonate jar and then collected for 15 and 60 min with: (1) Button Aerosol Sampler (SKC Inc., Eighty Four, PA) with polycarbonate, PTFE, and cellulose nitrate filters, (2) BioSampler (SKC Inc.) with 5 and 20 mL of collection liquid, and (3) our newly developed Electrostatic Precipitator with Superhydrophobic Surface (EPSS). For all aerosolization and sampling parameters we compared the ATP bioluminescence output per bacterium relative to that before aerosolization and sampling. In addition, we also determined the ATP reagent storage and preparation conditions that that do not affect the bioluminescence signal intensity. Our results show that aerosolization by a Collison nebulizer with a polycarbonate jar yields higher bioluminescence output per bacterium compared to the glass jar. Interestingly enough, the bioluminescence output by P. fluorescens increased substantially after its aerosolization compared to the fresh liquid suspension. For both test microorganisms, the bioluminescence intensity per bacterium after sampling was significantly lower than that before sampling suggesting negative effect of sampling stress on bioluminescence output. The decrease in bioluminescence intensity was more pronounces for longer sampling times and significantly and substantially depended on the sampling method. Among the investigated method, the EPSS was the least injurious for both microorganisms and sampling times. While the ATP-based bioluminescence offers a quick bioaerosol

  19. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model : A Qualitative Study

    NARCIS (Netherlands)

    Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.


    Background 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 stu

  20. Protocol Improvements for Low Concentration DNA-Based Bioaerosol Sampling and Analysis.

    Directory of Open Access Journals (Sweden)

    Irvan Luhung

    Full Text Available As bioaerosol research attracts increasing attention, there is a need for additional efforts that focus on method development to deal with different environmental samples. Bioaerosol environmental samples typically have very low biomass concentrations in the air, which often leaves researchers with limited options in choosing the downstream analysis steps, especially when culture-independent methods are intended.This study investigates the impacts of three important factors that can influence the performance of culture-independent DNA-based analysis in dealing with bioaerosol environmental samples engaged in this study. The factors are: 1 enhanced high temperature sonication during DNA extraction; 2 effect of sampling duration on DNA recoverability; and 3 an alternative method for concentrating composite samples. In this study, DNA extracted from samples was analysed using the Qubit fluorometer (for direct total DNA measurement and quantitative polymerase chain reaction (qPCR.The findings suggest that additional lysis from high temperature sonication is crucial: DNA yields from both high and low biomass samples increased up to 600% when the protocol included 30-min sonication at 65°C. Long air sampling duration on a filter media was shown to have a negative impact on DNA recoverability with up to 98% of DNA lost over a 20-h sampling period. Pooling DNA from separate samples during extraction was proven to be feasible with margins of error below 30%.

  1. Data processing of small samples based on grey distance information approach

    Institute of Scientific and Technical Information of China (English)

    Ke Hongfa; Chen Yongguang; Liu Yi


    Data processing of small samples is an important and valuable research problem in the electronic equipment test.Because it is difficult and complex to determine the probability distribution of small samples, it is difficult to use the traditional probability theory to process the samples and assess the degree of uncertainty.Using the grey relational theory and the norm theory, the grey distance information approach, which is based on the grey distance information quantity of a sample and the average grey distance information quantity of the samples, is proposed in this article.The definitions of the grey distance information quantity of a sample and the average grey distance information quantity of the samples, with their characteristics and algorithms, are introduced.The correlative problems, including the algorithm of estimated value, the standard deviation, and the acceptance and rejection criteria of the samples and estimated results, are also proposed.Moreover, the information whitening ratio is introduced to select the weight algorithm and to compare the different samples.Several examples are given to demonstrate the application of the proposed approach.The examples show that the proposed approach, which has no demand for the probability distribution of small samples, is feasible and effective.

  2. Health care burden and cost associated with fetal alcohol syndrome: based on official Canadian data.

    Directory of Open Access Journals (Sweden)

    Svetlana Popova

    Full Text Available BACKGROUND: Fetal Alcohol Spectrum Disorder (FASD is a group of disorders caused by prenatal alcohol exposure. From this group, Fetal Alcohol Syndrome (FAS is the only disorder coded in the International Classification of Diseases, version 10 (ICD-10. This coding was used to gain an understanding on the health care utilization and the mortality rate for individuals diagnosed with FAS, as well as to estimate the associated health care costs in Canada for the most recent available fiscal year (2008-2009. METHODS: Health care utilization data associated with a diagnosis of FAS were directly obtained from the Canadian Institute for Health Information (CIHI. Mortality data associated with a diagnosis of FAS were obtained from Statistics Canada. RESULTS: The total direct health care cost of acute care, psychiatric care, day surgery, and emergency department services associated with FAS in Canada in 2008-2009, based on the official CIHI data, was about $6.7 million. The vast majority of the most responsible diagnoses, which account for the majority of a patient's length of stay in hospital, fall within the ICD-10 category Mental and Behavioural Disorders (F00-F99. It was evident that the burden and cost of acute care hospitalizations due to FAS is increasing -1.6 times greater in 2008-2009, compared to 2002-2003. The mortality data due to FAS, obtained from Statistics Canada (2000-2008, may be underreported, and are likely invalid. DISCUSSION: The official data on the utilization of health care services by individuals diagnosed with FAS are likely to be underreported and therefore, the reported cost figures are most likely underestimated. The quantification of the health care costs associated with FAS is crucial for policy developers and decision makers alike, of the impact of prenatal alcohol exposure, with the ultimate goal of initiating preventive interventions to address FASD.

  3. Diagnostic significance of atypical category in the voided urine samples: A retrospective study in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Mokhtar Ghadeer


    Full Text Available Background: Voided urine samples continue to play an important role in the surveillance of urothelial malignancy and also as a screening mode for high risk patients. In some cases, it is difficult to reliably distinguish changes induced by inflammation, stone or other reactive condition from neoplasm, and these cases are categorized as atypical. The aim of our study is to evaluate the prevalence and the significance of atypical diagnosis in the voided urine samples and also to identify the cytomorphologic features that are seen more frequently in the atypical malignant urine samples. Materials and Methods: All voided urine cytology samples with a diagnosis of atypical urothelial cells, between the period of 2000 and 2009, were obtained from the cytology database. Only those cases with histologic follow-up were included in the study. The cytology and the histology slides were retrieved and reviewed. The following parameters were evaluated: cellularity, cell clusters, nuclear membrane irregularities, hyperchromasia and India-ink type nuclei, the presence of spindle cells and the cytoplasmic characteristics. Results: Out of 72 voided urine samples included in the study, 49 cases (68% had a positive histologic diagnosis of urothelial malignancy in the follow-up histology; of these (55% were high-grade urothelial carcinoma. Increased cellularity, papillary cell clusters, nuclear membrane irregularity, hyperchromasia and India-ink type nuclei were observed more frequently in the atypical malignant urine samples, while cytoplasmic vacuolization were seen more in the negative reactive urine samples. Conclusion: The atypical category diagnosis is associated with a significant proportion of urothelial carcinoma. It should be used by the pathologist to convey concern to the clinician in difficult cases that may require close follow-up.

  4. 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


    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.

  5. Use of Drop-In Clinic Versus Appointment-Based Care for LGBT Youth: Influences on the Likelihood to Access Different Health-Care Structures. (United States)

    Newman, Bernie S; Passidomo, Kim; Gormley, Kate; Manley, Alecia


    The structure of health-care service delivery can address barriers that make it difficult for lesbian, gay, bisexual, and transgender (LGBT) adolescents to use health services. This study explores the differences among youth who access care in one of two service delivery structures in an LGBT health-care center: the drop-in clinic or the traditional appointment-based model. Analysis of 578 records of LGBT and straight youth (aged 14-24) who accessed health care either through a drop-in clinic or appointment-based care within the first year of offering the drop-in clinic reveals patterns of use when both models are available. We studied demographic variables previously shown to be associated with general health-care access to determine how each correlated with a tendency to use the drop-in structure versus routine appointments. Once the covariates were identified, we conducted a logistic regression analysis to identify its association with likelihood of using the drop-in clinic. Insurance status, housing stability, education, race, and gender identity were most strongly associated with the type of clinic used. Youth who relied on Medicaid, those in unstable housing, and African Americans were most likely to use the drop-in clinic. Transgender youth and those with higher education were more likely to use the appointment-based clinic. Although sexual orientation and HIV status were not related to type of clinic used, youth who were HIV positive used the appointment-based clinic more frequently. Both routes to health care served distinct populations who often experience barriers to accessible, affordable, and knowledgeable care. Further study of the factors related to accessing health care may clarify the extent to which drop-in hours in a youth-friendly context may increase the use of health care by the most socially marginalized youth.

  6. Acute care clinical pharmacy practice: unit- versus service-based models. (United States)

    Haas, Curtis E; Eckel, Stephen; Arif, Sally; Beringer, Paul M; Blake, Elizabeth W; Lardieri, Allison B; Lobo, Bob L; Mercer, Jessica M; Moye, Pamela; Orlando, Patricia L; Wargo, Kurt


    This commentary from the 2010 Task Force on Acute Care Practice Model of the American College of Clinical Pharmacy was developed to compare and contrast the "unit-based" and "service-based" orientation of the clinical pharmacist within an acute care pharmacy practice model and to offer an informed opinion concerning which should be preferred. The clinical pharmacy practice model must facilitate patient-centered care and therefore must position the pharmacist to be an active member of the interprofessional team focused on providing high-quality pharmaceutical care to the patient. Although both models may have advantages and disadvantages, the most important distinction pertains to the patient care role of the clinical pharmacist. The unit-based pharmacist is often in a position of reacting to an established order or decision and frequently is focused on task-oriented clinical services. By definition, the service-based clinical pharmacist functions as a member of the interprofessional team. As a team member, the pharmacist proactively contributes to the decision-making process and the development of patient-centered care plans. The service-based orientation of the pharmacist is consistent with both the practice vision embraced by ACCP and its definition of clinical pharmacy. The task force strongly recommends that institutions pursue a service-based pharmacy practice model to optimally deploy their clinical pharmacists. Those who elect to adopt this recommendation will face challenges in overcoming several resource, technologic, regulatory, and accreditation barriers. However, such challenges must be confronted if clinical pharmacists are to contribute fully to achieving optimal patient outcomes.

  7. 40 CFR 761.298 - Decisions based on PCB concentration measurements resulting from sampling. (United States)


    ... 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)...

  8. The Effects of Simulation-based Transvaginal Ultrasound Training on Quality and Efficiency of Care

    DEFF Research Database (Denmark)

    xgz472, xgz472; Ringsted, Charlotte; Rosthøj, Susanne


    OBJECTIVE: To explore the effect of adding simulation-based transvaginal ultrasound training to trainees' clinical training compared with only clinical training on quality of and efficiency of care. BACKGROUND: Simulation-based ultrasound training may be an effective adjunct to clinical training,......, 33.5-55.1) and 19.8% (95% CI, 4.1-32.9) in the intervention and control group, respectively (P = 0.005). CONCLUSIONS: Simulation-based ultrasound training improved quality of care and reduced the need for repeated patient examination and trainee supervision.......OBJECTIVE: To explore the effect of adding simulation-based transvaginal ultrasound training to trainees' clinical training compared with only clinical training on quality of and efficiency of care. BACKGROUND: Simulation-based ultrasound training may be an effective adjunct to clinical training......, but no studies have examined its effects on quality and efficiency of care. METHODS: Trainees from 4 University Hospitals in East Denmark were included (N = 54). Participants were randomized to either simulation-based ultrasound training and clinical training (intervention group, n = 28), or to clinical training...

  9. Adaptive Sampling-Based Information Collection for Wireless Body Area Networks. (United States)

    Xu, Xiaobin; Zhao, Fang; Wang, Wendong; Tian, Hui


    To collect important health information, WBAN applications typically sense data at a high frequency. However, limited by the quality of wireless link, the uploading of sensed data has an upper frequency. To reduce upload frequency, most of the existing WBAN data collection approaches collect data with a tolerable error. These approaches can guarantee precision of the collected data, but they are not able to ensure that the upload frequency is within the upper frequency. Some traditional sampling based approaches can control upload frequency directly, however, they usually have a high loss of information. Since the core task of WBAN applications is to collect health information, this paper aims to collect optimized information under the limitation of upload frequency. The importance of sensed data is defined according to information theory for the first time. Information-aware adaptive sampling is proposed to collect uniformly distributed data. Then we propose Adaptive Sampling-based Information Collection (ASIC) which consists of two algorithms. An adaptive sampling probability algorithm is proposed to compute sampling probabilities of different sensed values. A multiple uniform sampling algorithm provides uniform samplings for values in different intervals. Experiments based on a real dataset show that the proposed approach has higher performance in terms of data coverage and information quantity. The parameter analysis shows the optimized parameter settings and the discussion shows the underlying reason of high performance in the proposed approach.

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

    Directory of Open Access Journals (Sweden)

    Marek Miskowicz


    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.

  11. Reachable Distance Space: Efficient Sampling-Based Planning for Spatially Constrained Systems

    KAUST Repository

    Xinyu Tang,


    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).

  12. Immunophenotype Discovery, Hierarchical Organization, and Template-based Classification of Flow Cytometry Samples

    Directory of Open Access Journals (Sweden)

    Ariful Azad


    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.

  13. Long-term care and hospital collaboration. To survive in a reformed healthcare system, long-term care facilities can initiate hospital-based SNFs. (United States)

    Hume, S K


    Establishing relationships with hospitals may be critical for long-term care facilities facing financial pressures and uncertain futures. One option is to initiate collaborative efforts to develop hospital-based skilled nursing facilities (SNFs). Hospitals, under pressure to move patients to less intensive settings and to diversify, are naturally drawn to long-term care as a related business where they can make limited personnel and financial commitments and extend their continuum of care. Before approaching hospitals to initiate collaborative efforts, long-term care providers should understand how they think and what their strengths and weaknesses are. Long-term and acute care providers have many options for collaboration, including management contracts and joint ventures. In a traditional management contract, the long-term care provider furnishes the administrator and a few key staff in exchange for direct reimbursement for those staff plus a management fee. Another option is for the long-term care facility to provide all the staff for a fee or percentage of revenue. Joint venture options are to form a subsidiary corporation to renovate a floor of the hospital or to have the hospital buy a large percentage of the long-term care facility and share the profits. All these options have potential pitfalls, including differing financial expectations and the threat of unionization at the SNF. Nevertheless, for long-term care facilities struggling under reimbursement cutbacks and other pressures, the benefits may outweigh the risks.

  14. Genital mycoplasmas in semen samples of males attending a tertiary care hospital in Nigeria: any role in sperm count reduction? (United States)

    Agbakoba, N R; Adetosoye, A I; Ikechebelu, J I


    Semen samples from 54 married men attending the outpatient clinics for problems of infertility and routine semen analysis were examined for the presence of genital mycoplasmas. The mean age of the men was 36.1 years with a range of 25 55 years. Majority of the men 57.4% (31 of 54) were in their fourth decade of life (30 39 years). This age group also had the highest percentage 57.2% (8 of 14) of positive isolates of genital mycoplasmas on semen culture. A total of 21 organisms obtained from 14 (26.0%) positive samples were isolated. Mycoplasma and Ureaplasma spp. separately isolated from the samples yielded frequencies of 1 (1.9%) and 6 (11.1%) respectively and the remaining 7 (13.0%) samples were infected with both organisms. A breakdown of the mycoplasma species include 5 (23.8%) M. hominis, 2 (9.5%) M. fermentans and 1 (4.8%) M. penetrans. Apart from one isolate of M. hominis other Mycoplasma species were found in association with Ureaplasma species. Fifteen (71.4%) of the 21 isolates [8 (53.3%) ureaplasmas and 7 (46.7%) mycoplasmas] were isolated from samples with sperm counts less than 20 million/ml while the remaining 6 (21.6%) isolates [5 (83.3%) ureaplasmas and 1 (16.7) mycoplasma] were from samples with counts greater than 20 million/ml. This finding could indicate a possible influence of genital mycoplasmas especially mycoplasmas species on sperm count.

  15. Alcohol-based hand disinfection: a more robust hand-hygiene method in an intensive care unit. (United States)

    Tvedt, C; Bukholm, G


    This study involved observation of hand-hygiene behaviour and evaluation of the effect of alcohol-based hand disinfection and handwashing with plain liquid soap on microbial flora. The study was performed in a combined medical and surgical intensive care unit. We demonstrated a crude compliance of hand hygiene of 50.4%, which was only performed adequately in 20.8% of cases. Of this group, handwashing and hand-disinfection procedures were performed properly 34.0% and 71.6% of the time, respectively. Hand samples for bacteriological examinations with the glove juice method demonstrated that whilst handwashing was sensitive to the way in which hand hygiene was performed, alcohol-based hand disinfection was less sensitive to such performance. Our study demonstrated that alcohol-based hand disinfection is a robust hand-hygiene method with many advantages in a practical setting. It is very feasible for use in hospital wards.

  16. Geochemical and petrological sampling and studies at the first moon base (United States)

    Haskin, L. A.; Korotev, R. L.; Lindstrom, D. J.; Lindstrom, M. M.

    Strategic sampling appropriate to the first-order lunar base can advance a variety of first-order lunar geochemical and petrological problems. Field observation and collection of samples would be done on the lunar surface, but detailed analysis would be done mainly in terrestrial laboratories. Among the most important areas of investigation for which field observations can be made and samples can be collected at the initial base are regolith studies, studies of mare and highlands stratigraphy, and a search for rare materials such as mantle nodules. Since the range of exploration may be limited to a radius of about 20 km from the first lunar base, locating the base near a mare-highlands boundary would enable the greatest latitude in addressing these problems.

  17. 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)


    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.

  18. Geochemical and petrological sampling and studies at the first moon base (United States)

    Haskin, L. A.; Korotev, R. L.; Lindstrom, D. J.; Lindstrom, M. M.


    Strategic sampling appropriate to the first-order lunar base can advance a variety of first-order lunar geochemical and petrological problems. Field observation and collection of samples would be done on the lunar surface, but detailed analysis would be done mainly in terrestrial laboratories. Among the most important areas of investigation for which field observations can be made and samples can be collected at the initial base are regolith studies, studies of mare and highlands stratigraphy, and a search for rare materials such as mantle nodules. Since the range of exploration may be limited to a radius of about 20 km from the first lunar base, locating the base near a mare-highlands boundary would enable the greatest latitude in addressing these problems.

