WorldWideScience

Sample records for care based sample

  1. Increased cardiopulmonary disease risk in a community-based sample with chemical odor intolerance: implications for women's health and health-care utilization.

    Science.gov (United States)

    Baldwin, C M; Bell, I R

    1998-01-01

    Chemical intolerance, or reported illness from odors of common environmental chemicals (e.g., car exhaust, pesticides), is emerging as an important environmental and public health-care issue. Epidemiologic methods provide relevant heuristic devices for studies of complex disorders, such as chemical intolerance. The authors examined personal and reported parental cardiopulmonary disease prevalence rates in a community sample of chemically intolerant and control individuals. A county government (Tucson, Arizona) employee and kin subset (N = 181; 113 households) completed standard health questionnaires. Investigators determined chemical intolerance (n = 41/181) from self-reports of individuals who felt "moderately" to "severely" ill from exposure to at least three of five chemicals (i.e., car exhaust, pesticides, paint, new carpet, and perfume) on a Chemical Odor Intolerance Index. The authors chose the control group (n = 57/181) on the basis of self-reports of "never" feeling ill on the Chemical Odor Intolerance Index. The chemically intolerant group, which primarily comprised women (78% versus 51% of controls, p < .05), was significantly more likely to report-and to have sought--medical attention for heart problems, bronchitis, asthma, and pneumonia. Reports of heart problems in the chemically intolerant index cases and the occurrence of heart disease in both of their parents were significant (Fisher's p < .05). The chemically intolerant individuals were also significantly more likely to report maternal histories of chest problems (e.g., inhalant allergens, tuberculosis) than controls. The findings of the study suggested that the chemically intolerant individuals (a preponderance of whom were women [sex-related risk]) were more likely to have (a) reported cardiopulmonary problems (i.e., greater health risk); (b) actively sought medical care for these problems (i.e., increased medical utilization); and (c) reported more parental illnesses-particularly heart disease

  2. Community-Based Care

    Science.gov (United States)

    ... respite care, transportation, medication coverage, rehabilitation (including maintenance physical and occupational therapy ), hearing aids, eyeglasses, and a variety of other benefits. The program also has the flexibility to pay ...

  3. Montessori-based dementia care.

    Science.gov (United States)

    Cline, Janet

    2006-10-01

    Montessori-based Dementia Care is an approach used in Alzheimer's care that does not involve chemical or physical restraints. This program works by giving the elder with Alzheimer/Dementia a purpose by getting them involved. When staff/families care for a confused Alzheimer/Dementia patient, who is having behaviors, the Montessori program teaches them to look at what is causing the behavior. When assessing the elder to determine what is causing the behavior, the goal is to find the answer, but the answer cannot be dementia. The goal of the program is to bring meaning to the life of an Alzheimer/Dementia elder. PMID:17111647

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

    Directory of Open Access Journals (Sweden)

    Kimber Jo

    2010-02-01

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

  5. Quantization based recursive Importance Sampling

    CERN Document Server

    Frikha, Noufel

    2011-01-01

    We investigate in this paper an alternative method to simulation based recursive importance sampling procedure to estimate the optimal change of measure for Monte Carlo simulations. We propose an algorithm which combines (vector and functional) optimal quantization with Newton-Raphson zero search procedure. Our approach can be seen as a robust and automatic deterministic counterpart of recursive importance sampling by means of stochastic approximation algorithm which, in practice, may require tuning and a good knowledge of the payoff function in practice. Moreover, unlike recursive importance sampling procedures, the proposed methodology does not rely on simulations so it is quite generic and can come along on the top of Monte Carlo simulations. We first emphasize on the consistency of quantization for designing an importance sampling algorithm for both multi-dimensional distributions and diffusion processes. We show that the induced error on the optimal change of measure is controlled by the mean quantizatio...

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

    OpenAIRE

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

    2006-01-01

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

  7. Evidence-based health care in pediatrics.

    Science.gov (United States)

    Robertson-Malt, Suzanne

    2014-12-01

    This article examines current trends in the type and quality of systematic reviews underpinning the evidence base for pediatric health care. A case study is used to highlight the quality standards for the conduct and publication of systematic reviews and the processes being used to transition the evidence produced from systematic reviews into the everyday systems and processes of care. PMID:25458134

  8. Silicon based ultrafast optical waveform sampling

    DEFF Research Database (Denmark)

    Ji, Hua; Galili, Michael; Pu, Minhao;

    2010-01-01

    A 300 nmx450 nmx5 mm silicon nanowire is designed and fabricated for a four wave mixing based non-linear optical gate. Based on this silicon nanowire, an ultra-fast optical sampling system is successfully demonstrated using a free-running fiber laser with a carbon nanotube-based mode-locker as the...

  9. Sampling Procedures for Coordinating Stratified Samples : Methods Based on Microstrata

    OpenAIRE

    Nedyalkova, Desislava; Tillé, Yves; Pea, Johan

    2016-01-01

    The aim of sampling coordination is to maximize or minimize the overlap between several samples drawn successively in a population that changes over time. Therefore, the selection of a new sample will depend on the samples previously drawn. In order to obtain a larger (or smaller) overlap of the samples than the one obtained by independent selection of samples, a dependence between the samplesmust be introduced. This dependence will emphasize (or limit) the number of common units in the selec...

  10. Patterns of Health Care Expenditures, Utilization and Demand for Medical Care in Sample Philippine Households

    OpenAIRE

    Bautista, Cristina M.

    1995-01-01

    Due to tight fiscal budget, health care planners have started to explore alternative financing mechanisms. These alternatives can be effectively implemented given thorough understanding of mechanisms that direct household demand for health care. This paper investigates the factors of households’ health seeking behavior to determine the implications for health care financing reforms. In addition, it looks into the responsiveness of households to changes in prices and income. Insights of househ...

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

    Directory of Open Access Journals (Sweden)

    E Amoran

    2012-05-01

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

  12. Revisiting Digital Sampling Rhetorics with an Ethic of Care

    OpenAIRE

    Colton, Jared Sterling

    2016-01-01

    Rhetoric and composition studies have conceptualized and defined digital sampling as a method of composition in many ways and for various pedagogical purposes: from a means of free-play invention that is critical of more formalistic writing practices to a semiotic strategy rooted in African American rhetorical traditions designed to effect political change. The latter view is critical of the former in that the former does not account for student digital sampling projects that unquestioningly ...

  13. Urine sampling techniques in symptomatic primary-care patients: a diagnostic accuracy review

    OpenAIRE

    Holm, Anne; Aabenhus, Rune

    2016-01-01

    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 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 ...

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

    Directory of Open Access Journals (Sweden)

    Latika Nath Sinha

    2014-09-01

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

  15. Reality of evidence-based practice in palliative care.

    Science.gov (United States)

    Visser, Claire; Hadley, Gina; Wee, Bee

    2015-09-01

    There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by 'gold standard' randomised controlled trials (RCTs) is not necessarily applicable. The 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 difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This 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. The 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. PMID:26487964

  16. Reality of evidence-based practice in palliative care

    Institute of Scientific and Technical Information of China (English)

    Claire Visser; Gina Hadley; Bee Wee

    2015-01-01

    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.

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

    OpenAIRE

    E Amoran; O Ogunsola; O Salako; O Alausa

    2012-01-01

    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...

  18. Sample-Based Vegetation Distribution Information Synthesis.

    Directory of Open Access Journals (Sweden)

    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.

  19. Applying activity-based costing in long-term care.

    Science.gov (United States)

    Wodchis, W P

    1998-01-01

    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. PMID:10339203

  20. Bayesian individualization via sampling-based methods.

    Science.gov (United States)

    Wakefield, J

    1996-02-01

    We consider the situation where we wish to adjust the dosage regimen of a patient based on (in general) sparse concentration measurements taken on-line. A Bayesian decision theory approach is taken which requires the specification of an appropriate prior distribution and loss function. A simple method for obtaining samples from the posterior distribution of the pharmacokinetic parameters of the patient is described. In general, these samples are used to obtain a Monte Carlo estimate of the expected loss which is then minimized with respect to the dosage regimen. Some special cases which yield analytic solutions are described. When the prior distribution is based on a population analysis then a method of accounting for the uncertainty in the population parameters is described. Two simulation studies showing how the methods work in practice are presented. PMID:8827585

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

    Science.gov (United States)

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

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals. PMID:27382731

  2. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Helena; Hallström, Inger; Kjaergaard, Hanne;

    2011-01-01

    Hospital-based home care (HBHC) is widely applied in Pediatric Oncology. We reviewed the potential effect of HBHC on children's physical health and risk of adverse events, parental and child satisfaction, quality of life of children and their parents, and costs. A search of PubMed, CINAHL......, and EMBASE led to identification of five studies that met the inclusion criteria. All sample sizes were small, and both the interventions and the outcome measures were diverse. Although burdened by these limitations, the studies indicate that HBHC is feasible and carries no crucial negative effects...

  3. Model of Independency Mother in Caring for Preterm Infant Based on Experiential Learning Care (ELC)

    Science.gov (United States)

    Saudah, Noer; Nursalam; Meriana; Sulistyono, Agus

    2015-01-01

    The role of parents has done less during the preterm infant care in hospitals caused dependence in caring for the baby. The objective of the research was to development a model of independence of the mother in the care of preterm infants with experiential learning approach based theory of goal attainment. Research's design used analytic…

  4. Refining Approximating Betweenness Centrality Based on Samplings

    CERN Document Server

    Ji, Shiyu

    2016-01-01

    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...

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients...... with type 2 diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by insurance data analysis. Intervention: We compared protocol-based care management including structured assessment, action...

  6. Confidentiality or continuity? Family caregivers' experiences with care for HIV/AIDS patients in home-based care in Lesotho.

    Science.gov (United States)

    Makoae, Mokhantso G; Jubber, Ken

    2008-04-01

    In the context of poor access to antiretroviral therapies in sub-Saharan Africa, the minimum treatment package intended to treat opportunistic infections common with HIV infection is inadequate but appealing, since it presumes universal coverage of medical care for patients living with HIV and AIDS. The overall objective of this study was to analyse the challenges which family caregivers encountered in home-based care when they tried to access medical treatment for home-based AIDS patients in the context of confidentiality and limited medical care. A qualitative study using in-depth interviews with a sample of 21 family caregivers -16 females and 5 males aged between 23 and 85 years was conducted with the assistance of health personnel in two hospitals in Lesotho. Using the concept of continuity of care, this article discusses the experiences of family caregivers about home care, including their experiences of adherence to confidentiality by health care professionals and non-disclosure of AIDS as the context of illness, the circumstances under which the caregivers initiated caregiving and sought medical care, and how these factors could be stressors in caregiving. There was continuity of care where the caregivers obtained hospital support. However, when confidentiality was adhered to the caregivers were frustrated by lack of information, disrupted treatment, exclusion of their perspectives in medical care, failure to secure hospitalisation, ambiguous goals and non-responsiveness, so that continuity of care was jeopardised. Thus it can be concluded that professional-assisted disclosure benefited the patients because it facilitated continuity of care through the caregivers. PMID:18496618

  7. Problematising Home-based Care for Children with Cancer

    OpenAIRE

    Fletcher, Hannah Kate

    2013-01-01

    Background and Literature Review This study explores issues around home-based care for children with cancer. Current policy tends to promote home-based care for children with cancer; this project seeks to interrogate that approach further and to explore the evidence base for this policy direction. The literature review is structured around key themes and demonstrates the gap in the evidence from health care professionals‘ perspectives and UK based research Methodology I adopt a quali...

  8. QUALITY ASSESSEMENT OF ANTE-NATAL CARE USING THE METHOD OF LOT QUALITY ASSURANCE SAMPLING

    Directory of Open Access Journals (Sweden)

    Sh. Salarilak

    1999-08-01

    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.

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

    Science.gov (United States)

    Salazar, Amy M.

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Bailey Kerry A

    2010-08-01

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

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

    Science.gov (United States)

    Brucato, John Robert

    2016-07-01

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

  12. Sample introduction interface for on-chip nucleic acid-based analysis of Helicobacter pylori from stool samples.

    Science.gov (United States)

    Mosley, O; Melling, L; Tarn, M D; Kemp, C; Esfahani, M M N; Pamme, N; Shaw, K J

    2016-05-24

    Despite recent advances in microfluidic-based integrated diagnostic systems, the sample introduction interface, especially with regards to large volume samples, has often been neglected. We present a sample introduction interface that allows direct on-chip processing of crude stool samples for the detection of Helicobacter pylori (H. pylori). The principle of IFAST (immiscible filtration assisted by surface tension) was adapted to include a large volume sample chamber with a septum-based interface for stool sample introduction. Solid chaotropic salt and dry superparamagnetic particles (PMPs) could be stored on-chip and reconstituted upon sample addition, simplifying the process of release of DNA from H. pylori cells and its binding to the PMPs. Finally, the PMPs were pulled via a magnet through a washing chamber containing an immiscible oil solution and into an elution chamber where the DNA was released into aqueous media for subsequent analysis. The entire process required only 7 min while enabling a 40-fold reduction in working volume from crude biological samples. The combination of a real-world interface and rapid DNA extraction offers the potential for the methodology to be used in point-of-care (POC) devices. PMID:27164181

  13. Drug usage review sample studies in long-term care facilities.

    Science.gov (United States)

    Stewart, J E; Kabat, H F; Wertheimer, A I

    1976-02-01

    The usage of 10 drugs in five long-term care facilities was reviewed to evaluate the effectiveness of a five-step systematic method of drug usage review. Medical care evaluation sample studies are required under the Medicare and Medicaid programs, and drug usage review sample studies may satisfy this requirement. The five-step method involved selection of the health problem to be studied; development of criteria of care; measurement of specific performance data and comparison with the criteria; establishment of the audit committee evaluation process; and design and implementation of educational activities. In each facility, data were collected on abstract sheets designed to indicate when a patient's drug usage did not conform to criteria established by a committee of health professionals. Incidents of nonconformance were then examined. The largest number of exceptions to the criteria related to monitoring the effectiveness of drug therapy. Data by drug revealed higher nonconformance rates for digoxin, hydrochlorothiazide, methyldopa and thioridazine. A small number of exceptions was found in drug administration, indicating that the patients were receiving medications as ordered and that few errors were made in transcribing. This systematic approach to identifying drug usage patterns can be used by pharmacists to coordinate sample studies and to fulfill their consultant role in long-term facilities required by federal regulations. PMID:816197

  14. Microfluidic-Based Robotic Sampling System for Radioactive Solutions

    Energy Technology Data Exchange (ETDEWEB)

    Jack D. Law; Julia L. Tripp; Tara E. Smith; Veronica J. Rutledge; Troy G. Garn; John Svoboda; Larry Macaluso

    2014-02-01

    A novel microfluidic based robotic sampling system has been developed for sampling and analysis of liquid solutions in nuclear processes. This system couples the use of a microfluidic sample chip with a robotic system designed to allow remote, automated sampling of process solutions in-cell and facilitates direct coupling of the microfluidic sample chip with analytical instrumentation. This system provides the capability for near real time analysis, reduces analytical waste, and minimizes the potential for personnel exposure associated with traditional sampling methods. A prototype sampling system was designed, built and tested. System testing demonstrated operability of the microfluidic based sample system and identified system modifications to optimize performance.

  15. Miniaturized sample preparation based on carbon nanostructures

    OpenAIRE

    Cárdenas Soledad

    2014-01-01

    The evolution of analytical methodologies has been driven by the objective to reduce the complexity of sample treatment while increasing the efficiency of the overall analytical process. For this reason, the analytical chemist takes into consideration advances in other scientific areas and systematically evaluates the potential influence that such discoveries might have on its own discipline. This is the present situation with nanostructured materials, which have alrea...

  16. Template-Based Sampling of Anisotropic BRDFs

    Czech Academy of Sciences Publication Activity Database

    Filip, Jiří; Vávra, Radomír

    2014-01-01

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

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

    OpenAIRE

    Joanna Kobza; Magdalena Syrkiewicz-Świtała

    2014-01-01

    Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011) have be...

  18. Nanotechnology-Based Cosmetics for Hair Care

    OpenAIRE

    Jamie Rosen; Angelo Landriscina; Friedman, Adam J.

    2015-01-01

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

  19. Decision support for health care: the PROforma evidence base

    Directory of Open Access Journals (Sweden)

    John Fox

    2006-03-01

    Full Text Available Cancer Research UK has developed PROforma, a formal language for modelling clinical processes, along with associated tools for creating decision support, care planning, clinical workflow management and other applications. The PROforma method has been evaluated in a variety of settings: in primary health care (prescribing, referral of suspected cancer patients, genetic risk assessment and in specialist care of patients with breast cancer, leukaemia, HIV infection and other conditions. About nine years of experience have been gained with PROforma technologies. Seven trials of decision support applications have been published or are in preparation. Each of these has shown significant positive effects on a variety of measures of quality and/or outcomes of care. This paper reviews the evidence base for the clinical effectiveness of these PROforma applications, and previews the CREDO project _a multi-centre trial of a complex PROforma application for supporting integrated breast cancer care across primary and secondary care settings.

  20. Comparison of methods of sampling for Toxocara species and fecal coliforms in an outdoor day care environment

    OpenAIRE

    Carabin, Hélène; Gyorkos, Theresa W.; Kokoskin, Evelyne; Payment, Pierre; Joseph, Lawrence; Soto, Julio

    1998-01-01

    OBJECTIVE: To compare three sampling methods and to pretest methods for the determination of fecal coliform (FC) counts and Toxocara species from sand in the day care outdoor environment.DESIGN: The sand samples were obtained from the play area and the sandbox of a day care centre and examined for the presence of FC and Toxocara species, the common roundworm of dogs and cats. The sampling methods included random selection and two types of judgement methods. The latter included one method wher...

  1. Compressive-sampling-based positioning in wireless body area networks.

    Science.gov (United States)

    Banitalebi-Dehkordi, Mehdi; Abouei, Jamshid; Plataniotis, Konstantinos N

    2014-01-01

    Recent achievements in wireless technologies have opened up enormous opportunities for the implementation of ubiquitous health care systems in providing rich contextual information and warning mechanisms against abnormal conditions. This helps with the automatic and remote monitoring/tracking of patients in hospitals and facilitates and with the supervision of fragile, elderly people in their own domestic environment through automatic systems to handle the remote drug delivery. This paper presents a new modeling and analysis framework for the multipatient positioning in a wireless body area network (WBAN) which exploits the spatial sparsity of patients and a sparse fast Fourier transform (FFT)-based feature extraction mechanism for monitoring of patients and for reporting the movement tracking to a central database server containing patient vital information. The main goal of this paper is to achieve a high degree of accuracy and resolution in the patient localization with less computational complexity in the implementation using the compressive sensing theory. We represent the patients' positions as a sparse vector obtained by the discrete segmentation of the patient movement space in a circular grid. To estimate this vector, a compressive-sampling-based two-level FFT (CS-2FFT) feature vector is synthesized for each received signal from the biosensors embedded on the patient's body at each grid point. This feature extraction process benefits in the combination of both short-time and long-time properties of the received signals. The robustness of the proposed CS-2FFT-based algorithm in terms of the average positioning error is numerically evaluated using the realistic parameters in the IEEE 802.15.6-WBAN standard in the presence of additive white Gaussian noise. Due to the circular grid pattern and the CS-2FFT feature extraction method, the proposed scheme represents a significant reduction in the computational complexity, while improving the level of the

  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

    2014-01-01

    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. Sample classroom activities based on climate science

    Science.gov (United States)

    Miler, T.

    2009-09-01

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

  4. Nanotechnology-Based Cosmetics for Hair Care

    Directory of Open Access Journals (Sweden)

    Jamie Rosen

    2015-07-01

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

  5. Group-based care: does it change problem behaviour?

    OpenAIRE

    van Weel, Chris

    1980-01-01

    As a result of disappointing experiences in managing problem behaviour presented by patients in general practice, a system of team or group-based care was developed at the Ommoord Health Centre in Rotterdam, the Netherlands.

  6. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

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

    2012-01-01

    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...... decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. According to family members of children with cancer, hospital-based home care support enhanced their quality of life during the child's cancer trajectory...... 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, as it...

  7. Evidence-based care in Iran: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Morteza Ghojazadeh

    2014-08-01

    Conclusion: Weak knowledge, weak attitude, and time shortage .are among the most significant barriers of evidence-based care in Iran. These problems require more accurate planning and more favorable policies on the part of medical science authorities.

  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

    2008-09-01

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

  9. Silicon waveguide based 320 Gbit/s optical sampling

    DEFF Research Database (Denmark)

    Ji, Hua; Galili, Michael; Pu, Minhao; Liu, Liu; Oxenløwe, Leif Katsuo; Jeppesen, Palle; Veng, T.; Grüner-Nielsen, L.

    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....

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

    Science.gov (United States)

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

    2016-01-01

    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

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

    LENUS (Irish Health Repository)

    O'Kelly, C M

    2012-02-01

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

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

    International Nuclear Information System (INIS)

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

  13. Technology-based interventions in health care.

    Science.gov (United States)

    Kane, J M

    2014-12-01

    There are several converging forces that create a particularly opportune time for technological solutions to enhance cost efficiency in healthcare. Health care costs are unsustainable, yet many patients do not have adequate access to state-of-the-art treatments or to ongoing disease management. Consumerism is an increasingly powerful force in healthcare and the emphasis on personalised medicine will help to define future research and clinical treatment strategies. At the same time, the phenomenal advances in internet utilisation and mobile device applications provide possibilities that have never before existed. We have reason to be very optimistic about these opportunities, but appropriate research will be required to develop scalable and sustainable methods as well as determine expected outcomes. PMID:25154596

  14. A Story-Based Simulation for Teaching Sampling Distributions

    Science.gov (United States)

    Turner, Stephen; Dabney, Alan R.

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

    The purpose of this article is to support the need for a change of care, based on cooperation between those who provide care and those who receive it. This article develops the decisive factors for change: the investee cooperation, the reference in case management, the concept of recovery and terminal care, the reduction of suffering and the value of change reflected in the 'win-win'. In each of them a questioning of the current situation, a methodological analysis and an input of tools and consequences of the change is made. To conclude, the article incorporates the 'itinerary of shared care' as a resource and one of the ways to bring these changes to the reality of day-to-day care. PMID:26553866

  16. Prevalence of Aspergillus species in clinical samples isolated in an Indian tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Xess Immaculata

    2004-12-01

    Full Text Available CONTEXT (BACKGROUND: In recent times, it has become important to determine the prevalence of different Aspergillus species in clinical samples in view of difference in antifungal susceptibility noted in some species. AIMS: To determine the species prevalence of Aspergillus isolates in various clinical samples received in the Mycology Laboratory at our institute. METHOD: Over a period of 4-years, a total of 18,731 samples were processed, and species identification carried out by standard microbiological methods. RESULTS: Four hundred and fifty six samples (2.43% were culture positive for Aspergillus species. A.flavus (46.93% was the most common isolate, followed by A.fumigatus (37.72% and A.niger (15.35%. It was observed that A.fumigatus was the predominant species isolated from blood and respiratory specimens, A.flavus was predominantly isolated from nasal polyps whereas A.niger predominated in nail specimens. Culture positivity was highest in the age group 12-65 years and in males. Sixty-nine patients (15.13% were admitted to the intensive care unit. CONCLUSIONS: The study highlights the diverse manifestations caused by Aspergillus species in human beings and also throws light on the different species prevalent locally. The knowledge would prove useful in selecting empirical antifungal therapy and formulating prophylactic and pre-emptive strategies.

  17. Nursing students' perceptions of instructor caring: an instrument based on Watson's Theory of Transpersonal Caring.

    Science.gov (United States)

    Wade, Gail Holland; Kasper, Natalie

    2006-05-01

    This study describes the development and testing of an instrument to measure nursing students' perceptions of instructor caring. Originally, 69 statements about instructors' caring behaviors, based on Watson's 10 carative factors, were created with Dr. Jean Watson. The Nursing Students' Perceptions of Instructor Caring (NSPIC) instrument uses a 6-point Likert scale for students' responses to the statements. After pretesting the instrument with a small group of nursing students, the NSPIC was tested with 133 baccalaureate nursing students. Based on item analysis, factor analysis, and student comments, the number of statements were reduced to 31. Psychometric testing revealed that the NSPIC is internally consistent (alpha = 0.97) and contains five subscales. Convergent validity was established between the NSPIC and a semantic differential scale of students' perceptions of instructor caring. Predictive validity was assessed with Coates Caring Efficacy Scale. Although the NSPIC is in its early stages of development, its psychometric properties indicate that it is a valid and reliable measure of nursing students' perceptions of instructor caring. PMID:16722498

  18. Generating a synthetic population of individuals in households: Sample-free vs sample-based methods

    OpenAIRE

    Lenormand, M.; Deffuant, G.

    2013-01-01

    We compare a sample-free method proposed by Gargiulo et al. (2010) and a sample-based method proposed by Ye et al. (2009) for generating a synthetic population, organised in households, from various statistics. We generate a reference population for a French region including 1310 municipalities and measure how both methods approximate it from a set of statistics derived from this reference population. We also perform a sensitivity analysis. The sample-free method better fits the reference dis...

  19. Community-based care coordination: practical applications for childhood asthma.

    Science.gov (United States)

    Findley, Sally; Rosenthal, Michael; Bryant-Stephens, Tyra; Damitz, Maureen; Lara, Marielena; Mansfield, Carol; Matiz, Adriana; Nourani, Vesall; Peretz, Patricia; Persky, Victoria W; Valencia, Gilberto Ramos; Uyeda, Kimberly; Viswanathan, Meera

    2011-11-01

    Care coordination programs have been used to address chronic illnesses, including childhood asthma, but primarily via practice-based models. An alternative approach employs community-based care coordinators who bridge gaps between families, health care providers, and support services. Merck Childhood Asthma Network, Inc. (MCAN) sites developed community-based care coordination approaches for childhood asthma. Using a community-based care coordination logic model, programs at each site are described along with program operational statistics. Four sites used three to four community health workers (CHWs) to provide care coordination, whereas one site used five school-based asthma nurses. This school-based site had the highest caseload (82.5 per year), but program duration was 3 months with 4 calls or visits. Other sites averaged fewer cases (35 to 61 per CHW per year), but families received more (7 to 17) calls or visits over a year. Retention was 43% to 93% at 6 months and 24% to 75% at 12 months. Pre-post cross-site data document changes in asthma management behaviors and outcomes. After program participation, 93% to 100% of caregivers had confidence in controlling their child's asthma, 85% to 92% had taken steps to reduce triggers, 69% to 100% had obtained an asthma action plan, and 46% to 100% of those with moderate to severe asthma reported appropriate use of controller medication. Emergency department visits for asthma decreased by 36% to 63%, and asthma-related hospitalizations declined by 26% to 78%. More than three fourths had fewer school absences. In conclusion, MCAN community-based care coordination programs improved management behaviors and decreased morbidity across all sites. PMID:22068360

  20. 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

    2010-03-01

    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.

    Opsomming

    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

  1. Biosignal-based relaxation evaluation of head-care robot.

    Science.gov (United States)

    Ando, Takeshi; Takeda, Maki; Maruyama, Tomomi; Susuki, Yuto; Hirose, Toshinori; Fujioka, Soichiro; Mizuno, Osamu; Yamada, Kenji; Ohno, Yuko; Yukio, Honda

    2013-01-01

    Such popular head care procedures as shampooing and scalp massages provide physical and mental relaxation. However, they place a big burden such as chapped hands on beauticians and other practitioners. Based on our robot hand technology, we have been developing a head care robot. In this paper, we quantitatively evaluated its relaxation effect using the following biosignals: accelerated plethymography (SDNN, HF/TP, LF/HF), heart rate (HR), blood pressure, salivary amylase (sAA) and peripheral skin temperature (PST). We compared the relaxation of our developed head care robot with the head care provided by nurses. In our experimental result with 54 subjects, the activity of the autonomic nerve system changed before and after head care procedures performed by both a human nurse and our proposed robot. Especially, in the proposed robot, we confirmed significant differences with the procedure performed by our proposed head care robot in five indexes: HF/TP, LF/HF, HR, sAA, and PST. The activity of the sympathetic nerve system decreased, because the values of its indexes significantly decreased: LF/HF, HR, and sAA. On the other hand, the activity of the parasympathetic nerve system increased, because of the increase of its indexes value: HF/TP and PST. Our developed head care robot provided satisfactory relaxation in just five minutes of use. PMID:24111288

  2. Oncology Nursing Is Evidence-Based Care.

    Science.gov (United States)

    Kennedy Sheldon, Lisa; Brown, Carlton G

    2016-06-01

    This issue of the Clinical Journal of Oncology Nursing (CJON) will be the final time that you will see the Evidence-Based Practice (EBP) feature column. Why? Because we have seen oncology nursing evolve in the past 20 years and EBP is everywhere! We use it in our clinics and hospital units, incorporate it into decisions about symptom management, and use evidence to develop survivorship guidelines. We discuss EBP in journal clubs and use applications on mobile devices to find the best interventions for our patients. We have oncology nurses sitting on committees to develop guidelines based on the best evidence and expert opinion. We have come a long way and it is our belief that EBP is included in almost every article in CJON and, therefore, a need no longer exists for an individual column about EBP. 
. PMID:27206287

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

    Science.gov (United States)

    Parks, Jennifer A

    2015-06-01

    In this paper, I will argue that there is a deep connection between home-based care, technology, and the self. Providing the means for persons (especially older persons) to receive care at home is not merely a kindness that respects their preference to be at home: it is an important means of extending their selfhood and respecting the unique selves that they are. Home-based technologies like telemedicine and robotic care may certainly be useful tools in providing care for persons at home, but they also have important implications for sustaining selfhood in ways that are of value to individuals and those who care for them. I will argue, by appealing to Hilde Lindemann's notion of "holding" persons' identities in place, that technological interventions are not only useful tools for improving and sustaining health and good care at home, but that they may also help to extend our personal identities and relational capacities in ways that are practically and ethically good. Because of these important goods, I will claim that there is a prima facie moral duty to do this "holding" work and that it is best done by family members and loved ones who are well suited to the job because of their history and relationship with the individual that needs to be "held" in place. PMID:25787720

  4. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

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

    2013-01-01

    BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety, and...... home-care group. No significant difference was found in the Family Impact Module. CONCLUSION: This study indicates that HBHC is a feasible alternative to hospital care for children with cancer, and is greatly preferred by parents. Specific aspects of children's HRQOL may be improved with HBHC and the...... 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. The logic of tax-based financing for health care.