  19. Back disorders and lumbar load in nursing staff in geriatric care: a comparison of home-based care and nursing homes

    Directory of Open Access Journals (Sweden)

    Beck Barbara-Beate


    Full Text Available Abstract Background Back pain is one of the most frequent complaints in the nursing profession. Thus, the 12-month prevalence of pain in the lumbar spine in nursing staff is as high as 76%. Only a few representative studies have assessed the prevalence rates of back pain and its risk factors among nursing staff in nursing homes in comparison to staff in home-based care facilities. The present study accordingly investigates the prevalence in the lumbar and cervical spine and determines the physical workload to lifting and caring in geriatric care. Methods 1390 health care workers in nursing homes and home care participated in this cross sectional survey. The nursing staff members were examined by occupational physicians according to the principals of the multistep diagnosis of musculoskeletal disorders. Occupational exposure to daily care activities with patient transfers was measured by a standardised questionnaire. The lumbar load was calculated with the Mainz-Dortmund dose model. Information on ergonomic conditions were recorded from the management of the nursing homes. Comparisons of all outcome variables were made between both care settings. Results Complete documentation, including the findings from the occupational physicians and the questionnaire, was available for 41%. Staff in nursing homes had more often positive orthopaedic findings than staff in home care. At the same time the values calculated for lumbar load were found to be significant higher in staff in nursing homes than in home-based care: 45% vs. 6% were above the reference value. Nursing homes were well equipped with technical lifting aids, though their provision with assistive advices is unsatisfactory. Situation in home care seems worse, especially as the staff often has to get by without assistance. Conclusions Future interventions should focus on counteracting work-related lumbar load among staff in nursing homes. Equipment and training in handling of assistive devices

  20. Developing the Botswana Primary Care Guideline: an integrated, symptom-based primary care guideline for the adult patient in a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Tsima BM


    Full Text Available Billy M Tsima,1 Vincent Setlhare,1 Oathokwa Nkomazana2 1Department of Family Medicine and Public Health, 2Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana Background: Botswana’s health care system is based on a primary care model. Various national guidelines exist for specific diseases. However, most of the guidelines address management at a tertiary level and often appear nonapplicable for the limited resources in primary care facilities. An integrated symptom-based guideline was developed so as to translate the Botswana national guidelines to those applicable in primary care. The Botswana Primary Care Guideline (BPCG integrates the care of communicable diseases, including HIV/AIDS and noncommunicable diseases, by frontline primary health care workers.Methods: The Department of Family Medicine, Faculty of Medicine, University of Botswana, together with guideline developers from the Knowledge Translation Unit (University of Cape Town collaborated with the Ministry of Health to develop the guideline. Stakeholder groups were set up to review specific content of the guideline to ensure compliance with Botswana government policy and the essential drug list.Results: Participants included clinicians, academics, patient advocacy groups, and policymakers from different disciplines, both private and public. Drug-related issues were identified as necessary for implementing recommendations of the guideline. There was consensus by working groups for updating the essential drug list for primary care and expansion of prescribing rights of trained nurse prescribers in primary care within their scope of practice. An integrated guideline incorporating common symptoms of diseases seen in the Botswana primary care setting was developed.Conclusion: The development of the BPCG took a broad consultative approach with buy in from relevant stakeholders. It is anticipated that implementation of the BPCG will translate into better

  1. Comparison of conventional Papanicolaou cytology samples with liquid-based cervical cytology samples from women in Pernambuco, Brazil

    Directory of Open Access Journals (Sweden)

    M.O.L.P. Costa


    Full Text Available In the present study, we compared the performance of a ThinPrep cytological method with the conventional Papanicolaou test for diagnosis of cytopathological changes, with regard to unsatisfactory results achieved at the Central Public Health Laboratory of the State of Pernambuco. A population-based, cross-sectional study was performed with women aged 18 to 65 years, who spontaneously sought gynecological services in Public Health Units in the State of Pernambuco, Northeast Brazil, between April and November 2011. All patients in the study were given a standardized questionnaire on sociodemographics, sexual characteristics, reproductive practices, and habits. A total of 525 patients were assessed by the two methods (11.05% were under the age of 25 years, 30.86% were single, 4.4% had had more than 5 sexual partners, 44% were not using contraception, 38.85% were users of alcohol, 24.38% were smokers, 3.24% had consumed drugs previously, 42.01% had gynecological complaints, and 12.19% had an early history of sexually transmitted diseases. The two methods showed poor correlation (k=0.19; 95%CI=0.11–0.26; P<0.001. The ThinPrep method reduced the rate of unsatisfactory results from 4.38% to 1.71% (χ2=5.28; P=0.02, and the number of cytopathological changes diagnosed increased from 2.47% to 3.04%. This study confirmed that adopting the ThinPrep method for diagnosis of cervical cytological samples was an improvement over the conventional method. Furthermore, this method may reduce possible losses from cytological resampling and reduce obstacles to patient follow-up, improving the quality of the public health system in the State of Pernambuco, Northeast Brazil.

  2. Technology-based self-care methods of improving antiretroviral adherence: a systematic review.

    Directory of Open Access Journals (Sweden)

    Parya Saberi

    Full Text Available As HIV infection has shifted to a chronic condition, self-care practices have emerged as an important topic for HIV-positive individuals in maintaining an optimal level of health. Self-care refers to activities that patients undertake to maintain and improve health, such as strategies to achieve and maintain high levels of antiretroviral adherence.Technology-based methods are increasingly used to enhance antiretroviral adherence; therefore, we systematically reviewed the literature to examine technology-based self-care methods that HIV-positive individuals utilize to improve adherence. Seven electronic databases were searched from 1/1/1980 through 12/31/2010. We included quantitative and qualitative studies. Among quantitative studies, the primary outcomes included ARV adherence, viral load, and CD4+ cell count and secondary outcomes consisted of quality of life, adverse effects, and feasibility/acceptability data. For qualitative/descriptive studies, interview themes, reports of use, and perceptions of use were summarized. Thirty-six publications were included (24 quantitative and 12 qualitative/descriptive. Studies with exclusive utilization of medication reminder devices demonstrated less evidence of enhancing adherence in comparison to multi-component methods.This systematic review offers support for self-care technology-based approaches that may result in improved antiretroviral adherence. There was a clear pattern of results that favored individually-tailored, multi-function technologies, which allowed for periodic communication with health care providers rather than sole reliance on electronic reminder devices.

  3. Risk for suicidal ideation and attempt among a primary care sample of adolescents engaging in nonsuicidal self-injury. (United States)

    Jenkins, Abigail L; Singer, Jonathan; Conner, Bradley T; Calhoun, Shawna; Diamond, Guy


    One in five adolescents in the United States has engaged in nonsuicidal self-injury (NSSI), one in eight have had serious thoughts of suicide, and one in 25 have attempted suicide. Research suggests that NSSI may increase risk for suicide attempt, yet little is known about the relationship between NSSI and suicidal ideation or attempts. In a primary care setting, 1,561 youth aged 14-24 years completed a brief, comprehensive, mental health screen as part of a routine well visit to determine which factors were most likely to predict suicidal ideation and attempt among youth engaging in NSSI. Results of recursive partitioning revealed that current depression and history of alcohol use best differentiated youth engaging in NSSI with low versus high risk for suicidal ideation and attempts. This simple algorithm is presented as a clinical screening tool that might aid medical providers in determining which youth would benefit from more intensive assessment and intervention.

  4. DSM-5 PTSD's symptom dimensions and relations with major depression's symptom dimensions in a primary care sample

    DEFF Research Database (Denmark)

    Contractor, A. A.; Durham, T. A.; Brennan, J. A.


    Existing literature indicates significant comorbidity between posttraumatic stress disorder (PTSD) and major depression. We examined whether PTSD's dysphoria and mood/cognitions factors, conceptualized by the empirically supported four-factor DSM-5 PTSD models, account for PTSD's inherent...... relationship with depression. We hypothesized that depression's somatic and non-somatic factors would be more related to PTSD's dysphoria and mood/cognitions factors than other PTSD model factors. Further, we hypothesized that PTSD's arousal would significantly mediate relations between PTSD's dysphoria...... and somatic/non-somatic depression. Using 181 trauma-exposed primary care patients, confirmatory factor analyses (CFA) indicated a well-fitting DSM-5 PTSD dysphoria model, DSM-5 numbing model and two-factor depression model. Both somatic and non-somatic depression factors were more related to PTSD's dysphoria...

  5. HIV prevalence, sexual behaviors, and engagement in HIV medical care among an online sample of sexually active MSM in Venezuela (United States)

    Perez-Brumer, Amaya G.; Oldenburg, Catherine E.; Biello, Katie B.; Novak, David S.; Rosenberger, Joshua G.; Mimiaga, Matthew J.


    In Venezuela, members of a social and sexual partner-networking site for MSM completed an online survey regarding sexual behaviors and HIV medical care. Among the 3,175 respondents, self-reported HIV prevalence was 7.8%. Of participants living with HIV, 73.2% reported taking antiretroviral medication and, 56.6% reported complete adherence within the past month. Participants living with HIV were more likely to be older (aOR=1.04 per one-year increase in age, 95% CI: 1.02, 1.06) and diagnosed with an STI in the previous year (aOR=32.35,10.2). These data provide further understanding of the HIV epidemic among MSM in Venezuela, and potential targets for HIV prevention interventions. PMID:26378188

  6. HIV prevalence, sexual behaviours and engagement in HIV medical care among an online sample of sexually active MSM in Venezuela. (United States)

    Perez-Brumer, Amaya G; Oldenburg, Catherine E; Biello, Katie B; Novak, David S; Rosenberger, Joshua G; Mimiaga, Matthew J


    In Venezuela, members of a social and sexual partner networking site for men who have sex with men (MSM) completed an online survey regarding sexual behaviours and HIV medical care. Among the 2851 respondents, self-reported HIV prevalence was 6.6%. Of participants living with HIV, 73.2% reported taking antiretroviral medication and 56.6% reported complete adherence within the past month. Participants living with HIV were more likely to be older (aOR = 1.04 per one-year increase in age, 95% CI: 1.02, 1.06) and diagnosed with a sexually transmitted infection in the previous year (aOR 3.26, 95% CI: 2.11, 5.04). These data provide further understanding of the HIV epidemic among MSM in Venezuela, and potential targets for HIV prevention interventions.

  7. Prevalence of enterococci and its antibiotic resistance in various clinical samples at tertiary care hospital in Southern Rajasthan, India

    Directory of Open Access Journals (Sweden)

    Deepika Atray


    Conclusions: The prevalence of multiple drug resistance enterococci with 11% VRE is observed in present study. The study emphasizes on invitro antibiotic susceptibility testing for clinical samples and also rational drug usage. [Int J Res Med Sci 2016; 4(8.000: 3413-3416

  8. A venue-based method for sampling hard-to-reach populations. (United States)

    Muhib, F B; Lin, L S; Stueve, A; Miller, R L; Ford, W L; Johnson, W D; Smith, P J


    Constructing scientifically sound samples of hard-to-reach populations, also known as hidden populations, is a challenge for many research projects. Traditional sample survey methods, such as random sampling from telephone or mailing lists, can yield low numbers of eligible respondents while non-probability sampling introduces unknown biases. The authors describe a venue-based application of time-space sampling (TSS) that addresses the challenges of accessing hard-to-reach populations. The method entails identifying days and times when the target population gathers at specific venues, constructing a sampling frame of venue, day-time units (VDTs), randomly selecting and visiting VDTs (the primary sampling units), and systematically intercepting and collecting information from consenting members of the target population. This allows researchers to construct a sample with known properties, make statistical inference to the larger population of venue visitors, and theorize about the introduction of biases that may limit generalization of results to the target population. The authors describe their use of TSS in the ongoing Community Intervention Trial for Youth (CITY) project to generate a systematic sample of young men who have sex with men. The project is an ongoing community level HIV prevention intervention trial funded by the Centers for Disease Control and Prevention. The TSS method is reproducible and can be adapted to hard-to-reach populations in other situations, environments, and cultures.

  9. Optimised Spatial Sampling Scheme for Soil Electriclal Conductivity Based on Variance Quad-Tree(VQT)Method

    Institute of Scientific and Technical Information of China (English)

    LI Yan; SHI Zhou; WU Ci-fang; LI Feng; LI Hong-yi


    The acquisition of precise soil data representative of the entire survey area,is a critical issue for many treatments such as irrigation or fertilization in precision agriculture.The aim of this study was to investigate the spatial variability of soil bulk electrical conductivity(ECb)in a coastal saline field and design an optimized spatial sampling scheme of ECb based on a sampling design algorithm,the variance quad-tree(VQT)method.Soil ECb data were collected from the field at 20m interval in a regular grid scheme.The smooth contour map of the whole field was obtained by ordinary kriging interpolation,VQT algorithm was then used to split the smooth contour map into strata of different number desired,the sampling locations can be selected within each stratum in subsequent sampling.The result indicated that the probability of choosing representative sampling sites was increased significantly by using VQT method with the sampling number being greatly reduced compared to grid sampling design while retaining the same prediction accuracy.The advantage of the VQT method is that this scheme samples sparsely in fields where the spatial variability is relatively uniform and more intensive where the variability is large.Thus the sampling efficiency can be improved,hence facilitate an assessment methodology that can be applied in a rapid,practical and cost-effective manner.

  10. Rounded Data Analysis Based on Multi-Layer Ranked Set Sampling

    Institute of Scientific and Technical Information of China (English)

    Wei Ming LI; Zhi Dong BAI


    Observations of sampling are often subject to rounding,but are modeled as though they were unrounded.This paper examines the impact of rounding errors on parameter estimation with multi-layer ranked set sampling.It shows that the rounding errors seriously distort the behavior of covariance matrix estimate,and lead to inconsistent estimation.Taking this into account,we present a new approach to implement the estimation for this model,and further establish the strong consistency and asymptotic normality of the proposed estimators.Simulation experiments show that our estimates based on rounded multi-layer ranked set sampling are always more efficient than those based on rounded simple random sampling.

  11. Analyzing the Interprofessional Working of a Home-Based Primary Care Team. (United States)

    Smith-Carrier, Tracy; Neysmith, Sheila


    Increasingly, interprofessional teams are responsible for providing integrated health care services. Effective teams, however, are not the result of chance but require careful planning and ongoing attention to team processes. Based on a case study involving interviews, participant observation, and a survey, we identified key attributes for effective interprofessional working (IPW) within a home-based primary care (HBPC) setting. Recognizing the importance of a theoretical model that reflects the multidimensional nature of team effectiveness research, we employed the integrated team effectiveness model to analyze our findings. The results indicated that a shared vision, common goals, respect, and trust among team members – as well as processes for ongoing communication, effective leadership, and mechanisms for conflict resolution – are vital in the development of a high-functioning IPW team. The ambiguity and uncertainty surrounding the context of service provision (clients' homes), as well the negotiation of external relationships in the HBPC field, require further investigation.

  12. Health Care Use by Patients with Somatoform Disorders A Register-Based Follow-Up Study*

    DEFF Research Database (Denmark)

    Andersen, Nadia Lyhne Trærup; Eplov, Lene Falgaard; Andersen, Jon Trærup;


    OBJECTIVE: Studies have shown a greater use of medical than mental health services in patients with somatoform disorders. However, not many studies are based on structured interviews and include the entire somatoform spectrum of diagnoses. We conducted a register-based case-control study...... to investigate medical care use prior to and three years after diagnosis in patients with somatoform disorders. METHODS: We included 380 patients with somatoform diagnoses (SCID-NP for DSM-IIIR) in a case-control study and compared them with 174 patients with anxiety disorders and 5540 controls from...... effect on health care use when controlling for psychiatric comorbidity. CONCLUSIONS: Patients with somatoform disorders make significantly greater use of health care services than do controls and patients with anxiety. Somatoform patients made more use of psychiatric services than expected. The use...

  13. A Web-based GIS for health care decision-support. (United States)

    Jean-Baptiste, Richard; Toubiana, Laurent; Le Mignot, Loïc; Ben Said, Mohamed; Mugnier, Claude; Le Bihan-Benjamin, Christine; Jaïs, Jean Philippe; Landais, Paul


    This Web-based application allows to access views of End-Stage Renal Disease (ESRD) concerning the epidemiology of the demand and the supply of care. It is a Web-based Geographic Information System (Web-GIS), the SIGNe (Système d'Information Géographique pour la Néphrologie), designed for the Renal Epidemiology and Information Network (REIN) dedicated to ESRD. It is a visualisation and decision-support tool. This Web-GIS was coupled to a data warehouse and embedded in an n-tier architecture designed as the Multi-Source Information System (MSIS). It provides maps matching the offer of care to the demand. It is presented with insights on the design and underlying technologies. It is dedicated to professionals and to public health care decision-makers.

  14. Student learning with concept mapping of care plans in community-based education. (United States)

    Hinck, Susan M; Webb, Patricia; Sims-Giddens, Susan; Helton, Caroline; Hope, Kathryn L; Utley, Rose; Savinske, Deborah; Fahey, Elizabeth M; Yarbrough, Sue


    Concept mapping, a learning strategy used to understand key concepts and relationships between concepts, has been suggested as a method to plan and evaluate nursing care. The purpose of this study was to empirically test the effectiveness of concept mapping for student learning and the students' satisfaction with the strategy. A quasi-experimental pre- and posttest design was used to examine the content of concept maps of care plans constructed by junior-level baccalaureate students (n = 23) at the beginning and end of a community-based mental health course. Additionally, students completed a questionnaire to self-evaluate their learning and report their satisfaction with concept mapping. Findings indicated that concept mapping significantly improved students' abilities to see patterns and relationships to plan and evaluate nursing care, and most students (21/23) expressed satisfaction in using the strategy. This study supported concept mapping as an additional learning strategy and has extended knowledge in community-based nursing education.

  15. Flexible Time-Triggered Sampling in Smart Sensor-Based Wireless Control Systems

    CERN Document Server

    Xia, Feng


    Wireless control systems (WCSs) often have to operate in dynamic environments where the network traffic load may vary unpredictably over time. The sampling in sensors is conventionally time triggered with fixed periods. In this context, only worse-than-possible quality of control (QoC) can be achieved when the network is underloaded, while overloaded conditions may significantly degrade the QoC, even causing system instability. This is particularly true when the bandwidth of the wireless network is limited and shared by multiple control loops. To address these problems, a flexible time-triggered sampling scheme is presented in this work. Smart sensors are used to facilitate dynamic adjustment of sampling periods, which enhances the flexibility and resource efficiency of the system based on time-triggered sampling. Feedback control technology is exploited for adapting sampling periods in a periodic manner. The deadline miss ratio in each control loop is maintained at/around a desired level, regardless of workl...