    Science.gov (United States)

    Bodenheimer, T; Sullivan, K

    1997-01-01

    Employment-based health insurance faces serious problems. For the first time, the number of Americans covered by such health insurance is falling. Employers strongly oppose the employer mandate approach to extending health insurance. Employment-based financing is regressive and complex. Serious debate is needed on an alternative solution to financing health care for all Americans. Taxation represents a clear alternative to employment-based health care financing. The major criterion for choosing a tax is equity, with simplicity a second criterion. An earmarked, progressive individual income tax is a fair and potentially simple tax with which to finance health care. The political feasibility of such a tax is greater than that of employer mandate legislation. PMID:9285274

  6. Model-based decision support in diabetes care.

    Science.gov (United States)

    Salzsieder, E; Vogt, L; Kohnert, K-D; Heinke, P; Augstein, P

    2011-05-01

    The model-based Karlsburg Diabetes Management System (KADIS®) has been developed as a patient-focused decision-support tool to provide evidence-based advice for physicians in their daily efforts to optimize metabolic control in diabetes care of their patients on an individualized basis. For this purpose, KADIS® was established in terms of a personalized, interactive in silico simulation procedure, implemented into a problem-related diabetes health care network and evaluated under different conditions by conducting open-label mono- and polycentric trials, and a case-control study, and last but not least, by application in routine diabetes outpatient care. The trial outcomes clearly show that the recommendations provided to the physicians by KADIS® lead to significant improvement of metabolic control. This model-based decision-support system provides an excellent tool to effectively guide physicians in personalized decision-making to achieve optimal metabolic control for their patients. PMID:20621384

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

    Directory of Open Access Journals (Sweden)

    Joanna Kobza

    2014-08-01

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

  8. A method for selecting training samples based on camera response

    Science.gov (United States)

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

    2016-09-01

    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.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  10. Sample-Based Planning with Volumes in Configuration Space

    CERN Document Server

    Shkolnik, Alexander

    2011-01-01

    A simple sample-based planning method is presented which approximates connected regions of free space with volumes in Configuration space instead of points. The algorithm produces very sparse trees compared to point-based planning approaches, yet it maintains probabilistic completeness guarantees. The planner is shown to improve performance on a variety of planning problems, by focusing sampling on more challenging regions of a planning problem, including collision boundary areas such as narrow passages.

  11. Medical Researchers' Ancillary Care Obligations: The Relationship-Based Approach.

    Science.gov (United States)

    Olson, Nate W

    2016-06-01

    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. PMID:26424512

  12. Refined Stratified Sampling for efficient Monte Carlo based uncertainty quantification

    International Nuclear Information System (INIS)

    A general adaptive approach rooted in stratified sampling (SS) is proposed for sample-based uncertainty quantification (UQ). To motivate its use in this context the space-filling, orthogonality, and projective properties of SS are compared with simple random sampling and Latin hypercube sampling (LHS). SS is demonstrated to provide attractive properties for certain classes of problems. The proposed approach, Refined Stratified Sampling (RSS), capitalizes on these properties through an adaptive process that adds samples sequentially by dividing the existing subspaces of a stratified design. RSS is proven to reduce variance compared to traditional stratified sample extension methods while providing comparable or enhanced variance reduction when compared to sample size extension methods for LHS – which do not afford the same degree of flexibility to facilitate a truly adaptive UQ process. An initial investigation of optimal stratification is presented and motivates the potential for major advances in variance reduction through optimally designed RSS. Potential paths for extension of the method to high dimension are discussed. Two examples are provided. The first involves UQ for a low dimensional function where convergence is evaluated analytically. The second presents a study to asses the response variability of a floating structure to an underwater shock. - Highlights: • An adaptive process, rooted in stratified sampling, is proposed for Monte Carlo-based uncertainty quantification. • Space-filling, orthogonality, and projective properties of stratified sampling are investigated • Stratified sampling is shown to possess attractive properties for certain classes of problems. • Refined Stratified Sampling, a new sampling method is proposed that enables the adaptive UQ process. • Optimality of RSS stratum division is explored

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

    Science.gov (United States)

    Karthikeyan, N; Sukanesh, R

    2012-12-01

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

  14. [An intervention to promote team-based care: two focus groups--what promotes team-based care?].

    Science.gov (United States)

    Sano, Itsuki

    2014-01-01

    There has recently been interest in new models of care delivery that promote a team-based approach in psychiatric care. The aim of the study was to clarify the way in which to promote a team-based approach in psychiatric hospitals. Two focus groups were held to collect data from psychiatric hospital nurses who underwent the intervention to improve collaborative behavior. The results indicated the effectiveness of the program to encourage different professionals to meet and interact in learning to improve collaborative practice. We commented on the importance of conflict management and system change. The results are discussed in relation to previous research and practical implications. PMID:24864561

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

    Directory of Open Access Journals (Sweden)

    Andréa Maria Eleutério de Barros Lima Martins

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jing Pan

    2014-01-01

    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.

  17. ATTEND: Toward a Mindfulness-Based Bereavement Care Model

    Science.gov (United States)

    Cacciatore, Joanne; Flint, Melissa

    2012-01-01

    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,…

  18. Evidence Based Order Sets as a Nursing Care Planning System

    OpenAIRE

    LaCrosse, Lisa M.; Heermann, Judith; Azevedo, Karen; Sorrentino, Catherine; Straub, Dawn; O'Dowd, Gloria

    2002-01-01

    The process for developing the nursing care planning (NCP) function for integration into a clinical information system (CIS) will be described. This NCP system uses evidence based order sets or interventions that are specific to a problem with associated patient focused goals or outcomes. The problem, order set, goal framework will eventually be used by all disciplines in the patient focused record.

  19. 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: campolina@cdtn.br, E-mail: pauloinacio@cpejr.com.br [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: claubia@nuclear.ufmg.br, E-mail: dora@nuclear.ufmg.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Dept. de Engenharia Nuclear

    2015-07-01

    Sample size and computational uncertainty were varied in order to investigate sample efficiency and convergence of the sampling based method for uncertainty propagation. Transport code MCNPX was used to simulate a LWR model and allow the mapping, from uncertain inputs of the benchmark experiment, to uncertain outputs. Random sampling efficiency was improved through the use of an algorithm for selecting distributions. Mean range, standard deviation range and skewness were verified in order to obtain a better representation of uncertainty figures. Standard deviation of 5 pcm in the propagated uncertainties for 10 n-samples replicates was adopted as convergence criterion to the method. Estimation of 75 pcm uncertainty on reactor k{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)

  20. Three sample preparation protocols for polymerase chain reaction based detection of Cryptosporidium parvum in environmental samples.

    Science.gov (United States)

    Kostrzynska, M; Sankey, M; Haack, E; Power, C; Aldom, J E; Chagla, A H; Unger, S; Palmateer, G; Lee, H; Trevors, J T; De Grandis, S A

    1999-02-01

    Cryptosporidium parvum is a protozoan parasite responsible for an increasing number of outbreaks of gastrointestinal illness worldwide. In this report, we describe development of sample preparation protocols for polymerase chain reaction (PCR)-based detection of C. parvum in fecal material and environmental water samples. Two of these methods were found adequate for isolation of Cryptosporidium DNA from filtered water pellet suspensions. The first involved several filtration steps, immunomagnetic separation and freeze-thaw cycles. The second method involved filtration, addition of EnviroAmp lysis reagent, freeze-thaw cycles and precipitation of the DNA with isopropanol. Using nested PCR, we detected 100 oocysts/ml of filtered water pellet suspension, with either of the above sample preparation procedures. Nested PCR increased sensitivity of the assay by two to three orders of magnitude as compared to the primary PCR. The detection limit for seeded fecal samples was 10-fold higher than for filtered environmental water pellet suspension. Nested PCR results showed 62.4 and 91.1% correlation with immunofluorescence assay (IFA) for fecal samples and filtered environmental water pellet suspensions, respectively. This correlation decreased to 47.2% and 44.4%, respectively, when only IFA positive samples were analyzed. However, in fecal samples contaminated with a high number (> 10(5)/g) of C. parvum oocysts, this correlation was 100%. PMID:10076632

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

    International Nuclear Information System (INIS)

    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 keff 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)

  2. Outcome of eating disorders in a primary care-based study.

    OpenAIRE

    Son, G. van; Hoeken, D. van; Furth, E. van; Donker, G.; Hoek, H.

    2009-01-01

    Purpose: Most outcome studies of eating disorders are based on samples of patients that had entered specialized mental health care. This might be a group that does not represent all patients with an eating disorder and possibly shows a different course and outcome. Little is known about the outcome of newly diagnosed patients with an eating disorder in primary care. Method: We studied the course and outcome of eating disorders in a nationwide 3–7 year follow-up study of patients detected in p...

  3. Optimal sampling and sample preparation for NIR-based prediction of field scale soil properties

    Science.gov (United States)

    Knadel, Maria; Peng, Yi; Schelde, Kirsten; Thomsen, Anton; Deng, Fan; Humlekrog Greve, Mogens

    2013-04-01

    The representation of local soil variability with acceptable accuracy and precision is dependent on the spatial sampling strategy and can vary with a soil property. Therefore, soil mapping can be expensive when conventional soil analyses are involved. Visible near infrared spectroscopy (vis-NIR) is considered a cost-effective method due to labour savings and relative accuracy. However, savings may be offset by the costs associated with number of samples and sample preparation. The objective of this study was to find the most optimal way to predict field scale total organic carbon (TOC) and texture. To optimize the vis-NIR calibrations the effects of sample preparation and number of samples on the predictive ability of models with regard to the spatial distribution of TOC and texture were investigated. Conditioned Latin hypercube sampling (cLHs) method was used to select 125 sampling locations from an agricultural field in Denmark, using electromagnetic induction (EMI) and digital elevation model (DEM) data. The soil samples were scanned in three states (field moist, air dried and sieved to 2 mm) with a vis-NIR spectrophotometer (LabSpec 5100, ASD Inc., USA). The Kennard-Stone algorithm was applied to select 50 representative soil spectra for the laboratory analysis of TOC and texture. In order to investigate how to minimize the costs of reference analysis, additional smaller subsets (15, 30 and 40) of samples were selected for calibration. The performance of field calibrations using spectra of soils at the three states as well as using different numbers of calibration samples was compared. Final models were then used to predict the remaining 75 samples. Maps of predicted soil properties where generated with Empirical Bayesian Kriging. The results demonstrated that regardless the state of the scanned soil, the regression models and the final prediction maps were similar for most of the soil properties. Nevertheless, as expected, models based on spectra from field

  4. Choosing quality of care measures based on the expected impact of improved care on health.

    OpenAIRE

    Siu, A L; McGlynn, E A; Morgenstern, H; Beers, M H; Carlisle, D M; Keeler, E B; Beloff, J.; Curtin, K; Leaning, J; Perry, B C

    1992-01-01

    Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy o...

  5. Monte-Carlo based uncertainty analysis: Sampling efficiency and sampling convergence

    International Nuclear Information System (INIS)

    Monte Carlo analysis has become nearly ubiquitous since its introduction, now over 65 years ago. It is an important tool in many assessments of the reliability and robustness of systems, structures or solutions. As the deterministic core simulation can be lengthy, the computational costs of Monte Carlo can be a limiting factor. To reduce that computational expense as much as possible, sampling efficiency and convergence for Monte Carlo are investigated in this paper. The first section shows that non-collapsing space-filling sampling strategies, illustrated here with the maximin and uniform Latin hypercube designs, highly enhance the sampling efficiency, and render a desired level of accuracy of the outcomes attainable with far lesser runs. In the second section it is demonstrated that standard sampling statistics are inapplicable for Latin hypercube strategies. A sample-splitting approach is put forward, which in combination with a replicated Latin hypercube sampling allows assessing the accuracy of Monte Carlo outcomes. The assessment in turn permits halting the Monte Carlo simulation when the desired levels of accuracy are reached. Both measures form fairly noncomplex upgrades of the current state-of-the-art in Monte-Carlo based uncertainty analysis but give a substantial further progress with respect to its applicability.

  6. Sampling based Association Rules Mining- A Recent Overview

    OpenAIRE

    V.Umarani,; Dr.M.Punithavalli

    2010-01-01

    Association rule discovery from large databases is one of the tedious tasks in datamining.The process of frequent itemset mining, the first step in the mining of association rules, is a computational and IO intensive process necessitating repeated passes over the entiredatabase. Sampling has been often suggested as an effective tool to reduce the size of the dataset operated at some cost to accuracy. Data mining literature presents with numerous sampling based approaches to speed up the proce...

  7. Variance optimal sampling based estimation of subset sums

    CERN Document Server

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

    2008-01-01

    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.

  8. Use of a guideline based questionnaire to audit hospital care of acute asthma.

    OpenAIRE

    Bell, D.; Layton, A J; Gabbay, J.

    1991-01-01

    OBJECTIVES--To design an audit questionnaire and pilot its use by an audit assistant to monitor inpatient management of acute asthma and to compare the care given by chest physicians and general physicians. DESIGN--Retrospective review by a chest physician and audit assistant of a random sample of 76 case records of patients by a criterion based questionnaire developed from hospital guidelines on management of acute asthma. SETTING--One district general hospital. PATIENTS--76 adult patients w...

  9. [A study on the establishment of a fee system for hospital based home nursing care].

    Science.gov (United States)

    Kim, C J

    1993-01-01

    This study was done in order to provide basic data to a Fee System for hospital based Home Health Care services in Korea in the future. It was done by investigating activities provided to possible Home Health Care clients who could be discharged early from general hospitals and then estimating the nursing care fee according to each nursing activity based upon the time used for activity. The subjects of the study were selected by convenience sampling and consisted of 35 clients who might be clients for Home Nursing Care and were presently admitted to a medical-surgical ward of Y University Medical Center located in Seoul, Korea. The data collection period was from September 1, 1991 to September 30, 1991. The research instruments utilized for the study were a client selection criteria for Home Health Care developed by Choo (1991) and a check-list of nursing activity developed by researcher. The results of the study were as follows: 1. There were 44 different nursing activities provided in the seven days but the time was calculated for only 25 of the nursing activities. 2. Fees for the 25 different nursing activities were calculated by multiplying the median of the average wage of a staff nurse having five years experience in an A grade general hospital to the time of the nursing activity. The results were compared with the insurance fee which the government recognized as an appropriate fee for that activity. The nursing activities with a lower calculated fee than the insurance fee were suction, catheterization, exercise education and dressing change. The nursing activities with a higher calculated fee than the government recognized fee were IM injection and vital sign check. 3. There was a range of 1-15 nursing activities provided daily to the client. For the average number of nursing activities per day of 6.26 events the nursing care fee was calculated at W 6136 per day. 4. Based upon the results of the study, a recommendation for a Home Health Care fee per visit

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

    Directory of Open Access Journals (Sweden)

    Francis Rebecca

    2010-01-01

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

  11. The benefits of measurement-based care for primary care patients with depression.

    Science.gov (United States)

    Jackson, W Clay

    2016-03-01

    Follow the case of Mrs C, a primary care patient with depression who fails to respond to initial antidepressant treatment, and see how measurement-based care helps her clinician confirm her diagnosis, track symptom response, and assess her sense of well-being. Using rating scales such as the 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7), and Mood Disorder Questionnaire (MDQ) can help clinicians recognize suboptimal response and make treatment adjustments such as optimizing the medication dose, switching to another medication, or augmenting with medications, psychotherapy, or exercise. For Mrs C and other patients with depression, the goal of treatment must go beyond symptom remission to improve quality of life. PMID:27046318

  12. SAMURAI: Polar AUV-Based Autonomous Dexterous Sampling

    Science.gov (United States)

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

    2006-12-01

    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

  13. 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 http://code.google.com/p/d2-tools/. CONCLUSIONS: The k-tuple based sequence signature measures can effectively reveal major groups and

  14. Sampling-based Algorithms for Optimal Motion Planning

    CERN Document Server

    Karaman, Sertac

    2011-01-01

    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...

  15. Evaluation of the integrated community based home care model

    Directory of Open Access Journals (Sweden)

    LR Uys

    2001-09-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Kayser Gian

    2009-02-01

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

  17. Small Sample Issues for Microarray-Based Classification

    OpenAIRE

    Dougherty, Edward R

    2006-01-01

    In order to study the molecular biological differences between normal and diseased tissues, it is desirable to perform classification among diseases and stages of disease using microarray-based gene-expression values. Owing to the limited number of microarrays typically used in these studies, serious issues arise with respect to the design, performance and analysis of classifiers based on microarray data. This paper reviews some fundamental issues facing small-sample classification: classific...

  18. Space Group Debris Imaging Based on Sparse Sample

    OpenAIRE

    Zhu Jiang; Deng Jiaxin; Liao Guisheng; Zhu Shengqi

    2016-01-01

    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 scatter...

  19. Efficacy of a Morinda citrifolia Based Skin Care Regimen

    OpenAIRE

    West, Brett J.; Rachel A. Sabin

    2012-01-01

    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 parti...

  20. Cost Effectiveness of Facility-Based Care, Home-Based Care and Mobile Clinics for Provision of Antiretroviral Therapy in Uganda

    OpenAIRE

    Babigumira, Joseph B; Sethi, Ajay K.; Smyth, Kathleen A.; Singer, Mendel E.

    2009-01-01

    Background: Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money. Objective: To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda. Methods: Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical ...

  1. A sampling-based approach to probabilistic pursuit evasion

    KAUST Repository

    Mahadevan, Aditya

    2012-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Evangelia Prevyzi

    2013-01-01

    Full Text Available 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 longevity and reducing complications, based on scientific data and international guidelines. Material-Method: The methodology followed in this review relied on literatures reviews and investigative studies, which were carried out during the period 2000-2012 and international (Medline, PubMed, Cinahl and Greek databases (Iatrotek on the care and management of fistula in people undergoing chronic haemodialysis. Key-words were used: Arteriovenous fistula, cannulation techniques fistula, guidelines, vascular access, role of nurse. Results: The arteriovenous fistula (AVF is the life line for patients undergoing haemodialysis. For this reason, the appropriate care of fistula and its maintenance in a good condition plays an important role for patient΄s life. Conclusions: Nephrology nurse has a major role in the proper management of the fistula and the education of the patient. Additionally, there is a need for cooperation between all the members of the multidisciplinary team, which includes dialysis nurse, nefrologist, access surgeon, and radiologist, for the broader assessment of fistula and the prevention and timely treatment of any complications.

  3. The Team Approach to Home-Based Primary Care: Restructuring Care to Meet Patient, Program, and System Needs

    Science.gov (United States)

    Reckrey, Jennifer M.; Soriano, Theresa A.; Hernandez, Cameron R.; DeCherrie, Linda V.; Chavez, Silvia; Zhang, Meng; Ornstein, Katherine

    2016-01-01

    Team-based models of care are an important way to meet the complex medical and psychosocial needs of the homebound. As part of a quality improvement project to address patient, program, and system needs, we restructured a portion of our large, physician-led academic home-based primary care practice into a team-based model. With support from an office-based nurse practitioner, a dedicated social worker, and a dedicated administrative assistant, physicians were able to care for a larger number of patients. Hospitalizations, readmissions, and patient satisfaction remained the same while physician panel size increased and physician satisfaction improved. Our Team Approach is an innovative way to improve interdisciplinary, team-based care though practice restructuring and serves as an example of how other practices can approach the complex task of caring for the homebound. PMID:25645568

  4. PFPSO: An Optimised Filtering Approach Based on Sampling

    Directory of Open Access Journals (Sweden)

    Y. Hernane

    2010-01-01

    Full Text Available Extended Kalman filter is the first algorithm applied to nonlinear state estimation problem and following its limits, other methods based on sampling were developed. We can consider two categories of particle filters: filters which apply a deterministic sampling as the famous unscented Kalman filter and those whose principle is the random sampling as the Particle filter. Furthermore, other approaches that take these two forms of sampling were proposed as Sigma Point Particle filter. The major difficulty of these methods is the computation time which is related to the complexity of sampling. Particle Filter is one among the methods that has attracted particular interest recently; however, PF suffers the problem of degeneration of particles that occurs after re-sampling. We propose to improve PF by the bioinspired algorithm Particle Swarm Optimization as these 2 models have several common. The hybrid method developed in this study is called PFPSO. The PFPSO reduces significantly the degeneracy of the particles; empirical results obtained by applying PFPSO to the problem of estimating the trajectory of a mobile robot illustrate robustness and computational efficiency of our approach.

  5. CdTe detector based PIXE mapping of geological samples

    OpenAIRE

    Chaves, P. C.; Taborda, A.; Oliveira, Daniel P. S.; Reis, M. A.

    2014-01-01

    A sample collected from a borehole drilled approximately 10 km ESE of Bragança, Trás-os-Montes, was analysed by standard and high energy PIXE at both CTN (previous ITN) PIXE setups. The sample is a fine-grained metapyroxenite grading to coarse-grained in the base with disseminated sulphides and fine veinlets of pyrrhotite and pyrite. Matrix composition was obtained at the standard PIXE setup using a 1.25 MeV H+ beam at three different spots. Medium and high Z elemental concentrati...

  6. Evaluation of Demands and Needs For Dental Care in a Sample of the Turkish Population

    OpenAIRE

    Pekiner, Filiz; Gumru, Birsay; Borahan, Mehmet Oguz; Aytugar, Emre

    2010-01-01

    Objectives: To evaluate the demands and needs for dental care and to identify the level of dental and periodontal status in patients of different age groups visiting the Faculty of Dentistry, Marmara University, Istanbul, Turkey. Methods: A total of 1000 first-visit patients (517 female and 483 male) were examined and questioned. The main complaint of each patient was recorded and considered to be a measure of demand for dental care. The World Health Organization’s (WHO) basic methods were us...

  7. Disease Prevalence and Use of Health Care among a National Sample of Black and White Male State Prisoners

    OpenAIRE

    Rosen, David L.; Hammond, Wizdom P.; Wohl, David A.; Golin, Carol E.

    2012-01-01

    U.S. prisons have a court-affirmed mandate to provide health care to prisoners. Given this mandate, we sought to determine whether use of prison health care was equitable across race using a nationally-representative sample of Black and White male state prisoners. We first examined the prevalence of health conditions by race. Then, across all health conditions and for each of 15 conditions, we compared the proportion of Black and White male prisoners with the condition who received health car...

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

    Science.gov (United States)

    Chen, Chiehfeng

    2014-12-01

    Public attention to evidence-based health care (EBHC) has increased significantly in recent years. Key problems related to applying EBHC in current healthcare practice include the timely update of up-to-date knowledge and skills and the methodology used to implement EBHC in clinical settings. EBHC has been introduced to the Taiwan healthcare system for the past two decades. The annual EBM (Evidence based medicine) National Competition is a unique and important EBHC activity in Taiwan. EBHC has been promoted widely in medicine, nursing, pharmacy, public health and other professions, and EBHC-related organizations such as the Taiwan Evidence Based Medicine Association (TEBMA), and Taiwan Evidence Based Nursing Association (TEBNA), have increased in number and grown in membership. In addition to domestic developments, Taiwan is also actively involved in global organizations, such as the Cochrane Collaboration, East Asian Cochrane Alliance (EACA), and the International Society for Evidence Based Health Care (ISEHC). In Taiwan, most medical professionals work cooperatively to promote EBHC, which facilitates the gradual improvement of healthcare quality. PMID:25464951

  9. Simplified CFC sampling method and spreadsheet based CFC data evaluation

    International Nuclear Information System (INIS)

    Several sampling methods exist to collect groundwater samples for CFC analysis. The established methods like sealing water samples in glass ampoules, using field-crimped copper tubes or taking large volume samples in glass bottles have some drawbacks when intended to be applied worldwide at remote locations without special trained staff. After establishment of a CFC analysis facility at IAEA, efforts were undertaken to develop a more robust and simple technique for CFC sampling. The method developed at IAEA uses commercial 50 ml glass bottles with plastic caps. In order to prevent the sample contamination via CFCs absorbed in the plastic cap, a round metal foil liner of laboratory grade aluminum is placed into the inside of the plastic cap. After extensive flushing of both bottle and cap with sample water in a metal container, the bottle is sealed under water with the cap. The glass bottle and the metal-foil liner provide a gas-tight sealing suitable for sample storage of more than one year. Essential for a successful sampling is the absence of any visible air bubble in the bottle directly after sampling, which of course can be easily checked. The method facilitates the strongly recommended custom to take multiple samples at each sampling site, being cheap and using small sized samples. Altogether five different sampling techniques with several variations were tested during a field experiment at a remote site at the Reichenkar glacier mound in the Oetztal region, Western Alps, Austria. The suitability of the sampling method described above was verified by those results and was further on extensively tested with CFC free water stored for extended time periods before analysis. For easy evaluation of measured CFC data it was desired to have available a suitable spreadsheet program. QCFC ('Quick-CFC') is an easy-to-use interactive Excel spreadsheet program for carrying out quick calculations in hydrologic studies using chlorofluorocarbons as time-dependent tracers

  10. What matters most for end-of-life care? Perspectives from community-based palliative care providers and administrators

    OpenAIRE

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

    2015-01-01

    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 pall...

  11. 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

    2006-01-01

    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.

  12. MOMENT-METHOD ESTIMATION BASED ON CENSORED SAMPLE

    Institute of Scientific and Technical Information of China (English)

    NI Zhongxin; FEI Heliang

    2005-01-01

    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.

  13. 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...

  14. Using Measurement-Based Care to Enhance Any Treatment

    Science.gov (United States)

    Scott, Kelli; Lewis, Cara C.

    2016-01-01

    Measurement-based care (MBC) can be defined as the practice of basing clinical care on client data collected throughout treatment. MBC is considered a core component of numerous evidence-based practices (e.g., Beck & Beck, 2011; Klerman, Weissman, Rounsaville, & Chevron, 1984) and has emerging empirical support as an evidence-based framework that can be added to any treatment (Lambert et al., 2003, Trivedi et al., 2007). The observed benefits of MBC are numerous. MBC provides insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration, and improves client outcomes (Lambert et al., 2005). Moreover, as a framework to guide treatment, MBC has transtheoretical and transdiagnostic relevance with broad reach across clinical settings. Although MBC has primarily focused on assessing symptoms (e.g., depression, anxiety), MBC can also be used to assess valuable information about (a) symptoms, (b) functioning and satisfaction with life, (c) putative mechanisms of change (e.g., readiness to change), and (d) the treatment process (e.g., session feedback, working alliance). This paper provides an overview of the benefits and challenges of MBC implementation when conceptualized as a transtheoretical and transdiagnostic framework for evaluating client therapy progress and outcomes across these four domains. The empirical support for MBC use is briefly reviewed, an adult case example is presented to serve as a guide for successful implementation of MBC in clinical practice, and future directions to maximize MBC utility are discussed.

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

    OpenAIRE

    RAMOS-GOMEZ, FRANCISCO J.

    2014-01-01

    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 ca...

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

    Science.gov (United States)

    Li, Ruihong; Han, Yueping

    2014-09-01

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

  17. Empirical likelihood based inference under complex sampling designs

    OpenAIRE

    Berger, Yves G.

    2015-01-01

    The approach proposed gives design-consistent estimators of parameters which are solutions of estimating equations (e.g. averages, totals, quantiles, correlation, (non)linear regression parameters). It can be used to construct confidence intervals without variance estimates. These confidence intervals are not based on the normality of the point estimator. Linearisation, re-sampling (jackknife or bootstrap) or joint-inclusion probabilities are not necessary, even when the parameter of interest...

  18. Fourier-transfrom Ghost Imaging based on Compressive Sampling algorithm

    OpenAIRE

    Wang, Hui; Han, Shensheng

    2010-01-01

    A special algorithm for the Fourier-transform Ghost Imaging (GI) scheme is discussed based on the Compressive Sampling (CS) theory. The CS algorithm could also be used for the Fourier spectrum reconstruction of pure phase object by setting a proper sensing matrix. This could find its application in diffraction imaging of X-ray, neutron and electron with higher efficiency and resolution. Experiment results are also presented to prove the feasibility.

  19. Missile trajectory shaping using sampling-based path planning

    OpenAIRE

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

    2013-01-01

    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 improvements over classical...

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

    Directory of Open Access Journals (Sweden)

    Kelly Concannon

    2014-05-01

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

  1. Pharmacy-based care for perimenopausal and postmenopausal women.

    Science.gov (United States)

    Shepherd, Janet E; Bopp, Janice

    2002-01-01

    Perimenopause and menopause represent a major physiologic and, often, psychosocial transition in the lives of women. During this time, women often experience disturbing new symptoms and develop an increased awareness of their risks for major chronic illnesses. Women in this stage of life are often highly motivated to improve their health and can benefit greatly from pharmacy-based preventive health care services. Although perimenopausal and menopausal women represent an important target market, some pharmacists may wish to offer more focused services within the broader arena of women's health. For example, a number of community pharmacies have developed niche services for these patients, such as osteoporosis screening, (46) breast cancer risk assessment, (50) or bioidentical HRT consulting and compounding. (59) Other pharmacy care services that may be targeted to women in midlife include smoking cessation, weight management, and dietary supplement consulting. Based on the experiences of the Mar-Main Pharmacy staff, a practical approach is to implement new services gradually, while focusing on providing high-quality, individualized service to a small number of patients. Using this strategy, Mar-Main Pharmacy has experienced tremendous growth in its bioidentical HRT services. This increase in demand for pharmacy services has arisen from word-of-mouth referrals from patients and physicians rather than formal marketing. Perimenopausal and menopausal women represent a growing and increasingly knowledgeable group of patients. Many of these women are seeking care that is individualized, responsive to their health beliefs, and designed to help them maintain a high quality of life. Providing pharmacy-based consulting services for these patients can be extremely rewarding, both professionally and personally. PMID:12269705

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

    OpenAIRE

    Zdena Křesinová; Klára Petrů; Ondřej Lhotský; Torgeir Rodsand; Tomáš Cajthaml

    2016-01-01

    Passive sampling is a rapidly developing technology, which is widely used for the monitoring of pollutants in different environments. Passive sampling offers significant advantages over traditional grab sampling. In the present review, the authors summarize the current literature on the methods of passive sampling used in the environmental monitoring of polar or semi-polar compounds in aqueous matrices. Methods of calibrating, design and deployment of samplers are also discussed. A major focu...

  3. Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life

    OpenAIRE

    Christine Ritchie; Robin Andersen; Jessica Eng; Garrigues, Sarah K.; Gina Intinarelli; Helen Kao; Suzanne Kawahara; Kanan Patel; Lisa Sapiro; Anne Thibault; Erika Tunick; Barnes, Deborah E.

    2016-01-01

    Introduction The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers. Aims To describe adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center. Setting 152 high-risk patients (≥5 ED visits or ≥2 hosp...

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

    Science.gov (United States)

    McGreevy, Jessica

    2016-02-01

    This article presents a review of arts-based and creative approaches to dementia care as an alternative to antipsychotic medications. While use of antipsychotics may be appropriate for some people, the literature highlights the success of creative approaches and the benefits of their lack of negative side effects associated with antipsychotics. The focus is the use of biographical approaches, music, dance and movement to improve wellbeing, enhance social networks, support inclusive practice and enable participation. Staff must be trained to use these approaches. A case study is presented to demonstrate how creative approaches can be implemented in practice and the outcomes that can be expected when used appropriately. PMID:26938607

  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

    2015-12-01

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

  6. A rapid wire-based sampling method for DNA profiling.

    Science.gov (United States)

    Chen, Tong; Catcheside, David E A; Stephenson, Alice; Hefford, Chris; Kirkbride, K Paul; Burgoyne, Leigh A

    2012-03-01

    This paper reports the results of a commission to develop a field deployable rapid short tandem repeat (STR)-based DNA profiling system to enable discrimination between tissues derived from a small number of individuals. Speed was achieved by truncation of sample preparation and field deployability by use of an Agilent 2100 Bioanalyser(TM). Human blood and tissues were stabbed with heated stainless steel wire and the resulting sample dehydrated with isopropanol prior to direct addition to a PCR. Choice of a polymerase tolerant of tissue residues and cycles of amplification appropriate for the amount of template expected yielded useful profiles with a custom-designed quintuplex primer set suitable for use with the Bioanalyser(TM). Samples stored on wires remained amplifiable for months, allowing their transportation unrefrigerated from remote locations to a laboratory for analysis using AmpFlSTR(®) Profiler Plus(®) without further processing. The field system meets the requirements for discrimination of samples from small sets and retains access to full STR profiling when required. PMID:22211864

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

    Directory of Open Access Journals (Sweden)

    Heather L. Maracle, Pharm.D.

    2012-01-01

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

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

    LENUS (Irish Health Repository)

    Fitzsimons, Mary

    2012-02-01

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

  9. Chinese Health Care Products Industry's Future Strategic Positioning: Elderly Biotechnological Health Care Products Based on TCM

    OpenAIRE

    Yong Liu; Suzhen Zhang; Dazheng Wang

    2015-01-01

    In order to study future strategic positioning of elderly biotechnological health care products from biological extraction technology in Chinese health care products industries, we analyze that the development of high-quality elderly health care products is needed and still remains a challenge due to the rapid growth in biological extraction technology. In this study, with the improvement of people's living standards, health care products has become a major consumer products for elderly, Trad...

  10. LÉVY-BASED ERROR PREDICTION IN CIRCULAR SYSTEMATIC SAMPLING

    Directory of Open Access Journals (Sweden)

    Kristjana Ýr Jónsdóttir

    2013-06-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Christopher Ouma Onyango

    2010-09-01

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

  12. Solar-thermal complex sample processing for nucleic acid based diagnostics in limited resource settings.

    Science.gov (United States)

    Gumus, Abdurrahman; Ahsan, Syed; Dogan, Belgin; Jiang, Li; Snodgrass, Ryan; Gardner, Andrea; Lu, Zhengda; Simpson, Kenneth; Erickson, David

    2016-05-01

    The use of point-of-care (POC) devices in limited resource settings where access to commonly used infrastructure, such as water and electricity, can be restricted represents simultaneously one of the best application fits for POC systems as well as one of the most challenging places to deploy them. Of the many challenges involved in these systems, the preparation and processing of complex samples like stool, vomit, and biopsies are particularly difficult due to the high number and varied nature of mechanical and chemical interferents present in the sample. Previously we have demonstrated the ability to use solar-thermal energy to perform PCR based nucleic acid amplifications. In this work demonstrate how the technique, using similar infrastructure, can also be used to perform solar-thermal based sample processing system for extracting and isolating Vibrio Cholerae nucleic acids from fecal samples. The use of opto-thermal energy enables the use of sunlight to drive thermal lysing reactions in large volumes without the need for external electrical power. Using the system demonstrate the ability to reach a 95°C threshold in less than 5 minutes and maintain a stable sample temperature of +/- 2°C following the ramp up. The system is demonstrated to provide linear results between 10(4) and 10(8) CFU/mL when the released nucleic acids were quantified via traditional means. Additionally, we couple the sample processing unit with our previously demonstrated solar-thermal PCR and tablet based detection system to demonstrate very low power sample-in-answer-out detection. PMID:27231636

  13. Solar-thermal complex sample processing for nucleic acid based diagnostics in limited resource settings

    Science.gov (United States)

    Gumus, Abdurrahman; Ahsan, Syed; Dogan, Belgin; Jiang, Li; Snodgrass, Ryan; Gardner, Andrea; Lu, Zhengda; Simpson, Kenneth; Erickson, David

    2016-01-01

    The use of point-of-care (POC) devices in limited resource settings where access to commonly used infrastructure, such as water and electricity, can be restricted represents simultaneously one of the best application fits for POC systems as well as one of the most challenging places to deploy them. Of the many challenges involved in these systems, the preparation and processing of complex samples like stool, vomit, and biopsies are particularly difficult due to the high number and varied nature of mechanical and chemical interferents present in the sample. Previously we have demonstrated the ability to use solar-thermal energy to perform PCR based nucleic acid amplifications. In this work demonstrate how the technique, using similar infrastructure, can also be used to perform solar-thermal based sample processing system for extracting and isolating Vibrio Cholerae nucleic acids from fecal samples. The use of opto-thermal energy enables the use of sunlight to drive thermal lysing reactions in large volumes without the need for external electrical power. Using the system demonstrate the ability to reach a 95°C threshold in less than 5 minutes and maintain a stable sample temperature of +/− 2°C following the ramp up. The system is demonstrated to provide linear results between 104 and 108 CFU/mL when the released nucleic acids were quantified via traditional means. Additionally, we couple the sample processing unit with our previously demonstrated solar-thermal PCR and tablet based detection system to demonstrate very low power sample-in-answer-out detection. PMID:27231636

  14. Which European Model for Elderly Care? Equity and Cost-Effectiveness in Home Based Care in Three European Countries

    OpenAIRE

    Francesca Bettio; Giovanni Solinas

    2009-01-01

    Long term care for the elderly is growing apace in developed economies. As growth is forcing change in existing production and delivery systems of elderly care services, the question arises as to how different systems compare in terms of cost-effectiveness, equity or quality. Based on an in depth survey carried out in Denmark, Ireland and Italy – the GALCA survey – this articles compares prevailing arrangements of home based long-term care in these three countries, focussing on the overall co...

  15. Workplace-based assessment in a primary-care setting.

    Science.gov (United States)

    Hecker, Kent G; Norris, Jill; Coe, Jason B

    2012-01-01

    Workplace-based assessment (WBA) is the process of directly observing students' work within a clinical setting, assessing their performance, and providing specific, goal oriented feedback. Assessment methods used for workplace-based assessment include tools developed for clinical interaction (e.g., the mini clinical evaluation exercise [mini-CEX]), for procedural or technical skills (e.g., the direct observation of procedural skills [DOPS]), and multi-source feedback tools to assess interpersonal and technical skills. While several of these assessment methods are being adopted by veterinary schools to evaluate students' progress through their clinical rotations, there is little reported at this time about their utility and effectiveness within the veterinary context. This article provides an introduction to the use of these tools and offers guidance in selecting appropriate methods for assessment in the primary health care setting. PMID:22951458

  16. 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

    2009-01-01

    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.

  17. Promising Outcomes in Teen Mothers Enrolled in a School-Based Parent Support Program and Child Care Center

    Science.gov (United States)

    Sadler, Lois S.; Swartz, Martha K.; Ryan-Krause, Patricia; Seitz, Victoria; Meadows-Oliver, Mikki; Grey, Margaret; Clemmens, Donna A.

    2007-01-01

    Background: This study described a cohort of teen mothers and their children attending an urban high school with a parent support program and school-based child care center. Specific aims of the study were to describe maternal characteristics and outcomes, and child developmental and health outcomes. Methods: A volunteer sample of 65 adolescent…

  18. Chinese Health Care Products Industry's Future Strategic Positioning: Elderly Biotechnological Health Care Products Based on TCM

    Directory of Open Access Journals (Sweden)

    Yong Liu

    2015-02-01

    Full Text Available In order to study future strategic positioning of elderly biotechnological health care products from biological extraction technology in Chinese health care products industries, we analyze that the development of high-quality elderly health care products is needed and still remains a challenge due to the rapid growth in biological extraction technology. In this study, with the improvement of people's living standards, health care products has become a major consumer products for elderly, Traditional Chinese Medicine (TCM as a traditional medicine health and health culture, is health care products developed an important theoretical basis and effective material source, development with biological extraction technology can promote future strategic positioning of elderly biotechnological health care products in Chinese health care products industry.

  19. Costs and prospects for home based Long Term Care in Northern Italy: the Galca survey

    OpenAIRE

    Bettio, Francesca; Mazzotta, Fernanda; Solinas, Giovanni

    2007-01-01

    An important issue in the design of sustainable Long Term Care policies is the relative social cost of community or home based care versus institutional care. Here we undertake this cost comparison making use of the findings from the GALCA surveys on Long Term Care in Denmark, Ireland and Italy but confining attention to Italy. The survey for Italy was conducted in the municipality of Modena that may be considered broadly representative of Long Term Care conditions in the North of the country...

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

    OpenAIRE

    Gesse, Theresa; Golembeski, Susan; Potter, Jonell

    1999-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nishikitani Mariko

    2010-06-01

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

  2. CdTe detector based PIXE mapping of geological samples

    International Nuclear Information System (INIS)

    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+ 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

  3. CdTe detector based PIXE mapping of geological samples

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-01-01

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

  4. Sampling-based Decentralized Monitoring for Networked Embedded Systems

    Directory of Open Access Journals (Sweden)

    Ezio Bartocci

    2013-08-01

    Full Text Available Decentralized monitoring (DM refers to a monitoring technique, where each component must infer, based on a set of partial observations if the global property is satisfied. Our work is inspired by the theoretical results presented by Baurer and Falcone at FM 2012, where the authors introduced an algorithm for distributing and monitoring LTL formulae, such that satisfaction or violation of specifications can be detected by local monitors alone. However, their work is based on the main assumption that neither the computation nor communication take time, hence it does not take into account how to set a sampling time among the components such that their local traces are consistent. In this work we provide a timed model in UPPAAL and we show a case study on a networked embedded systems board.

  5. 76 FR 21372 - Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions...

    Science.gov (United States)

    2011-04-15

    ... the Medicare Community-Based Care Transitions Program AGENCY: Centers for Medicare & Medicaid Services... to participate in the Medicare Community-based Care Transitions Program, which was authorized by... Tiongson, (410) 786-0342 or by e-mail at CareTransitions@cms.hhs.gov . ADDRESSES: Proposals should...

  6. Fast Sampling-Based Whole-Genome Haplotype Block Recognition.

    Science.gov (United States)

    Taliun, Daniel; Gamper, Johann; Leser, Ulf; Pattaro, Cristian

    2016-01-01

    Scaling linkage disequilibrium (LD) based haplotype block recognition to the entire human genome has always been a challenge. The best-known algorithm has quadratic runtime complexity and, even when sophisticated search space pruning is applied, still requires several days of computations. Here, we propose a novel sampling-based algorithm, called S-MIG (++), where the main idea is to estimate the area that most likely contains all haplotype blocks by sampling a very small number of SNP pairs. A subsequent refinement step computes the exact blocks by considering only the SNP pairs within the estimated area. This approach significantly reduces the number of computed LD statistics, making the recognition of haplotype blocks very fast. We theoretically and empirically prove that the area containing all haplotype blocks can be estimated with a very high degree of certainty. Through experiments on the 243,080 SNPs on chromosome 20 from the 1,000 Genomes Project, we compared our previous algorithm MIG (++) with the new S-MIG (++) and observed a runtime reduction from 2.8 weeks to 34.8 hours. In a parallelized version of the S-MIG (++) algorithm using 32 parallel processes, the runtime was further reduced to 5.1 hours. PMID:27045830

  7. Condition based payment: improving care of chronic illness

    OpenAIRE

    DiPiero, Albert; Sanders, David G

    2005-01-01

    Fee-for-service is more than a payment method; it defines the method of care. Fee-for-condition—a payment method that rewards superior results and encourages innovation—could greatly improve care for chronic conditions

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

    Data.gov (United States)

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

  9. Efficacy of adrenal venous sampling is increased by point of care cortisol analysis

    OpenAIRE

    Viste, Kristin; Grytaas, Marianne A; Jørstad, Melissa D; Jøssang, Dag E; Høyden, Eivind N; Fotland, Solveig S; Jensen, Dag K; Løvås, Kristian; Thordarson, Hrafnkell; Almås, Bjørg; Mellgren, Gunnar

    2013-01-01

    Primary aldosteronism (PA) is a common cause of secondary hypertension and is caused by unilateral or bilateral adrenal disease. Treatment options depend on whether the disease is lateralized or not, which is preferably evaluated with selective adrenal venous sampling (AVS). This procedure is technically challenging, and obtaining representative samples from the adrenal veins can prove difficult. Unsuccessful AVS procedures often require reexamination. Analysis of cortisol during the procedur...

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

    OpenAIRE

    Rahmatollah Marzband; Seyed Hamzeh Hosseini; Zeinab Hamzehgardeshi

    2016-01-01

    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 analy...

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

    OpenAIRE

    Symoens Sara AA; Colman Elien; Bracke Piet F; Van Praag Lore

    2010-01-01

    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. Furthermor...

  12. Knowledge-based nonuniform sampling in multidimensional NMR

    OpenAIRE

    Schuyler, Adam D; Maciejewski, Mark W.; Arthanari, Haribabu; Hoch, Jeffrey C.

    2011-01-01

    The full resolution afforded by high-field magnets is rarely realized in the indirect dimensions of multidimensional NMR experiments because of the time cost of uniformly sampling to long evolution times. Emerging methods utilizing nonuniform sampling (NUS) enable high resolution along indirect dimensions by sampling long evolution times without sampling at every multiple of the Nyquist sampling interval. While the earliest NUS approaches matched the decay of sampling density to the decay of ...

  13. Receipt of HIV prevention interventions is more common in community-based clinics than in primary care or acute care settings for Black men who have sex with men in the District of Columbia.

    Science.gov (United States)

    Levy, Matthew E; Watson, Christopher Chauncey; Glick, Sara Nelson; Kuo, Irene; Wilton, Leo; Brewer, Russell A; Fields, Sheldon D; Criss, Vittoria; Magnus, Manya

    2016-05-01

    Characterization of structural barriers that impede the receipt of HIV prevention and care services is critical to addressing the HIV epidemic among Black men who have sex with men (BMSM). This study investigated the utilization of HIV prevention and general care services among a non-clinic-based sample of BMSM who reported at least one structural barrier to engagement in care. Proportions of participants who had received HIV prevention services and general care services in different settings were compared using Fisher's exact test and correlates of service receipt were assessed using logistic regression. Among 75 BMSM, 60% had accessed a community-based clinic, 21% had accessed a primary care setting, and 36% had accessed an acute care setting in the last 6 months. Greater proportions of participants who had accessed community-based clinics received HIV prevention services during these visits (90%) compared to those who had accessed primary care (53%) and acute care (44%) settings (p = .005). Opportunities for BMSM to receive HIV prevention interventions differed by care setting. Having access to health care did not necessarily facilitate the uptake of HIV prevention interventions. Further investigation of the structurally rooted reasons why BMSM are often unable to access HIV prevention services is warranted. PMID:26643856

  14. Efficacy of a Morinda citrifolia Based Skin Care Regimen

    Directory of Open Access Journals (Sweden)

    Brett J. West

    2012-04-01

    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.

  15. Microfluidic-Based sample chips for radioactive solutions

    International Nuclear Information System (INIS)

    Historical nuclear fuel cycle process sampling techniques required sample volumes ranging in the tens of milliliters. The radiation levels experienced by analytical personnel and equipment, in addition to the waste volumes generated from analysis of these samples, have been significant. These sample volumes also impacted accountability inventories of required analytes during process operations. To mitigate radiation dose and other issues associated with the historically larger sample volumes, a microcapillary sample chip was chosen for further investigation. The ability to obtain microliter volume samples coupled with a remote automated means of sample loading, tracking, and transporting to the analytical instrument would greatly improve analytical efficiency while reducing both personnel exposure and radioactive waste volumes. Sample chip testing was completed to determine the accuracy, repeatability, and issues associated with the use of microfluidic sample chips used to supply µL sample volumes of lanthanide analytes dissolved in nitric acid for introduction to an analytical instrument for elemental analysis

  16. Microfluidic-Based Sample Chips for Radioactive Solutions

    Energy Technology Data Exchange (ETDEWEB)

    Tripp, J. L.; Law, J. D.; Smith, T. E.; Rutledge, V. J.; Bauer, W. F.; Ball, R. D.; Hahn, P. A.

    2014-02-01

    Historical nuclear fuel cycle process sampling techniques required sample volumes ranging in the tens of milliliters. The radiation levels experienced by analytical personnel and equipment, in addition to the waste volumes generated from analysis of these samples, have been significant. These sample volumes also impacted accountability inventories of required analytes during process operations. To mitigate radiation dose and other issues associated with the historically larger sample volumes, a microcapillary sample chip was chosen for further investigation. The ability to obtain microliter volume samples coupled with a remote automated means of sample loading, tracking, and transporting to the analytical instrument would greatly improve analytical efficiency while reducing both personnel exposure and radioactive waste volumes. Sample chip testing was completed to determine the accuracy, repeatability, and issues associated with the use of microfluidic sample chips used to supply µL sample volumes of lanthanide analytes dissolved in nitric acid for introduction to an analytical instrument for elemental analysis.

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

    Science.gov (United States)

    Oomkens, Rosanne; Hoogenboom, Marcel; Knijn, Trudie

    2016-07-01

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

  18. The baryonic Tully-Fisher relation cares about the galaxy sample

    Science.gov (United States)

    Sorce, Jenny G.; Guo, Quan

    2016-05-01

    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 article, we use the EAGLE simulation to study the dependence of the BTFR on the size of the simulated galaxy sample. The huge number of data points 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 a large range of masses and rotation rates. Accordingly, to compare observational and theoretical results, we build a large number of various size data sets using the same criterion and derive the BTFR for all of them. Unmistakably, there is an effect resulting from the number of galaxies used to derive the relation. The smaller the number, the larger the standard deviation around the average slope and intrinsic scatter of a given size sample of galaxies. This observation allows us to alleviate the tensions between observational measurements and ΛCDM predictions. Namely, the size of the observational samples adds up to the complexity in comparing observed and simulated relations to discredit or confirm ΛCDM. Similarly, samples, even large, that do not reflect the galaxy distribution give biased results on average. Large size samples reproducing the underlying distribution of galaxies constitute a supplementary necessity to compare observations and simulations efficiently.

  19. Preview-based sampling for controlling gaseous simulations

    KAUST Repository

    Huang, Ruoguan

    2011-01-01

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

  20. Fan Fault Diagnosis Based on Wavelet Packet and Sample Entropy

    Directory of Open Access Journals (Sweden)

    Xiaogang Xu

    2013-06-01

    Full Text Available To accurately diagnose the mechanical failure of the fan, two diagnostic methods based on the wavelet packet energy feature and sample entropy feature are proposed. Vibration signals acquisition of 13 kinds of running states are achieved on the 4-73 No.8D centrifugal fan test bench. The wavelet packet energy feature vector of each vibration signal is rapidly extracted through the wavelet packet denoising, decomposition and reconstruction. The vibration signal wavelet packet energy feature vector of the five measuring points in the same instantaneous running state are fused into the fan fault feature vector. Finally, the fault diagnosis of the fan is achieved by using improved SVM (Support Vector Machine classifier, and the accuracy rate is 94.6%. A new fan fault feature vector is put forward, which is the integration of the vibration signal sample entropy of the five measuring points in the same instantaneous running state, and then the fault diagnosis of the fan is achieved by using improved BP (Back Propagation neural network, and the accuracy rate is 99.23%. The diagnostic results show that these two methods are able to effectively diagnose the category, severity and site of the fan mechanical failures, and suitable for online diagnosis.

  1. Skew Divergence-Based Fuzzy Segmentation of Rock Samples

    Science.gov (United States)

    Carvalho, Bruno M.; Garduño, Edgar; Santos, Iraçú O.

    2014-03-01

    Digital image segmentation is a process in which one assigns distinct labels to different objects in a digital image. The MOFS (Multi Object Fuzzy Segmentation) algorithm has been successfully applied to the segmentation of images from several modalities. However, the traditional MOFS algorithm fails when applied to images whose composing objects are characterized by textures whose patterns cannot be successfully described by simple statistics computed over a very restricted area. Here, we present an extension of the MOFS algorithm that achieves the segmentation of textures by employing adaptive affinity functions that use the Skew Divergence as a measure of distance between two distributions. These affinity functions are called adaptive because their associated area (neighborhood) changes according to the characteristics of the texture being processed. We performed experiments on mosaic images composed by combining rock sample images which show the effectiveness of the adaptive skew divergence based fuzzy affinity functions.

  2. Skew Divergence-Based Fuzzy Segmentation of Rock Samples

    International Nuclear Information System (INIS)

    Digital image segmentation is a process in which one assigns distinct labels to different objects in a digital image. The MOFS (Multi Object Fuzzy Segmentation) algorithm has been successfully applied to the segmentation of images from several modalities. However, the traditional MOFS algorithm fails when applied to images whose composing objects are characterized by textures whose patterns cannot be successfully described by simple statistics computed over a very restricted area. Here, we present an extension of the MOFS algorithm that achieves the segmentation of textures by employing adaptive affinity functions that use the Skew Divergence as a measure of distance between two distributions. These affinity functions are called adaptive because their associated area (neighborhood) changes according to the characteristics of the texture being processed. We performed experiments on mosaic images composed by combining rock sample images which show the effectiveness of the adaptive skew divergence based fuzzy affinity functions

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

    Science.gov (United States)

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

    2016-01-01

    The assessment of wildlife health has been enhanced by the ability of point-of-care (POC) blood analysers to provide biochemical analyses of non-domesticated animals in the field. However, environmental limitations (e.g. temperature, atmospheric humidity and rain) and lack of reference values may inhibit researchers from using such a device with certain wildlife species. Evaluating the use of alternative sample types, such as plasma, in a POC device may afford researchers the opportunity to delay sample analysis and the ability to use banked samples. In this study, we examined fresh whole blood, fresh plasma and frozen plasma (sample type) pH, partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3 (-)), total carbon dioxide (TCO2), base excess (BE), partial pressure of oxygen (PO2), oxygen saturation (sO2) and lactate concentrations in 23 juvenile American alligators (Alligator mississippiensis) using an i-STAT CG4+ cartridge. Our results indicate that sample type had no effect on lactate concentration values (F 2,65 = 0.37, P = 0.963), suggesting that the i-STAT analyser can be used reliably to quantify lactate concentrations in fresh and frozen plasma samples. In contrast, the other seven blood parameters measured by the CG4+ cartridge were significantly affected by sample type. Lastly, we were able to collect blood samples from all alligators within 2 min of capture to establish preliminary reference ranges for juvenile alligators based on values obtained using fresh whole blood. PMID:27382469

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

    Directory of Open Access Journals (Sweden)

    Morita Tatsuya

    2012-01-01

    populations are a nearly representative sample of advanced cancer patients, bereaved family members, physicians, and nurses in the region. Qualitative process studies consist of 3 studies with each aim: 1 to describe the process in developing regional palliative care in each local context, 2 to understand how and why the regional palliative care program led to changes in the region and to propose a model for shaping regional palliative care, and 3 to systemically collect the barriers of palliative care at a regional level and potential resolutions. The study methodology is a case descriptive study, a grounded theory approach based on interviews, and a content analysis based on systemically collected data, respectively. Discussion This study is, to our knowledge, one of the most comprehensive evaluations of a region-based palliative care intervention program. This study has 3 unique aspects: 1 it measures a wide range of outcomes, including quality of care and quality of life measures specifically designed for palliative care populations, whether patients died where they actually preferred, the changes in physicians and nurses at a regional level; 2 adopts qualitative studies along with quantitative evaluations; and 3 the intervention is without a fundamental change in health care systems. A comprehensive understanding of the findings in this study will contribute to a deeper insight into how to develop community palliative care. Trial Registration UMIN Clinical Trials Registry (UMIN-CTR, Japan, UMIN000001274.

  5. Prevalence of perceived experiences of emotional, physical, sexual, and health care abuse in a Swedish male patient sample

    OpenAIRE

    Swahnberg, Katarina; Hearn, Jeffery; Wijma, Barbro

    2009-01-01

    The aim of the present study was to estimate the prevalence of and current suffering from emotional abuse (EA), physical abuse (PA), and sexual abuse (SA) and abuse in health care (AHC) among male Swedish patients and compare prevalences of abuse between female and male patients at a Swedish university hospital. For data collection we used the NorVold Abuse Questionnaire, which has been validated in a female sample and in the present study. The lifetime prevalences were EA = 12.8%, PA = 45.7%...

  6. Apparatus for point-of-care detection of nucleic acid in a sample

    Energy Technology Data Exchange (ETDEWEB)

    Bearinger, Jane P.; Dugan, Lawrence C.

    2016-04-19

    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.