  16. 350 keV accelerator based PGNAA setup to detect nitrogen in bulk samples

    Energy Technology Data Exchange (ETDEWEB)

    Naqvi, A.A., E-mail: [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)


    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. 350 keV accelerator based PGNAA setup to detect nitrogen in bulk samples (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.


    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.

  18. Preference-based approaches to measuring the benefits of perinatal care. (United States)

    Petrou, Stavros; Henderson, Jane


    Studies that measure benefits of health care interventions in natural or physical units cannot incorporate the several health changes that might occur within a single measure, and they overlook individuals' preferences for those health changes. This paper discusses and critically appraises the application of preference-based approaches to the measurement of the benefits of perinatal care that have developed out of economic theory. These include quality adjusted life year (QALY)-based approaches, monetary-based approaches, and discrete choice experiments. QALY-based approaches use scaling techniques, such as the rating scale, standard gamble approach, and time trade-off approach, or multi-attribute utility measures, to measure the health-related quality of life weights of health states. Monetary-based approaches include the revealed preference approach, which involves observing decisions that individuals actually make concerning health risks, and the willingness-to-pay approach, which provides a framework for investigating individuals' willingness to pay for benefits of health care interventions. Discrete choice experiments describe health care interventions in terms of their attributes, and elicit preferences for scenarios that combine different levels of those attributes. Empirical examples are used to illustrate each preference-based approach to benefit measurement, and several methodological issues raised by the application of these approaches to the perinatal context are discussed. Particular attention is given to identifying the relevant attributes to incorporate into the measurement instrument, appropriate respondents for the measurement exercise, potential sources of bias in description and valuation processes, and the practicality, reliability, and validity of alternative measurement approaches. The paper's conclusion is that researchers should be explicit and rigorous in their application of preference-based approaches to benefit measurement in the context

  19. A hybrid design-based and model-based sampling approach to estimate the temporal trend of spatial means

    NARCIS (Netherlands)

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


    This paper launches a hybrid sampling approach, entailing a design-based approach in space followed by a model-based approach in time, for estimating temporal trends of spatial means or totals. The underlying space–time process that generated the soil data is only partly described, viz. by a linear

  20. Association of antenatal care with facility delivery and perinatal survival – a population-based study in Bangladesh

    Directory of Open Access Journals (Sweden)

    Pervin Jesmin


    Full Text Available Abstract Background Antenatal Care (ANC during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006 and after (2008–2009 implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR 1.91; 95% confidence intervals (CI: 1.50, 2.42 among women who received ≤1 ANC compared to women who received ≥3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78 to non-significance (OR 0.81; 95% CI: 0.65, 1.01, when comparing cohorts before

  1. EURISWEB – Web-based epidemiological surveillance of antibiotic-resistant pneumococci in Day Care Centers

    Directory of Open Access Journals (Sweden)

    Sanches Ilda Santos


    Full Text Available Abstract Background EURIS (European Resistance Intervention Study was launched as a multinational study in September of 2000 to identify the multitude of complex risk factors that contribute to the high carriage rate of drug resistant Streptococcus pneumoniae strains in children attending Day Care Centers in several European countries. Access to the very large number of data required the development of a web-based infrastructure – EURISWEB – that includes a relational online database, coupled with a query system for data retrieval, and allows integrative storage of demographic, clinical and molecular biology data generated in EURIS. Methods All components of the system were developed using open source programming tools: data storage management was supported by PostgreSQL, and the hypertext preprocessor to generate the web pages was implemented using PHP. The query system is based on a software agent running in the background specifically developed for EURIS. Results The website currently contains data related to 13,500 nasopharyngeal samples and over one million measures taken from 5,250 individual children, as well as over one thousand pre-made and user-made queries aggregated into several reports, approximately. It is presently in use by participating researchers from three countries (Iceland, Portugal and Sweden. Conclusion An operational model centered on a PHP engine builds the interface between the user and the database automatically, allowing an easy maintenance of the system. The query system is also sufficiently adaptable to allow the integration of several advanced data analysis procedures far more demanding than simple queries, eventually including artificial intelligence predictive models.

  2. Implementation of evidence-based stroke care: enablers, barriers, and the role of facilitators

    Directory of Open Access Journals (Sweden)

    Purvis T


    Full Text Available Tara Purvis,1,2 Karen Moss,2 Sonia Denisenko,3 Chris Bladin,2,5 Dominique A Cadilhac1,2,4 1Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Monash Medical Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; 2Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia; 3Commission for Hospital Improvement, Department of Health Victoria, VIC, Australia; 4Department of Medicine, University of Melbourne, Parkville, VIC, Australia; 5Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia Abstract: A stroke care strategy was developed in 2007 to improve stroke services in Victoria, Australia. Eight stroke network facilitators (SNFs were appointed in selected hospitals to enable the establishment of stroke units, develop thrombolysis services, and implement protocols. We aimed to explain the main issues being faced by clinicians in providing evidence-based stroke care, and to determine if the appointment of an SNF was perceived as an acceptable strategy to improve stroke care. Face-to-face semistructured interviews were used in a qualitative research design. Interview transcripts were verified by respondents prior to coding. Two researchers conducted thematic analysis of major themes and subthemes. Overall, 84 hospital staff participated in 33 interviews during 2008. The common factors found to impact on stroke care included staff and equipment availability, location of care, inconsistent use of clinical pathways, and professional beliefs. Other barriers included limited access to specialist clinicians and workload demands. The establishment of dedicated stroke units was considered essential to improve the quality of care. The SNF role was valued for identifying gaps in care and providing capacity to change clinical processes. This is the first large, qualitative multicenter study to

  3. Microcontroller-based system for collecting anaerobic blood samples from a running greyhound. (United States)

    Schmalzried, R T; Toll, P W; Devore, J J; Fedde, M R


    Many physiological variables change rapidly in the blood during sprint exercise. To characterize the dynamics and extent of these changes, blood samples must be obtained during exercise. We describe herein a portable, microcontroller-based system used to automatically obtain repeated, anaerobic, arterial blood samples from greyhounds before, during, and following a race on a track. In addition, the system also records the blood temperature in the pulmonary artery each time a blood sample is taken. The system has been tested for more than 2 years and has proven to be reliable and effective.

  4. Rappertk: a versatile engine for discrete restraint-based conformational sampling of macromolecules

    Directory of Open Access Journals (Sweden)

    Karmali Anjum M


    Full Text Available Abstract Background Macromolecular structures are modeled by conformational optimization within experimental and knowledge-based restraints. Discrete restraint-based sampling generates high-quality structures within these restraints and facilitates further refinement in a continuous all-atom energy landscape. This approach has been used successfully for protein loop modeling, comparative modeling and electron density fitting in X-ray crystallography. Results Here we present a software toolkit (Rappertk which generalizes discrete restraint-based sampling for use in structural biology. Modular design and multi-layered architecture enables Rappertk to sample conformations of any macromolecule at many levels of detail and within a variety of experimental restraints. Performance against a Cα-tracing benchmark shows that the efficiency has not suffered despite the overhead required by this flexibility. We demonstrate the toolkit's capabilities by building high-quality β-sheets and by introducing restraint-driven sampling. RNA sampling is demonstrated by rebuilding a protein-RNA interface. Ability to construct arbitrary ligands is used in sampling protein-ligand interfaces within electron density. Finally, secondary structure and shape information derived from EM are combined to generate multiple conformations of a protein consistent with the observed density. Conclusion Through its modular design and ease of use, Rappertk enables exploration of a wide variety of interesting avenues in structural biology. This toolkit, with illustrative examples, is freely available to academic users from

  5. The positive effects of population-based preferential sampling in environmental epidemiology. (United States)

    Antonelli, Joseph; Cefalu, Matthew; Bornn, Luke


    SummaryIn environmental epidemiology, exposures are not always available at subject locations and must be predicted using monitoring data. The monitor locations are often outside the control of researchers, and previous studies have shown that "preferential sampling" of monitoring locations can adversely affect exposure prediction and subsequent health effect estimation. We adopt a slightly different definition of preferential sampling than is typically seen in the literature, which we call population-based preferential sampling. Population-based preferential sampling occurs when the location of the monitors is dependent on the subject locations. We show the impact that population-based preferential sampling has on exposure prediction and health effect estimation using analytic results and a simulation study. A simple, one-parameter model is proposed to measure the degree to which monitors are preferentially sampled with respect to population density. We then discuss these concepts in the context of PM2.5 and the EPA Air Quality System monitoring sites, which are generally placed in areas of higher population density to capture the population's exposure.


    Directory of Open Access Journals (Sweden)



    Full Text Available : Candida is one of the most frequently encountered opportunistic fungi that cause infection in humans. The pathogenesis of Candida is complex and probably varies with each infection. This study was conducted to understand the prevalence of Candida from various clinical specimens of patients and to show the emergence of Non albicans Candida in clinical samples. This study also focused on the antifungal susceptibility which guides the clinicians to treat the infection effectively. METHODS: Clinical samples were collected from outpatients and inpatients of Government General Hospital, Kurnool over a period of one year from March2008 to June2009. Isolation, culture, speciation of Candida was done by using standard methods. Antifungal susceptibility testing was done by disc diffusion technique against amphotericin B, nystatin, fluconazole and clotrimazole. RESULTS: Candida manifests in various sites depending on the predisposing factors and immune status of the person. In this study we found the association of Candida with various predisposing factors (Pregnancy, Oral contraceptive pills’s, Immune suppression, Diabetes. This study observed the dominance of non-albicans Candida (51% in the clinical samples over Candida albicans (49%. The maximum antifungal susceptibility was observed against amphotericin B in both the albicans and non-albicans Candia, but non-albicans Candida showed maximum resistance to azoles. CONCLUSION: Candida albicans was the most predominant species (49% isolated in various clinical samples. There was an increase in the prevalence of non albicans Candida in this study. Among the nonalbicans Candida (51% Candid tropicalis was the commonest species isolated. Candida albicans showed maximum susceptibility to amphotericin B and maximum resistance to azoles was seen in nonalbicans Candida.

  7. The Influence of Individual and Contextual Socioeconomic Status on Obstetric Care Utilization in the Democratic Republic of Congo: A Population-based Study

    Directory of Open Access Journals (Sweden)

    Olatunde Aremu


    Full Text Available Background: Maternal health care utilization continues to focus on the agenda of health care planners around the world, with high attention being paid to the developing countries. The devastating effect of maternal death at birth on the affected families is untold. This study examines the utilization of obstetric care in the Democratic Republic of Congo. Methods: We have used the nationally representative data from the 2007. Democratic Republic of Congo Demographic and Health Survey. Multilevel regression analysis has been applied to a nationally representative sample of 6,695 women, clustered around 299 communities in the country. Results: The results show that there are variations in the use of antenatal care and delivery care. Individual-level characteristics, such as women′s occupation and household wealth status are shown to be associated with the use of antenatal care. Uptake of facility-based delivery has been seen to be dependent on the household wealth status, women′s education, and partner′s education. The effect of the neighborhoods′ socioeconomic disadvantage on the use of antenatal care and facility-based delivery are the same. Women from highly socioeconomically disadvantaged communities, compared to their counterparts from less socioeconomically disadvantaged neighborhoods, are less likely to utilize both the antenatal services and healthcare facility for child delivery. The result of this study has shown that both individual and contextual socioeconomic status play an important role in obstetric care uptake. Conclusion: Thus, intervention aimed at improving the utilization of obstetrics care should target both the individual economic abilities of the women and that of their environment when considering the demand side.

  8. The Influence of Individual and Contextual Socioeconomic Status on Obstetric Care Utilization in the Democratic Republic of Congo: A Population-based Study (United States)

    Aremu, Olatunde; Lawoko, Stephen; Dalal, Koustuv


    Background: Maternal health care utilization continues to focus on the agenda of health care planners around the world, with high attention being paid to the developing countries. The devastating effect of maternal death at birth on the affected families is untold. This study examines the utilization of obstetric care in the Democratic Republic of Congo. Methods: We have used the nationally representative data from the 2007. Democratic Republic of Congo Demographic and Health Survey. Multilevel regression analysis has been applied to a nationally representative sample of 6,695 women, clustered around 299 communities in the country. Results: The results show that there are variations in the use of antenatal care and delivery care. Individual-level characteristics, such as women's occupation and household wealth status are shown to be associated with the use of antenatal care. Uptake of facility-based delivery has been seen to be dependent on the household wealth status, women's education, and partner's education. The effect of the neighborhoods’ socioeconomic disadvantage on the use of antenatal care and facility-based delivery are the same. Women from highly socioeconomically disadvantaged communities, compared to their counterparts from less socioeconomically disadvantaged neighborhoods, are less likely to utilize both the antenatal services and healthcare facility for child delivery. The result of this study has shown that both individual and contextual socioeconomic status play an important role in obstetric care uptake. Conclusion: Thus, intervention aimed at improving the utilization of obstetrics care should target both the individual economic abilities of the women and that of their environment when considering the demand side. PMID:22624085

  9. The Role of Vertex Consistency in Sampling-based Algorithms for Optimal Motion Planning

    CERN Document Server

    Arslan, Oktay


    Motion planning problems have been studied by both the robotics and the controls research communities for a long time, and many algorithms have been developed for their solution. Among them, incremental sampling-based motion planning algorithms, such as the Rapidly-exploring Random Trees (RRTs), and the Probabilistic Road Maps (PRMs) have become very popular recently, owing to their implementation simplicity and their advantages in handling high-dimensional problems. Although these algorithms work very well in practice, the quality of the computed solution is often not good, i.e., the solution can be far from the optimal one. A recent variation of RRT, namely the RRT* algorithm, bypasses this drawback of the traditional RRT algorithm, by ensuring asymptotic optimality as the number of samples tends to infinity. Nonetheless, the convergence rate to the optimal solution may still be slow. This paper presents a new incremental sampling-based motion planning algorithm based on Rapidly-exploring Random Graphs (RRG...

  10. A Novel Sampling Method for Satellite-Based Offshore Wind Resource Estimation

    DEFF Research Database (Denmark)

    Badger, Merete; Badger, Jake; Hasager, Charlotte Bay

    advantage of satellite-based offshore wind resource assessment is the spatial information gained at high resolution from the satellite imagery. Limitations include the low sampling rate and the fixed acquisition times of satellite data. A new satellite scene is typically available every 3-4 days over......-based wind climatology have improved gradually as more data were collected. The satellite scenes have been treated as random samples and weighted equally in our previous analyses. Here we introduce a novel sampling strategy based on the wind class methodology that is normally applied in numerical modeling...... of wind resources. The method is applied within a wind and solar resource assessment study for the United Arab Emirates funded by MASDAR and coordinated by UNEP. Thirty years of NCEP/NCAR reanalysis data are used to define approximately 100 geostrophic wind classes. These wind classes show...

  11. The role of values-based leadership in sustaining a culture of caring. (United States)

    Faith, Karen E


    At the heart of healthcare are fundamental values like caring and compassion as well as the duty shared by healthcare organizations to address the care needs of those in their communities who are vulnerable, injured, or ill. A concern being raised by some political analysts in Canada is that fundamental values are being challenged by current economic and political influences that are reshaping the landscape of healthcare in this country. Influences from industry, technology, and business have significantly shifted healthcare from its moral foundations. A culture of caring is also challenged by the values and behaviours of individuals that negatively impact staff morale and inter-professional collaboration in many work settings. If a "culture of caring" is to survive the canons of cost containment, the impact of recurrent political wrangling, and other substantive influences, then healthcare must be guided by committed values-based leadership. Using case illustrations, this article attempts to explain the characteristics and role of values-based leaders in promoting those values that inspire a culture of caring.

  12. A comparison between data processing techniques for FTS based on high frequency interferogram sampling (United States)

    Panzeri, R.; Saggin, S.; Scaccabarozzi, D.; Tarabini, M.


    This paper compares different data processing techniques for FTS with the aim of assessing the feasibility of a spectrometer leveraging on standard DAC boards, without dedicated hardware for sampling and speed control of the moving mirrors. Fourier transform spectrometers rely on the sampling of the interferogram at constant steps of the optical path difference (OPD) to evaluate the spectra through standard discrete Fourier transform. Constant OPD sampling is traditionally achieved with dedicated hardware but, recently, sampling methods based on the use of common analog to digital converters with large dynamic range and high sampling frequency have become viable when associated with specific data processing techniques. These methods offer advantages from the point of view of insensitivity to disturbances, in particular mechanical vibrations, and should be less sensitive to OPD speed errors. In this work the performances of three algorithms, two taken from literature based on phase demodulation of a reference interferogram have been compared with a method based on direct phase computation of the reference interferogram in terms of robustness against mechanical vibrations and OPD speed errors. All methods provided almost correct spectra with vibrations amplitudes up to 10% of the average OPD speed and speed drifts within the scan up to 20% of the average, as long as the disturbance frequency was lower than the reference signal nominal one. The developed method based on the arccosine function keeps working also with frequencies of the disturbances larger than the reference channel one, the common limit for the other two.

  13. Recommended Mass Spectrometry-Based Strategies to Identify Ricin-Containing Samples

    Directory of Open Access Journals (Sweden)

    Suzanne R. Kalb


    Full Text Available Ricin is a protein toxin produced by the castor bean plant (Ricinus communis together with a related protein known as R. communis agglutinin (RCA120. Mass spectrometric (MS assays have the capacity to unambiguously identify ricin and to detect ricin’s activity in samples with complex matrices. These qualitative and quantitative assays enable detection and differentiation of ricin from the less toxic RCA120 through determination of the amino acid sequence of the protein in question, and active ricin can be monitored by MS as the release of adenine from the depurination of a nucleic acid substrate. In this work, we describe the application of MS-based methods to detect, differentiate and quantify ricin and RCA120 in nine blinded samples supplied as part of the EQuATox proficiency test. Overall, MS-based assays successfully identified all samples containing ricin or RCA120 with the exception of the sample spiked with the lowest concentration (0.414 ng/mL. In fact, mass spectrometry was the most successful method for differentiation of ricin and RCA120 based on amino acid determination. Mass spectrometric methods were also successful at ranking the functional activities of the samples, successfully yielding semi-quantitative results. These results indicate that MS-based assays are excellent techniques to detect, differentiate, and quantify ricin and RCA120 in complex matrices.

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

    DEFF Research Database (Denmark)

    Verdezoto, Nervo

    -clinical settings. As such, sustaining daily care activities in the home (or other non-clinical settings) is challenging as they are becoming more and more intertwined into people’s everyday life. Thus, this dissertation is concerned about one major challenge in Pervasive Healthcare: the design of technology......Demographic changes are challenging healthcare systems as well as societies around the world due to an increasing aging population and rapid propagation of chronic diseases. To deal with the consequences of these changes, more and more long-term care services are being implemented including home...... 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...