  7. Sample treatment in chromatography-based speciation of organometallic pollutants.

    Science.gov (United States)

    Gómez-Riza, J L; Morales, E; Giráldez, I; Sánchez-Rodas, D; Velasco, A

    2001-12-14

    Speciation analysis is nowadays performed routinely in many laboratories to control the quality of the environment, food and health. Chemical speciation analyses generally include the study of different oxidation state of elements or individual organometallic compounds. The determination of the different chemical forms of elements is still an analytical challenge, since they are often unstable and concentrations in different matrices of interest are in the microg l(-1) or even in the ng l(-1) range (e.g., estuarine waters) or ng g(-1) in sediments and biological tissues. For this reason, sensitive and selective analytical atomic techniques are being used as available detectors for speciation, generally coupled with chromatography for the time-resolved introduction of analytes into the atomic spectrometer. The complexity of these instrumental couplings has a straightforward consequence on the duration of the analysis, but sample preparation to separate and transfer the chemical species present in the sample into a solution to be accepted readily by a chromatographic column is the more critical step of total analysis, and demands considerable operator skills and time cost. Traditionally, liquid-liquid extraction has been employed for sample treatment with serious disadvantages, such as consumption, disposal and long-term exposure to organic solvent. In addition, they are usually cumbersome and time-consuming. Therefore, the introduction of new reagents such as sodium tetraethylborate for the simultaneous derivatization of several elements has been proposed. Other possibilities are based in the implementation of techniques for efficient and accelerated isolation of species from the sample matrix. This is the case for microwave-assisted extraction, solid-phase extraction and microextraction, supercritical fluid extraction or pressurized liquid extraction, which offer new possibilities in species treatment, and the advantages of a drastic reduction of the extraction

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

    Science.gov (United States)

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

    2015-01-01

    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 study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Methods Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through “Embrace,” an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Results Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes “Struggling with health,” “Increasing dependency,” “Decreasing social interaction,” “Loss of control,” and “Fears;” and 2) Experiences with Embrace, with the themes “Relationship with the case manager,” “Interactions,” and “Feeling in control, safe, and secure”. The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants’ ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. Conclusion The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging. PMID:26489096

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

    Directory of Open Access Journals (Sweden)

    Sophie L W Spoorenberg

    Full Text Available Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs.Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach.Responses of participants concerned two focus areas: 1 Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2 Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system.The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

  10. Case Study: Evidence-Based Interventions Enhancing Diabetic Foot Care Behaviors among Hospitalized DM Patients

    Directory of Open Access Journals (Sweden)

    Titis Kurniawan

    2011-01-01

    Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients

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

    Directory of Open Access Journals (Sweden)

    Xiaomeng Zhang

    2006-01-01

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

  12. Space Group Debris Imaging Based on Sparse Sample

    Directory of Open Access Journals (Sweden)

    Zhu Jiang

    2016-02-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Douangvichit Daovieng

    2012-01-01

    Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family

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

    Directory of Open Access Journals (Sweden)

    Rahmatollah Marzband

    2016-05-01

    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.

  15. A Web-Based Model for Diabetes Education and Decision Support for the Home Care Nurse

    OpenAIRE

    Hill, Michelle; Kirby, Judy

    1998-01-01

    Diabetes education for the home care population requires expert knowledge to be available at the point-of-care, the patient's home. This poster displays a model for Web-based diabetes education and decision support for the home care nurse. The system utilizes the line of reasoning (LOR) model to organize and represent expert decision-making thought processes.

  16. Blood sample tube transporting system versus point of care technology in an emergency department; effect on time from collection to reporting?

    DEFF Research Database (Denmark)

    Nørgaard, Birgitte; Mogensen, Christian Backer

    technologies (POCT) are used in emergency departments. This study assesses the hypothesis, that using Point of Care Technology in analysing blood samples versus tube transporting blood samples for laboratory analyses results in shorter time from the blood sample is collected to the result is reported in an...

  17. Performance of Local Information Based Link Prediction: A Sampling Perspective

    OpenAIRE

    Zhao, Jichang; Feng, Xu; Dong, Li; Liang, Xiao; Xu, Ke

    2011-01-01

    Link prediction is pervasively employed to uncover the missing links in the snapshots of real-world networks, which are usually obtained from kinds of sampling methods. Contrarily, in the previous literature, in order to evaluate the performance of the prediction, the known edges in the sampled snapshot are divided into the training set and the probe set randomly, without considering the diverse sampling approaches beyond. However, different sampling methods might lead to different missing li...

  18. Hospital-based palliative care: A case for integrating care with cure

    Directory of Open Access Journals (Sweden)

    Priya Darshini Kulkarni

    2011-01-01

    Full Text Available The reason that probably prompted Dame Cicely Saunders to launch the palliative care movement was the need to move away from the impersonal, technocratic approach to death that had become the norm in hospitals after the Second World War. Palliative care focuses on relieving the suffering of patients and families. Not limited to just management of pain, it includes comprehensive management of any symptom, which affects the quality of life. Care is optimized through early initiation and comprehensive implementation throughout the disease trajectory. Effective palliative care at the outset can help accelerate a positive clinical outcome. At the end of life, it can enhance the opportunity for the patient and family to achieve a sense of growth, resolve differences, and find a comfortable closure. It helps to reduce the suffering and fear associated with dying and prepares the family for bereavement.

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

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

    As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for...

  20. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities.

    Science.gov (United States)

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

    2015-01-01

    Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. PMID:25499658

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

    CERN Document Server

    G., Sorce Jenny

    2016-01-01

    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 ...

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

    Directory of Open Access Journals (Sweden)

    Dantas Guilherme

    2003-05-01

    Full Text Available Abstract Background The objectives of this study were: a to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM in primary care; b to investigate the influence of patient preferences on clinical decision-making; and c to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

  3. Android-based access to holistic emergency care record.

    Science.gov (United States)

    Koufi, Vassiliki; Malamateniou, Flora; Prentza, Andriana; Vassilacopoulos, George

    2013-01-01

    This paper is concerned with the development of an Emergency Medical Services (EMS) system which interfaces with a Holistic Emergency Care Record (HECR) that aims at managing emergency care holistically by supporting EMS processes and is accessible by Android-enabled mobile devices. PMID:23823406

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

    KAUST Repository

    Denny, Jory

    2012-05-01

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

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

    International Nuclear Information System (INIS)

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

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

    DEFF Research Database (Denmark)

    Losacco, Valentina; Cuttini, Marina; Greisen, Gorm; Haumont, Dominique; Pallás-Alonso, Carmen R; Pierrat, Veronique; Warren, Inga; Smit, Bert J; Westrup, Björn; Sizun, Jacques

    2011-01-01

    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 with...

  7. Watson's theory of transpersonal caring: factors impacting nurses professional caring.

    Science.gov (United States)

    Vandenhouten, Christine; Kubsch, Sylvia; Peterson, Margaret; Murdock, Jennifer; Lehrer, Leslie

    2012-01-01

    This study's purpose was to identify factors impacting nurses' perceived professional caring. The sample of 242 nurses completed a researcher-developed survey based on Watson's theory of transpersonal caring. Results showed that experienced, hospital-based nurses and those demonstrating greater familiarity with Watson's theory had higher caring scores. Implications for education, practice, and research are suggested. PMID:23075749

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

    Directory of Open Access Journals (Sweden)

    Poortaghi

    2015-09-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Nik Sherina Hanafi

    Full Text Available Continuity of care is an important quality outcome of patient care. This study aimed to investigate the relationship between personal continuity and blood pressure (BP control among the patients with hypertension in an academic primary care centre. Between January and May 2012, we conducted a retrospective review of medical records of patients with hypertension who had been followed up for at least 1 year in the Primary Care Clinic, University of Malaya Medical Centre, Malaysia. In this setting, doctors who provided care for hypertension included postgraduate family medicine trainees, non-trainee doctors and academic staff. Systematic random sampling (1:4 was used for patient selection. BP control was defined as less than 130/80 mm Hg for patients with diabetes mellitus, proteinuria and chronic kidney disease and less than 140/90 mm Hg for all other patients. Continuity of care was assessed using the usual provider continuity index (UPCI, which is the ratio of patient visits to the usual provider to the total number of visits to all providers in 1 year. A UPC index of zero denotes no continuity while an index of one reflects perfect continuity with only the usual provider. We reviewed a total of 1060 medical records. The patients' mean age was 62.0 years (SD 10.4. The majority was women (59.2% and married (85.7%. The mean number of visits in a year was 3.85 (SD 1.36. A total of 72 doctors had provided consultations (55 postgraduate family medicine trainees, 8 non-trainee doctors and 9 academic staff. The mean UPCI was 0.43 (SD 0.34. Target BP was achieved in 42% of the patients. There was no significant relationship between BP control and personal continuity after adjustment for total number of visits. Continuity of care was not associated with BP control in our centre. Further studies are needed to explore the reasons for this.

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

    Directory of Open Access Journals (Sweden)

    Youngdoe Kim

    2015-01-01

    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.

  11. Droplet-Based Segregation and Extraction of Concentrated Samples

    Energy Technology Data Exchange (ETDEWEB)

    Buie, C R; Buckley, P; Hamilton, J; Ness, K D; Rose, K A

    2007-02-23

    Microfluidic analysis often requires sample concentration and separation techniques to isolate and detect analytes of interest. Complex or scarce samples may also require an orthogonal separation and detection method or off-chip analysis to confirm results. To perform these additional steps, the concentrated sample plug must be extracted from the primary microfluidic channel with minimal sample loss and dilution. We investigated two extraction techniques; injection of immiscible fluid droplets into the sample stream (''capping'''') and injection of the sample into an immiscible fluid stream (''extraction''). From our results we conclude that capping is the more effective partitioning technique. Furthermore, this functionality enables additional off-chip post-processing procedures such as DNA/RNA microarray analysis, realtime polymerase chain reaction (RT-PCR), and culture growth to validate chip performance.

  12. Inpatients hypospadias care: Trends and outcomes from the American nationwide inpatient sample

    Science.gov (United States)

    Sukumar, Shyam; Sood, Akshay; Hanske, Julian; Vetterlein, Malte; Elder, Jack S.; Fisch, Margit; Trinh, Quoc-Dien; Friedman, Ariella A.

    2015-01-01

    Purpose Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. Materials and Methods The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. Results A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. Conclusions Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays. PMID:26279829

  13. Awareness and action for eliminating health care disparities in pain care: Web-based resources.

    Science.gov (United States)

    Fan, Ling; Thomas, Melissa; Deitrick, Ginna E; Polomano, Rosemary C

    2008-01-01

    Evidence shows that disparities in pain care exist, and this problem spans across all health care settings. Health care disparities are complex, and stem from the health system climate, limitations imposed by laws and regulations, and discriminatory practices that are deep seated in biases, stereotypes, and uncertainties surrounding communication and decision-making processes. A search of the Internet identified thousands of Web sites, documents, reports, and educational materials pertaining to health and pain disparities. Web sites for federal agencies, private foundations, and professional and consumer-oriented organizations provide useful information on disparities related to age, race, ethnicity, geography, socioeconomic status, and specific populations. The contents of 10 Web sites are examined for resources to assist health professionals and consumers in better understanding health and pain disparities and ways to overcome them in practice. PMID:19042858

  14. Patient and nurse experiences of theory-based care.

    Science.gov (United States)

    Flanagan, Jane

    2009-04-01

    The pre-surgery nursing practice model derived from Newman's theory was developed to change the delivery of nursing care in a pre-surgical clinic. Guided by the theoretical knowledge of health as expanding consciousness, transpersonal caring, and reflective practice, key practice changes included a) incorporating Newman's praxis process, b) changing the physical space, and c) providing opportunities to reflect on practice. The purpose of this study was to utilize a phenomenological approach to evaluate a new model of care among 31 patients and 4 nurses. PMID:19342715

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

    Directory of Open Access Journals (Sweden)

    Maria Hernandez-Valladares

    2016-08-01

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

  16. New approach based on compressive sampling for sample rate enhancement in DASs for low-cost sensing nodes.

    Science.gov (United States)

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

    2014-01-01

    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. PMID:25313493

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

    Directory of Open Access Journals (Sweden)

    Francesco Bonavolontà

    2014-10-01

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

  18. Optical biosensor system with integrated microfluidic sample preparation and TIRF based detection

    Science.gov (United States)

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

    2013-05-01

    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

  19. Weight gain, metabolic disturbances, and physical health care in a Brazilian sample of outpatients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Gordon PC

    2013-01-01

    Full Text Available Pedro Caldana Gordon,1,2 Josefa Cynara Xavier,2 Mario Rodrigues Louzã21Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, Brazil; 2Schizophrenia Research Program, Institute of Psychiatry, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, BrazilBackground: In the last few decades, a large number of studies have produced compelling evidence that patients with schizophrenia are at increased risk for developing several medical conditions and diseases, including obesity, metabolic disturbances, and cardiovascular diseases. Several protocols have been designed with the aim of reducing such risk.Objective: To investigate current physical health status in a population of outpatients with schizophrenia.Methods: A cross-sectional study was conducted in our outpatient clinic, selecting subjects who met DSM-IV diagnosis criteria for schizophrenia. Data were collected regarding clinical characteristics, lifestyle, medication in use, and biometric and laboratory parameters.Results: A total of 261 patients were included. We found a high prevalence of elevated body mass index (BMI > 25 (70%, dyslipidemia (73.2%, and metabolic syndrome (28.7%. Patients' ages were associated with worsened lipid profiles, but other variables, such as disorder duration or type of antipsychotic in use, were not associated with any metabolic disturbance. Despite the increased prevalence of these conditions, only a small portion of the sample was under regular medical treatment.Conclusion: Outpatients with schizophrenia show signs of poor physical health conditions. These findings reinforce the need for an intensive and appropriate approach to assure that these patients receive adequate clinical referral and treatment.Keywords: psychosis, obesity, public health, antipsychotic drugs, cardiovascular disorders

  20. Market-Based Health Care in Specialty Surgery: Finding Patient-Centered Shared Value.

    Science.gov (United States)

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

    2015-10-01

    : 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. PMID:26308640

  1. Evidence-Based Care of Acute Wounds: A Perspective

    OpenAIRE

    Ubbink, Dirk T.; Brölmann, Fleur E; Go, Peter M N Y H; Vermeulen, Hester

    2015-01-01

    Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects.

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

    Directory of Open Access Journals (Sweden)

    Joerg Weber

    2013-05-01

    Full Text Available Any response to the needs of people with visual impairment and their families will be more effective if eye care workers and CBR programme staff can work together at the community level.

  3. The Appreciative Pedagogy of Palliative Care: Arts-Based or Evidence-Based?

    OpenAIRE

    Lander, Dorothy A.; Graham-Pole, John R

    2006-01-01

    The authors integrate poetry and narrative into their self-study application of the research methodology known as Appreciative Inquiry (AI) focused on: (a) their personal and professional practice and development; (b) their teaching practice in universities and informal/popular education settings; and, (c) their educational research in the area of hospice and palliative care giving. AI is both an arts-based participatory philosophy of practice and a qualitative research methodology.

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

    OpenAIRE

    Hollander, Marcus J.; Kadlec, Helena

    2015-01-01

    This study used Canadian Ministry of Health administrative data for Fiscal Year 2010–2011. After controlling for patients’ age, sex, service-needs level, and continuity of care (ie, attachment to a general practice), the incentives reduced the net annual health care costs for patients with hypertension, chronic obstructive pulmonary disease, and congestive heart failure, but not for diabetes. The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and ...

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

    OpenAIRE

    Evangelia Prevyzi

    2013-01-01

    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...

  6. [Palliative care: an approach based on the professional health categories].

    Science.gov (United States)

    Hermes, Hélida Ribeiro; Lamarca, Isabel Cristina Arruda

    2013-09-01

    Palliative care has emerged as a humanitarian philosophy of caring for terminally ill patients, alleviating their pain and suffering. This care involves the action of an interdisciplinary team, in which all the professional recognize the limits of their performance will help the terminally ill patient to die with dignity. This article deals with the issue of death and dying, both from the traditional and the contemporary standpoint, and how palliative care have been treated in the job categories of medicine, social work, psychology and nursing. The methodology of this study consists of a literature review of articles in the SciELO database, electronic journals and technical books related to the topic. Analysis of the articles revealed a shortage of subjects that deal with the theme of death in professional curricula, as well as few palliative care services in Brazilian society and barriers faced by this new approach to the terminal patient. This research aims to broaden the discussion of palliative care in public health, and provide information for future studies that will address the theme. PMID:23989564

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

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  8. Stigma, burden, social support, and willingness to care among caregivers of PLWHA in home based care South Africa

    OpenAIRE

    Singh, Dinesh; Chaudoir, Stephenie R.; Escobar, Maria Cabrera; Kalichman, Seth

    2011-01-01

    Despite its benefits for people living with HIV/AIDS (PLWHA), home based care (HBC) may have negative effects on caregivers. Caregivers experience high levels of burden and may be targets of HIV related prejudice and discrimination. In this cross-sectional survey of 358 caregivers from five hospices across KwaZulu-Natal, South Africa, 49 (13.7 %) caregivers personally experienced discrimination as a result of caring for PLWHA. One hundred and seventy (47.5%) marked one or more items on the HI...

  9. Event detection using population-based health care databases in randomized clinical trials

    DEFF Research Database (Denmark)

    Thuesen, Leif; Jensen, Lisette Okkels; Tilsted, Hans Henrik; Mæng, Michael; Terkelsen, Christian; Thayssen, Per; Ravkilde, Jan; Christiansen, Evald Høj; Bøtker, Hans Erik; Madsen, Morten; Lassen, Jens F

    2013-01-01

    To describe a new research tool, designed to reflect routine clinical practice and relying on population-based health care databases to detect clinical events in randomized clinical trials.......To describe a new research tool, designed to reflect routine clinical practice and relying on population-based health care databases to detect clinical events in randomized clinical trials....

  10. Application of Rejection Sampling based methodology to variance based parametric sensitivity analysis

    International Nuclear Information System (INIS)

    For estimating the effect of uncertain distribution parameter on the variance of failure probability function (FPF), the map from distribution parameters to FPF is built and the high efficient approximation form is extended to solve the parametric variance-based sensitivity index. Then the parametric variance-based sensitivity index can be firstly expressed as the moments of the FPF, and the FPF is approximated by a product of the univariate functions of the distribution parameters, on which the moments of the FPF approximated by the univariate functions can be easily evaluated by the Gaussian integration using the values of the FPF at the Gaussian nodes. Thus the primary task of evaluating the parametric variance-based sensitivity is transformed to calculate the FPF at Gaussian nodes of the univariate functions, for which Monte Carlo (MC), Extended Monte Carlo (EMC) and Rejection Sampling (RS) are employed and compared here. Only one set of samples of inputs are needed in either EMC or RS. Several numerical and engineering examples are presented to verify the accuracy and efficiency of the proposed approximate methods. Additionally, the results also reveal the virtue of RS which can be more accurate and more unlimited than EMC. - Highlights: • An efficient approximate form is applied for parametric sensitivity analysis. • Gaussian integration techniques are used to compute the moments of FPF. • Extended Monte Carlo is used to compute the FPF with only one set of samples. • Rejection Sampling is applied to estimate FPF by reusing the original samples

  11. Creating an Ethnodrama to Catalyze Dialogue in Home-Based Dementia Care.

    Science.gov (United States)

    Speechley, Mark; DeForge, Ryan T; Ward-Griffin, Catherine; Marlatt, Nicole M; Gutmanis, Iris

    2015-11-01

    This article describes the development of a theater script derived from a critical ethnographic study that followed people living with dementia--and their family and professional caregivers--over an 18-month period. Analysis of the ethnographic data yielded four themes that characterized home-based dementia care relationships: managing care resources, making care decisions, evaluating care practices, and reifying care norms. The research team expanded to include a colleague with playwright experience, who used these themes to write a script. A theater director was included to cast and direct the play, and finally, a videography company filmed the actors on a realistic set. To contribute to the qualitative health research and the research-based theater knowledge translation literatures, this article describes and explains the creative decisions taken as part of our effort to disseminate research focused on home-based dementia care in a way that catalyzes and fosters critical (actionable) dialogue. PMID:26468252

  12. Change in attitudes and performance of critical care teams after a multi-disciplinary simulation-based intervention

    OpenAIRE

    Jennifer Weller; Robert Frengley; Jane Torrie; Webster, Craig S.; Susan Tomlinson; Kaylene Henderson

    2012-01-01

    Objectives: To conduct an in-depth exploration of the self-reported long-term change in attitudes and performance after a full-day multidisciplinary simulation-based course focussed on team management of emergency events in the Critical Care Unit. To address the current lack of knowledge of factors which can lead to improved teamwork performance and their measurement through identification of measurable markers of behaviour and attitude change. Methods: A purposive sample of course participan...

  13. Toward a More Complete Picture of Outpatient, Office-Based Health Care in the U.S.

    Science.gov (United States)

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

    2016-09-01

    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. PMID:27079637

  14. Optimal designs of the median run length based double sampling X chart for minimizing the average sample size.

    Directory of Open Access Journals (Sweden)

    Wei Lin Teoh

    Full Text Available Designs of the double sampling (DS X chart are traditionally based on the average run length (ARL criterion. However, the shape of the run length distribution changes with the process mean shifts, ranging from highly skewed when the process is in-control to almost symmetric when the mean shift is large. Therefore, we show that the ARL is a complicated performance measure and that the median run length (MRL is a more meaningful measure to depend on. This is because the MRL provides an intuitive and a fair representation of the central tendency, especially for the rightly skewed run length distribution. Since the DS X chart can effectively reduce the sample size without reducing the statistical efficiency, this paper proposes two optimal designs of the MRL-based DS X chart, for minimizing (i the in-control average sample size (ASS and (ii both the in-control and out-of-control ASSs. Comparisons with the optimal MRL-based EWMA X and Shewhart X charts demonstrate the superiority of the proposed optimal MRL-based DS X chart, as the latter requires a smaller sample size on the average while maintaining the same detection speed as the two former charts. An example involving the added potassium sorbate in a yoghurt manufacturing process is used to illustrate the effectiveness of the proposed MRL-based DS X chart in reducing the sample size needed.

  15. Comparing Child, Parent, and Family Characteristics in Usual Care and Empirically Supported Treatment Research Samples for Children with Disruptive Behavior Disorders

    Science.gov (United States)

    Baker-Ericzen, Mary J.; Hurlburt, Michael S.; Brookman-Frazee, Lauren; Jenkins, Melissa M.; Hough, Richard L.

    2010-01-01

    This study compared data from 34 research trials of five empirically supported treatments (ESTs) with one large usual care (UC) sample on child, parent, and family characteristics for children with Disruptive Behavior Disorders. Large variations were found within and across ESTs on sample characteristics during the past two decades. Most parent…

  16. [The present and future of community/home-based palliative care in Taiwan].

    Science.gov (United States)

    Ueng, Ruey-Shiuan; Hsu, Su-Hsuan; Shih, Chih-Yuan; Huang, Sheng-Jean

    2015-04-01

    In Taiwan, the Department of Health (DOH) has implemented regulations and policies related to hospice and palliative care since 1995. Taiwan is the first country in Asia to have a Natural Death Act, promulgated in 2000. Although recognition of the need for palliative care in non-cancer terminally ill patients is increasing, at present, the needs of these patients are often not met. Moreover, while a majority of the population prefers to die at home, the percentage of patients who die in the home setting remains small. The palliative care system should be adjusted to improve the accessibility and continuity of care based on the needs of patients. Therefore, the Jin-Shan Branch of the National Taiwan University Hospital has run a pilot community palliative care service model since 2012. National Health Insurance reimbursement was introduced in 2014 for community-based palliative care services. Establishing a formal system of community-based palliative care should be encouraged in order to improve the quality of care at the end of life and to allow more patients to receive end-of-life care and die in their own communities. This system will require that skilled nurses provide discharge planning, symptoms control, end-of-life communications, social-resources integration, and social-support networks in order to achieve a high quality of end-of-life care. PMID:25854944

  17. Effective protein conformational sampling based on predicted torsion angles.

    Science.gov (United States)

    Yang, Yuedong; Zhou, Yaoqi

    2016-04-30

    Protein structure prediction is a long-standing problem in molecular biology. Due to lack of an accurate energy function, it is often difficult to know whether the sampling algorithm or the energy function is the most important factor for failure of locating near-native conformations of proteins. This article examines the size dependence of sampling effectiveness by using a perfect "energy function": the root-mean-squared distance from the target native structure. Using protein targets up to 460 residues from critical assessment of structure prediction techniques (CASP11, 2014), we show that the accuracy of near native structures sampled is relatively independent of protein sizes but strongly depends on the errors of predicted torsion angles. Even with 40% out-of-range angle prediction, 2 Å or less near-native conformation can be sampled. The result supports that the poor energy function is one of the bottlenecks of structure prediction and predicted torsion angles are useful for overcoming the bottleneck by restricting the sampling space in the absence of a perfect energy function. © 2015 Wiley Periodicals, Inc. PMID:26696379

  18. Space distribution of quasars based on optically selected samples

    International Nuclear Information System (INIS)

    A large-scale search for bright quasars was started in 1972. This survey for ultraviolet-excess stellar objects covers some 10,700 sq. deg. and is aimed to be complete, on the average, to B = 16.2. The authors undertook spectroscopic observations of all objects and produced a sample of over 100 quasars with redshifts and magnitudes that constitute the Palomar Bright Quasar Survey. They have used the results of this Survey, together with the Braccesi sample, two objective-prism quasar surveys discussed by Osmer and Smith (1980) and Osmer (1980), and a small, deep sample in SA 57 (Kron and Chiu 1981) to study the space distribution and optical luminosity function of quasars. Some of the main results are summarised. (Auth.)

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

    Directory of Open Access Journals (Sweden)

    Lingli Li

    2013-07-01

    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.  

  20. Searching for evidence-based information in eye care

    OpenAIRE

    Karen Blackhall

    2005-01-01

    A growth in health awareness has led to an increase in the volume and availability of health information. Health care professionals may feel under pressure to read this increasing volume of material. A search on the internet is often a quick and efficient way to find information and this can be done by using one of the many search engines such as Google or Google Scholar2 or one of the health care information portals such as Omni. A previous article by Sally Parsley in the Community Eye Healt...

  1. Prevention and primary care research for children. The need for evidence to precede "evidence-based".

    Science.gov (United States)

    Kleinman, L C

    1998-05-01

    Medical care in the United States continues to face tremendous financial pressures. Public and private health policy claim to encourage primary care and preventive services, but also discourage services that have not been demonstrated to be effective and/or cost-effective. This article suggests a model to illustrate the conceptual relationship between traditional American medical care and "evidenced-based" medicine. It further examines how the lack of an adequate research base makes a move to purely evidence-based care premature for primary care and prevention services. The paper defines a new conceptual statistic, the uncertainty index, as the proportion of non-refuted current practice that is also not corroborated by research evidence. The greater the uncertainty index, the less appropriate is a clinical model restricted to evidence-based care. Specific theoretical barriers to outcomes research in prevention are discussed and simple criteria to determine the desirable components of care are suggested. The need for theoretical and empirical research into primary care and prevention, especially for children, is emphasized. Care that is of low risk, not of extremely high cost, and that is generally believed useful by the community of practitioners is particularly desirable in the absence of data refuting its value. PMID:9635081

  2. Out of care and into care again: A Danish register‐based study of children placed in out-of‐home care before their third birthday

    DEFF Research Database (Denmark)

    Ubbesen, Mads Bonde; Petersen, Liselotte; Mortensen, Preben Bo;

    2012-01-01

    Objective: When children are reunited with their families of origin and the reasons for placing them in out-of-home care no longer exist, it is usually considered a good outcome. Unfortunately, some children are later returned to care. The objective of this register-based study is to describe in ...... histories. A psychiatric history is associated with re-entry only when the family structure consists of two parents. An immigration background is associatedwith a higher like- lihood of reunification and with a lower likelihood of re-entry. ©......Objective: When children are reunited with their families of origin and the reasons for placing them in out-of-home care no longer exist, it is usually considered a good outcome. Unfortunately, some children are later returned to care. The objective of this register-based study is to describe in...... terms of rates the processes of reunification and re-entry, involving children placed in out-of-homecare before their third birthday. Further- more, the objective is to study whether individual and parental characteristics predict reunifications and re-entries. Method: Data were obtained by using...

  3. The Effects of a School-Based Atopy Care Program for School-Aged Children.

    Science.gov (United States)

    Ryu, Hosihn; Lee, Youngjin

    2015-08-01

    The aim of the present study was to evaluate the effectiveness of a school-based atopy care program (SACP) for children with atopic dermatitis (AD). The program is administered by health teachers who are also school nurses. The study compared groups using a pre- and post-test design. Participants were children with AD and their parents (98 dyads; 32 in the test group and 66 in the control group) sampled from four elementary schools in Seoul. After completing the SACP, parents in the test group had significantly increased knowledge of AD (p = .04) and a greater sense of parental efficacy (p = .02) when compared with the control group. This study derived guidelines that elementary health teachers can use in practice for school-aged children with AD. We concluded that there is sufficient evidence of effectiveness for the SACP to be used as a model for chronic disease management in school-aged children. PMID:24942774

  4. Nanotechnology Based Materials and Devices for Health Care

    Science.gov (United States)

    Srivastava, Deepaka; Cho, K.; Brenner, Don; Menon, Madhu; Andriotis, Antonis; Sagman, Uri; Biegel, Bryan A. (Technical Monitor)

    2002-01-01

    This viewgraph presentation provides information on trends in NASA nanotechnology research and development, and future biotechnological applications for that nanotechnology. The presentation covers nanoelectronics, nanosensors, and nanomaterials, biomimetics, devices and materials for health care, carbon nanotubes, biosensors for astrobiology, solid-state nanopores for DNA sequencing, and protein nanotubes.

  5. Surviving managed care: the effect on job satisfaction in hospital-based nursing.

    Science.gov (United States)

    Buiser, M

    2000-06-01

    Major changes brought about by managed care have redefined the nursing profession. Current trends such as case management, downsizing, restructuring of the workforce, and changes in the patient profile have had numerous effects, particularly on job satisfaction among hospital-based nurses. Strategies to improve job satisfaction during this era of increased managed care penetration include enhanced communication mechanisms, support from hospital administration, implementation of care models that promote professional nursing practice, adequate staffing, and competitive salaries and benefits. PMID:11033702

  6. Translating an Evidence-based Lifestyle Intervention Program into Primary Care: Lessons Learned

    OpenAIRE

    Blonstein, Andrea C.; Yank, Veronica; Stafford, Randall S.; Wilson, Sandra R.; Rosas, Lisa Goldman; Ma, Jun

    2013-01-01

    Obesity is one of the top health priorities in the United States. Primary care physicians are the designated “gatekeepers” for obesity prevention, detection, and treatment. However, they and the current U.S. health care structure and reimbursement systems are often ill-equipped to implement evidence-based obesity care. The Group Lifestyle Balance™ (GLB) program is a group-delivery adaptation of the predominantly one-on-one lifestyle intervention proven efficacious in the Diabetes Prevention P...

  7. Men's experiences of emotional, physical, and sexual abuse and abuse in health care : A cross-sectional study of a Swedish random male population sample

    OpenAIRE

    Swahnberg, Katarina; Davidsson-Simmons, Johanna; Hearn, Jeff; Wijma, Barbro

    2012-01-01

    Aims: This article addresses the under-researched area ofmen’s experiences of abuse. The aims were to estimate prevalence ofemotional, physical, and sexual abuse and abuse in health care in a random sample of Swedish adult men, to compare these estimates with previously collected prevalence rates in a male clinical sample to see if prevalence rates were dependant on response rate and sampling method. We also wanted to contribute to a more general analysis of men’s experiences ofvictimisation....

  8. Efficiency of event-based sampling according to error energy criterion.

    Science.gov (United States)

    Miskowicz, Marek

    2010-01-01

    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. PMID:22294925

  9. Tone-Mapped Mean-Shift Based Environment Map Sampling.

    Science.gov (United States)

    Feng, Wei; Yang, Ying; Wan, Liang; Yu, Changguo

    2016-09-01

    In this paper, we present a novel approach for environment map sampling, which is an effective and pragmatic technique to reduce the computational cost of realistic rendering and get plausible rendering images. The proposed approach exploits the advantage of adaptive mean-shift image clustering with aid of tone-mapping, yielding oversegmented strata that have uniform intensities and capture shapes of light regions. The resulted strata, however, have unbalanced importance metric values for rendering, and the strata number is not user-controlled. To handle these issues, we develop an adaptive split-and-merge scheme that refines the strata and obtains a better balanced strata distribution. Compared to the state-of-the-art methods, our approach achieves comparable and even better rendering quality in terms of SSIM, RMSE and HDRVDP2 image quality metrics. Experimental results further show that our approach is more robust to the variation of viewpoint, environment rotation, and sample number. PMID:26584494

  10. MEMS-based shear characterization of soft hydrated samples

    Science.gov (United States)

    Higgs, Gadryn C.; Simmons, Chelsey S.; Gao, Yingning; Fried, Andrew T.; Park, Sung-Jin; Chung, Cindy; Pruitt, Beth L.

    2013-08-01

    We have designed, fabricated, calibrated and tested actuators for shear characterization to assess microscale shear properties of soft substrates. Here, we demonstrate characterization of dry silicone and hydrated polyethylene glycol. Microscale tools, including atomic force microscopes and nanoindenters, often have limited functionality in hydrated environments. While electrostatic comb-drive actuators are particularly susceptible to moisture damage, through chemical vapor deposition of hexamethyldisiloxane, we increase the hydrophobicity of our electrostatic devices to a water contact angle 90 ± 3°. With this technique, we determine the effective shear stiffness of both dry and hydrated samples for a range of soft substrates. Using computational and analytical models, we compare our empirically determined effective shear stiffness with existing characterization methods, rheology, and nanoindentation, for samples with shear moduli ranging from 5-320 kPa. This work introduces a new approach for microscale assessment of synthetic materials that can be used on biological materials for basic and applied biomaterials research.

  11. Nonparametric estimation of a trend based upon sampled continuous processes

    OpenAIRE

    Degras, David

    2008-01-01

    Let X be a second order random process indexed by a compact interval [0,T]. Assume that n independent realizations of X are observed on a fixed grid of p time points. Under mild regularity assumptions on the sample paths of X, we show the asymptotic normality of suitable nonparametric estimators of the trend function mu = EX in the space C([0,T]) as n, p go to infinity and, using Gaussian process theory, we derive approximate simultaneous confidence bands for mu.

  12. Evaluation of biological sample preparation for immunosignature-based diagnostics.

    Science.gov (United States)

    Chase, Brian Andrew; Johnston, Stephen Albert; Legutki, Joseph Barten

    2012-03-01

    To address the need for a universal system to assess health status, we previously described a method termed "immunosignaturing" which splays the entire humoral antibody repertoire across a peptide microarray. Two important issues relative to the potential broad use of immunosignatures are sample preparation and stability. In the present study, we compared the immunosignatures developed from serum, plasma, saliva, and antibodies eluted from blood dried onto filter paper. We found that serum and plasma provide identical immunosignatures. Immunosignatures derived from dried blood also correlated well with those from nondried serum from the same individual. Immunosignatures derived from dried blood were capable of distinguishing naïve mice from those infected with influenza virus. Saliva was applied to the arrays, and the IgA immunosignature correlated strongly with that from dried blood. Finally, we demonstrate that dried blood retains immunosignature information even when exposed to high temperature. This work expands the potential diagnostic uses for immunosignatures. These features suggest that different forms of archival samples can be used for diagnosis development and that in prospective studies samples can be easily procured. PMID:22237890

  13. The Performance Analysis Based on SAR Sample Covariance Matrix

    Directory of Open Access Journals (Sweden)

    Esra Erten

    2012-03-01

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

  14. Associations between birth health, maternal employment, and child care arrangement among a community sample of mothers with young children.

    Science.gov (United States)

    Chiao, Chi; Chyu, Laura; Ksobiech, Kate

    2014-01-01

    Although a large body of literature exists on how different types of child care arrangements affect a child's subsequent health and sociocognitive development, little is known about the relationship between birth health and subsequent decisions regarding type of nonparental child care as well as how this relationship might be influenced by maternal employment. This study used data from the Los Angeles Families and Neighborhoods Survey (L.A.FANS). Mothers of 864 children (ages 0-5) provided information regarding birth weight, maternal evaluation of a child's birth health, child's current health, maternal employment, type of child care arrangement chosen, and a variety of socioeconomic variables. Child care options included parental care, relative care, nonrelative care, and daycare center. Multivariate analyses found that birth weight and subjective rating of birth health had similar effects on child care arrangement. After controlling for a child's age and current health condition, multinomial logit analyses found that mothers with children with poorer birth health are more likely to use nonrelative and daycare centers than parental care when compared to mothers with children with better birth health. The magnitude of these relationships diminished when adjusting for maternal employment. Working mothers were significantly more likely to use nonparental child care than nonemployed mothers. Results suggest that a child's health early in life is significantly but indirectly related to subsequent decisions regarding child care arrangements, and this association is influenced by maternal employment. Development of social policy aimed at improving child care service should take maternal and family backgrounds into consideration. PMID:24188296

  15. Who Shall Not Be Treated: Public Attitudes on Setting Health Care Priorities by Person-Based Criteria in 28 Nations

    Science.gov (United States)

    Rogge, Jana; Kittel, Bernhard

    2016-01-01

    The principle of distributing health care according to medical need is being challenged by increasing costs. As a result, many countries have initiated a debate on the introduction of explicit priority regulations based on medical, economic and person-based criteria, or have already established such regulations. Previous research on individual attitudes towards setting health care priorities based on medical and economic criteria has revealed consistent results, whereas studies on the use of person-based criteria have generated controversial findings. This paper examines citizens’ attitudes towards three person-based priority criteria, patients’ smoking habits, age and being the parent of a young child. Using data from the ISSP Health Module (2011) in 28 countries, logistic regression analysis demonstrates that self-interest as well as socio-demographic predictors significantly influence respondents’ attitudes towards the use of person-based criteria for health care prioritization. This study contributes to resolving the controversial findings on person-based criteria by using a larger country sample and by controlling for country-level differences with fixed effects models. PMID:27280775

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

    International Nuclear Information System (INIS)

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

  17. A portable system for identifying urinary tract infection in primary care using a PC-based chromatic technique

    International Nuclear Information System (INIS)

    An approach is described for monitoring urine samples using a portable system based on chromatic techniques and for predicting urinary tract infection (UTI) from the results. The system uses a webcam–computer combination with the screen of a computer visual display unit as a tuneable illumination source. It is shown that the system can operate in a robust manner under ambient lighting conditions and with potential for use as a point of care test in primary care. The present approach combines information on urine liquid concentration and turbidity. Its performance in an exploratory study is compared with microbiological culture of 200 urine samples, of which 79 had bacterial growth >105 colony forming unit/millilitre (cfu ml−1) indicative of UTI. It is shown that both sensitivity and negative predictive value of 0.92 could be achieved. (paper)

  18. Point-of-care multiplexed assays of nucleic acids using microcapillary-based loop-mediated isothermal amplification.

    Science.gov (United States)

    Zhang, Yi; Zhang, Lu; Sun, Jiashu; Liu, Yulei; Ma, Xingjie; Cui, Shangjin; Ma, Liying; Xi, Jianzhong Jeff; Jiang, Xingyu

    2014-07-15

    This report demonstrates a straightforward, robust, multiplexed and point-of-care microcapillary-based loop-mediated isothermal amplification (cLAMP) for assaying nucleic acids. This assay integrates capillaries (glass or plastic) to introduce and house sample/reagents, segments of water droplets to prevent contamination, pocket warmers to provide heat, and a hand-held flashlight for a visual readout of the fluorescent signal. The cLAMP system allows the simultaneous detection of two RNA targets of human immunodeficiency virus (HIV) from multiple plasma samples, and achieves a high sensitivity of two copies of standard plasmid. As few nucleic acid detection methods can be wholly independent of external power supply and equipment, our cLAMP holds great promise for point-of-care applications in resource-poor settings. PMID:24937125

  19. Evidence based nursing practice : one exploratory study between different care settings

    OpenAIRE

    Pereira, Rui Pedro Gomes; Martins, Alice; Peixoto, Maria José; Martins, Teresa; Barbieri, Maria do Céu; Carneiro, António Vaz

    2014-01-01

    Introduction: Currently, the importance of a clinical practice based on the best available evidence justifies the development of investigation to construct a situational diagnosis that allows to identify in different contexts of care, barriers, attitudes and practices towards an evidence-based nursing. Objective: In this investigation we aim to identify barriers regarding the adoption of an Evidence Based Practice (EBP) in different care settings and describe the main nurse’s attitudes and pr...

  20. Direct writing electrodes using a ball pen for paper-based point-of-care testing.

    Science.gov (United States)

    Li, Zedong; Li, Fei; Hu, Jie; Wee, Wei Hong; Han, Yu Long; Pingguan-Murphy, Belinda; Lu, Tian Jian; Xu, Feng

    2015-08-21

    The integration of paper with an electrochemical device has attracted growing attention for point-of-care testing, where it is of great importance to fabricate electrodes on paper in a low-cost, easy and versatile way. In this work, we report a simple strategy for directly writing electrodes on paper using a pressure-assisted ball pen to form a paper-based electrochemical device (PED). This method is demonstrated to be capable of fabricating electrodes on paper with good electrical conductivity and electrochemical performance, holding great potential to be employed in point-of-care applications, such as in human health diagnostics and food safety detection. As examples, the PEDs fabricated using the developed method are applied for detection of glucose in artificial urine and melamine in sample solutions. Furthermore, our developed strategy is also extended to fabricate PEDs with multi-electrode arrays and write electrodes on non-planar surfaces (e.g., paper cup, human skin), indicating the potential application of our method in other fields, such as fabricating biosensors, paper electronics etc. PMID:26079757

  1. An Empirical Typology of Residential Care/Assisted Living Based on a Four-State Study

    Science.gov (United States)

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

    2006-01-01

    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…

  2. Mediators of Telephone-Based Continuing Care for Alcohol and Cocaine Dependence

    Science.gov (United States)

    Mensinger, Janell Lynn; Lynch, Kevin G.; Tenhave, Thomas R.; McKay, James R.

    2007-01-01

    A previous randomized trial with 224 alcohol and/or cocaine addicts who had completed an initial phase of treatment indicated that 12 weeks of telephone-based continuing care yielded higher abstinence rates over 24 months than did group counseling continuing care. The current study examined mediators of this treatment effect. Results suggested…

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

    OpenAIRE

    Poortaghi; Salsali; Ebadi; Rahnavard; Maleki

    2015-01-01

    Background Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally. Objectives This study aimed to audit nursing care based on a nursing process model. Patients and Methods This was a cross-sectional descriptive study in which a nursing audit checkl...

  4. Iterations of the SafeCare Model: An Evidence-Based Child Maltreatment Prevention Program

    Science.gov (United States)

    Edwards, Anna; Lutzker, John R.

    2008-01-01

    SafeCare is an evidenced-based parenting program for at-risk and maltreating parents that addresses the social and family ecology in which child maltreatment occurs. SafeCare home visitors focus on behavioral skills that are trained to predetermined performance criteria. Recent research has stressed the importance of successful dissemination and…

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

    NARCIS (Netherlands)

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

    2015-01-01

    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

  6. 75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting

    Science.gov (United States)

    2010-11-03

    ... Transitions Program (CCTP) Meeting AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice... about the upcoming Community-based Care Transitions Program. The meeting is open to the public, but... will be posted on the CMS Care Transitions Web site at...

  7. A FCA-based analysis of sequential care trajectories

    OpenAIRE

    Egho, Elias; Jay, Nicolas; Raïssi, Chedy; Napoli, Amedeo

    2011-01-01

    This paper presents a research work in the domains of sequential pattern mining and formal concept analysis. Using a combined method, we show how concept lattices and interestingness measures such as stability can improve the task of discovering knowledge in symbolic sequential data. We give example of a real medical application to illustrate how this approach can be useful to discover patterns of trajectories of care in a french medico-economical database.

  8. Episode-Based Payment for Perinatal Care in Medicaid: Implications for Practice and Policy.

    Science.gov (United States)

    Jarlenski, Marian; Borrero, Sonya; La Charité, Trey; Zite, Nikki B

    2016-06-01

    Medicaid is an important source of health insurance coverage for low-income pregnant women and covers nearly half of all deliveries in the United States. In the face of budgetary pressures, several state Medicaid programs have implemented or are considering implementing episode-based payments for perinatal care. Under the episode-based payment model, Medicaid programs make a single payment for all pregnancy-related medical services provided to women with low- and medium-risk pregnancies from 40 weeks before delivery through 60 days postpartum. The health care provider who delivers a live birth is assigned responsibility for all care and must meet certain quality metrics and stay within delineated cost-per-episode parameters. Implementation of cost- and quality-dependent episode-based payments for perinatal care is notable because there is no published evidence about the effects of such initiatives on pregnancy or birth outcomes. In this article, we highlight challenges and potential adverse consequences related to defining the perinatal episode and assigning a responsible health care provider. We also describe concerns that perinatal care quality metrics may not address the most pressing health care issues that are likely to improve health outcomes and reduce costs. In their current incarnations, Medicaid programs' episode-based payments for perinatal care may not improve perinatal care delivery and subsequent health outcomes. Rigorous evaluation of the new episode-based payment initiatives is critically needed to inform policymakers about the intended and unintended consequences of implementing episode-based payments for perinatal care. PMID:27159762

  9. Care Seeking Patterns Among Women Who Have Experienced Gender-Based Violence in Afghanistan.

    Science.gov (United States)

    Stokes, Sonya; Seritan, Andreea L; Miller, Elizabeth

    2016-06-01

    This study explored patterns of abuse and care seeking among women victims of gender-based violence (GBV) in Afghanistan. Individual, semi-structured interviews were conducted with 22 Afghan women (M age = 19 years) living in a shelter for victims of GBV. Interviews were analyzed thematically. Participants reported experiencing multiple forms of abuse. The majority received medical treatment for abuse-related health concerns. However, less than half reported abuse to health care providers or were asked by health care providers about the context of their injuries. Strategies to improve health care responses to GBV are needed to ensure safety and support for Afghan women. PMID:26681300

  10. FEAMAC/CARES Stochastic-Strength-Based Damage Simulation Tool for Ceramic Matrix Composites

    Science.gov (United States)

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

    2016-01-01

    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.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    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...

  12. Integrated optical deserialiser time sampling based SiGe photoreceiver.

    Science.gov (United States)

    Hai, Mohammed Shafiqul; Ménard, Michaël; Liboiron-Ladouceur, Odile

    2015-12-14

    A novel photoreceiver architecture enabling parallel processing in the electronic domain of a high-speed optical signal is demonstrated. This allows the electronics to operate at significantly lower frequency than the optical signal and hence reduce power consumption and the impact of parasitics. The photoreceiver performs optical time sampling with four integrated SiGe photodetectors connected in series by waveguide delay lines. Four variations of the optical time sampling receiver are designed and demonstrated which differ by the data rate (10 Gb/s and 20 Gb/s) and silicon delay waveguide loss (2.5 dB/cm and 0.2 dB/cm). The bit error rate performance of the photodetectors in the receiver was measured individually and reached a performance below 1 × 10⁻¹⁰ at an input optical power between 4.8 and 6.3 dBm through an off-chip 50 Ω load at the output. After O/E conversion, the electrical signal (one segment of 2¹⁵ - 1 PRBS data) from each of the photodetector is processed without errors at a quarter of the bit rate, leading to an overall more power efficient receiver front-end. PMID:26698966

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

    Directory of Open Access Journals (Sweden)

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

    2011-01-01

    Full Text Available 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 services in Karachi. Pharmaceutical care services were developed and offered to pharmacy customers for a period of two months. Acceptability was evaluated with respect to enrollment of participants in the program, discontinuation, and complaints registered. The findings provide a better understanding of pharmaceutical care marketing strategies and are discussed within the context of the health care environment in Karachi.

  14. Student Perceptions of and Confidence in Self-Care Course Concepts Using Team-based Learning.

    Science.gov (United States)

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

    2016-04-25

    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. PMID:27170817

  15. Student Perceptions of and Confidence in Self-Care Course Concepts Using Team-based Learning

    Science.gov (United States)

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

    2016-01-01

    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. PMID:27170817

  16. Perceptions of postnatal depression and health care needs in a South African sample: the “mental” in maternal health care

    OpenAIRE

    Kathree, Tasneem; Selohilwe, One M; Bhana, Arvin; Petersen, Inge

    2014-01-01

    Background Maternal mental health care is a neglected area in low and middle income countries (LAMIC) such as South Africa, where maternal and child health care priorities are focused on reducing maternal and infant mortality and promoting infant physical health. In the context of a paucity of mental health specialists, the aim of this study was to understand the explanatory models of illness held by women with maternal depression with the view to informing the development of an appropriate c...

  17. Sexual offender recidivism among a population-based prison sample.

    Science.gov (United States)

    Rettenberger, Martin; Briken, Peer; Turner, Daniel; Eher, Reinhard

    2015-04-01

    The present study examines recidivism rates in sexual offenders using officially registered reconvictions in a representative data set of N = 1,115 male sexual offenders from Austria. In general, results indicate that most sexual offenders do not reoffend sexually after release from prison. More detailed, within the first 5 years after release, the sexual recidivism rate was 6% for the total sample, 4% for the rapist subgroup, and 8% for the child molester subgroup. The findings confirmed previous studies about sex offender recidivism which have shown that first-time sexual offenders are significantly less likely to sexually reoffend than those with previous sexual convictions. With regard to the relationship between age and sexual recidivism, the results challenged the traditional assumption of a clear linear function between age and recidivism. Taken together, compared with previous studies, the recidivism rates found in the present investigation are substantially lower than previous research has indicated. PMID:24398599

  18. 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.

    1994-09-01

    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.

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

    Directory of Open Access Journals (Sweden)

    van der Weijden Trudy

    2008-08-01

    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

  20. Protein expression based multimarker analysis of breast cancer samples

    Directory of Open Access Journals (Sweden)

    Rajasekaran Ayyappan K

    2011-06-01

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

  1. Protein expression based multimarker analysis of breast cancer samples

    International Nuclear Information System (INIS)

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

  2. A review of instruments to measure interprofessional team-based primary care.

    Science.gov (United States)

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

    2016-07-01

    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: http://primarycaremeasures.ahrq.gov/team-based-care/ ). 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. PMID:27212003

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

    Directory of Open Access Journals (Sweden)

    Aleksandra Korzeniewska-Eksterowicz

    2013-01-01

    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.

  4. An Agent-Based Approach to Care in Independent Living

    Science.gov (United States)

    Kaluža, Boštjan; Mirchevska, Violeta; Dovgan, Erik; Luštrek, Mitja; Gams, Matjaž

    This paper presents a multi-agent system for the care of elderly people living at home on their own, with the aim to prolong their independence. The system is composed of seven groups of agents providing a reliable, robust and flexible monitoring by sensing the user in the environment, reconstructing the position and posture to create the physical awareness of the user in the environment, reacting to critical situations, calling for help in the case of an emergency, and issuing warnings if unusual behavior is detected. The system has been tested during several on-line demonstrations.

  5. Safeguard for Mars Sample Return Based on an Apoptotic Approach

    Science.gov (United States)

    Clark, B.

    A critical link in assuring no inadvertent exposure of returned martian material to the terrestrial biosphere before it has been certified safe by laboratory analysis is the reentry into Earth's atmosphere. For optimized designs, the hypervelocity phase of entry can be traversed safely provided the return capsule remains oriented properly and the angle of entry does not exceed some critical value, beyond which the peak heating rates could overwhelm the forebody protective ablator. Various potential failure modes, although of extremely low probability, c uld result in advertento release of material from an interior vault due to burnthrough and/or breakup of the capsule. It is proposed that an effective, yet mass-efficient and affordable countermeasure to this unlikely event would be a Programmed Self-Sterilization Protocol, by which any deviation from nominal entry conditions (such as failed separation, loss of control, impaired orientation, or improper flight trajectory) would result in autonomous neutralization of sample material by an onboard system prior to reaching the atmospheric interface. The approach is analogous and mimetic of the widespread biological mechanism of inhibited apoptosis, in which programmed cell death is derepressed and allowed to proceed if the cell is not functioning properly.

  6. Feature-Based Digital Modulation Recognition Using Compressive Sampling

    Directory of Open Access Journals (Sweden)

    Zhuo Sun

    2016-01-01

    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.

  7. Columbia University's Competency and Evidence-based Acute Care Nurse Practitioner Program.

    Science.gov (United States)

    Curran, Christine R.; Roberts, W. Dan

    2002-01-01

    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)

  8. Enhanced Conformational Sampling in Molecular Dynamics Simulations of Solvated Peptides: Fragment-Based Local Elevation Umbrella Sampling.

    Science.gov (United States)

    Hansen, Halvor S; Daura, Xavier; Hünenberger, Philippe H

    2010-09-14

    A new method, fragment-based local elevation umbrella sampling (FB-LEUS), is proposed to enhance the conformational sampling in explicit-solvent molecular dynamics (MD) simulations of solvated polymers. The method is derived from the local elevation umbrella sampling (LEUS) method [ Hansen and Hünenberger , J. Comput. Chem. 2010 , 31 , 1 - 23 ], which combines the local elevation (LE) conformational searching and the umbrella sampling (US) conformational sampling approaches into a single scheme. In LEUS, an initial (relatively short) LE build-up (searching) phase is used to construct an optimized (grid-based) biasing potential within a subspace of conformationally relevant degrees of freedom, which is then frozen and used in a (comparatively longer) US sampling phase. This combination dramatically enhances the sampling power of MD simulations but, due to computational and memory costs, is only applicable to relevant subspaces of low dimensionalities. As an attempt to expand the scope of the LEUS approach to solvated polymers with more than a few relevant degrees of freedom, the FB-LEUS scheme involves an US sampling phase that relies on a superposition of low-dimensionality biasing potentials optimized using LEUS at the fragment level. The feasibility of this approach is tested using polyalanine (poly-Ala) and polyvaline (poly-Val) oligopeptides. Two-dimensional biasing potentials are preoptimized at the monopeptide level, and subsequently applied to all dihedral-angle pairs within oligopeptides of 4,  6,  8, or 10 residues. Two types of fragment-based biasing potentials are distinguished: (i) the basin-filling (BF) potentials act so as to "fill" free-energy basins up to a prescribed free-energy level above the global minimum; (ii) the valley-digging (VD) potentials act so as to "dig" valleys between the (four) free-energy minima of the two-dimensional maps, preserving barriers (relative to linearly interpolated free-energy changes) of a prescribed magnitude

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

    DEFF Research Database (Denmark)

    Poulsen, Carl Esben

    , droplet packing, imaging and amplification (heating). The project has been broken into sub-projects, in which several devices of simpler application have been developed. Most of these employ gravity for concentrating and packing droplets, which has been made possible by the use of large area chambers...... energy directors for ultrasonic welding of microfluidic systems have been presented: 1. Tongue-and-groove energy directors. 2. Laser ablated micropillar energy directors. • Fabrication: Annealing of polymer devices for use with hydrocarbon based multiphase systems. • Experimental design and data analysis...

  10. Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model

    OpenAIRE

    Grier Gareth; Davies Gareth; Habig Karel; Bredmose Per P; Lockey David J

    2010-01-01

    Abstract Introduction We describe a system of scenario-based training using simple mannequins under realistic circumstances for the training of pre-hospital care providers. Methods A simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic). Training is conducted outdoors at the base location all year round. The scenarios are led by scenario facilitators who are predo...

  11. Course and outcome of eating disorders in a primary care-based cohort.

    OpenAIRE

    Son, G.E. van; Hoeken, D. van; Furth, E.F. van; Donker, G A; Hoek, H.W.

    2010-01-01

    OBJECTIVE: To study the course and outcome of patients with eating disorder detected in primary care. METHOD: General practitioners (GP's) provided information on the course and outcome of eating disorders in patients (n = 147) diagnosed with anorexia nervosa (AN) or bulimia nervosa (BN) identified during a Dutch nationwide primary care-based incidence study. The research team determined the outcome based on the data provided by the GP's. The mean duration of the follow-up was 4.8 years. RESU...

  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;

    2012-01-01

    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...... background population. Data from the Danish National Registers were used to assess health care use in both primary and secondary care. RESULTS: Somatoform patients incurred 2.11 (2.09-2.12) times the primary care visits of controls. They had 3.12 (3.08-3.16) times as many somatic bed-days than controls and 3...

  13. SAT-Based Complete Don't-Care Computation for Network Optimization

    CERN Document Server

    Mishchenko, Alan

    2011-01-01

    This paper describes an improved approach to Boolean network optimization using internal don't-cares. The improvements concern the type of don't-cares computed, their scope, and the computation method. Instead of the traditionally used compatible observability don't-cares (CODCs), we introduce and justify the use of complete don't-cares (CDC). To ensure the robustness of the don't-care computation for very large industrial networks, a optional windowing scheme is implemented that computes substantial subsets of the CDCs in reasonable time. Finally, we give a SAT-based don't-care computation algorithm that is more efficient than BDD-based algorithms. Experimental results confirm that these improvements work well in practice. Complete don't-cares allow for a reduction in the number of literals compared to the CODCs. Windowing guarantees robustness, even for very large benchmarks on which previous methods could not be applied. SAT reduces the runtime and enhances robustness, making don't-cares affordable for a v...

  14. A miniaturised image based fluorescence detection system for point-of-care-testing of cocaine abuse

    Science.gov (United States)

    Walczak, Rafał; Krüger, Jan; Moynihan, Shane

    2015-08-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Yasmeen Shagufta

    2012-02-01

    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

  16. Posttraumatic stress disorder across two generations: concordance and mechanisms in a population-based sample

    Science.gov (United States)

    Roberts, Andrea L.; Galea, Sandro; Austin, S. Bryn; Cerda, Magdalena; Wright, Rosalind J.; Rich-Edwards, Janet W.; Koenen, Karestan C.