  15. Effects of Rational-Emotive Hospice Care Therapy on Problematic Assumptions, Death Anxiety, and Psychological Distress in a Sample of Cancer Patients and Their Family Caregivers in Nigeria

    Directory of Open Access Journals (Sweden)

    Kay Chinonyelum Nwamaka Onyechi


    Full Text Available This study was a preliminary investigation that aimed to examine the effects of rational emotive hospice care therapy (REHCT on problematic assumptions, death anxiety, and psychological distress in a sample of cancer patients and their family caregivers in Nigeria. The study adopted a pre-posttest randomized control group design. Participants were community-dwelling cancer patients (n = 32 and their family caregivers (n = 52. The treatment process consisted of 10 weeks of full intervention and 4 weeks of follow-up meetings that marked the end of intervention. The study used repeated-measures analysis of variance for data analysis. The findings revealed significant effects of a REHCT intervention program on problematic assumptions, death anxiety, and psychological distress reduction among the cancer patients and their family caregivers at the end of the intervention. The improvements were also maintained at follow-up meetings in the treatment group compared with the control group who received the usual care and conventional counseling. The researchers have been able to show that REHCT intervention is more effective than a control therapy for cancer patients’ care, education, and counseling in the Nigerian context.

  16. Conflict-cost based random sampling design for parallel MRI with low rank constraints (United States)

    Kim, Wan; Zhou, Yihang; Lyu, Jingyuan; Ying, Leslie


    In compressed sensing MRI, it is very important to design sampling pattern for random sampling. For example, SAKE (simultaneous auto-calibrating and k-space estimation) is a parallel MRI reconstruction method using random undersampling. It formulates image reconstruction as a structured low-rank matrix completion problem. Variable density (VD) Poisson discs are typically adopted for 2D random sampling. The basic concept of Poisson disc generation is to guarantee samples are neither too close to nor too far away from each other. However, it is difficult to meet such a condition especially in the high density region. Therefore the sampling becomes inefficient. In this paper, we present an improved random sampling pattern for SAKE reconstruction. The pattern is generated based on a conflict cost with a probability model. The conflict cost measures how many dense samples already assigned are around a target location, while the probability model adopts the generalized Gaussian distribution which includes uniform and Gaussian-like distributions as special cases. Our method preferentially assigns a sample to a k-space location with the least conflict cost on the circle of the highest probability. To evaluate the effectiveness of the proposed random pattern, we compare the performance of SAKEs using both VD Poisson discs and the proposed pattern. Experimental results for brain data show that the proposed pattern yields lower normalized mean square error (NMSE) than VD Poisson discs.

  17. Analysis of Pharmaceutical and Personal Care Compounds in Wastewater Sludge and Aqueous Samples using GC-MS/MS

    Energy Technology Data Exchange (ETDEWEB)

    Zhong, Lirong [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Mitroshkov, Alexandre V. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Gilmore, Tyler J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)


    The Bioenergy Program at Pacific Northwest National Laboratory (PNNL) is evaluating the feasibility of converting wastewater sludge materials to fuels. Wastewater sludge from various municipalities will be used in the evaluation process and as with any municipal waste, there is the potential for residual contaminates to remain in the sludge following wastewater treatment. Many surveys and studies have confirmed the presence of pharmaceuticals in municipal wastewater and effluents (World Health Organization, 2011). Determination of the presence and concentrations of the contaminants is required to define the proper handling of this sludge. A list of targeted compounds was acquired from the literature and an analytical method was developed for the pharmaceutical and personal care compounds. The presence of organics complicated the analytical techniques and, in some cases, the precision of the results. However, residual concentrations of a range of compounds were detected in the wastewater sludge and the presence and concentrations of these compounds will be considered in identifying the appropriate handling of this material in conduct of research.

  18. 2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers. (United States)

    Brush, John E; Handberg, Eileen M; Biga, Cathleen; Birtcher, Kim K; Bove, Alfred A; Casale, Paul N; Clark, Michael G; Garson, Arthur; Hines, Jerome L; Linderbaum, Jane A; Rodgers, George P; Shor, Robert A; Thourani, Vinod H; Wyman, Janet F


    The mission of the American College of Cardiology is "to transform cardiovascular care and improve heart health." Cardiovascular team-based care is a paradigm for practice that can transform care, improve heart health, and help meet the demands of the future. One strategic goal of the College is to help members successfully transition their clinical practices to the future, with all its complexity, challenges, and opportunities. The ACC's strategic plan is aligned with the triple aim of improved care, improved population health, and lower costs per capita. The traditional understanding of quality, access, and cost is that you cannot improve one component without diminishing the others. With cardiovascular team-based care, it is possible to achieve the triple aim of improving quality, access, and cost simultaneously to also improve cardiovascular health. Striving to serve the best interests of patients is the true north of our guiding principles. Cardiovascular team-based care is a model that can improve care coordination and communication and allow each team member to focus more on the quality of care. In addition, the cardiovascular team-based care model increases access to cardiovascular care and allows expansion of services to populations and geographic areas that are currently underserved. This document will increase awareness of the important components of cardiovascular team-based care and create an opportunity for more discussion about the most creative and effective means of implementing it. We hope that this document will stimulate further discussions and activities within the ACC and beyond about team-based care. We have identified areas that need improvement, specifically in APP education and state regulation. The document encourages the exploration of collaborative care models that should enable team members to optimize their education, training, experience, and talent. Improved team leadership, coordination, collaboration, engagement, and efficiency

  19. Capacity Enhancement of Hepatitis C Virus Treatment through Integrated, Community-Based Care

    Directory of Open Access Journals (Sweden)

    Warren D Hill


    Full Text Available BACKGROUND: An estimated 250,000 Canadians are infected with the hepatitis C virus (HCV. The present study describes a cohort of individuals with HCV referred to community-based, integrated prevention and care projects developed in British Columbia. Treatment outcomes are reported for a subset of individuals undergoing antiviral therapy at four project sites.

  20. The Role of Attending Center-Based Care for Kindergarten-Aged Children with Disabilities (United States)

    Gottfried, Michael A.


    Background/Context: Families have been increasingly utilizing center-based care both during prekindergarten as well as before/after school during kindergarten (CBC-K), and the literature has addressed the relative effectiveness of attending the former on early schooling outcomes. However, missing in the field is an analysis of the efficacy of…

  1. A Comparative Analysis of the Costs of Substitute Care and Family Based Services. Monograph 2. (United States)

    Hutchinson, Janet

    Family based services attempt to maintain and strengthen the client family and prevent family dissolution and the placement of a child or several children in substitute care. This study compared programs that serve children and their families in their home. Variances in program costs were attributed to differences in number of casework hours per…

  2. Generic project definitions for improvement of health care delivery: A case-base approach

    NARCIS (Netherlands)

    Niemeijer, G.C.; Does, R.J.M.M.; de Mast, J.; Trip, A.; van den Heuvel, J.


    Background: The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. Methods: This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning a

  3. Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study

    NARCIS (Netherlands)

    Zwart, J.J.; Dupuis, J.R.O.; Richters, A.; Öry, F.; Roosmalen, J. van


    Purpose: As part of a larger nationwide enquiry into severe maternal morbidity, our aim was to assess the incidence and possible risk factors of obstetric intensive care unit (ICU) admission in the Netherlands. Methods: In a 2-year nationwide prospective population-based cohort study, all ICU admiss

  4. Evidence-based Diabetes Care in Indonesia - Knowledge translation and transfer of best practice

    NARCIS (Netherlands)

    Widyahening, IS


    Indonesia is continuously among the top ten countries worldwide in the number of people living with diabetes. Evidence-based practice (EBP) has the potential to improve the effectiveness and efficiency of diabetes care. However, the strategy to efficiently translate the best evidence into practice i

  5. A discourse on the contributions of evidence-based medicine to wound care. (United States)

    Al-Benna, Sammy


    Although a healthcare system crippled by lack of resources cannot perform effectively, spending more money in an ineffective system may not lead to better outcomes. To ensure systemwide resource maximization, evidence-based medicine and guidelines that consider treatment cost-effectiveness and recommend treatment for persons with the most to gain are required. To demonstrate that increasing use of evidence-based medicine can improve wound care, the effect of informed treatment decisions on improving patient care was reviewed. A Medline and OvidSP literature search was conducted of English-language literature using the MESH terms evidence-based practice and wounds and injuries. The adoption of evidence-based medicine by individual healthcare professionals can help ensure the limited resources available are used efficiently, enhancing confidence that additional funds will translate into more people receiving better wound care and having better health. Wound care professionals are encouraged to participate in conducting well-designed and controlled clinical studies of wound dressings and to resist the routine use of new, usually more expensive, dressings in the absence of good quality clinical evidence for their benefit over existing products.

  6. 75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting (United States)


    ... provide a forum for community-based organizations, hospitals, Quality Improvement Organizations... materials will be posted on the CMS Care Transitions Web site prior to the meeting. FOR FURTHER INFORMATION CONTACT: Juliana Tiongson, Social Science Research Analyst, Centers for Medicare & Medicaid Services,...

  7. Mutational analysis of primary and metastatic colorectal cancer samples underlying the resistance to cetuximab-based therapy

    Directory of Open Access Journals (Sweden)

    Nemecek R


    Full Text Available Radim Nemecek,1 Jitka Berkovcova,2 Lenka Radova,3 Tomas Kazda,4 Jitka Mlcochova,3 Petra Vychytilova-Faltejskova,1,3 Ondrej Slaby,1,3 Marek Svoboda1 1Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic; 2Department of Oncological and Experimental Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; 3Central European Institute of Technology, Masaryk University, Brno, Czech Republic; 4Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic Purpose: Although several molecular markers predicting resistance to cetuximab- or panitumumab-based therapy of metastatic colorectal cancer were described, mutations in RAS proto-oncogenes remain the only predictors being used in daily clinical practice. However, 35%–45% of wild-type RAS patients still do not respond to this anti-epidermal growth factor receptor (anti-EGFR monoclonal antibody-based therapy, and therefore the definition of other predictors forms an important clinical need. The aim of the present retrospective single-institutional study was to evaluate potential genes responsible for resistance to anti-EGFR therapy in relation to mutational analysis of primary versus metastatic lesions. Patients and methods: Twenty-four paired primary and corresponding metastatic tissue samples from eight nonresponding and four responding metastatic colorectal cancer patients treated with cetuximab-based therapy were sequenced using a next-generation sequencing panel of 26 genes involved in EGFR signaling pathway and colorectal carcinogenesis. Results: Mutational status of primary tumors and metastatic lesions was highly concordant in TP53, APC, CTNNB1, KRAS, PIK3CA, PTEN, and FBXW7 genes. Metastatic samples harbor significantly more mutations than primary tumors. Potentially negative predictive value of FBXW7 mutations in relationship to anti-EGFR treatment outcomes was confirmed

  8. A qualitative study of community home-based care and antiretroviral adherence in Swaziland

    Directory of Open Access Journals (Sweden)

    Robin Root


    Full Text Available Introduction: Antiretroviral therapy (ART has rendered HIV and AIDS a chronic condition for individuals in many parts of the world. Adherence, however, is integral to achieving chronicity. Studies have shown both relatively high ART adherence rates in sub-Saharan Africa and the importance of community home-based care (CHBC to facilitating this process. In light of diminished HIV and AIDS funding globally and increased reliance on CHBC throughout Africa, a better understanding of how CHBC may strengthen ART adherence is essential to improving patients’ quality of life, tending to the needs of care supporters and achieving healthier populations. Methods: This article reports findings from a qualitative study of a CHBC organiztion serving an estimated 2500 clients in rural Swaziland. Semi-structured questionnaires with 79 HIV-positive clients [people living with HIV and AIDS (PLWHA] yielded data on diverse aspects of being HIV positive, including insights on whether and how PLWHA perceived care supporters to facilitate ART adherence in a high stigma and structurally impoverished setting. Results: Ninety-two percent of participants said their health had improved since care supporters came into their lives. A major finding was that an estimated 53% of participants said they would have died, a few from suicide had the care supporter never intervened. More than one in four participants (27.9% sought HIV testing after a care supporter began visiting them. Nearly a third (31% commenced ART after and largely as a consequence of care supporter intervention. Approximately one in four (23% reported that their care supporter had helped them to disclose their HIV-positive status to family members. Twenty-seven percent said they had felt discouraged or had been discouraged from taking ART by members of their family or community. Discussion: General inductive analysis of participant reports suggested two social mechanisms of CHBC impact on ART adherence: (i

  9. Debt and Foregone Medical Care (United States)

    Kalousova, Lucie; Burgard, Sarah A.


    Most American households carry debt, yet we have little understanding of how debt influences health behavior, especially health care seeking. We examined associations between foregone medical care and debt using a population-based sample of 914 southeastern Michigan residents surveyed in the wake of the late-2000s recession. Overall debt and…

  10. Managing and caring for distressed and disturbed service users: the thoughts and feelings experienced by a sample of English mental health nurses. (United States)

    Chambers, M; Kantaris, X; Guise, V; Välimäki, M


    This paper reports the thoughts and feelings experienced by registered mental health nurses caring for distressed and/or disturbed service users in acute inpatient psychiatric settings in England. The prevailing thoughts of nurses were of cognitive dissonance and the conflict between benevolence and malevolence if coercive measures were seen as negative rather than positive; prevailing feelings experienced by nurses were fear, anxiety and vulnerability. To enhance care quality, nurses expressed the need for better communication with service users, and preventing the use of coercive measures and promotion of alternative methods of care and management. The nurses considered that debriefing dialogues following untoward incidents, practice development initiatives, education and training together with clinical supervision could be the way forward. The paper builds on the existing literature in offering clear explanations of nurses' thoughts and feelings when caring for distressed and/or disturbed service users in an English acute, inpatient psychiatric setting. Despite the small sample size and the limitations that it generates, the study findings will be of interest to the wider mental health nursing community. The findings will link to other national and international studies and therefore be valuable for future research studies of this kind. Collectively, they are building up a general picture of the distress, cognitive and emotional dissonance experienced by mental health nurses when using coercive interventions. The findings will help to develop mental health nurse education and enhance practice. High levels of distress and disturbance among service users experiencing acute mental illness is a major problem for mental health nurses (MHNs). The thoughts and feelings experienced by these nurses when caring for service users are of paramount importance as they influence clinical practice and caregiving. Similarly to research by other countries, this paper reports

  11. The knowledge and practices of primary care givers regarding home-based care of HIV/AIDS children in Blantyre (Malawi.

    Directory of Open Access Journals (Sweden)

    EW Zimba


    Full Text Available Knowledge is one of the major factors that promotes adherence to treatment regimens. With the current trends worldwide of home and community-based services for the management of HIV/AIDS patients, knowledge of care givers about the home care of these patients will determine the success of the programs. The purpose of this descriptive study was to explore the knowledge and practices of primary care givers of HIV/AIDS children in the provision of home care services. In this study an attempt was made to describe the factors which are associated with knowledge. Thirty-six primary care givers were randomly selected from three major home based care centres in Blantyre City, Malawi. A structured interview schedule was used to collect data. Data were analysed manually and by computer, using the Statistical Package for Social Science (SPSS. The findings revealed a gap in knowledge since in many instances taking a child to the hospital for the management of minor ailments was the action of choice, thus perpetuating the problem of overburdening hospital resources. Lack of prior preparation for home based care was found to be the major factor contributing to the lack of knowledge. Recommendations proposed include the need to put into place mechanisms that will ensure that all the primary care givers are adequately prepared in good time for home care service. Ensuring regular home visits was also thought to be helpful for efficient and effective supervision and reinforcement of information given to fill the gaps in knowledge wherever necessary.

  12. Suicide risk in a representative sample of people receiving HIV care: Time to target most-at-risk populations (ANRS VESPA2 French national survey) (United States)

    Fressard, Lisa; Préau, Marie; Sagaon-Teyssier, Luis; Suzan-Monti, Marie; Guagliardo, Valérie; Mora, Marion; Roux, Perrine; Dray-Spira, Rosemary; Spire, Bruno


    Background Suicide risk is high among people living with HIV (PLHIV). This study aimed to identify major correlates of suicide risk in a representative sample of PLHIV in France, in order to help target individuals who would benefit from suicide risk screening and psychiatric care. Methods The ANRS VESPA2 cross-sectional survey (April 2011-January 2012) collected socio-demographic, medical and behavioral data from 3,022 PLHIV recruited in 73 French HIV hospital departments. The study sample comprised the 2,973 participants with available self-reported data on suicide risk (defined as having either thought about and planned to commit suicide during the previous 12 months or attempted suicide during the same period of time) and medical data on comorbidities. Weighted Poisson models adjusted for HCV co-infection and significant clinical variables were used to estimate the relationship between suicide risk and HIV transmission groups, experience with HIV disease and other psychosocial factors. Results Suicide risk was reported by 6.3% of PLHIV in the study sample. After adjustment for HIV immunological status and HCV co-infection, women (IRR [95%CI]:1.93 [1.17; 3.19]) and men who have sex with men (MSM) (1.97 [1.22; 3.19]) had a higher suicide risk than the rest of the sample. Moreover, the number of discrimination-related social contexts reported (1.39 [1.19; 1.61]), homelessness (4.87 [1.82; 13.02]), and reporting a feeling of loneliness (4.62 [3.06; 6.97]) were major predictors of suicide risk. Conclusions Reducing the burden of precarious social conditions and discrimination is an important lever for preventing suicide risk among PLHIV in France. Comprehensive care models involving peer/community social interventions targeted at women and MSM need to be implemented to lower the risk of suicide in these specific subgroups of PLHIV. PMID:28192455

  13. Evaluation of Helicobacter pylori antigen positivity in stool samples of patients with dyspeptic complaints in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Mehmet Burak Selek


    Full Text Available Objective: Helicobacter pylori is a microorganism associatedwith gastritis, peptic ulcer disease and gastriccancer. We aimed to figure out the positivity rate in stoolsamples of outpatients with dyspeptic complaints visitinggastroenterology department and to evaluate its relationwith age, gender and seasonal changes.Methods: Between January 01, 2012 and December 31,2012, stool samples of 330 adult outpatients admitted togastroenterology department are investigated with an immunochromatographictest kit using monoclonal antibodiesfor detection of H. pylori antigen.Results: Among 330 patients’ stool samples tested, 67(20.3% were positive. 18.6% of men and 22.2% of womenwere detected as positive. According to age groups,17.1% patients were positive for 15-35 age groups,27.1% patients were positive for 36-55 age groups and18.2% patients were positive for above 56. Seasonal differenceof H. pylori antigen positivity in stool samples wasstatistically significant (p=0.001. Highest positivity rate29.7% was detected for winter months (December-January-February. According to logistic regression analysis,winter is found as a risk factor with statistically significant2.295 times greater risk [p=0001, Exp (B = 2.925, 95.0%C.I. for EXP (B = 1.668-5.129].Conclusion: H. pylori antigen positivity rate of our study islower than other previously conducted studies in Turkey.But, positivity rates are higher among women comparedto men, concordant with other studies. Even more, detectionof high positivity rates in winter shows primary infectionand/or relapse can be affected by seasonal changes.Key words: Helicobacter pylori, gastroenterology, stool antigen test

  14. Evidence-based benefit design: toward a sustainable health care future for employers. (United States)

    Bunn, William B; Stave, Gregg M; Allen, Harris; Naim, Ahmad B


    Health care costs for employers are rising much faster than inflation. The common approach to health benefit design of increasing cost sharing has failed to contain costs. Some employers, however, have been successful at mitigating the cost trend or actually reducing health care costs. These employers have in common a dedication to data analysis, a search for cost drivers, and a willingness to adjust their approach to health benefit design to address these cost drivers. This approach has much in common with the movement in clinical practice toward evidence-based medicine. We propose that employers adopt a similar approach toward health benefits termed evidence-based benefit design, which is based on a health and productivity framework focused on direct and indirect costs. Evidence-based benefit design incorporates the relevant literature and employer-specific data that are integrated and regularly analyzed.

  15. Field portable mobile phone based fluorescence microscopy for detection of Giardia lamblia cysts in water samples (United States)

    Ceylan Koydemir, Hatice; Gorocs, Zoltan; McLeod, Euan; Tseng, Derek; Ozcan, Aydogan


    Giardia lamblia is a waterborne parasite that causes an intestinal infection, known as giardiasis, and it is found not only in countries with inadequate sanitation and unsafe water but also streams and lakes of developed countries. Simple, sensitive, and rapid detection of this pathogen is important for monitoring of drinking water. Here we present a cost-effective and field portable mobile-phone based fluorescence microscopy platform designed for automated detection of Giardia lamblia cysts in large volume water samples (i.e., 10 ml) to be used in low-resource field settings. This fluorescence microscope is integrated with a disposable water-sampling cassette, which is based on a flow-through porous polycarbonate membrane and provides a wide surface area for fluorescence imaging and enumeration of the captured Giardia cysts on the membrane. Water sample of interest, containing fluorescently labeled Giardia cysts, is introduced into the absorbent pads that are in contact with the membrane in the cassette by capillary action, which eliminates the need for electrically driven flow for sample processing. Our fluorescence microscope weighs ~170 grams in total and has all the components of a regular microscope, capable of detecting individual fluorescently labeled cysts under light-emitting-diode (LED) based excitation. Including all the sample preparation, labeling and imaging steps, the entire measurement takes less than one hour for a sample volume of 10 ml. This mobile phone based compact and cost-effective fluorescent imaging platform together with its machine learning based cyst counting interface is easy to use and can even work in resource limited and field settings for spatio-temporal monitoring of water quality.

  16. Challenges in the Use of Compact Disc-Based Centrifugal Microfluidics for Healthcare Diagnostics at the Extreme Point of Care

    Directory of Open Access Journals (Sweden)

    Jordon Gilmore


    Full Text Available Since its inception, Compact Disc (CD-based centrifugal microfluidic technology has drawn a great deal of interest within research communities due to its potential use in biomedical applications. The technology has been referred to by different names, including compact-disc microfluidics, lab-on-a-disk, lab-on-a-CD and bio-disk. This paper critically reviews the state-of-the-art in CD-based centrifugal microfluidics devices and attempts to identify the challenges that, if solved, would enable their use in the extreme point of care. Sample actuation, manufacturing, reagent storage and implementation, target multiplexing, bio-particle detection, required hardware and system disposal, and sustainability are the topics of focus.

  17. Psychological Resilience, Affective Mechanisms and Symptom Burden in a Tertiary-care Sample of Patients with Fibromyalgia. (United States)

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


    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 modelling revealed statistically significant direct effects of resilience on fibromyalgia symptom burden (β = -0.10, P fibromyalgia symptom burden through affect (β = -0.36, P fibromyalgia symptom burden. Our results suggest that improving affect through resiliency training could be studied as a modality for improving fibromyalgia symptom burden.

  18. Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews

    Directory of Open Access Journals (Sweden)

    Risa Fukuda


    Full Text Available Objective: Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. Methods: This was a qualitative study using focus group interviews (FGIs. The setting was six acute hospitals with surgical and medical wards in the western region of Japan. Participants were nurses in surgical and internal medicine wards, excluding intensive care units. Nurses with less than 3 years working experience, those without experience in dementia patient care in their currently assigned ward, and head nurses were excluded from participation. FGIs were used to collect data from February to December 2008. Interviews were scheduled for 1–1.5 h. The qualitative synthesis method was used for data analysis. Results: In total, 50 nurses with an average experience of 9.8 years participated. Eight focus groups were formed. Issues in administering care to patients with dementia at acute care hospitals were divided into seven groups. Three of these groups, that is, problematic patient behaviors, recurrent problem, and problems affecting many people equally, interact to result in a burdensome cycle. This cycle is exacerbated by lack of nursing experience and lack of organization in hospitals. In coping with this cycle, the nurses develop protection plans for themselves and for the hospital. Conclusions: The two main issues experienced by nurses while administering care to patients with dementia in acute care hospitals were as follows: (a the various problems and difficulties faced by nurses were interactive and caused a burdensome cycle, and (b nurses do their best to adapt to these conditions despite feeling conflicted.

  19. Identification of forensic samples by using an infrared-based automatic DNA sequencer. (United States)

    Ricci, Ugo; Sani, Ilaria; Klintschar, Michael; Cerri, Nicoletta; De Ferrari, Francesco; Giovannucci Uzielli, Maria Luisa


    We have recently introduced a new protocol for analyzing all core loci of the Federal Bureau of Investigation's (FBI) Combined DNA Index System (CODIS) with an infrared (IR) automatic DNA sequencer (LI-COR 4200). The amplicons were labeled with forward oligonucleotide primers, covalently linked to a new infrared fluorescent molecule (IRDye 800). The alleles were displayed as familiar autoradiogram-like images with real-time detection. This protocol was employed for paternity testing, population studies, and identification of degraded forensic samples. We extensively analyzed some simulated forensic samples and mixed stains (blood, semen, saliva, bones, and fixed archival embedded tissues), comparing the results with donor samples. Sensitivity studies were also performed for the four multiplex systems. Our results show the efficiency, reliability, and accuracy of the IR system for the analysis of forensic samples. We also compared the efficiency of the multiplex protocol with ultraviolet (UV) technology. Paternity tests, undegraded DNA samples, and real forensic samples were analyzed with this approach based on IR technology and with UV-based automatic sequencers in combination with commercially-available kits. The comparability of the results with the widespread UV methods suggests that it is possible to exchange data between laboratories using the same core group of markers but different primer sets and detection methods.

  20. Respiratory clinical guidelines inform ward-based nurses' clinical skills and knowledge required for evidence-based care. (United States)

    Johnson, Alisha M; Smith, Sheree M S


    Respiratory clinical guidelines provide clinicians with evidence-based guidance for practice. Clinical guidelines also provide an opportunity to identify the knowledge and technical and non-technical skills required by respiratory ward-based registered nurses. The aim of this review was to use a systematic process to establish the core technical and non-technical skills and knowledge identified in evidence-based clinical guidelines that enable the care of hospitalised adult respiratory patients. 17 guidelines were identified in our systematic review. The quality assessment demonstrated variability in these guidelines. Common core knowledge and technical and non-technical skills were identified. These include pathophysiology, understanding of physiological measurements and monitoring, education, counselling, and ward and patient management. The knowledge and skills extracted from respiratory clinical guidelines may inform a curriculum for ward-based respiratory nursing to ensure optimal care of adult patients.

  1. Web-based simulation: a tool for teaching critical care nursing


    Barbosa, Sayonara de Fatima Faria; Marin,Heimar de Fatima


    The objectives of this study were to develop, to implement and to evaluate a web-based simulation for critical care nursing, as a tool for teaching nursing students at the undergraduate level. An adapted methodology was used to develop teaching material in a web-based learning environment, consisting of three evaluation phases (ergonomic, pedagogical and usability), carried out by web-designers/programmers, nursing teachers/nurses, and undergraduate nursing students. The research tools used w...

  2. Part 1: Evidence-based facility design using Transforming Care at the Bedside principles. (United States)

    Devine, Deborah A; Wenger, Barb; Krugman, Mary; Zwink, Jennifer E; Shiskowsky, Kaycee; Hagman, Jan; Limon, Shelly; Sanders, Carolyn; Reeves, Catherine


    An academic hospital used Transforming Care at the Bedside (TCAB) principles as the framework for generating evidence-based recommendations for the design of an expansion of the current hospital. The interdisciplinary team used the table of evidence-based data to advocate for a patient- and family-centered, safe, and positive work environment. A nurse project manager acted as liaison between the TCAB design team, architects, and facilities and design consultants. Part 2 of this series describes project evaluation outcomes.

  3. Networked Estimation for Event-Based Sampling Systems with Packet Dropouts

    Directory of Open Access Journals (Sweden)

    Young Soo Suh


    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.

  4. Sample processing for DNA chip array-based analysis of enterohemorrhagic Escherichia coli (EHEC

    Directory of Open Access Journals (Sweden)

    Enfors Sven-Olof


    Full Text Available Abstract Background Exploitation of DNA-based analyses of microbial pathogens, and especially simultaneous typing of several virulence-related genes in bacteria is becoming an important objective of public health these days. Results A procedure for sample processing for a confirmative analysis of enterohemorrhagic Escherichia coli (EHEC on a single colony with DNA chip array was developed and is reported here. The protocol includes application of fragmented genomic DNA from ultrasonicated colonies. The sample processing comprises first 2.5 min of ultrasonic treatment, DNA extraction (2×, and afterwards additional 5 min ultrasonication. Thus, the total sample preparation time for a confirmative analysis of EHEC is nearly 10 min. Additionally, bioinformatic revisions were performed in order to design PCR primers and array probes specific to most conservative regions of the EHEC-associated genes. Six strains with distinct pathogenic properties were selected for this study. At last, the EHEC chip array for a parallel and simultaneous detection of genes etpC-stx1-stx2-eae was designed and examined. This should permit to sense all currently accessible variants of the selected sequences in EHEC types and subtypes. Conclusion In order to implement the DNA chip array-based analysis for direct EHEC detection the sample processing was established in course of this work. However, this sample preparation mode may also be applied to other types of EHEC DNA-based sensing systems.

  5. Efficient Bayes-Adaptive Reinforcement Learning using Sample-Based Search

    CERN Document Server

    Guez, Arthur; Dayan, Peter


    Bayesian model-based reinforcement learning is a formally elegant approach to learning optimal behaviour under model uncertainty. In this setting, a Bayes-optimal policy captures the ideal trade-off between exploration and exploitation. Unfortunately, finding Bayes-optimal policies is notoriously taxing due to the enormous search space in the augmented belief-state MDP. In this paper we exploit recent advances in sample-based planning, based on Monte-Carlo tree search, to introduce a tractable method for approximate Bayes-optimal planning. Unlike prior work in this area, we avoid expensive applications of Bayes rule within the search tree, by lazily sampling models from the current beliefs. Our approach outperformed prior Bayesian model-based RL algorithms by a significant margin on several well-known benchmark problems.

  6. 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: [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)


    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

  7. Calibrating passive sampling and passive dosing techniques to lipid based concentrations

    DEFF Research Database (Denmark)

    Mayer, Philipp; Schmidt, Stine Nørgaard; Annika, A.;


    towards equilibrium partitioning concentrations in lipids (Clipid,partitioning). The first approach proceeds in two steps; (i) the concentration in the PDMS (CPDMS ) is determined and (ii) multiplied with recently determined lipid to PDMS partition ratios (Klipid,PDMS). The second approach applies...... external partitioning standards in vegetable or fish oil for the complete calibration of equilibrium sampling techniques without additional steps. Equilibrium in tissue sampling in three different fish yielded lipid based PCB concentrations in good agreement with those determined using total extraction...... and lipid normalization. These results support the validity of the in tissue sampling technique, while at the same time confirming that the fugacity capacity of these lipid-rich fish tissues for PCBs was dominated by the lipid fraction. Equilibrium sampling of PCB contaminated lake sediments with PDMS...

  8. Repeating cytological preparations on liquid-based cytology samples: A methodological advantage? (United States)

    Pinto, Alvaro P; Maia, Henrique Felde; di Loretto, Celso; Krunn, Patrícia; Túlio, Siumara; Collaço, Luis Martins


    This study investigates the rule that repeating cytological preparations on liquid-based cytology improves sample adequacy, diagnosis, microbiological, and hormonal evaluations. We reviewed 156 cases of pap-stained preparations of exfoliated cervical cells in two slides processed by DNA-Cytoliq System. After sample repeat/dilution, limiting factors affecting sample adequacy were removed in nine cases and three unsatisfactory cases were reclassified as satisfactory. Diagnosis was altered in 24 cases. Of these, the original diagnosis in 15 was atypical squamous cells of undetermined significance; after the second slide examination, diagnosis in 5 of the 15 cases changed to low-grade squamous intraepithelial lesion, 3 to high-grade squamous intraepithelial lesion, and 7 to absence of lesion. Microbiological evaluation was altered, with Candida sp. detected in two repeated slides. Repeat slide preparation or dilution of residual samples enhances cytological diagnosis and decreases effects of limiting factors in manually processed DIGENE DCS LBC.

  9. Time-Expanded Sampling for Ensemble-Based Filters:Assimilation Experiments with Real Radar Observations

    Institute of Scientific and Technical Information of China (English)

    LU Huijuan; Qin XU; YAO Mingming; GAO Shouting


    By sampling perturbed state vectors from each ensenble prediction run at properly selected time levels in the vicinity of the analysis time, the recently proposed time-expanded sampling approach can enlarge the ensemble size without increasing the number of prediction runs and, hence, can reduce the computational cost of an ensemble-based filter. In this study, this approach is tested for the first time with real radar data from a tornadic thunderstorm. In particular, four assimilation experiments were performed to test the time-expanded sampling method against the conventional ensemble sampling method used by ensemblebased filters. In these experiments, the ensemble square-root filter (EnSRF) was used with 45 ensemble members generated by the time-expanded sampling and conventional sampling from 15 and 45 prediction runs, respectively, and quality-controlled radar data were compressed into super-observations with properly reduced spatial resolutions to improve the EnSRF performances. The results show that the time-expanded sampling approach not only can reduce the computational cost but also can improve the accuracy of the analysis, especially when the ensemble size is severely limited due to computational constraints for real-radar data assimilation. These potential merits are consistent with those previously demonstrated by assimilation experiments with simulated data.

  10. Evidence-based surgical care and the evolution of fast-track surgery

    DEFF Research Database (Denmark)

    Kehlet, H.; Wilmore, D.W.


    , randomized studies, and meta-analyses, the concept of the "fast-track methodology" has uniformly provided a major enhancement in recovery leading to decreased hospital stay and with an apparent reduction in medical morbidity but unaltered "surgery-specific" morbidity in a variety of procedures. However......BACKGROUND: Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program. OBJECTIVE: To assess, synthesize, and discuss implementation of "fast-track" recovery programs. DATA SOURCES: Medline MBASE...... (January 1966-May 2007) and the Cochrane library (January 1966-May 2007) were searched using the following keywords: fast-track, enhanced recovery, accelerated rehabilitation, and multimodal and perioperative care. In addition, the synthesis on the many specific interventions and organizational...

  11. Nonprofit health care services marketing: persuasive messages based on multidimensional concept mapping and direct magnitude estimation. (United States)

    Hall, Michael L


    Persuasive messages for marketing healthcare services in general and coordinated care in particular are more important now for providers, hospitals, and third-party payers than ever before. The combination of measurement-based information and creativity may be among the most critical factors in reaching markets or expanding markets. The research presented here provides an approach to marketing coordinated care services which allows healthcare managers to plan persuasive messages given the market conditions they face. Using market respondents' thinking about product attributes combined with distance measurement between pairs of product attributes, a conceptual marketing map is presented and applied to advertising, message copy, and delivery. The data reported here are representative of the potential caregivers for which the messages are intended. Results are described with implications for application to coordinated care services. Theory building and marketing practice are discussed in the light of findings and methodology.

  12. Comparative effectiveness research: evidence-based medicine meets health care reform in the USA. (United States)

    Tanenbaum, Sandra J


    Rationale Comparative effectiveness research (CER) is the study of two or more approaches to a health problem to determine which one results in better health outcomes. It is viewed by some in the USA as a promising strategy for health care reform. Aims and Objectives In this paper, nascent US CER policy will be described and analysed in order to determine its similarities and differences with EBM and its chances of success. Methods Document review and process tracing Results CER shares the logic of policies promoting evidence-based medicine, but invites greater methodological flexibility to ensure external validity across a range of health care topics. Conclusions This may narrow the inferential distance from knowledge to action, but efforts to change the US health care system through CER will face familiar epistemological quandaries and 'patient-centred' politics on the left and right.

  13. Systematization of nursing care based on CIPE® and the theory of adaptation in hypertensives

    Directory of Open Access Journals (Sweden)

    Denizielle de Jesus Moreira Moura


    Full Text Available Study aimed to identify diagnoses and plan outcomes and interventions based on the CIPE® nomenclature and on the theory of adaptation to hypertensive patients with associated diseases. It is a multiple case study conducted with 45 users of the Family Health Strategy and registered in HIPERDIA. The most frequent diagnoses identified were partial self-care (93.3%, decreased exercise pattern (84.4%, impaired dentition (82.2%, and low learning process (60%. Outcomes and interventions aimed at improving adherence to treatment and quality of life were planned for these diagnoses. The results of this study highlight the need for care of hypertensives with complications, supporting a theoretical foundation and practice of nursing care through the development of statements of diagnoses, outcomes, and interventions. doi: 10.5216/ree.v16i4.22945.