    2012-01-01

    Background Research conducted using small samples of persons exposed to extreme stressors has documented an association between parental and offspring posttraumatic stress disorder (PTSD), but it is unknown whether this association exists in the general population and whether trauma exposure mediates this association. We sought to determine whether mothers’ posttraumatic stress symptoms were associated with PTSD in their young adult children and whether this association was mediated by higher trauma exposure in children of women with PTSD. Methods Using data from a cohort of mothers (n=6924) and a cohort of their children (n=8453), we calculated risk ratios (RR) for child’s PTSD and examined mediation by trauma exposure. Results Mother’s lifetime posttraumatic stress symptoms were associated with child’s PTSD in dose-response fashion (mother’s 1 to 3 symptoms, child’s RR=1.2; mother’s 4-5 symptoms, RR=1.3; mother’s 6-7 symptoms, RR=1.6, compared to children of mothers with no symptoms, p<0.001 for each). Mother’s lifetime symptoms were also associated with child’s trauma exposure in dose-response fashion. Elevated exposure to trauma substantially mediated elevated risk for PTSD in children of women with symptoms (mediation proportion, 74%, p<0.001). Conclusions Intergenerational association of PTSD is clearly present in a large population-based sample. Children of women who had PTSD were more likely than children of women without PTSD to experience traumatic events; this suggests, in part, why the disorder is associated across generations. Health care providers who treat mothers with PTSD should be aware of the higher risk for trauma exposure and PTSD in their children. PMID:22521146

  17. The acceptability of Internet-based treatment and characteristics of an adult sample with obsessive compulsive disorder: an Internet survey.

    Directory of Open Access Journals (Sweden)

    Bethany M Wootton

    Full Text Available BACKGROUND: Obsessive-compulsive disorder (OCD is a disabling anxiety disorder, but most individuals delay seeking treatment. Internet-based cognitive behavioural therapy (iCBT is an innovative service delivery method that may help to improve access to care, but the acceptability to consumers of such programs has not yet been established. METHODOLOGY: People with symptoms of OCD were invited to complete an online survey enquiring about demographic characteristics, symptom severity, and acceptability of Internet-based treatment. Demographic and symptom severity data were compared with people with OCD identified in a national epidemiological survey and with a sample of patients with OCD from a specialist outpatient anxiety clinic. PARTICIPANTS: 129 volunteers to an online Internet survey, 135 patients at a specialist anxiety disorders outpatient clinic, and 297 cases identified in a national epidemiological survey. MAIN MEASURES: Demographic characteristics, and severity of symptoms as measured by the Kessler 10-Item scale, the 12-item World Health Organisation Disability Assessment Schedule-Second Edition and the Yale Brown Obsessive Compulsive Scale-Self Report Version. PRINCIPAL FINDINGS: The Internet sample was similar demographically but reported more severe symptoms than the comparison groups, although had similar severity of symptoms of OCD compared with other clinical samples reported in the literature. Participants reported Internet-based treatment for OCD would be highly acceptable. CONCLUSIONS: Internet-based treatment may reduce barriers to accessing treatment to people with OCD. Individuals in this study were similar demographically to other samples and had similar severity of symptoms as those identified in other clinical samples, suggesting that Internet-based treatment using techniques employed in face-to-face treatment may be effective in this group. Internet-based treatments for OCD need to be developed and evaluated.

  18. Predictors of caregiver burden across the home-based palliative care trajectory in Ontario, Canada.

    Science.gov (United States)

    Guerriere, Denise; Husain, Amna; Zagorski, Brandon; Marshall, Denise; Seow, Hsien; Brazil, Kevin; Kennedy, Julia; Burns, Sheri; Brooks, Heather; Coyte, Peter C

    2016-07-01

    Family caregivers of patients enrolled in home-based palliative care programmes provide unpaid care and assistance with daily activities to terminally ill family members. Caregivers often experience caregiver burden, which is an important predictor of anxiety and depression that can extend into bereavement. We conducted a longitudinal, prospective cohort study to comprehensively assess modifiable and non-modifiable patient and caregiver factors that account for caregiver burden over the palliative care trajectory. Caregivers (n = 327) of patients with malignant neoplasm were recruited from two dedicated home-based palliative care programmes in Southern Ontario, Canada from 1 July 2010 to 31 August 2012. Data were obtained from bi-weekly telephone interviews with caregivers from study admission until death, and from palliative care programme and home-care agency databases. Information collected comprised patient and caregiver demographics, utilisation of privately and publicly financed resources, patient clinical status and caregiver burden. The average age of the caregivers was 59.0 years (SD: 13.2), and almost 70% were female. Caregiver burden increased over time in a non-linear fashion from study admission to patient death. Increased monthly unpaid care-giving time costs, monthly public personal support worker costs, emergency department visits and low patient functional status were associated with higher caregiver burden. Greater use of hospice care was associated with lower burden. Female caregivers tended to report more burden compared to men as death approached, and burden was higher when patients were male. Low patient functional status was the strongest predictor of burden. Understanding the influence of modifiable and non-modifiable factors on the experience of burden over the palliative trajectory is essential for the development and targeting of programmes and policies to support family caregivers and reduce burden. Supporting caregivers can have

  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

    2014-12-01

    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. Penn State Worry Questionnaire - 10: A new tool for measurement-based care.

    Science.gov (United States)

    Yao, Beier; Sripada, Rebecca K; Klumpp, Heide; Abelson, James L; Muzik, Maria; Zhao, Zhuo; Rosenblum, Katherine; Briggs, Hedieh; Kaston, Michelle; Warren, Ricks

    2016-05-30

    The Penn State Worry Questionnaire - Past Week (PSWQ-PW) is an adaptation of the widely used Penn State Worry Questionnaire, measuring pathological worry weekly. However, it contains problematic negatively worded items and has not been validated in a large sample yet. To meet the needs of measurement-based care (MBC), we developed a shortened version (PSWQ-10) based on the PSWQ-PW, retaining only positively worded items, and examined its psychometric properties and clinical utility. Patients with Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), and other anxiety disorders completed the PSWQ-10 and other instruments during routine evaluation in an academic anxiety clinic. A second cohort from a perinatal clinic was evaluated similarly. The PSWQ-10 displayed excellent internal consistency, convergent and discriminant validity, and criterion group validity. Patients with GAD scored significantly higher than those with other anxiety disorders but did not differ from those with MDD. The PSWQ-10 showed sensitivity to change over time and demonstrated excellent psychometric properties in the perinatal population. The PSWQ-10 is a reliable, valid, efficient, and straightforward worry-focused instrument that can be readily used in MBC and help clinicians objectively measure worry as a treatment outcome in broad clinical populations. PMID:27137962

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

    Science.gov (United States)

    Fotouhi, Gareth

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

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

    OpenAIRE

    Tsima,; Setlhare, Vincent; Nkomazana, Oathokwa

    2016-01-01

    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 in...

  3. Operationalising emergency care delivery in sub-Saharan Africa: consensus-based recommendations for healthcare facilities.

    Science.gov (United States)

    Calvello, Emilie J B; Tenner, Andrea G; Broccoli, Morgan C; Skog, Alexander P; Muck, Andrew E; Tupesis, Janis P; Brysiewicz, Petra; Teklu, Sisay; Wallis, Lee; Reynolds, Teri

    2016-08-01

    A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. PMID:26202673

  4. Solar-thermal complex sample processing for nucleic acid based diagnostics in limited resource settings

    OpenAIRE

    Gumus, Abdurrahman; Ahsan, Syed; Dogan, Belgin; Jiang, Li; Snodgrass, Ryan; Gardner, Andrea; Lu, Zhengda; Simpson, Kenneth; Erickson, David

    2016-01-01

    The use of point-of-care (POC) devices in limited resource settings where access to commonly used infrastructure, such as water and electricity, can be restricted represents simultaneously one of the best application fits for POC systems as well as one of the most challenging places to deploy them. Of the many challenges involved in these systems, the preparation and processing of complex samples like stool, vomit, and biopsies are particularly difficult due to the high number and varied natu...

  5. Validating evidence based decision making in health care

    DEFF Research Database (Denmark)

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

    Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register 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 are...

  6. 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

    2011-06-01

    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

  7. 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

    2008-01-01

    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.

  8. Health-related Quality of Life across the Anxiety Disorders: Findings from a Sample of Primary Care Patients

    OpenAIRE

    Beard, Courtney; Weisberg, Risa B.; Keller, Martin B.

    2010-01-01

    Previous studies have not compared Health-related Quality of Life (HR-QoL) across all DSM-IV anxiety disorders and comorbid conditions. We compared the effects of each anxiety disorder on HR-QoL, controlling for demographic variables, medical conditions, and comorbid Axis I disorders. Data are obtained from the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxiety disorders in 539 primary care patients. Each of the anxiety disorders was associated with worse self-...

  9. Cost Analysis of a Home-Based Nurse Care Coordination Program

    OpenAIRE

    Marek, Karen Dorman; Stetzer, Frank; Adams, Scott J.; Bub, Linda Denison; Schlidt, Andrea; Colorafi, Karen Jiggins

    2014-01-01

    Objectives To determine whether a home-based care coordination program focused on medication self-management would affect the cost of care to the Medicare program and whether the addition of technology, a medication-dispensing machine, would further reduce cost. Design Randomized, controlled, three-arm longitudinal study. Setting Participant homes in a large Midwestern urban area. Participants Older adults identified as having difficulty managing their medications at discharge from Medicare H...

  10. Speed of updating online evidence based point of care summaries: prospective cohort analysis

    OpenAIRE

    Banzi, Rita; Cinquini, Michela; Liberati, Alessandro; Moschetti, Ivan; Pecoraro, Valentina; Tagliabue, Ludovica; Moja, Lorenzo

    2011-01-01

    Objective To evaluate the ability of international point of care information summaries to update evidence relevant to medical practice. Design Prospective cohort bibliometric analysis. Setting Top five point of care information summaries (Clinical Evidence, EBMGuidelines, eMedicine, Dynamed, UpToDate) ranked for coverage of medical conditions, editorial quality, and evidence based methodology. Main outcome measures From June 2009 to May 2010 we measured the incidence of research findings rela...

  11. The effects of psychological treatment in primary care in Sweden—A practice-based study

    OpenAIRE

    Holmqvist, Rolf; Ström, Thomas; Foldemo, Anniqa

    2014-01-01

    Background: Practice-based studies have found substantial effects of psychological treatment in routine care, often equivalent between treatment methods. Factors that moderate treatment outcome may be important to assess. Aim: The purpose of this study was to evaluate treatment outcome in psychological treatment in primary care, and to compare outcome between the most frequently used methods. An additional aim was to study factors that might moderate outcome differences. Method: The Clinical ...

  12. Music therapists’ practice-based research in cancer and palliative care: Creative methods and situated findings

    OpenAIRE

    Philippa Barry; Clare O'Callaghan

    2009-01-01

    Although randomized controlled trials are described as the gold standard in health care research, their superiority is being questioned in palliative care which is focused on addressing individualized needs to maximize life quality. We use creative practice-based research to examine the usefulness of our music therapy work amongst people with life threatening conditions. Examined voices include “collective” (patients, visitors, staff, and music therapist), "their” (patients or caregivers), "o...

  13. The Effect of Performance-Based Financial Incentives on Improving Patient Care Experiences: A Statewide Evaluation

    OpenAIRE

    Hector P. Rodriguez; Glahn, Ted; Elliott, Marc N.; Rogers, William H.; Safran, Dana Gelb

    2009-01-01

    BACKGROUND Patient experience measures are central to many pay-for-performance (P4P) programs nationally, but the effect of performance-based financial incentives on improving patient care experiences has not been assessed. METHODS The study uses Clinician & Group CAHPS data from commercially insured adult patients (n = 124,021) who had visits with 1,444 primary care physicians from 25 California medical groups between 2003 and 2006. Medical directors were interviewed to assess the magnitude ...

  14. Practice-Based Discourse Analysis of Information Security Policy in Health Care

    OpenAIRE

    Karlsson, Fredrik; Goldkuhl, Göran; Hedström, Karin

    2014-01-01

    Information security is an understudied area within electronic government. In this study, we examine the quality of information security policy design in health care. Employees cause a majority of the security breaches in health care, and many of them are unintentional. In order to support the formulation of practical, from the employees’ perspective, information security policies, we propose eight tentative quality criteria. These criteria were developed using practice-based discourse analys...

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

    Directory of Open Access Journals (Sweden)

    Yousef A Al-Turki

    2007-01-01

    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.

  16. Factors affecting the choice of treatment in occupational therapy practices in hospital-based care.

    OpenAIRE

    Driessen, M.J.; Dekker, J.; Lankhorst, G; Zee, J. van der

    1996-01-01

    The aim of this article was twofold: to describe the occurrence of treatment goals, health-care programmes and type of interventions chosen by occupational therapists; and to investigate relationships between treatment goals, health-care programmes and interventions. A survey on occupational therapy practice was carried out in The Netherlands. A registration form based on the International Classification of Impairments, Disabilities and Handicapts (ICIDH) was filled out for 944 patients. This...

  17. Application of evidence-based urology in improving quality of care

    OpenAIRE

    Panda, Arabind; Dorairajan, L. N.; Kumar, Santosh

    2007-01-01

    Evidence-based medicine requires use of the best available evidence for optimal patient care. Increasingly scarce resources and escalating demands on time have led to emphasis on effective treatment. Opinion is slowly yielding to high-quality existent evidence. It is important that urologists adapt to these changes for them to deliver optimum care to the patients. This article discusses the levels of evidence, the nature of desirable evidence, means of assessing quality of clinical trials and...

  18. Technology-Based Self-Care Methods of Improving Antiretroviral Adherence: A Systematic Review

    OpenAIRE

    SABERI, Parya; Johnson, Mallory O.

    2011-01-01

    Background 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. Methodology/Principal Findings Technology-based methods are increasingly used to enhance antiretroviral adherence; therefore, we system...

  19. Reconciling evidence-based medicine and patient-centred care: defining evidence-based inputs to patient-centred decisions.

    Science.gov (United States)

    Weaver, Robert R

    2015-12-01

    Evidence-based and patient-centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards 'cookbook' medicine undermine the view of patients as unique particulars, and diminish what might be considered patient-centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence-based and person-centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients' uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner-patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence-based and patient-centred approaches. PMID:26456314

  20. Impact of a computerized system for evidence-based diabetes care on completeness of records: a before–after study

    Directory of Open Access Journals (Sweden)

    Roshanov Pavel S

    2012-07-01

    Full Text Available Abstract Background Physicians practicing in ambulatory care are adopting electronic health record (EHR systems. Governments promote this adoption with financial incentives, some hinged on improvements in care. These systems can improve care but most demonstrations of successful systems come from a few highly computerized academic environments. Those findings may not be generalizable to typical ambulatory settings, where evidence of success is largely anecdotal, with little or no use of rigorous methods. The purpose of our pilot study was to evaluate the impact of a diabetes specific chronic disease management system (CDMS on recording of information pertinent to guideline-concordant diabetes care and to plan for larger, more conclusive studies. Methods Using a before–after study design we analyzed the medical record of approximately 10 patients from each of 3 diabetes specialists (total = 31 who were seen both before and after the implementation of a CDMS. We used a checklist of key clinical data to compare the completeness of information recorded in the CDMS record to both the clinical note sent to the primary care physician based on that same encounter and the clinical note sent to the primary care physician based on the visit that occurred prior to the implementation of the CDMS, accounting for provider effects with Generalized Estimating Equations. Results The CDMS record outperformed by a substantial margin dictated notes created for the same encounter. Only 10.1% (95% CI, 7.7% to 12.3% of the clinically important data were missing from the CDMS chart compared to 25.8% (95% CI, 20.5% to 31.1% from the clinical note prepared at the time (p p  Conclusions The CDMS chart captured information important for the management of diabetes more often than dictated notes created with or without its use but we were unable to detect a difference in completeness between notes dictated in CDMS-associated and usual-care encounters. Our sample of

  1. A high efficiency microwave-based sample introduction system for ICP techniques

    OpenAIRE

    Grindlay Lledó, Guillermo; Mora Pastor, Juan; Gras García, Luis; Hernandis Martínez, Vicente

    2007-01-01

    Póster presentado en XIV EuroAnalysis, Antwerp, Belgium, 9-14 September 2007. In this work, a new sample introduction system fully based on MW radiation (MWSIS) has been developed and characterized in ICP-AES. Variables affecting the MWSIS behaviour are: MW power, matrix nature (i.e. acids, salts, organic solvents), sample uptake rate and nozzle diameter. New sample introduction system gives rise to sensitivities and LODs between 10 and 20 times better than a conventional sample introducti...

  2. MONITORING THE PROCESS MEAN BASED ON QUALITY CONTROL CHARTS USING ON FOLDED RANKED SET SAMPLING

    Directory of Open Access Journals (Sweden)

    Amjad Al-Nasser

    2013-02-01

    Full Text Available In this paper, we propose a new quality control chart for the sample mean based on the folded ranked set sampling (FRSS method. The new charts are compared with the classical control charts using simple random sampling (SRS and ranked set sampling (RSS. A simulation study shows that the FRSS control charts have smaller average run length (ARL compared with their counterpart charts using SRS and RSS.

  3. Two-sample Hotelling's T² statistics based on the functional Mahalanobis semi-distance

    OpenAIRE

    Lillo, Rosa E.; Galeano, Pedro; Joseph, Esdras

    2015-01-01

    The comparison of the means of two independent samples is one of the most popular problems in real-world data analysis. In the multivariate context, two-sample Hotelling's T² frequently used to test the equality of means of two independent Gaussian random samples assuming either the same or a different covariance matrix. In this paper, we derive two-sample Hotelling's T² from two functional distributions. The statistics that we propose are based on the functional Mahalanobis semi-distance and...

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

    OpenAIRE

    Robinson, Oliver

    2014-01-01

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

  5. Academic-practice partnerships to promote evidence-based practice in long-term care: oral hygiene care practices as an exemplar.

    Science.gov (United States)

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

    2007-01-01

    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

  6. Determination of free energy profiles by repository based adaptive umbrella sampling: Bridging nonequilibrium and quasiequilibrium simulations

    OpenAIRE

    Zheng, Han; Zhang, Yingkai

    2008-01-01

    We propose a new adaptive sampling approach to determine free energy profiles with molecular dynamics simulations, which is called as “repository based adaptive umbrella sampling” (RBAUS). Its main idea is that a sampling repository is continuously updated based on the latest simulation data, and the accumulated knowledge and sampling history are then employed to determine whether and how to update the biasing umbrella potential for subsequent simulations. In comparison with other adaptive me...

  7. Multiview Sample Classification Algorithm Based on L1-Graph Domain Adaptation Learning

    OpenAIRE

    Huibin Lu; Zhengping Hu; Hongxiao Gao

    2015-01-01

    In the case of multiview sample classification with different distribution, training and testing samples are from different domains. In order to improve the classification performance, a multiview sample classification algorithm based on L1-Graph domain adaptation learning is presented. First of all, a framework of nonnegative matrix trifactorization based on domain adaptation learning is formed, in which the unchanged information is regarded as the bridge of knowledge transformation from the...

  8. TV-Based Caring Videophone System for the Elderly in the Smart Home Environment

    OpenAIRE

    Jingshuang Shen; Chongyang Zhang; Chuanwen Jiang

    2013-01-01

    A novel videophone system for the elderly-care application is proposed. Based on the detailed analysis of the elderly’s physical and psychological characteristics, a TV-based caring videophone system for the elderly is developed: an embedded multimedia device is designed to implement the interactive video and audio processing and IP-based communication, in which TV is adopted as the display terminal to achieve a low-cost but high-quality service. Considering the user’s convenience, many perso...

  9. Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

    OpenAIRE

    Bachmann Max O

    2009-01-01

    Abstract Background Children aged under five years with severe acute malnutrition (SAM) in Africa and Asia have high mortality rates without effective treatment. Primary care-based treatment of SAM can have good outcomes but its cost effectiveness is largely unknown. Method This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition in government primary health care centres in Lusaka, Zambia, compared to no care. A decision...

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

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    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.

  11. Implementation of evidence-based health care using action research: An emancipatory approach.

    Science.gov (United States)

    Cordeiro, Luciana; Soares, Cassia Baldini

    2016-08-01

    The aim of the study is to discuss the emancipatory approach to action research as an appropriate methodology for workers' meaningful implementation of evidence-based health care. Implementation of evidence-based health care using action research is well supported by the literature. There are various approaches to action research, and they are coherent with the objectives and methods elected to develop the investigation. It is not clear which approach of action research is responsible for meaningful worker engagement in changing praxis. This is a discussion paper based on our experiences and supported by literature on collective health. Health care is defined as a social praxis, dependent upon the capitalist mode of production in which health workers engage themselves in a labour process that has negative (as alienation) as well as positive (as creativity) meanings. Emancipatory changes of social praxis through implementation of evidence-based health care require that participants understand the positive and negative meanings of their work and engage health workers in a conscious and intentional collaborative educational process. Implementation of evidence-based health care through emancipatory action research is capable of overcoming alienation and changing social practice through a participatory meaningful process of knowledge translation. PMID:27562664

  12. Mental Health Care in a High School Based Health Service.

    Science.gov (United States)

    Jepson, Lisa; Juszczak, Linda; Fisher, Martin

    1998-01-01

    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,…

  13. Minnesota's Nursing Facility Performance-Based Incentive Payment Program: An Innovative Model for Promoting Care Quality

    Science.gov (United States)

    Cooke, Valerie; Arling, Greg; Lewis, Teresa; Abrahamson, Kathleen A.; Mueller, Christine; Edstrom, Lisa

    2010-01-01

    Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration…

  14. Factors associated with health care discrimination experiences among a national sample of female-to-male transgender individuals.

    Science.gov (United States)

    Shires, Deirdre A; Jaffee, Kim

    2015-05-01

    Transgender individuals experience harassment, violence, and discrimination in a number of settings. Although health care discrimination against transgender people has been documented, this issue is understudied. Using a national cross-sectional survey data set (N = 1,711), the authors sought to determine how gender identity and presentation predict health care discrimination experiences among female-to-male (FTM) transgender people after demographic and socioeconomic characteristics are controlled. Analyses were conducted using chi-square tests and a two-step logistic regression. The majority of participants were white (73.9 percent) and between 25 and 44 years old (65.2 percent). Overall, 41.8 percent of FTM participants reported verbal harassment, physical assault, or denial of equal treatment in a doctor's office or hospital. When other factors were controlled, being Native American or multiracial, identifying as queer or asexual/other, having a graduate degree, living full-time as nonbirth gender, using hormones or surgery for medical transition, and having identification documents that list one's preferred gender were associated with increased reporting of health care discrimination experiences; being 45 years or older and reporting an annual income of $60,000 or more were associated with decreased risk. The study's findings can be useful to social workers, who play a role in educating health care providers and advocating for policies that improve health care experiences for FTM and other transgender patients. PMID:26027422

  15. Implementing Electronic Tablet-Based Education of Acute Care Patients.

    Science.gov (United States)

    Sawyer, Tenita; Nelson, Monica J; McKee, Vickie; Bowers, Margaret T; Meggitt, Corilin; Baxt, Sarah K; Washington, Delphine; Saladino, Louise; Lehman, E Philip; Brewer, Cheryl; Locke, Susan C; Abernethy, Amy; Gilliss, Catherine L; Granger, Bradi B

    2016-02-01

    Poor education-related discharge preparedness for patients with heart failure is believed to be a major cause of avoidable rehospitalizations. Technology-based applications offer innovative educational approaches that may improve educational readiness for patients in both inpatient and outpatient settings; however, a number of challenges exist when implementing electronic devices in the clinical setting. Implementation challenges include processes for "on-boarding" staff, mediating risks of cross-contamination with patients' device use, and selling the value to staff and health system leaders to secure the investment in software, hardware, and system support infrastructure. Strategies to address these challenges are poorly described in the literature. The purpose of this article is to present a staff development program designed to overcome challenges in implementing an electronic, tablet-based education program for patients with heart failure. PMID:26830181

  16. A community based surveillance system for perinatal and neonatal care.

    Science.gov (United States)

    Dyal Chand, A; Khale, M

    1989-11-01

    The impact of maternal health services on perinatal and neonatal mortality depends on both the quantitative and qualitative coverage of pregnant women with obstetric services. In rural areas this becomes all the more difficult because of the requirement of a large decentralized infrastructure extending from village based health workers and subcentres to the Primary Health Centre and tertiary levels of referral. An effective introduction of socio-cultural, biomedical and managerial interventions is required to reduce perinatal and neonatal mortality. A community based surveillance and monitoring system is central to and facilitates the introduction of all other interventions. Finally, the system operated by grass-root level workers is a motivational tool for achieving expected levels of performance. PMID:2630471

  17. Method and Implementation of High-speed Digital Sampling Technology Based on Impulse Radar Signal

    Directory of Open Access Journals (Sweden)

    Shen Shao-xiang

    2012-06-01

    Full Text Available A High-speed digital sampling technology suitable for periodical impulse radar signal is proposed in this paper. One bit high-speed quantize is constructed by differential comparator in FPGA. Time-interleaved digital sampling and buffer encoding are used to one bit stream based on the internal multi-phase clock of FPGA, to achieve sampling rate higher than 1 GHz. High speed digital sampling is realized by the accumulation of one bit sampling data with different comparison levels. An 8 bit, 1.6 GHz ADC based on the proposed method is realized on XC2V3000 Xilinx’s FPGA, which is successfully applied in GPR. The proposed method has the advantages of low cost and power consumption as compared with real sampling, and exhibits higher efficiency as compared with equivalent sampling.

  18. 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

    2010-09-01

    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

  19. Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with advanced heart failure.

    Science.gov (United States)

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

    2016-09-01

    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. PMID:27490299

  20. Evaluation of an Interdisciplinary Curriculum Teaching Team-Based Palliative Care Integration in Oncology.

    Science.gov (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

    2016-06-01

    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. PMID:25708910

  1. Demand and Supply–Based Operating Modes—A Framework for Analyzing Health Care Service Production

    Science.gov (United States)

    Lillrank, Paul; Groop, P Johan; Malmström, Tomi J

    2010-01-01

    Context: The structure of organizations that provide services should reflect the possibilities of and constraints on production that arise from the market segments they serve. Organizational segmentation in health care is based on urgency and severity as well as disease type, bodily function, principal method, or population subgroup. The result is conflicting priorities, goals, and performance metrics. A managerial perspective is needed to identify activities with similar requirements for integration, coordination, and control. Methods: The arguments in this article apply new reasoning to the previous literature. Findings: The method used in this article to classify health care provision distinguishes different types of health problems that share generic constraints of production. Conclusions: The analysis leads to seven different demand-supply combinations, each with its own operational logic. These are labeled demand and supply–based operating modes (DSO modes), and constitute the managerial building blocks of health care organizations. The modes are Prevention, Emergency, One visit, Project, Elective, Cure, and Care. As analytical categories the DSO modes can be used to understand current problems. Several operating modes in one unit create managerial problems of conflicting priorities, goals, and performance metrics. The DSO modes are constructed as managerially homogeneous categories or care platforms responding to general types of demand, and supply constraints. The DSO modes bring methods of industrial management to bear on efforts to improve health care. PMID:21166870

  2. Market-based reforms in health care are both practical and morally sound.

    Science.gov (United States)

    Taylor, James Stacey

    2012-01-01

    In this paper I argue that the free-market provision of health care is both practical and morally sound, and is superior in both respects to its provision by the State. The State provision of health care will be inefficient compared to its free-market alternative. It will thus provide less health care to persons for the same amount of expenditure, and so save fewer lives and alleviate less suffering for two reasons: state actors have no incentive to husband their resources effectively, and that in a non-market setting, special interest groups can capture resources through lobbying, perverting them away from their efficient allocation. Given these considerations of efficiency a utilitarian should morally prefer the free-market provision of health care to its State-based rival. Furthermore, even if one is not a utilitarian, the free-market provision of health care will be more morally sound than its State-based alternative because it will likely better respect the autonomy of persons, and will better refrain from imposing values upon persons. With these points in hand, I address two prominent objections to a free market system of health care. PMID:23061582

  3. Original article The effects of kangaroo mother care in a sample of preterm, preschool aged children

    Directory of Open Access Journals (Sweden)

    Magdalena Chrzan-Dętkoś

    2014-08-01

    Full Text Available Background The research has shown that kangaroo mother care has a protective impact both on health and future cognitive skills of prematurely born babies. The aim of this study was to investigate the relation between the early skin-to-skin contact and the cognitive and emotional-social functioning of preschool aged preterm babies. Participants and procedure The study group included 99 preterm babies. The children participated in a psychological examination conducted using the Columbia Mental Maturity Scale and the Terman-Merrill Test. The data concerning the skin-to-skin contact during the child’s hospitalisation were acquired during interviews with mothers. The emotional development was assessed on the basis of interviews with mothers, conducted using the Rescorla DSM-IV Orientation Scale (2005. Results The study showed no relation between kangaroo mother care and cognitive development. Nevertheless the early skin-to-skin contact turned out to be connected with the emotional functioning of the subjects. Preterm babies who used to experience kangaroo mother care experienced fewer anxiety and depressive disorders than those who did not. In addition it was revealed that the children who suffered from early damage to the brain in the forms of intraventricular and periventricular haemorrhages and experienced kangaroo mother care demonstrated less intense depressive symptoms than those who did not. Conclusions The obtained results, combined with the review of the foreign literature of the subject, indicate the usefulness of introducing kangaroo mother care to neonatal wards and encouraging parents to care about their prematurely born babies in such a way.