  14. Faith-Based HIV Care and Prevention in Chinese Immigrant Communities: Rhetoric or Reality? (United States)

    Kang, Ezer; Chin, John J; Behar, Elana


    Ethnic churches attended by first generation Chinese immigrants are uniquely positioned to address emerging HIV prevention and care needs within the Chinese community at-large. Efforts to develop faith-based HIV programs necessitate identifying how HIV intersects with the sinicization of Christianity within Chinese churches. This paper will review the process of contextualizing HIV within theological and cultural frameworks that are meaningful for ethnic Chinese church leaders and members. The authors specifically propose two points of integration between public health and ecclesial functions: (1) HIV stigma-mitigation initiatives as informed by Christo-centric teachings of compassion and justice, and (2) HIV prevention and care reframed as social responsibility and informed by the Christian tradition of evangelism. Systems and practices that hinder and promote the involvement of Chinese churches in HIV prevention, care, and stigma-reduction will be discussed.

  15. Implementation Process of a Canadian Community-based Nurse Mentorship Intervention in HIV Care (United States)

    Caine, Vera; Mill, Judy; O’Brien, Kelly; Solomon, Patricia; Worthington, Catherine; Dykeman, Margaret; Gahagan, Jacqueline; Maina, Geoffrey; De Padua, Anthony; Arneson, Cheryl; Rogers, Tim; Chaw-Kant, Jean


    We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations. PMID:26644019

  16. Nitrogen Detection in Bulk Samples Using a D-D Reaction-Based Portable Neutron Generator

    Directory of Open Access Journals (Sweden)

    A. A. Naqvi


    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.

  17. Multicenter validation of PCR-based method for detection of Salmonella in chicken and pig samples

    DEFF Research Database (Denmark)

    Malorny, B.; Cook, N.; D'Agostino, M.;


    As part of a standardization project, an interlaboratory trial including 15 laboratories from 13 European countries was conducted to evaluate the performance of a noproprietary polymerase chain reaction (PCR)-based method for the detection of Salmonella on artificially contaminated chicken rinse...... and pig swab samples. The 3 levels were 1-10, 10-100, and 100-1000 colony-forming units (CFU)/100 mL. Sample preparations, including inoculation and pre-enrichment in buffered peptone water (BPW), were performed centrally in a German laboratory; the pre-PCR sample preparation (by a resin-based method...... specificity was 80.1% (with 85.7% accordance and 67.5% concordance) for chicken rinse, and 91.7% (with 100% accordance and 83.3% concordance) for pig swab. Thus, the interlaboratory variation due to personnel, reagents, thermal cyclers, etc., did not affect the performance of the method, which...

  18. A Study of Assimilation Bias in Name-Based Sampling of Migrants

    Directory of Open Access Journals (Sweden)

    Schnell Rainer


    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.

  19. Using Load Balancing to Scalably Parallelize Sampling-Based Motion Planning Algorithms

    KAUST Repository

    Fidel, Adam


    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.

  20. Tracking control and synchronization of chaotic systems based upon sampled-data feedback

    Institute of Scientific and Technical Information of China (English)

    陈士华; 刘杰; 谢进; 陆君安


    A novel tracking control and synchronization method is proposed based upon sampled-data feedback. This methodcan make a chaotic system approach any desired smooth orbit and synchronize the driving system and the responsesystem, both in the same structure and in diverse structures. Finally, a numerical simulation with a Lorenz system isprovided for the purpose of illustration and verification.

  1. Use of sampling based correction for non-radioactivity X-ray energy calibration

    Institute of Scientific and Technical Information of China (English)

    CHENG Cheng; WEI Yong-Bo; JIANG Da-Zhen


    As the requirement of non-radioactivity measurement has increased in recent years, various energy calibration methods applied in portable X-ray fluorescence (XRF) spectrometers have been developed. In this paper, a sampling based correction energy calibration has been discussed. In this method both history information and current state of the instrument are considered and relative high precision and reliability can be obtained.

  2. Effective sampling range of a synthetic protein-based attractant for Ceratitis capitata (Diptera: Tephritidae) (United States)

    Studies were conducted in Honduras to determine sampling range for female-targeted food-based synthetic attractants for pest tephritid fruit flies. Field studies were conducted in shaded coffee and adults of the Mediterranean fruit fly, Ceratitis capitata (Wiedemann), were captured. Traps (38 traps ...

  3. Sampling conditions for gradient-magnitude sparsity based image reconstruction algorithms

    DEFF Research Database (Denmark)

    Sidky, Emil Y.; Jørgensen, Jakob Heide; Pan, Xiaochuan


    in the compressive sensing (CS) community for this type of sparsity. The preliminary finding here, based on simulations using images of realistic sparsity levels, is that necessary sampling can go as low as N/4 views for an NxN pixel array. This work sets the stage for fixed-exposure studies where the number...

  4. 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


    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.

  5. Kernel Density Independence Sampling based Monte Carlo Scheme (KISMCS) for inverse hydrological modeling

    NARCIS (Netherlands)

    Shafiei, M.; Gharari, S.; Pande, S.; Bhulai, S.


    Posterior sampling methods are increasingly being used to describe parameter and model predictive uncertainty in hydrologic modelling. This paper proposes an alternative to random walk chains (such as DREAM-zs). We propose a sampler based on independence chains with an embedded feature of standardiz

  6. Reinforcing Sampling Distributions through a Randomization-Based Activity for Introducing ANOVA (United States)

    Taylor, Laura; Doehler, Kirsten


    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. Small-sample robust estimators of noncentrality-based and incremental model fit

    NARCIS (Netherlands)

    Boomsma, Anne; Herzog, W.


    Traditional estimators of fit measures based on the noncentral chi-square distribution (root mean square error of approximation [RMSEA], Steiger's , etc.) tend to overreject acceptable models when the sample size is small. To handle this problem, it is proposed to employ Bartlett's (1950), Yuan's (2

  8. Psychological Abuse between Parents: Associations with Child Maltreatment from a Population-Based Sample (United States)

    Chang, Jen Jen; Theodore, Adrea D.; Martin, Sandra L.; Runyan, Desmond K.


    Objective: This study examined the association between partner psychological abuse and child maltreatment perpetration. Methods: This cross-sectional study examined a population-based sample of mothers with children aged 0-17 years in North and South Carolina (n = 1,149). Mothers were asked about the occurrence of potentially neglectful or abusive…

  9. Using activity-based costing and theory of constraints to guide continuous improvement in managed care. (United States)

    Roybal, H; Baxendale, S J; Gupta, M


    Activity-based costing and the theory of constraints have been applied successfully in many manufacturing organizations. Recently, those concepts have been applied in service organizations. This article describes the application of activity-based costing and the theory of constraints in a managed care mental health and substance abuse organization. One of the unique aspects of this particular application was the integration of activity-based costing and the theory of constraints to guide process improvement efforts. This article describes the activity-based costing model and the application of the theory of constraint's focusing steps with an emphasis on unused capacities of activities in the organization.

  10. Jonathan E. Rhoads lecture 2012: improving patient care with practice-based research. (United States)

    Dickerson, Roland N


    Practice-based research plays a pivotal role for improving patient care as its primary intent is to solve a clinical dilemma or problem encountered in clinical practice. Its results are immediately applicable to day-to-day clinical practice and essential to the growth of an evidence-based clinical practice. This review emphasizes the importance of this type of research. In addition, it serves to identify common sources for project conception and gives examples based on personal experiences of the author as a clinical practitioner, educator, and researcher. Common barriers to practice-based research are discussed as well as potential solutions offered for consideration.

  11. Emotion-Aware Assistive System for Humanistic Care Based on the Orange Computing Concept

    Directory of Open Access Journals (Sweden)

    Jhing-Fa Wang


    Full Text Available Mental care has become crucial with the rapid growth of economy and technology. However, recent movements, such as green technologies, place more emphasis on environmental issues than on mental care. Therefore, this study presents an emerging technology called orange computing for mental care applications. Orange computing refers to health, happiness, and physiopsychological care computing, which focuses on designing algorithms and systems for enhancing body and mind balance. The representative color of orange computing originates from a harmonic fusion of passion, love, happiness, and warmth. A case study on a human-machine interactive and assistive system for emotion care was conducted in this study to demonstrate the concept of orange computing. The system can detect emotional states of users by analyzing their facial expressions, emotional speech, and laughter in a ubiquitous environment. In addition, the system can provide corresponding feedback to users according to the results. Experimental results show that the system can achieve an accurate audiovisual recognition rate of 81.8% on average, thereby demonstrating the feasibility of the system. Compared with traditional questionnaire-based approaches, the proposed system can offer real-time analysis of emotional status more efficiently.

  12. An evidence-based health workforce model for primary and community care

    Directory of Open Access Journals (Sweden)

    Leach Matthew J


    Full Text Available Abstract Background The delivery of best practice care can markedly improve clinical outcomes in patients with chronic disease. While the provision of a skilled, multidisciplinary team is pivotal to the delivery of best practice care, the occupational or skill mix required to deliver this care is unclear; it is also uncertain whether such a team would have the capacity to adequately address the complex needs of the clinic population. This is the role of needs-based health workforce planning. The objective of this article is to describe the development of an evidence-informed, needs-based health workforce model to support the delivery of best-practice interdisciplinary chronic disease management in the primary and community care setting using diabetes as a case exemplar. Discussion Development of the workforce model was informed by a strategic review of the literature, critical appraisal of clinical practice guidelines, and a consensus elicitation technique using expert multidisciplinary clinical panels. Twenty-four distinct patient attributes that require unique clinical competencies for the management of diabetes in the primary care setting were identified. Patient attributes were grouped into four major themes and developed into a conceptual model: the Workforce Evidence-Based (WEB planning model. The four levels of the WEB model are (1 promotion, prevention, and screening of the general or high-risk population; (2 type or stage of disease; (3 complications; and (4 threats to self-care capacity. Given the number of potential combinations of attributes, the model can account for literally millions of individual patient types, each with a distinct clinical team need, which can be used to estimate the total health workforce requirement. Summary The WEB model was developed in a way that is not only reflective of the diversity in the community and clinic populations but also parsimonious and clear to present and operationalize. A key feature of the

  13. Developing a web-based information resource for palliative care: an action-research inspired approach

    Directory of Open Access Journals (Sweden)

    Gliddon Terry


    Full Text Available Abstract Background General Practitioners and community nurses rely on easily accessible, evidence-based online information to guide practice. To date, the methods that underpin the scoping of user-identified online information needs in palliative care have remained under-explored. This paper describes the benefits and challenges of a collaborative approach involving users and experts that informed the first stage of the development of a palliative care website 1. Method The action research-inspired methodology included a panel assessment of an existing palliative care website based in Victoria, Australia; a pre-development survey (n = 197 scoping potential audiences and palliative care information needs; working parties conducting a needs analysis about necessary information content for a redeveloped website targeting health professionals and caregivers/patients; an iterative evaluation process involving users and experts; as well as a final evaluation survey (n = 166. Results Involving users in the identification of content and links for a palliative care website is time-consuming and requires initial resources, strong networking skills and commitment. However, user participation provided crucial information that led to the widened the scope of the website audience and guided the development and testing of the website. The needs analysis underpinning the project suggests that palliative care peak bodies need to address three distinct audiences (clinicians, allied health professionals as well as patients and their caregivers. Conclusion Web developers should pay close attention to the content, language, and accessibility needs of these groups. Given the substantial cost associated with the maintenance of authoritative health information sites, the paper proposes a more collaborative development in which users can be engaged in the definition of content to ensure relevance and responsiveness, and to eliminate unnecessary detail. Access to

  14. Perceived quality of care for common childhood illnesses: facility versus community based providers in Uganda.

    Directory of Open Access Journals (Sweden)

    Agnes Nanyonjo

    Full Text Available OBJECTIVE: To compare caretakers' perceived quality of care (PQC for under-fives treated for malaria, pneumonia and diarrhoea by community health workers (CHWs and primary health facility workers (PHFWs. METHODS: Caretaker rated PQC for children aged (2-59 months treated by either CHWs or PHFWs for a bought of malaria, pneumonia or diarrhoea was cross-sectionally compared in quality domains of accessibility, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment and trust. Child samples were randomly drawn from CHW (419 and clinic (399 records from eight Midwestern Uganda districts. An overall PQC score was predicted through factor analysis. PQC scores were compared for CHWs and PHFWs using Wilcoxon rank-sum test. Multinomial logistic regression models were used to specify the association between categorized PQC and service providers for each quality domain. Finally, overall PQC was dichotomized into "high" and "low" based on median score and relative risks (RR for PQC-service provider association were modeled in a "modified" Poisson regression model. RESULTS: Mean (SD overall PQC was significantly higher for CHWs 0.58 (0 .66 compared to PHFWs -0.58 (0.94, p<0.0001. In "modified" Poisson regression, the proportion of caretakers reporting high PQC was higher for CHWS compared to PHFWs, RR=3.1, 95%CI(2.5-3.8. In multinomial models PQC was significantly higher for CHWs compared to PHFWs in all domains except for continuity. CONCLUSION: PQC was significantly higher for CHWs compared to PHFWs in this resource constrained setting. CHWs should be tapped human resources for universal health coverage while scaling up basic child intervention as PQC might improve intervention utilization.

  15. Highly selective ionic liquid-based microextraction method for sensitive trace cobalt determination in environmental and biological samples

    Energy Technology Data Exchange (ETDEWEB)

    Berton, Paula [Analytical Chemistry Research and Development Group (QUIANID), (LISAMEN - CCT - CONICET - Mendoza), Av. Ruiz Leal S/N Parque General San Martin, M 5502 IRA Mendoza (Argentina); Wuilloud, Rodolfo G., E-mail: [Analytical Chemistry Research and Development Group (QUIANID), (LISAMEN - CCT - CONICET - Mendoza), Av. Ruiz Leal S/N Parque General San Martin, M 5502 IRA Mendoza (Argentina); Instituto de Ciencias Basicas, Universidad Nacional de Cuyo, Mendoza (Argentina)


    A simple and rapid dispersive liquid-liquid microextraction procedure based on an ionic liquid (IL-DLLME) was developed for selective determination of cobalt (Co) with electrothermal atomic absorption spectrometry (ETAAS) detection. Cobalt was initially complexed with 1-nitroso-2-naphtol (1N2N) reagent at pH 4.0. The IL-DLLME procedure was then performed by using a few microliters of the room temperature ionic liquid (RTIL) 1-hexyl-3-methylimidazolium hexafluorophosphate [C{sub 6}mim][PF{sub 6}] as extractant while methanol was the dispersant solvent. After microextraction procedure, the Co-enriched RTIL phase was solubilized in methanol and directly injected into the graphite furnace. The effect of several variables on Co-1N2N complex formation, extraction with the dispersed RTIL phase, and analyte detection with ETAAS, was carefully studied in this work. An enrichment factor of 120 was obtained with only 6 mL of sample solution and under optimal experimental conditions. The resultant limit of detection (LOD) was 3.8 ng L{sup -1}, while the relative standard deviation (RSD) was 3.4% (at 1 {mu}g L{sup -1} Co level and n = 10), calculated from the peak height of absorbance signals. The accuracy of the proposed methodology was tested by analysis of a certified reference material. The method was successfully applied for the determination of Co in environmental and biological samples.

  16. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study (United States)

    Boyle, Elaine M; Johnson, Samantha; Manktelow, Bradley; Seaton, Sarah E; Draper, Elizabeth S; Smith, Lucy K; Dorling, Jon; Marlow, Neil; Petrou, Stavros; Field, David J


    Objective To describe neonatal outcomes and explore variation in delivery of care for infants born late (34–36  weeks) and moderately (32–33 weeks) preterm (LMPT). Design/setting Prospective population-based study comprising births in four major maternity centres, one midwifery-led unit and at home between September 2009 and December 2010. Data were obtained from maternal and neonatal records. Participants All LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls. Outcome measures Neonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored. Results 1146 (83%) LMPT and 1258 (79% of eligible) term-born infants were recruited. LMPT infants were significantly more likely to receive resuscitation at birth (17.5% vs 7.4%), respiratory (11.8% vs 0.9%) and nutritional support (3.5% vs 0.3%) and were less likely to be fed breast milk (64.2% vs 72.2%) than term infants. For all interventions and morbidities, a gradient of increasing risk with decreasing gestation was evident. Although 60% of late preterm infants were never admitted to a NNU, 83% required medical input on postnatal wards. Clinical management differed significantly between services. Conclusions LMPT infants place high demands on specialist neonatal services. A substantial amount of previously unreported specialist input is provided in postnatal wards, beyond normal newborn care. Appropriate expertise and planning of early care are essential if such infants are managed away from specialised neonatal settings. Further research is required to clarify optimal and cost-effective postnatal management for LMPT babies. PMID:25834169

  17. Applying community-based participatory research to better understand and improve kinship care practices

    DEFF Research Database (Denmark)

    Chukwudozie, Oge; Feinstein, Clare; Jensen, Celina;


    While the principles behind community-based participatory research are firmly established, the process of taking community-based participatory research with children and youth to scale and integrating it into the programming of non-governmental organizations has been scarcely documented....... This article reflects on the experiences of Save the Children in implementing a multicountry community-based participatory research program to increase understanding of kinship care in the Democratic Republic of Congo, Nigeria, and Sierra Leone. The article discusses challenges faced and lessons learned...... and highlights how the research process enabled action and advocacy initiatives at different levels-leading to an increase in support and policy attention for children living in kinship care....

  18. Integrating Web-Based Applications into Aged Care: Two Case Studies and Discussion. (United States)

    Rehm, Imogen C; Musić, Selma; Carlsson, Anthony; Scanlan, Faye; Silver, Mark; Bhar, Sunil S


    In anticipation of the growing need for adequate mental health care for older adults in residential aged care facilities, psychologists are challenged to overcome several barriers that impede the uptake and delivery of their services in such settings. Information and communication technologies (ICT) have strong potential to overcome some of these barriers by supporting the delivery of evidence-based psychosocial treatments for common psychogeriatric issues. This paper presents two case studies that illustrate when and how psychologists can use various ICT applications (e.g., tablet devices, web-based applications) integrated with cognitive behavioural and reminiscence-based therapies. Both case studies demonstrate that ICT can effectively support the therapeutic alliance, enhance therapeutic engagement, and individualize treatment delivery to accommodate the needs of elderly patients. It is hoped that these case studies will encourage clinicians to consider using ICT to augment therapy with their elderly patients.

  19. Cloud based intelligent system for delivering health care as a service. (United States)

    Kaur, Pankaj Deep; Chana, Inderveer


    The promising potential of cloud computing and its convergence with technologies such as mobile computing, wireless networks, sensor technologies allows for creation and delivery of newer type of cloud services. In this paper, we advocate the use of cloud computing for the creation and management of cloud based health care services. As a representative case study, we design a Cloud Based Intelligent Health Care Service (CBIHCS) that performs real time monitoring of user health data for diagnosis of chronic illness such as diabetes. Advance body sensor components are utilized to gather user specific health data and store in cloud based storage repositories for subsequent analysis and classification. In addition, infrastructure level mechanisms are proposed to provide dynamic resource elasticity for CBIHCS. Experimental results demonstrate that classification accuracy of 92.59% is achieved with our prototype system and the predicted patterns of CPU usage offer better opportunities for adaptive resource elasticity.

  20. Paper membrane-based SERS platform for the determination of glucose in blood samples. (United States)

    Torul, Hilal; Çiftçi, Hakan; Çetin, Demet; Suludere, Zekiye; Boyacı, Ismail Hakkı; Tamer, Uğur


    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.

  1. Adequate prenatal care reduces the risk of adverse pregnancy outcomes in women with history of infertility: a nationwide population-based study.

    Directory of Open Access Journals (Sweden)

    Raushan Alibekova

    Full Text Available OBJECTIVES: To investigate the effects of various measures of prenatal care on adverse pregnancy outcomes in women with a history of infertility. STUDY DESIGN: A retrospective cohort study. METHODS: Data were derived by linking 2 large nationwide population-based datasets, the National Health Insurance Research Database and Taiwan Birth Certificate Registry. The study sample included 15,056 women with an infertility diagnosis and 60,224 randomly selected women without infertility matched to the study sample by maternal age. A conditional logistic regression analysis was performed for the analysis. RESULTS: Women diagnosed with infertility respectively had 1.39 (95% CI, 1.06~1.83, 1.15 (95% CI, 1.08~1.24, 1.13 (95% CI, 1.08~1.18, and 1.08 (95% CI, 1.05~1.12 higher odds of having very low birth weight (VLBW babies, preterm births, labor complications, and cesarean sections (CSs compared to women without infertility. Inadequate numbers of total and major prenatal visits and late initiation of prenatal care increased the risks of adverse pregnancy outcomes in women with infertility, especially the risk of a VLBW baby. However, no significant associations were found for the risks of adverse birth outcomes in infertile women with adequate prenatal care compared to fertile women with adequate care. CONCLUSIONS: Study findings suggest that adequate prenatal care can reduce the risk of adverse pregnancy outcomes in women with infertility.

  2. Associations of Caregiver Stress with Working Conditions, Caregiving Practices, and Child Behaviour in Home-Based Child Care (United States)

    Rusby, Julie C.; Jones, Laura Backen; Crowley, Ryann; Smolkowski, Keith


    Home-based child caregivers face unique stressors related to the nature of their work. One hundred and fifty-five home-based child care providers in Oregon, USA, participated in this cross-sectional correlational study. We investigated associations between indicators of caregiver stress and child care working conditions, the quality of caregiver…

  3. Introducing Evidence-Based Medicine and guidelines for maternal and newborn care in the Republic of Moldova

    DEFF Research Database (Denmark)

    Bacci, A; Wyn Huws, D; Baltag, V;


    Familiarity with Evidence-Based Medicine (EBM) concepts is low amongst key maternal and newborn care clinicians in Moldova. Simple interventions can increase the knowledge of EBM concepts there.......Familiarity with Evidence-Based Medicine (EBM) concepts is low amongst key maternal and newborn care clinicians in Moldova. Simple interventions can increase the knowledge of EBM concepts there....

  4. Application of In-Segment Multiple Sampling in Object-Based Classification

    Directory of Open Access Journals (Sweden)

    Nataša Đurić


    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.

  5. Structure and characteristics of community-based multidisciplinary wound care teams in Ontario: an environmental scan. (United States)

    Abrahamyan, Lusine; Wong, Josephine; Pham, Ba'; Trubiani, Gina; Carcone, Steven; Mitsakakis, Nicholas; Rosen, Laura; Rac, Valeria E; Krahn, Murray


    Multidisciplinary team approach is an essential component of evidence-based wound management in the community. The objective of this study was to identify and describe community-based multidisciplinary wound care teams in Ontario. For the study, a working definition of a multidisciplinary wound care team was developed, and a two-phase field evaluation was conducted. In phase I, a systematic survey with three search strategies (environmental scan) was conducted to identify all multidisciplinary wound care teams in Ontario. In phase II, the team leads were surveyed about the service models of the teams. We identified 49 wound care teams in Ontario. The highest ratio of Ontario seniors to wound team within each Ontario health planning region was 82,358:1; the lowest ratio was 14,151:1. Forty-four teams (90%) participated in the survey. The majority of teams existed for at least 5 years, were established as hospital outpatient clinics, and served patients with chronic wounds. Teams were heterogeneous in on-site capacity of specialized diagnostic testing and wound treatment, team size, and patient volume. Seventy-seven percent of teams had members from three or more disciplines. Several teams lacked essential disciplines. More research is needed to identify optimal service models leading to improved patient outcomes.

  6. A margin based approach to determining sample sizes via tolerance bounds.

    Energy Technology Data Exchange (ETDEWEB)

    Newcomer, Justin T.; Freeland, Katherine Elizabeth


    This paper proposes a tolerance bound approach for determining sample sizes. With this new methodology we begin to think of sample size in the context of uncertainty exceeding margin. As the sample size decreases the uncertainty in the estimate of margin increases. This can be problematic when the margin is small and only a few units are available for testing. In this case there may be a true underlying positive margin to requirements but the uncertainty may be too large to conclude we have sufficient margin to those requirements with a high level of statistical confidence. Therefore, we provide a methodology for choosing a sample size large enough such that an estimated QMU uncertainty based on the tolerance bound approach will be smaller than the estimated margin (assuming there is positive margin). This ensures that the estimated tolerance bound will be within performance requirements and the tolerance ratio will be greater than one, supporting a conclusion that we have sufficient margin to the performance requirements. In addition, this paper explores the relationship between margin, uncertainty, and sample size and provides an approach and recommendations for quantifying risk when sample sizes are limited.

  7. Directed sample interrogation utilizing an accurate mass exclusion-based data-dependent acquisition strategy (AMEx). (United States)

    Rudomin, Emily L; Carr, Steven A; Jaffe, Jacob D


    The ability to perform thorough sampling is of critical importance when using mass spectrometry to characterize complex proteomic mixtures. A common approach is to reinterrogate a sample multiple times by LC-MS/MS. However, the conventional data-dependent acquisition methods that are typically used in proteomics studies will often redundantly sample high-intensity precursor ions while failing to sample low-intensity precursors entirely. We describe a method wherein the masses of successfully identified peptides are used to generate an accurate mass exclusion list such that those precursors are not selected for sequencing during subsequent analyses. We performed multiple concatenated analytical runs to sample a complex cell lysate, using either accurate mass exclusion-based data-dependent acquisition (AMEx) or standard data-dependent acquisition, and found that utilization of AMEx on an ESI-Orbitrap instrument significantly increases the total number of validated peptide identifications relative to a standard DDA approach. The additional identified peptides represent precursor ions that exhibit low signal intensity in the sample. Increasing the total number of peptide identifications augmented the number of proteins identified, as well as improved the sequence coverage of those proteins. Together, these data indicate that using AMEx is an effective strategy to improve the characterization of complex proteomic mixtures.

  8. Determination of optimal samples for robot calibration based on error similarity

    Directory of Open Access Journals (Sweden)

    Tian Wei


    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.

  9. Contamination of apple orchard soils and fruit trees with copper-based fungicides: sampling aspects. (United States)

    Wang, Quanying; Liu, Jingshuang; Liu, Qiang


    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.

  10. A gel-based visual immunoassay for non-instrumental detection of chloramphenicol in food samples. (United States)

    Yuan, Meng; Sheng, Wei; Zhang, Yan; Wang, Junping; Yang, Yijin; Zhang, Shuguang; Goryacheva, Irina Yu; Wang, Shuo


    A gel-based non-instrumental immuno-affinity assay was developed for the rapid screening of chloramphenicol (CAP) in food samples with the limit of detection (LOD) of 1 μg L(-1). The immuno-affinity test column (IATC) consisted of a test layer containing anti-CAP antibody coupled gel, and a control layer with anti-HRP antibody coupled gel. Based on the direct competitive immuno-reaction and the horseradish peroxidase enzymatic reaction, the test results could be evaluated visually. Basically, blue color development represented the negative results, while the absence of color development represented the positive results. In this study, CAP spiked samples of raw milk, pasteurized milk, UHT milk, skimmed milk powder, acacia honey, date honey, fish and shrimp were tested. Little or none sample pretreatment was required for this assay. The whole procedure was completed within 10min. In conclusion, the gel-based immuno-affinity test is a simple, rapid, and promising on-site screening method for CAP residues in food samples, with no instrumental requirement.

  11. Immunological findings in psychotic syndromes: a tertiary care hospital´s CSF sample of 180 patients

    Directory of Open Access Journals (Sweden)

    Dominique eEndres


    Full Text Available Immunological mechanisms and therapy approaches in psychotic syndromes were recently supported by the discovery of autoantibody-associated limbic and non-limbic encephalitis. However, how clinical diagnostic procedures in psychiatry should be adapted to these new insights is still unclear. In this study, we analyzed the cerebrospinal fluid (CSF and neuroimmunological alterations and their association with cerebral MRI (cMRI and electroencephalographic (EEG findings. From 2006 until 2013, we acquired 180 CSF samples from psychotic patients. Between 2006 and 2009, CSF examinations were only performed in cases in which organic brain disease was suspected. Since then, this procedure has been integrated into our routine diagnostic workup. CSF basic diagnostics were supplemented by measuring antineuronal antibodies against intracellular synaptic antigens, antibodies against intracellular onconeural antigens, antibodies against neuronal cell surface antigens and thyroid antibodies. In addition, cMRIs and EEGs were conducted. We found white cell counts elevated in 3.4% of the cases, albumin quotient elevated in 21.8%, and protein concentration elevated in 42.2%. Evidence of intrathecal immunoglobulin synthesis was found in 7.2% of the cases. Antibodies measured against neuronal cell surface antigens were positive in 3.2%. Reactivity on antibodies against intracellular onconeural antigens were detected in 3.5%. Serum thyroid antibodies were elevated in 24.7%. Abnormalities were found in 39.5% of cMRIs and in 34.3% of EEGs. The main finding of our study was the high prevalence of CSF and autoantibody abnormalities in 54.4% of psychotic patients. In combination with cMRIs and EEGs, 75.6% showed abnormal findings. Our results are discussed with regard to the concept of immunological encephalopathy. Future studies should analyze the efficacy of immunomodulatory therapies.

  12. A new ion-selective electrode based on aluminium tungstate for Fe(III) determination in rock sample, pharmaceutical sample and water sample

    Indian Academy of Sciences (India)

    Mu Naushad


    An inorganic cation exchanger, aluminum tungstate (AT), has been synthesized by adding 0.1 M sodium tungstate gradually into 0.1 M aluminium nitrate at pH 1.2 with continuous stirring. The ion exchange capacity for Na+ ion and distribution coefficients of various metal ions was determined on the column of aluminium tungstate. The distribution studies of various metal ions showed the selectivity of Fe(III) ions by this cation exchange material. So, a Fe(III) ion-selective membrane electrode was prepared by using this cation exchange material as an electroactive material. The effect of plasticizers viz. dibutyl phthalate (DBP), dioctylphthalate (DOP), di-(butyl) butyl phosphate (DBBP) and tris-(2-ethylhexylphosphate) (TEHP), has also been studied on the performance of membrane sensor. It was observed that the membrane containing the composition AT: PVC: DBP in the ratio 2 : 20 : 15 displayed a useful analytical response with excellent reproducibility, low detection limit, wide working pH range (1–3.5), quick response time (15 s) and applicability over a wide concentration range of Fe(III) ions from 1 × 10-7 M to 1 × 10-1 M with a slope of 20 ± 1 mV per decade. The selectivity coefficients were determined by the mixed solution method and revealed that the electrode was selective for Fe(III) ions in the presence of interfering ions. The electrode was used for atleast 5 months without any considerable divergence in response characteristics. The constructed sensor was used as indicator electrode in the potentiometric titration of Fe(III) ions against EDTA and Fe(III) determination in rock sample, pharmaceutical sample and water sample. The results are found to be in good agreement with those obtained by using conventional methods.

  13. A GMM-Based Test for Normal Disturbances of the Heckman Sample Selection Model

    Directory of Open Access Journals (Sweden)

    Michael Pfaffermayr


    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.

  14. An evaluation of the implementation of integrated community home-based care services in Vhembe District, South Africa

    Directory of Open Access Journals (Sweden)

    Gandi J Moetlo


    Conclusion: Community home-based caregivers are largely able to implement home-based care services but would need more support (training, financial, career structure, and health system to improve on their services.

  15. A lab-on-a-chip system integrating tissue sample preparation and multiplex RT-qPCR for gene expression analysis in point-of-care hepatotoxicity assessment. (United States)

    Lim, Geok Soon; Chang, Joseph S; Lei, Zhang; Wu, Ruige; Wang, Zhiping; Cui, Kemi; Wong, Stephen


    A truly practical lab-on-a-chip (LOC) system for point-of-care testing (POCT) hepatotoxicity assessment necessitates the embodiment of full-automation, ease-of-use and "sample-in-answer-out" diagnostic capabilities. To date, the reported microfluidic devices for POCT hepatotoxicity assessment remain rudimentary as they largely embody only semi-quantitative or single sample/gene detection capabilities. In this paper, we describe, for the first time, an integrated LOC system that is somewhat close to a practical POCT hepatotoxicity assessment device - it embodies both tissue sample preparation and multiplex real-time RT-PCR. It features semi-automation, is relatively easy to use, and has "sample-in-answer-out" capabilities for multiplex gene expression analysis. Our tissue sample preparation module incorporating both a microhomogenizer and surface-treated paramagnetic microbeads yielded high purity mRNA extracts, considerably better than manual means of extraction. A primer preloading surface treatment procedure and the single-loading inlet on our multiplex real-time RT-PCR module simplify off-chip handling procedures for ease-of-use. To demonstrate the efficacy of our LOC system for POCT hepatotoxicity assessment, we perform a preclinical animal study with the administration of cyclophosphamide, followed by gene expression analysis of two critical protein biomarkers for liver function tests, aspartate transaminase (AST) and alanine transaminase (ALT). Our experimental results depict normalized fold changes of 1.62 and 1.31 for AST and ALT, respectively, illustrating up-regulations in their expression levels and hence validating their selection as critical genes of interest. In short, we illustrate the feasibility of multiplex gene expression analysis in an integrated LOC system as a viable POCT means for hepatotoxicity assessment.

  16. Exploring limits to market-based reform: managed competition and rehabilitation home care services in Ontario. (United States)

    Randall, Glen E; Williams, A Paul


    The rise of neo-liberalism, which suggests that only markets can deliver maximum economic efficiency, has been a driving force behind the trend towards using market-based solutions to correct health care problems. However, the broad application of market-based reforms has tended to assume the presence of fully functioning markets. When there are barriers to markets functioning effectively, such as the absence of adequate competition, recourse to market-based solutions can be expected to produce less than satisfactory, if not paradoxical results. One such case is rehabilitation homecare in Ontario, Canada. In 1996, a "managed competition" model was introduced as part of a province-wide reform of home care in an attempt to encourage high quality at competitive prices. However, in the case of rehabilitation home care services, significant obstacles to achieving effective competition existed. Notably, there were few private provider agencies to bid on contracts due to the low volume and specialized nature of services. There were also structural barriers such as the presence of unionized employees and obstacles to the entry of new providers. This paper evaluates the impact of Ontario's managed competition reform on community-based rehabilitation services. It draws on data obtained through 49 in-depth key informant interviews and a telephone survey of home care coordinating agencies and private rehabilitation provider agencies. Instead of reducing costs and improving quality, as the political rhetoric promised, the analysis suggests that providing rehabilitation homecare services under managed competition resulted in higher per-visit costs and reduced access to services. These findings support the contention that there are limits to market-based reforms.

  17. Home-based specialized palliative care in patients with advanced cancer

    DEFF Research Database (Denmark)

    Nordly, Mie; Vadstrup, Eva Soelberg; Sjøgren, Per


    OBJECTIVE: Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information on the organizat......OBJECTIVE: Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information...... on the organization and outcomes of home-based SPC for patients with advanced cancer. Outcomes related to place of death, survival time, quality of life, performance status, and symptom management are included. METHOD: A PICO process search strategy consisting of terms related to cancer, palliation, and home care...... for patients with advanced cancer, resulting in poor information and a lack of evidence. Generally, home-based SPC seems to have some positive effect on pain and dyspnea, but more high-quality studies are required....

  18. Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Miteku Andualem Limenih


    Full Text Available Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34, place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79, outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19, delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54, and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28 were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

  19. Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study. (United States)

    Limenih, Miteku Andualem; Endale, Zerfu Mulaw; Dachew, Berihun Assefa


    Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34)), place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79)), outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19)), delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54)), and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28)) were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

  20. Community-based care of children with HIV in Potchefstroom, South Africa. (United States)

    Van Graan, Anneke; Van der Walt, Engela; Watson, Mada


    Children contract HIV infection largely through vertical transmission and are vulnerable to AIDS illness due to an immature immune system. In South Africa, hospitals are often overburdened and thus children with HIV may be directed to the community for care. As a result, non-professional caregivers are a predominant source of care for children living with HIV. Various authors, including the Department of Health, have stipulated the importance of establishing the knowledge and needs of non-professional caregivers of children with HIV. Our research has investigated the extent of non-professional caregivers' knowledge and needs, specifically those within the Potchefstroom district of the North-West Province. The objectives included formulating guidelines for a training programme that can enhance relevant knowledge and skills among these caregivers. Quantitative data were gathered using a questionnaire, which was developed following a literature study. The 109 non-professional caregivers who responded to the questionnaire displayed some knowledge and skills concerning specifically the care of children with HIV or AIDS, although gaps existed concerning their knowledge of community-based referral, caring needs specific to children, and precautionary measures to prevent HIV transmission. Recommendations are made with specific reference to a training programme. We surmise that non-professional caregivers play a pivotal role in the care of children with HIV in the Potchefstroom district - a service that is sometimes rendered in perilous conditions. This study improves our understanding of the support and training needed for non-professional caregivers in their pursuit to care for children with HIV in resource-limited communities, and thus it contributes to the field of nursing science. The findings may generate ideas for future research on this important topic.