  4. Multi-Agent-Based Simulation of a Complex Ecosystem of Mental Health Care.

    Science.gov (United States)

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

    2016-02-01

    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. PMID:26590977

  5. Tablet-based patient monitoring and decision support systems in hospital care.

    Science.gov (United States)

    Baig, Mirza Mansoor; GholamHosseini, Hamid; Linden, Maria

    2015-08-01

    Remote patient monitoring with evidence-based decision support is revolutionizing healthcare. This novel approach could enable both patients and healthcare providers to improve quality of care and reduce costs. Clinicians can also view patients' data within the hospital network on tablet computers as well as other ubiquitous devices. Today, a wide range of applications are available on tablet computers which are increasingly integrating into the healthcare mainstream as clinical decision support systems. Despite the benefits of tablet-based healthcare applications, there are concerns around the accuracy, security and stability of such applications. In this study, we developed five tablet-based application screens for remote patient monitoring at hospital care settings and identified related issues and challenges. The ultimate aim of this research is to integrate decision support algorithms into the monitoring system in order to improve inpatient care and the effectiveness of such applications. PMID:26736485

  6. 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.

    2015-01-01

    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

  7. Carefree in child care ? : child wellbeing, caregiving quality, and intervention programs in center-based child care

    NARCIS (Netherlands)

    Werner, Claudia Denise

    2014-01-01

    The use of center child care in Western countries has increased over the last three decades and is nowadays the most frequently used type of non-parental care for children aged zero to four (OECD, 2013). The aim of the current dissertation is to shed more light on indicators of child care quality in

  8. Strength-based crisis programming: Evaluating the process of care.

    Science.gov (United States)

    Hootz, Terra; Mykota, David B; Fauchoux, Laurissa

    2016-02-01

    In this study, a utilization-focused process evaluation framework was used to explore client and service providers' experiences of Crisis Management Services (CMS), their perceptions of the services provided, and the process of client engagement CMS offers. CMS is a strength-based program that targets individuals who experience crises every day. The Community-University Institute for Social Research facilitated the evaluation by engaging academic expertise in a coordinated collaborative approach to community-university partnerships. Semi-structured interviews were conducted with the clients and service providers. The general inductive approach was used for transcript analysis with seven themes emerging. A conceptual model of service delivery is presented, which integrates the interviews conducted with clients and service providers. Results affirm that the establishment of a close personal strength-based relationship is key to client engagement. Collaborative goal setting with informal and formal community resources viewed as potential assets, characterizes the process that enables clients to live at their optimal level of independence. This study is unique as it provides valuable insight on the perspectives of vulnerable individuals in crisis situations. Through the establishment of community-university partnerships the gap between scholarly research and its applicability to community organizations is narrowed with opportunities for improving the quality of life enhanced. PMID:26512431

  9. Light based techniques for improving health care: studies at RRCAT

    International Nuclear Information System (INIS)

    The invention of Lasers in 1960, the phenomenal advances in photonics as well as the information processing capability of the computers has given a major boost to the R and D activity on the use of light for high resolution biomedical imaging, sensitive, non-invasive diagnosis and precision therapy. The effort has resulted in remarkable progress and it is widely believed that light based techniques hold great potential to offer simpler, portable systems which can help provide diagnostics and therapy in a low resource setting. At Raja Ramanna Centre for Advanced Technology (RRCAT) extensive studies have been carried out on fluorescence spectroscopy of native tissue. This work led to two important outcomes. First, a better understanding of tissue fluorescence and insights on the possible use of fluorescence spectroscopy for screening of cancer and second development of diagnostic systems that can serve as standalone tool for non-invasive screening of the cancer of oral cavity. The optical coherence tomography setups and their functional extensions (polarization sensitive, Doppler) have also been developed and used for high resolution (∼10 µm) biomedical imaging applications, in particular for non-invasive monitoring of the healing of wounds. Chlorophyll based photo-sensitisers and their derivatives have been synthesized in house and used for photodynamic therapy of tumors in animal models and for antimicrobial applications. Various variants of optical tweezers (holographic, Raman etc.) have also been developed and utilised for different applications notably Raman spectroscopy of optically trapped red blood cells. An overview of these activities carried out at RRCAT is presented in this article. (author)

  10. Investigation of anxiety and depression symptom co-morbidity in a community sample with type 2 diabetes: Associations with indicators of self-care.

    OpenAIRE

    Smith, K.; Pedneault, M; Schmitz, N.

    2016-01-01

    OBJECTIVES : Ascertain the association of elevated co-occurring anxiety and depression symptoms, elevated anxiety symptoms alone or elevated depression symptoms alone with indicators of self-care behaviours in people with type 2 diabetes. METHODS : Data from a community sample of 1,990 people diagnosed with type 2 diabetes for less than 10 years were assessed. All participants took part in a telephone interview. Questionnaires examined depression, anxiety, health, and indicators of self-ca...

  11. Cost-effectiveness and cost-utility analyses of hospital-based home care compared to hospital-based care for children diagnosed with type 1 diabetes; a randomised controlled trial; results after two years’ follow-up

    OpenAIRE

    Tiberg, Irén; Lindgren, Björn; Carlsson, Annelie; Hallström, Inger

    2016-01-01

    Background Practices regarding hospitalisation of children at diagnosis of type 1 diabetes vary both within countries and internationally, and high-quality evidence of best practice is scarce. The objective of this study was to close some of the gaps in evidence by comparing two alternative regimens for children diagnosed with type 1 diabetes: hospital-based care and hospital-based home care (HBHC), referring to specialist care in a home-based setting. Methods A randomised controlled trial, i...

  12. A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation.

    Science.gov (United States)

    Dalal, Anuj K; Dykes, Patricia C; Collins, Sarah; Lehmann, Lisa Soleymani; Ohashi, Kumiko; Rozenblum, Ronen; Stade, Diana; McNally, Kelly; Morrison, Constance Rc; Ravindran, Sucheta; Mlaver, Eli; Hanna, John; Chang, Frank; Kandala, Ravali; Getty, George; Bates, David W

    2016-01-01

    We implemented a web-based, patient-centered toolkit that engages patients/caregivers in the hospital plan of care by facilitating education and patient-provider communication. Of the 585 eligible patients approached on medical intensive care and oncology units, 239 were enrolled (119 patients, 120 caregivers). The most common reason for not approaching the patient was our inability to identify a health care proxy when a patient was incapacitated. Significantly more caregivers were enrolled in medical intensive care units compared with oncology units (75% vs 32%; P usability scores and satisfaction ratings of a sample of surveyed enrollees were favorable. From analysis of feedback, we identified barriers to adoption and outlined strategies to promote use. PMID:26239859

  13. Carefree in child care ?: child wellbeing, caregiving quality, and intervention programs in center-based child care

    OpenAIRE

    Werner, Claudia Denise

    2014-01-01

    The use of center child care in Western countries has increased over the last three decades and is nowadays the most frequently used type of non-parental care for children aged zero to four (OECD, 2013). The aim of the current dissertation is to shed more light on indicators of child care quality in center child care and to answer the question whether narrow-focused caregiver interventions are effective in improving child care quality. The reported meta-analysis shows that narrow-focus interv...

  14. Risk-Based Sampling: I Don't Want to Weight in Vain.

    Science.gov (United States)

    Powell, Mark R

    2015-12-01

    Recently, there has been considerable interest in developing risk-based sampling for food safety and animal and plant health for efficient allocation of inspection and surveillance resources. The problem of risk-based sampling allocation presents a challenge similar to financial portfolio analysis. Markowitz (1952) laid the foundation for modern portfolio theory based on mean-variance optimization. However, a persistent challenge in implementing portfolio optimization is the problem of estimation error, leading to false "optimal" portfolios and unstable asset weights. In some cases, portfolio diversification based on simple heuristics (e.g., equal allocation) has better out-of-sample performance than complex portfolio optimization methods due to estimation uncertainty. Even for portfolios with a modest number of assets, the estimation window required for true optimization may imply an implausibly long stationary period. The implications for risk-based sampling are illustrated by a simple simulation model of lot inspection for a small, heterogeneous group of producers. PMID:26033352

  15. 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.

  16. African American church-based HIV testing and linkage to care: assets, challenges and needs.

    Science.gov (United States)

    Stewart, Jennifer M; Thompson, Keitra; Rogers, Christopher

    2016-06-01

    The US National HIV AIDS strategy promotes the use of faith communities to lessen the burden of HIV in African American communities. One specific strategy presented is the use of these non-traditional venues for HIV testing and co-location of services. African American churches can be at the forefront of this endeavour through the provision of HIV testing and linkage to care. However, there are few interventions to promote the churches' involvement in both HIV testing and linkage to care. We conducted 4 focus groups (n = 39 participants), 4 interviews and 116 surveys in a mixed-methods study to examine the feasibility of a church-based HIV testing and linkage to care intervention in Philadelphia, PA, USA. Our objectives were to examine: (1) available assets, (2) challenges and barriers and (3) needs associated with church-based HIV testing and linkage to care. Analyses revealed several factors of importance, including the role of the church as an access point for testing in low-income neighbourhoods, challenges in openly discussing the relationship between sexuality and HIV, and buy-in among church leadership. These findings can support intervention development and necessitate situating African American church-based HIV testing and linkage to care interventions within a multi-level framework. PMID:26652165

  17. Patient Health Care Analysis based on ANFIS Sugeno Model

    Directory of Open Access Journals (Sweden)

    Mayilvaganan M

    2014-11-01

    Full Text Available The main research formulation of the problem deals with how blood pressure affects the different parts of the human body with the use of the proposed fuzzy logic controller. The proposed work focus about Adaptive Neuro Fuzzy Interface System (ANFIS depends on fuzzy logic controller to diagnose the various level of health risk factor value which is aggregated with Blood Pressure, Pulse Rate and Kidney function based on various Input Parameters. In this paper, Fuzzy Logic circuit was developed with 2’s Complement in full adder using the input such as Blood Pressure value taken from Systolic and Diastolic value, Pulse Rate and GFR value. Due to increase in blood pressure measurement values, such as systolic and diastolic values how the kidney and other parts of our body function values are heavily affected are also discussed in this paper. The proposed ANFIS system is validated with blood pressure data set values using Mat Lab Fuzzy Tool Box, and simulated output analyse the risk factor value of a human being

  18. 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

    2016-08-01

    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

  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

    2009-12-01

    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. Huddle-coaching: a dynamic intervention for trainees and staff to support team-based care.

    Science.gov (United States)

    Shunk, Rebecca; Dulay, Maya; Chou, Calvin L; Janson, Susan; O'Brien, Bridget C

    2014-02-01

    Many outpatient clinics where health professionals train will transition to a team-based medical home model over the next several years. Therefore, training programs need innovative approaches to prepare and incorporate trainees into team-based delivery systems. To address this need, educators at the San Francisco Veterans Affairs (VA) Medical Center included trainees in preclinic team "huddles," or briefing meetings to facilitate care coordination, and developed an interprofessional huddle-coaching program for nurse practitioner students and internal medicine residents who function as primary providers for patient panels in VA outpatient primary care clinics. The program aimed to support trainees' partnerships with staff and full participation in the VA's Patient Aligned Care Teams. The huddle-coaching program focuses on structuring the huddle process via scheduling, checklists, and designated huddle coaches; building relationships among team members through team-building activities; and teaching core skills to support collaborative practice. A multifaceted evaluation of the program showed positive results. Participants rated training sessions and team-building activities favorably. In interviews, trainees valued their team members and identified improvements in efficiency and quality of patient care as a result of the team-based approach. Huddle checklists and scores on the Team Development Measure indicated progress in team processes and relationships as the year progressed. These findings suggest that the huddle-coaching program was a worthwhile investment in trainee development that also supported the clinic's larger mission to deliver team-based, patient-aligned care. As more training sites shift to team-based care, the huddle-coaching program offers a strategy for successfully incorporating trainees. PMID:24362383

  1. User Interface Requirements for Web-Based Integrated Care Pathways: Evidence from the Evaluation of an Online Care Pathway Investigation Tool.

    Science.gov (United States)

    Balatsoukas, Panos; Williams, Richard; Davies, Colin; Ainsworth, John; Buchan, Iain

    2015-11-01

    Integrated care pathways (ICPs) define a chronological sequence of steps, most commonly diagnostic or treatment, to be followed in providing care for patients. Care pathways help to ensure quality standards are met and to reduce variation in practice. Although research on the computerisation of ICP progresses, there is still little knowledge on what are the requirements for designing user-friendly and usable electronic care pathways, or how users (normally health care professionals) interact with interfaces that support design, analysis and visualisation of ICPs. The purpose of the study reported in this paper was to address this gap by evaluating the usability of a novel web-based tool called COCPIT (Collaborative Online Care Pathway Investigation Tool). COCPIT supports the design, analysis and visualisation of ICPs at the population level. In order to address the aim of this study, an evaluation methodology was designed based on heuristic evaluations and a mixed method usability test. The results showed that modular visualisation and direct manipulation of information related to the design and analysis of ICPs is useful for engaging and stimulating users. However, designers should pay attention to issues related to the visibility of the system status and the match between the system and the real world, especially in relation to the display of statistical information about care pathways and the editing of clinical information within a care pathway. The paper concludes with recommendations for interface design. PMID:26446014

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

    Directory of Open Access Journals (Sweden)

    Zhuoshi Li

    2013-01-01

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

  3. Robust Controller Design by Convex Optimization based on Finite Frequency Samples of Spectral Models

    OpenAIRE

    Galdos, Gorka; Karimi, Alireza; Longchamp, Roland

    2010-01-01

    Some frequency-domain controller design problems are solved using a finite number of frequency samples. Consequently, the performance and stability conditions are not guaranteed for the frequencies between the frequency samples. In this paper, all possible interpolants between the frequency samples of the open-loop system are bounded using convex constraints on a linearly parameterized controller. These constraints are integrated in a method which solves an H_inf control problem based on spec...

  4. Gaussian Filter based on Deterministic Sampling for High Quality Nonlinear Estimation

    OpenAIRE

    Huber, Marco F.; Hanebeck, Uwe D.

    2008-01-01

    In this paper, a Gaussian filter for nonlinear Bayesian estimation is introduced that is based on a deterministic sample selection scheme. For an effective sample selection, a parametric density function representation of the sample points is employed, which allows approximating the cumulative distribution function of the prior Gaussian density. The computationally demanding parts of the optimization problem formulated for approximation are carried out off-line for obtaining an efficient filt...

  5. Evaluating the accuracy of sampling-based approaches to the calculation of posterior moments

    OpenAIRE

    Geweke, John F.

    1991-01-01

    Data augmentation and Gibbs sampling are two closely related, sampling-based approaches to the calculation of posterior moments. The fact that each produces a sample whose constituents are neither independent nor identically distributed complicates the assessment of convergence and numerical accuracy of the approximations to the expected value of functions of interest under the posterior. In this paper methods for spectral analysis are used to evaluate numerical accuracy formally and construc...

  6. Collaborative practice: usability of text-based, electronic patient care guidelines.

    Science.gov (United States)

    Wallace, C Jane; Bigelow, Sherry; Xu, Xiaomin; Elstein, Lynn

    2007-01-01

    The Intermountain Healthcare system has developed a text-based, electronic reference system for nonphysician staff to provide patient care guidelines intended to reduce variability in bedside care processes and improve patient outcomes. Implementation issues with two interface tools used to deploy the electronic documents at the bedside have caused difficulty with document accessibility. A third interface tool (Viewer) was designed to solve the accessibility problems. This study was designed to compare the time spent searching for information and success of information retrieval from all three interfaces before clinical deployment of the Viewer interface. Study results were used by nursing leadership in a decision to continue supporting the electronic dissemination of text-based practice guidelines for nonphysician staff within our health system's acute care settings. PMID:17215675

  7. Music therapists’ practice-based research in cancer and palliative care: Creative methods and situated findings

    Directory of Open Access Journals (Sweden)

    Philippa Barry

    2009-11-01

    Full Text Available Although randomized controlled trials are described as the gold standard in health care research, their superiority is being questioned in palliative care which is focused on addressing individualized needs to maximize life quality. We use creative practice-based research to examine the usefulness of our music therapy work amongst people with life threatening conditions. Examined voices include “collective” (patients, visitors, staff, and music therapist, "their” (patients or caregivers, "our” (a group of music therapists, and "my voice” (one music therapist. Data sources have included clinical journals, semi-structured questionnaires, interview responses, a focus group, reflexive groupwork supervision transcripts, and patients’ song lyrics. Findings, situated within varied theoretic lenses, substantiate music therapy’s role in oncology and palliative care settings. Readers are invited to devise creative ways to voice their clients’, bystanders’, and own wisdom about music therapy to meaningfully extend the knowledge base.

  8. Analyzing the Interprofessional Working of a Home-Based Primary Care Team.

    Science.gov (United States)

    Smith-Carrier, Tracy; Neysmith, Sheila

    2014-09-01

    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. PMID:26261888

  9. An optimization based sampling approach for multiple metrics uncertainty analysis using generalized likelihood uncertainty estimation

    Science.gov (United States)

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

    2016-09-01

    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.

  10. Evidence-based surgical care and the evolution of fast-track surgery

    DEFF Research Database (Denmark)

    Kehlet, H.; Wilmore, D.W.

    2008-01-01

    implementation issues were based on data published within the past 5 years from major anesthesiological and surgical journals, using systematic reviews where appropriate instead of multiple references of original work. DATA SYNTHESIS: Based on an increasing amount of multinational, multicenter cohort studies......, 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......, despite being based on a combination of evidence-based unimodal principles of care, recent surveys have demonstrated slow adaptation and implementation of the fast-track methodology. CONCLUSION: Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery...

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

    Science.gov (United States)

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

    2011-01-01

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

  12. Investigation of a Novel Optical Phase Demodulator based on Sampling Phase-Locked Loop

    DEFF Research Database (Denmark)

    Zibar, Darko; Johansson, L.A.; Chou, H.F.; Ramaswamy, A.; Rodwell, M.; Bowers, J.E.

    A novel phase-locked coherent demodulator, based on a sampling phase-locked loop, is presented and investigated theoretically. The demodulator is capable of operating at high-frequencies, by using optical sampling to downconvert the high-frequency input RF signal to the frequency range of the bas...

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

    Directory of Open Access Journals (Sweden)

    Sanches Ilda Santos

    2003-07-01

    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.

  14. 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;

    2004-01-01

    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 the...... questionnaire measures of rumination, sadness, and subjective sleep quality. Immune measures included leukocyte counts, lymphocyte subsets, natural killer cell activity, and T-cell proliferation. Contacts with primary care physicians were registered for 1 year through central registers. RESULTS: Rumination...... 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...

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

    Directory of Open Access Journals (Sweden)

    Pervin Jesmin

    2012-10-01

    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

  16. Elemental analysis of concrete samples using an accelerator-based PGNAA setup

    Science.gov (United States)

    Naqvi, A. A.; Nagadi, M. M.; Baghabra Al-Amoudi, Omar S.

    2004-09-01

    Elemental analysis of concrete samples was carried out using an accelerator-based prompt gamma ray neutron activation analysis (PGNAA) setup. The gamma rays were produced via the capture of thermal neutron in the concrete sample. The prompt gamma ray yield was measured for 12 cm long concrete samples as a function of sample radius over a range of 6-11.5 cm radii. The optimum yield of the prompt gamma rays from the concrete sample was measured from a sample with 11.5 cm radius. The gamma ray yield was also calculated for 12 cm long concrete samples with 6-11.5 cm radius using Monte Carlo simulations. The experimental results were in excellent agreement with the calculated yield of the prompt gamma rays from the samples. Result of this study has shown the useful application of an accelerator-based PGNAA setup in elemental analysis of concrete sample. The facility can be further used to determine the chloride and sulfate concentrations in concrete samples for corrosion studies of reinforcement steel in concrete structures.

  17. Elemental analysis of concrete samples using an accelerator-based PGNAA setup

    International Nuclear Information System (INIS)

    Elemental analysis of concrete samples was carried out using an accelerator-based prompt gamma ray neutron activation analysis (PGNAA) setup. The gamma rays were produced via the capture of thermal neutron in the concrete sample. The prompt gamma ray yield was measured for 12 cm long concrete samples as a function of sample radius over a range of 6-11.5 cm radii. The optimum yield of the prompt gamma rays from the concrete sample was measured from a sample with 11.5 cm radius. The gamma ray yield was also calculated for 12 cm long concrete samples with 6-11.5 cm radius using Monte Carlo simulations. The experimental results were in excellent agreement with the calculated yield of the prompt gamma rays from the samples. Result of this study has shown the useful application of an accelerator-based PGNAA setup in elemental analysis of concrete sample. The facility can be further used to determine the chloride and sulfate concentrations in concrete samples for corrosion studies of reinforcement steel in concrete structures

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

    Data.gov (United States)

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

  19. Hospital based palliative care in sub-Saharan Africa; a six month review from Malawi

    Directory of Open Access Journals (Sweden)

    Jane Bates M

    2011-07-01

    Full Text Available Abstract Background The World Health Organisation recognises the importance of palliative care in an African setting. Despite this services are often patchy and inconsistent, and many operate at health centre and/or community level. Few reports from hospital based palliative care services in sub-Saharan Africa exist in the current literature. As part of its activities Tiyanjane Clinic has been providing hospital based palliative care to patients at Queen Elizabeth Central Hospital, a large government tertiary referral institution, in the Southern region of Malawi since 2003, caring for patients with HIV, cancer and other non-malignant palliative diagnoses. Methods A retrospective review of case notes for all in-patients seen by Tiyanjane Clinic over a six month period (April-Sept 2009 was undertaken. Results A total of 177 patients were seen, for whom 137 case notes were available (77%. 58% of patients were male, 42% female. The average age of patients was 39.1 years (range 15-92 years. 54% of patients were HIV positive, with 34% on ARV drugs at the time of care. 42% of patients had HIV related diagnoses, including AIDS defining malignancies, 48% had (non AIDS related cancers and 9% had other palliative diagnoses. The mean age of patients with HIV related diagnoses was 34 years, for cancer patients it was 48 years. Pain was the most commonly reported symptom (74%, with 56% of patients requiring oral morphine. The mean daily dose of morphine was 30 mg/day (range 9-100 mg. 65% of patients were discharged home, 26% of patients died during admission. Conclusions The palliative care population in this setting is relatively young, especially among patients with HIV related diagnoses. HIV and cancer are the main diagnostic groups. Pain is the most commonly reported symptom, with oral morphine frequently required. Health workers require access to and knowledge of oral morphine in order to provide appropriate assistance to patients under their care.

  20. Investigating Unmet Health Needs in Primary Health Care Services in a Representative Sample of the Greek Population

    Directory of Open Access Journals (Sweden)

    Evelina Pappa

    2013-05-01

    Full Text Available 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.

  1. Data acquisition for forestry planning by remote sensing based sample plot imputation

    OpenAIRE

    Holmström, Hampus

    2001-01-01

    In forestry planning, accurate description of the state of the forests is essential. Advanced planning models often require input data with high resolution, i.e. data at the single-tree level. Field inventory procedures based on sample plot measurements are usually employed. However, such methods are expensive, so cost-efficient alternatives would be attractive. In the work described in this thesis, inventory methods based on imputation of reference sample plot data were evaluated. The refere...

  2. A single-nucleotide polymorphism-based approach for rapid and cost-effective genetic wolf monitoring in Europe based on noninvasively collected samples.

    Science.gov (United States)

    Kraus, Robert H S; vonHoldt, Bridgett; Cocchiararo, Berardino; Harms, Verena; Bayerl, Helmut; Kühn, Ralph; Förster, Daniel W; Fickel, Jörns; Roos, Christian; Nowak, Carsten

    2015-03-01

    Noninvasive genetics based on microsatellite markers has become an indispensable tool for wildlife monitoring and conservation research over the past decades. However, microsatellites have several drawbacks, such as the lack of standardisation between laboratories and high error rates. Here, we propose an alternative single-nucleotide polymorphism (SNP)-based marker system for noninvasively collected samples, which promises to solve these problems. Using nanofluidic SNP genotyping technology (Fluidigm), we genotyped 158 wolf samples (tissue, scats, hairs, urine) for 192 SNP loci selected from the Affymetrix v2 Canine SNP Array. We carefully selected an optimised final set of 96 SNPs (and discarded the worse half), based on assay performance and reliability. We found rates of missing data in this SNP set of <10% and genotyping error of ~1%, which improves genotyping accuracy by nearly an order of magnitude when compared to published data for other marker types. Our approach provides a tool for rapid and cost-effective genotyping of noninvasively collected wildlife samples. The ability to standardise genotype scoring combined with low error rates promises to constitute a major technological advancement and could establish SNPs as a standard marker for future wildlife monitoring. PMID:25042673

  3. 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 that......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...... 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...

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

    Science.gov (United States)

    Magarian, Edward O.; And Others

    1993-01-01

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

  5. Antibiotic prescribing patterns in out-of-hours primary care: A population-based descriptive study

    NARCIS (Netherlands)

    Huibers, L.; Moth, G.; Christensen, M.B.; Vedsted, P.

    2014-01-01

    Abstract Objective. To describe the frequency and characteristics of antibiotic prescribing for different types of contacts with the Danish out-of-hours (OOH) primary care service. Design. Population-based observational registry study using routine registry data from the OOH registration system on p

  6. Making connections: integration of psychiatric and medical-surgical nursing and relationship-based care.

    Science.gov (United States)

    Moriconi, Christine; Stabler-Haas, Susan

    2010-01-01

    There is a growing recognition of mind-body connection in our culture. Relationship-based care (RBC) represents a theoretical foundation for the application of the mind-body connection in the clinical setting. This article describes ways to incorporate mind-body and RBC concepts into nursing classroom and clinical experiences. PMID:20333918

  7. Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial.

    NARCIS (Netherlands)

    Graff, M.J.L.; Vernooij-Dassen, M.J.F.J.; Thijssen, M.; Dekker, J.; Hoefnagels, W.H.L.; Olde Rikkert, M.G.M.

    2006-01-01

    OBJECTIVE: To determine the effectiveness of community based occupational therapy on daily functioning of patients with dementia and the sense of competence of their care givers. DESIGN: Single blind randomised controlled trial. Assessors were blinded for treatment allocation. SETTING: Memory clinic

  8. Evaluation of the structure and provision of primary care in Slovakia: a survey-based project.

    NARCIS (Netherlands)

    Boerma, W.G.W.; Wiegers, T.A.; Baltag, V.

    2012-01-01

    Health reforms are part of the profound and comprehensive changes in essential societal functions and values occurring in many eastern European countries in economic and political transition. Primary care reform is not always evidence based and may be driven by political arguments or the interests o

  9. Child and Adolescent Inpatient Restraint Reduction: A State Initiative to Promote Strength-Based Care.

    Science.gov (United States)

    LeBel, Janice; Stromberg, Nan; Duckworth, Ken; Kerzner, Joan; Goldstein, Robert; Weeks, Michael; Harper, Gordon; LaFlair, Lareina; Sudders, Marylou

    2004-01-01

    Objective: To reduce the use of restraint and seclusion with children and adolescents in psychiatric inpatient units by promoting a preventive, strength-based model of care. Method: The State Mental Health Authority used data analysis, quality improvement strategies, regulatory oversight, and technical assistance to develop and implement system…

  10. Treating Opioid Addiction With Buprenorphine-Naloxone in Community-Based Primary Care Settings

    OpenAIRE

    Mintzer, Ira L.; Eisenberg, Mark; Terra, Maria; MacVane, Casey; Himmelstein, David U.; Woolhandler, Steffie

    2007-01-01

    PURPOSE Office-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002. Efficacy of this treatment in nonresearch clinical settings has not been studied. We examined the efficacy and practicality of buprenorphine-naloxone treatment in primary care settings.

  11. Evaluation of structure and provision of primary care in Romania: a survey-based project.

    NARCIS (Netherlands)

    Boerma, W.G.W.; Wiegers, T.A.; Baltag, V.; Teunissen, E.; Farcasanu, D.

    2012-01-01

    In many countries in transition, health reforms are part of profound and comprehensive changes in essential societal functions and values. Reforms of (primary) care are not always based on evidence, and progress may be driven by political arguments or the interests of specific professional groups, r

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

    Science.gov (United States)

    Azad, Ariful; Rajwa, Bartek; Pothen, Alex

    2016-01-01

    We describe algorithms for discovering immunophenotypes from large collections of flow cytometry 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-based scheme to analyze several datasets, including one representing a healthy immune system and one of acute myeloid leukemia (AML) samples. The last task is challenging due to the phenotypic heterogeneity of the several subtypes of AML. However, we identified thirteen immunophenotypes corresponding to subtypes of AML and were able to distinguish acute promyelocytic leukemia (APL) samples with the markers provided. Clinically, this is helpful since APL has a different treatment regimen from other subtypes of AML. Core algorithms used in our data analysis are

  13. 2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers.