  1. "Righteous minds" in health care: measurement and explanatory value of social intuitionism in accounting for the moral judgments in a sample of U.S. physicians. (United States)

    Tilburt, Jon C; James, Katherine M; Jenkins, Sarah M; Antiel, Ryan M; Curlin, Farr A; Rasinski, Kenneth A


    The broad diversity in physicians' judgments on controversial health care topics may reflect differences in religious characteristics, political ideologies, and moral intuitions. We tested an existing measure of moral intuitions in a new population (U.S. physicians) to assess its validity and to determine whether physicians' moral intuitions correlate with their views on controversial health care topics as well as other known predictors of these intuitions such as political affiliation and religiosity. In 2009, we mailed an 8-page questionnaire to a random sample of 2000 practicing U.S. physicians from all specialties. The survey included the Moral Foundations Questionnaire (MFQ30), along with questions on physicians' judgments about controversial health care topics including abortion and euthanasia (no moral objection, some moral objection, strong moral objection). A total of 1032 of 1895 (54%) physicians responded. Physicians' overall mean moral foundations scores were 3.5 for harm, 3.3 for fairness, 2.8 for loyalty, 3.2 for authority, and 2.7 for sanctity on a 0-5 scale. Increasing levels of religious service attendance, having a more conservative political ideology, and higher sanctity scores remained the greatest positive predictors of respondents objecting to abortion (β = 0.12, 0.23, 0.14, respectively, each p<0.001) as well as euthanasia (β = 0.08, 0.17, and 0.17, respectively, each p<0.001), even after adjusting for demographics. Higher authority scores were also significantly negatively associated with objection to abortion (β = -0.12, p<0.01), but not euthanasia. These data suggest that the relative importance physicians place on the different categories of moral intuitions may predict differences in physicians' judgments about morally controversial topics and may interrelate with ideology and religiosity. Further examination of the diversity in physicians' moral intuitions may prove illustrative in describing and addressing moral differences that

  2. Emergence and characterization of tigecycline resistance in multidrug-resistant Klebsiella pneumoniae isolates from blood samples of patients in intensive care units in northern China. (United States)

    Xu, Hui; Zhou, Yiheng; Zhai, Xingyue; Du, Zemin; Wu, Hao; Han, Yujia; Huo, Chunxiu; Chen, Yang


    Serious infections in intensive care unit patients caused by multidrug-resistant (MDR) Klebsiella pneumoniae represent a major threat worldwide owing to increased mortality and limited treatment options. With the application of tigecycline for MDR pathogens, tigecycline-non-susceptible K. pneumoniae isolates have recently emerged in China. To identify the susceptibility profile of MDR K. pneumoniae to tigecycline and evaluate the molecular characterization of tigecycline resistance, 214 MDR K. pneumoniae isolates were collected from blood samples of patients in intensive care units. MICs and clonal relatedness were determined by standard broth microdilution and multilocus sequence typing, respectively. Expression levels of efflux pumps and their global regulators were examined using real-time PCR. Mutations of local repressor were identified by PCR and sequencing. Our results show that the tigecycline resistance rate of 214 MDR K. pneumoniae isolates was 6.07 %. ST11 was the predominant clone type of tigecycline-non-susceptible K. pneumoniae isolates. Expression of efflux pump AcrB and global regulator RamA correlated with tigecycline MICs (AcrB: x2=8.91, P=0.03; RamA: x2=13.91, P<0.01), and mean expression levels of AcrB for the MICs ≥4 mg l-1 were significantly higher than MICs ≤2 mg l-1 (t=2.48, P=0.029). In addition, one tigecycline-resistant isolate harboured a deletion mutation in the ramR gene. These data indicated a linear correlative trend for overexpression of the AcrB and the tigecycline MICs resulting from the upregulation of RamA. The emergence of molecular type ST11 of MDR K. pneumoniae isolates should be monitored to identify factors that contribute to tigecycline resistance in intensive care units.

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

    NARCIS (Netherlands)

    Bosch, M.; Dijkstra, R.F.; Wensing, M.J.P.; Weijden, T.T. van der; Grol, R.P.T.M.


    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 team

  4. The PAMINO-project: evaluating a primary care-based educational program to improve the quality of life of palliative patients

    Directory of Open Access Journals (Sweden)

    Engeser Peter


    Full Text Available Abstract Background The care of palliative patients challenges the health care system in both quantity and quality. Especially the role of primary care givers needs to be strengthened to provide them with the knowledge and the confidence of applying an appropriate end-of-life care to palliative patients. To improve health care services for palliative patients in primary care, interested physicians in and around Heidelberg, Germany, are enabled to participate in the community-based program 'Palliative Medical Initiative North Baden (PAMINO' to improve their knowledge in dealing with palliative patients. The impact of this program on patients' health and quality of life remains to be evaluated. Methods/Design The evaluation of PAMINO is a non-randomized, controlled study. Out of the group of primary care physicians who took part in the PAMINO program, a sample of 45 physicians and their palliative patients will be compared to a sample of palliative patients of 45 physicians who did not take part in the program. Every four weeks for 6 months or until death, patients, physicians, and the patients' family caregivers in both groups answer questions to therapy strategies, quality of life (QLQ-C15-PAL, POS, pain (VAS, and burden for family caregivers (BSFC. The inclusion of physicians and patients in the study starts in March 2007. Discussion Although participating physicians value the increase in knowledge they receive from PAMINO, the effects on patients remain unclear. If the evaluation reveals a clear benefit for patients' quality of life, a larger-scale implementation of the program is considered. Trial registration: The study was registered at ‘current controlled trials (CCT’, registration number: ISRCTN78021852.

  5. Estimation of rumen outflow in dairy cows fed grass silage-based diets by use of reticular sampling as an alternative to sampling from the omasal canal. (United States)

    Krizsan, S J; Ahvenjärvi, S; Volden, H; Broderick, G A


    A study was conducted to compare nutrient flows determined by a reticular sampling technique with those made by sampling digesta from the omasal canal. Six lactating dairy cows fitted with ruminal cannulas were used in a design with a 3 x 2 factorial arrangement of treatments and 4 periods. Treatments were 3 grass silages differing mainly in neutral detergent fiber (NDF) concentrations: 412, 530, or 639 g/kg of dry matter, each combined with 1 of 2 levels of concentrate feed. Digesta was collected from the reticulum and the omasal canal to represent a 24-h feeding cycle. Nutrient flow was calculated using the reconstitution system based on 3 markers (Co, Yb, and indigestible NDF) and using (15)N as a microbial marker. Large and small particles and the fluid phase were recovered from digesta collected at both sampling sites. Bacterial samples from the reticulum and the omasum were separated into liquid- and particle-associated bacteria. Reticular samples were sieved through a 1-mm sieve before isolation of digesta phases and bacteria. Composition of the large particle phase differed mainly in fiber content of the digesta obtained from the 2 sampling sites. Sampling site did not affect marker concentration in any of the phases with which the markers were primarily associated. The (15)N enrichment of bacterial samples did not differ between sampling sites. The reticular and omasal canal sampling techniques gave similar estimates of marker concentrations in reconstituted digesta, estimates of ruminal flow, and ruminal digestibility values for dry matter, organic matter, starch, and N. Sampling site x diet interactions were also not significant. Concentration of NDF was 2.2% higher in reconstituted omasal digesta than in reconstituted reticular digesta. Ruminal NDF digestibility was 2.7% higher when estimated by sampling the reticulum than by sampling the omasal canal. The higher estimate of ruminal NDF digestibility with the reticular sampling technique was due to

  6. Effect of self-care educational program based on Orem’s Theory on hope in patients with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Dahmardeh H


    Full Text Available Background and Objective: Multiple sclerosis (MS as one of the major causes of disability in the world, can create a sense of hopelessness in patient. Thus the application of self-care methods is very important for these patients. The current study was conducted to determine the effect of self-care educational program based on Orem’s Theory on hope in patients with Multiple sclerosis. Materials and Method: In this clinical trial study, 88 patients with multiple sclerosis who were registered in MS Association of Zahedan, were selected through convenience sampling and then randomly allocated into two intervention and control groups of 44 people in 2014-2015. Then, nine educational sessions were designed and conducted according to patients’ needs based on Orem’s Theory. The rate of implementing the program by patients was measured through a self-report checklist. The hope of patients was measured by Snyder Hope Scale before and 3 months after the intervention. Data were analyzed by SPSS 16 using independent T-test, paired t-test and Chi-square. Results: The mean of total hope score, aspects of pathway thinking and agency thinking didn’t show significant difference between two groups before and after the intervention, but the mean of change score of total hope and aspects of pathway thinking and agency thinking in intervention group was increased significantly after the educational program in compare with control group (p<0.001. Conclusion: According to the results, implementation of Orem’s self-care program can increase the hope in patients with MS. Given the limitations of the present study, further studies is recommended.

  7. Pronounceability: a measure of language samples based on children's mastery of the phonemes employed in them. (United States)

    Whissell, Cynthia


    56 samples (n > half a million phonemes) of names (e.g., men's, women's jets'), song lyrics (e.g., Paul Simon's, rap, Beatles'), poems (frequently anthologized English poems), and children's materials (books directed at children ages 3-10 years) were used to study a proposed new measure of English language samples--Pronounceability-based on children's mastery of some phonemes in advance of others. This measure was provisionally equated with greater "youthfulness" and "playfulness" in language samples and with less "maturity." Findings include the facts that women's names were less pronounceable than men's and that poetry was less pronounceable than song lyrics or children's materials. In a supplementary study, 13 university student volunteers' assessments of the youth of randomly constructed names was linearly related to how pronounceable each name was (eta = .8), providing construct validity for the interpretation of Pronounceability as a measure of Youthfulness.

  8. Information-based sample size re-estimation in group sequential design for longitudinal trials. (United States)

    Zhou, Jing; Adewale, Adeniyi; Shentu, Yue; Liu, Jiajun; Anderson, Keaven


    Group sequential design has become more popular in clinical trials because it allows for trials to stop early for futility or efficacy to save time and resources. However, this approach is less well-known for longitudinal analysis. We have observed repeated cases of studies with longitudinal data where there is an interest in early stopping for a lack of treatment effect or in adapting sample size to correct for inappropriate variance assumptions. We propose an information-based group sequential design as a method to deal with both of these issues. Updating the sample size at each interim analysis makes it possible to maintain the target power while controlling the type I error rate. We will illustrate our strategy with examples and simulations and compare the results with those obtained using fixed design and group sequential design without sample size re-estimation.

  9. Transfer function design based on user selected samples for intuitive multivariate volume exploration

    KAUST Repository

    Zhou, Liang


    Multivariate volumetric datasets are important to both science and medicine. We propose a transfer function (TF) design approach based on user selected samples in the spatial domain to make multivariate volumetric data visualization more accessible for domain users. Specifically, the user starts the visualization by probing features of interest on slices and the data values are instantly queried by user selection. The queried sample values are then used to automatically and robustly generate high dimensional transfer functions (HDTFs) via kernel density estimation (KDE). Alternatively, 2D Gaussian TFs can be automatically generated in the dimensionality reduced space using these samples. With the extracted features rendered in the volume rendering view, the user can further refine these features using segmentation brushes. Interactivity is achieved in our system and different views are tightly linked. Use cases show that our system has been successfully applied for simulation and complicated seismic data sets. © 2013 IEEE.

  10. All-optical sampling based on quantum-dot semiconductor optical amplifier (United States)

    Wu, Chen; Wang, Yongjun; Wang, Lina


    In recent years, the all-optical signal processing system has become a hot research field of optical communication. This paper focused on the basic research of quantum-dot (QD) semiconductor optical amplifier (SOA) and studied its practical application to all-optical sampling. A multi-level dynamic physical model of QD-SOA is established, and its ultrafast dynamic characteristics are studied through theoretical and simulation research. For further study, an all-optical sampling scheme based on the nonlinear polarization rotation (NPR) effect of QD-SOA is also proposed. This paper analyzed the characteristics of optical switch window and investigated the influence of different control light pulses on switch performance. The presented optical sampling method has an important role in promoting the improvement of all-optical signal processing technology.

  11. All-optical sampling and magnification based on XPM-induced focusing

    CERN Document Server

    Nuno, J; Guasoni, M; Finot, C; Fatome, J


    We theoretically and experimentally investigate the design of an all-optical noiseless magnification and sampling function free from any active gain medium and associated high-power continuous wave pump source. The proposed technique is based on the co-propagation of an arbitrary shaped signal together with an orthogonally polarized intense fast sinusoidal beating within a normally dispersive optical fiber. Basically, the strong nonlinear phase shift induced by the sinusoidal pump beam on the orthogonal weak signal through cross-phase modulation turns the defocusing regime into localized temporal focusing effects. This periodic focusing is then responsible for the generation of a high-repetition-rate temporal comb upon the incident signal whose amplitude is directly proportional to its initial shape. This internal redistribution of energy leads to a simultaneous sampling and magnification of the signal intensity profile. This process allows us to experimentally demonstrate a 40-GHz sampling operation as well ...

  12. ORPOM model for optimum distribution of tree ring sampling based on the climate observation network

    Institute of Scientific and Technical Information of China (English)


    Tree ring dating plays an important role in obtaining past climate information.The fundamental study of obtaining tree ring samples in typical climate regions is particularly essential.The optimum distribution of tree ring sampling sites based on climate information from the Climate Observation Network(ORPOM model) is presented in this article.In this setup,the tree rings in a typical region are used for surface representation,by applying excellent correlation with the climate information as the main principle.Taking the Horqin Sandy Land in the cold and arid region of China as an example,the optimum distribution range of the tree ring sampling sites was obtained through the application of the ORPOM model,which is considered a reasonably practical scheme.

  13. Diversity selection of compounds based on 'protein affinity fingerprints' improves sampling of bioactive chemical space. (United States)

    Nguyen, Ha P; Koutsoukas, Alexios; Mohd Fauzi, Fazlin; Drakakis, Georgios; Maciejewski, Mateusz; Glen, Robert C; Bender, Andreas


    Diversity selection is a frequently applied strategy for assembling high-throughput screening libraries, making the assumption that a diverse compound set increases chances of finding bioactive molecules. Based on previous work on experimental 'affinity fingerprints', in this study, a novel diversity selection method is benchmarked that utilizes predicted bioactivity profiles as descriptors. Compounds were selected based on their predicted activity against half of the targets (training set), and diversity was assessed based on coverage of the remaining (test set) targets. Simultaneously, fingerprint-based diversity selection was performed. An original version of the method exhibited on average 5% and an improved version on average 10% increase in target space coverage compared with the fingerprint-based methods. As a typical case, bioactivity-based selection of 231 compounds (2%) from a particular data set ('Cutoff-40') resulted in 47.0% and 50.1% coverage, while fingerprint-based selection only achieved 38.4% target coverage for the same subset size. In conclusion, the novel bioactivity-based selection method outperformed the fingerprint-based method in sampling bioactive chemical space on the data sets considered. The structures retrieved were structurally more acceptable to medicinal chemists while at the same time being more lipophilic, hence bioactivity-based diversity selection of compounds would best be combined with physicochemical property filters in practice.

  14. The Single Training Sample Extraction of Visual Evoked Potentials Based on Wavelet Transform

    Institute of Scientific and Technical Information of China (English)

    LIU Fang; ZHANG Zhen; CHEN Wen-chao; QIN Bing


    Abstract.Based on the good localization characteristic of the wavelet transform both in time and frequency domain, a de-noising method based on wavelet transform is presented, which can make the extraction of visual evoked potentials in single training sample from the EEG background noise in favor of studying the changes between the single sample response happen. The information is probably related with the different function, appearance and pathologies of the brain. At the same time this method can also be used to remove those signal' s artifacts that do not appear with EP within the same scope of time or frequency. The traditional Fourier filter can hardly attain the similar result. This method is different from other wavelet de-noising methods in which different criteria are employed in choosing wavelet coefficient. It has a biggest virtue of noting the differences among the single training sample and making use of the characteristics of high time frequency resolution to reduce the effect of interference factors to a maximum extent within the time scope that EP appear. The experiment result proves that this method is not restricted by the signal-tonoise ratio of evoked potential and electroencephalograph (EEG) and even can recognize instantaneous event under the condition of lower signal-to-noise ratio, as well as recognize the samples which evoked evident response more easily. Therefore, more evident average evoked response could be achieved by de-nosing the signals obtained through averaging out the samples that can evoke evident responses than de-nosing the average of original signals. In addition, averaging methodology can dramatically reduce the number of record samples needed, thus avoiding the effect of behavior change during the recording process.This methodology pays attention to the differences among single training sample and also accomplishes the extraction of visual evoked potentials from single trainings sample. As a result, system speed and

  15. Technical data evaluation of a palliative care web-based documentation system. (United States)

    Hartz, Tobias; Brüntrup, René; Uckert, Frank


    A technical analysis of the web-based patient documentation system, eKernPäP, was conducted. The system is used by interdisciplinary pediatric palliative care teams in Germany to document outpatient care. The data of the system and the data of an external web analytic system have been evaluated. The results gave an overview how the system is used and what information is generated. A detailed analysis of singular forms showed that not all forms were filled in completely. With the help of the external web analytic system the navigation behavior of the users could be retraced. The users followed the given navigation from top to bottom. An existing exception in this pattern turned out to be misplacement and will be corrected in the next version. The technical analysis proved to be a good tool for improving a web-based documentation system.

  16. A knowledge based search tool for performance measures in health care systems. (United States)

    Beyan, Oya D; Baykal, Nazife


    Performance measurement is vital for improving the health care systems. However, we are still far from having accepted performance measurement models. Researchers and developers are seeking comparable performance indicators. We developed an intelligent search tool to identify appropriate measures for specific requirements by matching diverse care settings. We reviewed the literature and analyzed 229 performance measurement studies published after 2000. These studies are evaluated with an original theoretical framework and stored in the database. A semantic network is designed for representing domain knowledge and supporting reasoning. We have applied knowledge based decision support techniques to cope with uncertainty problems. As a result we designed a tool which simplifies the performance indicator search process and provides most relevant indicators by employing knowledge based systems.

  17. In-house servicing of microprocessor-based and digital patient care equipment. (United States)

    Ben-Zvi, S; Casaregola, D; Weissenberg, G


    Servicing of microprocessor-based and digital patient care instrumentation presents a special challenge to the in-house clinical engineering program. The complexity of this instrumentation, the cost of test equipment and support materials, and continuing education needs are pressing concerns. Servicing methods available to clinical engineering include the use of manufacturer diagnostics and board or subassembly swapping. Test equipment, such as digital oscilloscopes, logic analyzers, signature analyzers, and logic probes, can also be used during repair, even to the component level. In some instances, clinical engineering may choose alternative service arrangements, such as fee-for-service, service contracts, or maintenance insurance. Clinical engineering must objectively evaluate its resources and the level of technical expertise within the department; a realistic maintenance program for microprocessor-based and digital patient care equipment can thus be developed and can result in significant cost savings.

  18. Sampling strategies for estimating forest cover from remote sensing-based two-stage inventories