    Science.gov (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

    2015-05-19

    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

  14. eSensor: an electrochemical detection-based DNA microarray technology enabling sample-to-answer molecular diagnostics

    Science.gov (United States)

    Liu, Robin H.; Longiaru, Mathew

    2009-05-01

    DNA microarrays are becoming a widespread tool used in life science and drug screening due to its many benefits of miniaturization and integration. Microarrays permit a highly multiplexed DNA analysis. Recently, the development of new detection methods and simplified methodologies has rapidly expanded the use of microarray technologies from predominantly gene expression analysis into the arena of diagnostics. Osmetech's eSensor® is an electrochemical detection platform based on a low-to- medium density DNA hybridization array on a cost-effective printed circuit board substrate. eSensor® has been cleared by FDA for Warfarin sensitivity test and Cystic Fibrosis Carrier Detection. Other genetic-based diagnostic and infectious disease detection tests are under development. The eSensor® platform eliminates the need for an expensive laser-based optical system and fluorescent reagents. It allows one to perform hybridization and detection in a single and small instrument without any fluidic processing and handling. Furthermore, the eSensor® platform is readily adaptable to on-chip sample-to-answer genetic analyses using microfluidics technology. The eSensor® platform provides a cost-effective solution to direct sample-to-answer genetic analysis, and thus have a potential impact in the fields of point-of-care genetic analysis, environmental testing, and biological warfare agent detection.

  15. 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

    2001-09-01

    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.

  16. Utilization of Tabu search heuristic rules in sampling-based motion planning

    Science.gov (United States)

    Khaksar, Weria; Hong, Tang Sai; Sahari, Khairul Salleh Mohamed; Khaksar, Mansoor

    2015-05-01

    Path planning in unknown environments is one of the most challenging research areas in robotics. In this class of path planning, the robot acquires the information from its sensory system. Sampling-based path planning is one of the famous approaches with low memory and computational requirements that has been studied by many researchers during the past few decades. We propose a sampling-based algorithm for path planning in unknown environments using Tabu search. The Tabu search component of the proposed method guides the sampling to find the samples in the most promising areas and makes the sampling procedure more intelligent. The simulation results show the efficient performance of the proposed approach in different types of environments. We also compare the performance of the algorithm with some of the well-known path planning approaches, including Bug1, Bug2, PRM, RRT and the Visibility Graph. The comparison results support the claim of superiority of the proposed algorithm.

  17. A Large-scale Dissemination and Implementation Model for Evidence-based Treatment and Continuing Care

    OpenAIRE

    Godley, Susan H.; Garner, Bryan R.; Smith, Jane Ellen; Meyers, Robert J.; Godley, Mark D.

    2011-01-01

    Multiple evidence-based treatments for adolescents with substance use disorders are available; however, the diffusion of these treatments in practice remains minimal. A dissemination and implementation model incorporating research-based training components for simultaneous implementation across 33 dispersed sites and over 200 clinical staff is described. Key elements for the diffusion of the Adolescent Community Reinforcement Approach and Assertive Continuing Care were: (a) three years of fun...

  18. Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs

    OpenAIRE

    Gifford, Gregory A.; Edwards, Kevan R.; Knutson, David J.

    2004-01-01

    This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementa...

  19. Capacity Enhancement of Hepatitis C Virus Treatment through Integrated, Community-Based Care

    OpenAIRE

    Hill, Warren D; Butt, Gail; Alvarez, Maria; Krajden, Mel

    2008-01-01

    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.METHODS: Four demonstration projects based on a public health nurse and physician partnership were established in rural and small urban...

  20. Understanding home-based neonatal care practice in rural southern Tanzania.

    OpenAIRE

    Mrisho, Mwifadhi; Schellenberg, Joanna Armstrong; Mushi, Adiel K; Obrist, Brigit; Mshinda, Hassan; Tanner, Marcel; Schellenberg, David

    2008-01-01

    In order to understand home-based neonatal care practices in rural Tanzania, with the aim of providing a basis for the development of strategies for improving neonatal survival, we conducted a qualitative study in southern Tanzania. In-depth interviews, focus group discussions and case studies were used through a network of female community-based informants in eight villages of Lindi Rural and Tandahimba districts. Data collection took place between March 2005 and April 2007. The results show...

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

    International Nuclear Information System (INIS)

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

  2. Qualitative application based on IR spectroscopy for bone sample quality control in radiocarbon dating

    International Nuclear Information System (INIS)

    Bone samples suffer from contamination and deterioration, depending on their conservation state and previous restoration and consolidation processes. The sample preparation laboratory of the CEDAD (Center for Dating and Diagnostics) of University of Lecce is developing a quality control protocol for bone samples based on Fourier transform infrared (FTIR) spectroscopy to identify the presence of collagen in bone samples and to assess its quality. FTIR measurements were carried out on collagen extracted from many ancient samples dated at CEDAD. Efforts to shift the FTIR quality control test from the filtration step to a check-in treatment are proceeding to optimize the time for preparation and to reduce the overall turnaround time. A standard fast demineralization treatment was set up and applied to a variety of ancient samples of different origin and age

  3. Qualitative application based on IR spectroscopy for bone sample quality control in radiocarbon dating

    Science.gov (United States)

    Gianfrate, G.; D'Elia, M.; Quarta, G.; Giotta, L.; Valli, L.; Calcagnile, L.

    2007-06-01

    Bone samples suffer from contamination and deterioration, depending on their conservation state and previous restoration and consolidation processes. The sample preparation laboratory of the CEDAD (Center for Dating and Diagnostics) of the University of Lecce is developing a quality control protocol for bone samples based on Fourier transform infrared (FTIR) spectroscopy to identify the presence of collagen in bone samples and to assess its quality. FTIR measurements were carried out on collagen extracted from many ancient samples dated at CEDAD. Efforts to shift the FTIR quality control test from the filtration step to a check-in treatment are proceeding to optimize the time for preparation and to reduce the overall turnaround time. A standard fast demineralization treatment was set up and applied to a variety of ancient samples of different origin and age.

  4. 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

    2016-03-01

    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.

  5. Financial Planning for Military Child Care Centers: A Guidebook Based on the Experiences of the Fort Lewis Child Care Center.

    Science.gov (United States)

    Office of the Assistant Secretary of Defense for Manpower and Reserve Affairs (DOD), Washington, DC.

    Good record keeping--along with a constant and detailed knowledge of expenses, income, profit, and loss--is the first step toward profitable management of a child care center. Good record keeping is especially important in a center that provides "drop-in" or occasional care because income may fluctuate greatly as a result of the variable number of…

  6. An Efficacy Trial of Carescapes: Home-Based Child-Care Practices and Children's Social Outcomes.

    Science.gov (United States)

    Rusby, Julie C; Jones, Laura B; Crowley, Ryann; Smolkowski, Keith

    2016-07-01

    This study reported findings from a longitudinal randomized controlled trial of Carescapes, a professional development program for home-based child-care providers in promoting children's social competence. Participants included 134 child-care providers and 310 children, ages 3-5 years, in Oregon. The Carescapes intervention group made significant improvements in observed caregiver responsiveness and monitoring, and showed decreased caregiver-reported child problem behavior and improved parent-reported peer relationships compared to the control group. Increased caregiver-reported cooperation skills were found for the intervention group at follow-up. No differences in condition were found for kindergarten teacher-reported social-behavioral, classroom, and academic skills. Moderation effects on children's behavior and peer relations were found for child age and exposure to the intervention child care. PMID:27174665

  7. [An analysis of psychosocial care for adolescents in crisis based on their therapeutic itineraries].

    Science.gov (United States)

    Pereira, Melissa de Oliveira; Sá, Marilene de Castilho; Miranda, Lilian

    2014-10-01

    This study analyzes the care provided to adolescents in crisis in a municipality in Greater Metropolitan Rio de Janeiro, Brazil. The article reports on a qualitative health study that used Therapeutic Itinerary and Life Narratives as the methodological resources. The principal theoretical reference was psychoanalyst René Kaës. Based on the adolescents' own verbal accounts, the study aimed to grasp the collective realities that could potentially shed light on the different types of logic and professional practices applied to care for adolescents in psychosocial crisis situations. The underlying assumption was that an approach to the dialectical nature of the crisis required maintaining a framework that would allow establishing a space for transition within which to develop the necessary conditions for disruptive and paradoxical elements to be elaborated. However, crisis care in the context studied here proved to be hampered by infrastructure issues, institutional rigidity, and fragmentation of activities, with little orientation towards inter-sector work. PMID:25388317

  8. Implementation Process of a Canadian Community-based Nurse Mentorship Intervention in HIV Care.

    Science.gov (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

    2016-01-01

    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

  9. 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

    2007-01-01

    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.

  10. A web-based communication system for the integrated care setting of cerebral palsy: parents' experiences in a 6-month pilot in three Dutch care regions

    OpenAIRE

    Gulmans, J.; Vollenbroek-Hutten, M.M.R.; Gemert-Pijnen, van, Julia E.W.C.; Harten, van, W.H.

    2012-01-01

    Introduction: To improve communication in the integrated care setting of children with cerebral palsy, we developed a web-based system for parent-professional and inter-professional communication. The present study aimed to evaluate parents' experiences regarding the system's contribution to their communication with professionals during a 6-months pilot in three Dutch care regions. In addition, factors associated with parents' system use and non-use were analyzed. Theory and methods: The syst...

  11. Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital

    International Nuclear Information System (INIS)

    Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments

  12. Emotion-Aware Assistive System for Humanistic Care Based on the Orange Computing Concept

    Directory of Open Access Journals (Sweden)

    Jhing-Fa Wang

    2012-01-01

    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.

  13. Population-centered Risk- and Evidence-based Dental Interprofessional Care Team (PREDICT): study protocol for a randomized controlled trial

    OpenAIRE

    Cunha-Cruz, Joana; Milgrom, Peter; Shirtcliff, R. Michael; Bailit, Howard L.; Huebner, Colleen E; Conrad, Douglas; Ludwig, Sharity; Mitchell, Melissa; Dysert, Jeanne; Allen, Gary; Scott, JoAnna; Mancl, Lloyd

    2015-01-01

    Background To improve the oral health of low-income children, innovations in dental delivery systems are needed, including community-based care, the use of expanded duty auxiliary dental personnel, capitation payments, and global budgets. This paper describes the protocol for PREDICT (Population-centered Risk- and Evidence-based Dental Interprofessional Care Team), an evaluation project to test the effectiveness of new delivery and payment systems for improving dental care and oral health. Me...

  14. Clinician Adoption Patterns and Patient Outcome Results in Use of Evidence-Based Nursing Plans of Care

    OpenAIRE

    Kim, Tae Youn; Lang, Norma M.; Berg, Karen; Weaver, Charlotte; Murphy, Judy; Ela, Sue

    2007-01-01

    Delivery of safe, effective and appropriate health care is an imperative facing health care organizations globally. While many initiatives have been launched in a number of countries to address this need from a medical perspective, a similar focus for generating evidence-based nursing knowledge has been missing [1]. This paper reports on a collaborative evidence-based practice (EBP) research initiative that adds nursing knowledge into computerized care protocols. Here, a brief overview of the...

  15. Using activity-based costing and theory of constraints to guide continuous improvement in managed care.

    Science.gov (United States)

    Roybal, H; Baxendale, S J; Gupta, M

    1999-01-01

    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. PMID:10350791

  16. Developing a web-based information resource for palliative care: an action-research inspired approach

    Directory of Open Access Journals (Sweden)

    Gliddon Terry

    2007-09-01

    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

  17. The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation

    Science.gov (United States)

    O'Brien, Rosaleen; Fitzpatrick, Bridie; Higgins, Maria; Guthrie, Bruce; Watt, Graham; Wyke, Sally

    2016-01-01

    Objectives To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. Methods Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients. Results Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients. Discussion We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial. PMID:27068113

  18. Debt and Foregone Medical Care

    Science.gov (United States)

    Kalousova, Lucie; Burgard, Sarah A.

    2013-01-01

    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…

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    Marek Miskowicz

    2007-01-01

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

  1. [Study on an Algorithm for Near Infrared Singular Sample Identification Based on Strong Influence Degree].

    Science.gov (United States)

    Wu, Zhao-na; Ding, Xiang-qian; Gong, Hui-li; Dong, Mel; Wang, Mei-xun

    2015-07-01

    Correcting sample selection and elimination of singular sample is very important for the quantitative and qualitative modeling of near infrared spectroscopy. However, methods for identification of singular sample available are generally based on data center estimates which require an experience decision threshold, this largely limit its recognition accuracy and practicability. Aiming at the low accuracy of the existing methods of singular sample recognition problem, this paper improves the existing metric-Leverage value and presents a new algorithm for near infrared singular sample identification based on strong influence degree. This metric reduces the dependence on the data center to a certain extent, so that the normal samples become more aggregation, and the distance between the singular samples and the normal samples is opened; at the same time, in order to avoid artificial setting threshold unreasonably according to experience, this paper introduces the concept of the jump degree in the field of statistics, and proposes an automatic threshold setting method to distinguish singular samples. In order to verify the validity of our algorithm, abnormal samples of 200 representative samples were eliminated in the calibration set with using Mahalanobis distance, Leverage-Spectral residual method and the algorithm presented in this paper respectively; then through partial least squares (PLS), the rest of the calibration samples were made quantitative modelings (took Nicotine as index), and the results of quantitative modelings were made a comparative analysis; besides, 60 representative testing samples were made a prediction through the modelings; at last, all the algorithms above were made a comparison with took Root Mean Square Error of Cross Validation (RMSECV), Correlation Coefficient (r) and Root Mean Square Error of Prediction (RMSEP) as evaluation Index. The experimental results demonstrate that the algorithm for near infrared singular sample identification

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

    KAUST Repository

    Xinyu Tang,

    2010-01-25

    Motion planning for spatially constrained robots is difficult due to additional constraints placed on the robot, such as closure constraints for closed chains or requirements on end-effector placement for articulated linkages. It is usually computationally too expensive to apply sampling-based planners to these problems since it is difficult to generate valid configurations. We overcome this challenge by redefining the robot\\'s degrees of freedom and constraints into a new set of parameters, called reachable distance space (RD-space), in which all configurations lie in the set of constraint-satisfying subspaces. This enables us to directly sample the constrained subspaces with complexity linear in the number of the robot\\'s degrees of freedom. In addition to supporting efficient sampling of configurations, we show that the RD-space formulation naturally supports planning and, in particular, we design a local planner suitable for use by sampling-based planners. We demonstrate the effectiveness and efficiency of our approach for several systems including closed chain planning with multiple loops, restricted end-effector sampling, and on-line planning for drawing/sculpting. We can sample single-loop closed chain systems with 1,000 links in time comparable to open chain sampling, and we can generate samples for 1,000-link multi-loop systems of varying topologies in less than a second. © 2010 The Author(s).

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

    Science.gov (United States)

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

    2010-01-01

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

  4. Survey of sampling-based methods for uncertainty and sensitivity analysis.

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Jay Dean; Helton, Jon Craig; Sallaberry, Cedric J. PhD. (.; .); Storlie, Curt B. (Colorado State University, Fort Collins, CO)

    2006-06-01

    Sampling-based methods for uncertainty and sensitivity analysis are reviewed. The following topics are considered: (1) Definition of probability distributions to characterize epistemic uncertainty in analysis inputs, (2) Generation of samples from uncertain analysis inputs, (3) Propagation of sampled inputs through an analysis, (4) Presentation of uncertainty analysis results, and (5) Determination of sensitivity analysis results. Special attention is given to the determination of sensitivity analysis results, with brief descriptions and illustrations given for the following procedures/techniques: examination of scatterplots, correlation analysis, regression analysis, partial correlation analysis, rank transformations, statistical tests for patterns based on gridding, entropy tests for patterns based on gridding, nonparametric regression analysis, squared rank differences/rank correlation coefficient test, two dimensional Kolmogorov-Smirnov test, tests for patterns based on distance measures, top down coefficient of concordance, and variance decomposition.

  5. Risk management and clinical governance for complex home-based health care.

    Science.gov (United States)

    Lewis, Mary; Noyes, Jane

    2007-07-01

    Healthcare professionals have an obligation to enable children with complex needs to lead 'ordinary lives' at home but the views of professionals and family members often diverge in relation to the management of risks. Nurses are increasingly taking on the clinical responsibility for children with complex needs within a multidisciplinary, multi-agency team, yet have little training or experience in adapting risk management and clinical governance frameworks to home-based settings. Risk management frameworks for home-based care for children with complex health and social care needs are introduced in this article. Best practice guidance and resources for adapting risk management frameworks are presented to meet this identified gap in knowledge and experience. Children, young people and their parents have increasing expectations relating to the type and quality of home-based support they receive. Developing and applying clinical governance and risk management frameworks are part of improving outcomes for children with complex needs and their families. PMID:17694890

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

    DEFF Research Database (Denmark)

    Tolsgaard, Martin G; Ringsted, Charlotte; Rosthøj, Susanne;

    2016-01-01

    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 only (control group, n = 26).The primary outcome was patient-reported discomfort during transvaginal ultrasound examinations performed by study participants. Secondary outcomes included patient-reported perceived safety and confidence in ultrasound provider. Finally, the need for trainee...

  7. Cloud based intelligent system for delivering health care as a service.

    Science.gov (United States)

    Kaur, Pankaj Deep; Chana, Inderveer

    2014-01-01

    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. PMID:24139021

  8. Applying community-based participatory research to better understand and improve kinship care practices

    DEFF Research Database (Denmark)

    Chukwudozie, Oge; Feinstein, Clare; Jensen, Celina;

    2015-01-01

    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....

  9. Integrating Web-Based Applications into Aged Care: Two Case Studies and Discussion.

    Science.gov (United States)

    Rehm, Imogen C; Musić, Selma; Carlsson, Anthony; Scanlan, Faye; Silver, Mark; Bhar, Sunil S

    2016-09-01

    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. PMID:27073103

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-12-01

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

  11. 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

    2007-01-01

    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.

  12. Associations of Caregiver Stress with Working Conditions, Caregiving Practices, and Child Behaviour in Home-Based Child Care

    Science.gov (United States)

    Rusby, Julie C.; Jones, Laura Backen; Crowley, Ryann; Smolkowski, Keith

    2013-01-01

    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…

  13. HIV prevalence, sexual behaviours and engagement in HIV medical care among an online sample of sexually active MSM in Venezuela.

    Science.gov (United States)

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

    2016-08-01

    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. PMID:26378188

  14. Stochastic bounded consensus tracking of leader-follower multi-agent systems with measurement noises based on sampled data with general sampling delay

    International Nuclear Information System (INIS)

    In this paper we provide a unified framework for consensus tracking of leader-follower multi-agent systems with measurement noises based on sampled data with a general sampling delay. First, a stochastic bounded consensus tracking protocol based on sampled data with a general sampling delay is presented by employing the delay decomposition technique. Then, necessary and sufficient conditions are derived for guaranteeing leader-follower multi-agent systems with measurement noises and a time-varying reference state to achieve mean square bounded consensus tracking. The obtained results cover no sampling delay, a small sampling delay and a large sampling delay as three special cases. Last, simulations are provided to demonstrate the effectiveness of the theoretical results. (interdisciplinary physics and related areas of science and technology)

  15. 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.; De Medici, D.; Croci, L.; Abdulmawjood, A.; Fach, P.; Karpiskova, R.; Aymerich, T.; Kwaitek, K.; Kuchta, T.; Hoorfar, Jeffrey

    2004-01-01

    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......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...... or positive. Outlier results caused, for example, by gross departures from the experimental protocol, were omitted from the analysis. For both the chicken rinse and the pig swab samples, the diagnostic sensitivity was 100%, with 100% accordance (repeatability) and concordance (reproducibility). The...

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

    Energy Technology Data Exchange (ETDEWEB)

    Naqvi, A.A., E-mail: aanaqvi@kfupm.edu.sa [Department of Physics and King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia); Al-Matouq, Faris A.; Khiari, F.Z.; Gondal, M.A.; Rehman, Khateeb-ur [Department of Physics and King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia); Isab, A.A. [Department of Chemistry, King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia); Raashid, M.; Dastageer, M.A. [Department of Physics and King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia)

    2013-11-21

    Nitrogen concentration was measured in explosive and narcotics proxy material, e.g. anthranilic acid, caffeine, melamine, and urea samples, bulk samples through thermal neutron capture reaction using 350 keV accelerator based prompt gamma ray neutron activation (PGNAA) setup. Intensity of 2.52, 3.53–3.68, 4.51, 5.27–5.30 and 10.38 MeV prompt gamma rays of nitrogen from the bulk samples was measured using a cylindrical 100 mm×100 mm (diameter×height ) BGO detector. Inspite of interference of nitrogen gamma rays from bulk samples with capture prompt gamma rays from BGO detector material, an excellent agreement between the experimental and calculated yields of nitrogen gamma rays has been obtained. This is an indication of the excellent performance of the PGNAA setup for detection of nitrogen in bulk samples.

  17. 350 keV accelerator based PGNAA setup to detect nitrogen in bulk samples

    International Nuclear Information System (INIS)

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

    Science.gov (United States)

    Naqvi, A. A.; Al-Matouq, Faris A.; Khiari, F. Z.; Gondal, M. A.; Rehman, Khateeb-ur; Isab, A. A.; Raashid, M.; Dastageer, M. A.

    2013-11-01

    Nitrogen concentration was measured in explosive and narcotics proxy material, e.g. anthranilic acid, caffeine, melamine, and urea samples, bulk samples through thermal neutron capture reaction using 350 keV accelerator based prompt gamma ray neutron activation (PGNAA) setup. Intensity of 2.52, 3.53-3.68, 4.51, 5.27-5.30 and 10.38 MeV prompt gamma rays of nitrogen from the bulk samples was measured using a cylindrical 100 mm×100 mm (diameter×height ) BGO detector. Inspite of interference of nitrogen gamma rays from bulk samples with capture prompt gamma rays from BGO detector material, an excellent agreement between the experimental and calculated yields of nitrogen gamma rays has been obtained. This is an indication of the excellent performance of the PGNAA setup for detection of nitrogen in bulk samples.

  19. Teaching and learning evidence-based medicine: cross-sectional survey investigating knowledge and attitudes of teachers and learners in primary and secondary care

    OpenAIRE

    Siriwardena, A Niroshan; Sandars, John; Gemmell, Islay; Rashid, Aly

    2007-01-01

    Evidence-based medicine (EBM) is an important component of quality healthcare and a key part of the curriculum for doctors in training. There have been no previous studies comparing attitudes and knowledge of doctors in primary and secondary care towards EBM practice and teaching and this study sets out to investigate this area. We asked participants, a stratified sample of general practitioners, hospital consultants, GP registrars and junior hospital doctors in Leicester, Northamptonshire...

  20. Effect of residence on mothers’ health care seeking behavior for common childhood illness in Northwest Ethiopia: a community based comparative cross – sectional study

    OpenAIRE

    Gelaw, Yalemzewod Assefa; Biks, Gashaw Andargie; Alene, Kefyalew Addis

    2014-01-01

    Background Children are at higher risk of acquiring infections and developing severe disease. This study assessed the health care seeking behavior and associated factors of urban and rural mothers for common childhood illness in Northwest Ethiopia. Methods A comparative community based cross-sectional study was conducted among urban and rural mothers living in the district. A multistage sampling technique was used to select the study participants. A pre-tested and structured questioner via in...

  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

    2015-01-01

    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. Pt@AuNPs integrated quantitative capillary-based biosensors for point-of-care testing application.

    Science.gov (United States)

    Wu, Ze; Fu, Qiangqiang; Yu, Shiting; Sheng, Liangrong; Xu, Meng; Yao, Cuize; Xiao, Wei; Li, Xiuqing; Tang, Yong

    2016-11-15

    Current diagnostic technologies primarily rely on bulky and costly analytical instruments. Therefore, cost-effective and portable diagnosis tools that can be used for point-of-care tests (POCT) are highly desirable. In this study, we report a cost-effective, portable capillary-based biosensor for quantitative detection of biomarkers by the naked eye. This capillary-based biosensor was tested by measuring the distance of blue ink movement, which was directly correlated with the oxygen (O2) produced by efficient core-shell Pt@Au nanoparticles (Pt@AuNPs) catalysts decomposed hydrogen peroxide (H2O2). By linking the Pt@AuNPs with antibodies, capillary-based biosensor sandwich immunoassays were constructed. The concentrations of the target proteins were positively correlated with the distances of ink movement. To demonstrate their performance, the biosensors were used to detect the cancer biomarker sprostate-specific antigen (PSA) and carcinoembryonic antigen (CEA). The linear detection range (LDR) of the capillary-based biosensor for detecting PSA was from 0.02 to 2.5ng/mL, and the limit of detection (LOD) was 0.017ng/mL. LDR of the biosensor for detecting CEA was from 0.063 to 16ng/mL, and the LOD was 0.044ng/mL. For detection of PSA and CEA in clinical serum samples, the detection results of the capillary-based biosensor were well correlate with the results from of chemiluminescence immunoassays (CLIAs). Thus, the capillary-based biosensor may potentially be a useful strategy for point-of-care testing, in addition to being portable and cost effective. PMID:27240013

  3. Association of Aggression and Non-Suicidal Self Injury: A School-Based Sample of Adolescents

    OpenAIRE

    Tang, Jie; Ma, Ying; Guo, Yong; Ahmed, Niman Isse; Yu, Yizhen; Wang, Jiaji

    2013-01-01

    Purpose Non-suicidal self-injury (NSSI) in adolescent has drawn increasing attention because it is associated with subsequent depression, drug abuse, anxiety disorders, and suicide. In the present study, we aimed to estimate the prevalence of non-suicidal self-injury (NSSI) in a school-based sample of Chinese adolescents and to explore the association between aggression and NSSI. Methods This study was part of a nationwide study on aggression among adolescents in urban areas of China. A sampl...

  4. Single-Sample Face Recognition Based on Intra-Class Differences in a Variation Model

    OpenAIRE

    Jun Cai; Jing Chen; Xing Liang

    2015-01-01

    In this paper, a novel random facial variation modeling system for sparse representation face recognition is presented. Although recently Sparse Representation-Based Classification (SRC) has represented a breakthrough in the field of face recognition due to its good performance and robustness, there is the critical problem that SRC needs sufficiently large training samples to achieve good performance. To address these issues, we challenge the single-sample face recognition problem with intra-...

  5. Exploring limits to market-based reform: managed competition and rehabilitation home care services in Ontario.

    Science.gov (United States)

    Randall, Glen E; Williams, A Paul

    2006-04-01

    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. PMID:16198035

  6. Farrow structure based Digital Decimator for Fractional Rate Sample Conversion using Lagrange Polynomial

    Directory of Open Access Journals (Sweden)

    Preeti,

    2012-06-01

    Full Text Available The concept of decimation plays very important role in the modern digital communication systems. Digital decimators or decimation filters are used to decrease the sampling rate of a sampled signal in digital domain. The Farrow Structure provides an efficient way to implement the decimation filter using polynomial approximation method for arbitrary sample rate change which offers the option of continuously adjustable resample ratio. In this paper, Lagrange polynomial approximation method has been used to implement Farrow structure based decimator. The optimum filter coefficients have been calculated using Lagrange Polynomials. Simulation results have been presented.

  7. Forestry inventory based on multistage sampling with probability proportional to size

    Science.gov (United States)

    Lee, D. C. L.; Hernandez, P., Jr.; Shimabukuro, Y. E.

    1983-01-01

    A multistage sampling technique, with probability proportional to size, is developed for a forest volume inventory using remote sensing data. The LANDSAT data, Panchromatic aerial photographs, and field data are collected. Based on age and homogeneity, pine and eucalyptus classes are identified. Selection of tertiary sampling units is made through aerial photographs to minimize field work. The sampling errors for eucalyptus and pine ranged from 8.34 to 21.89 percent and from 7.18 to 8.60 percent, respectively.

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

    Directory of Open Access Journals (Sweden)

    Karmali Anjum M

    2007-03-01

    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 http://www-cryst.bioc.cam.ac.uk/~swanand/mysite/rtk/index.html.

  9. 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

    2011-01-01

    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.

  10. Standard and Non-Standardized Data Bases in Long Term Care

    OpenAIRE

    Miller, R. Paul; Guhde, Robert; Downey, Edward; Hamlin, Kurt

    1990-01-01

    The Resource Utilization Groups (RUG-II), a case mix payment system for long term care facilities in New York State, is a highly structured and standardized data base. By mandating the electronic submission of data elements, the RUG-II forced computerization of nursing homes. As this data base has to be maintained, we visualized it as the core to which other data bases could be related. Examination of Federal and State mandate functions which regulate nursing homes identified a series of data...

  11. Product qualification: a barrier to point-of-care microfluidic-based diagnostics?

    Science.gov (United States)

    Tantra, Ratna; van Heeren, Henne

    2013-06-21

    One of the most exciting applications of microfluidics-based diagnostics is its potential use in next generation point-of-care (POC) devices. Many prototypes are already in existence, but, as of yet, few have achieved commercialisation. In this article, we consider the issue surrounding product qualification as a potential barrier to market success. The study discusses, in the context of POC microfluidics-based diagnostics, what the generic issues are and potential solutions. Our findings underline the need for a community-based effort that is necessary to speed up the product qualification process. PMID:23652789

  12. Care participation and burden among informal caregivers of older adults with care needs and associations with dementia

    OpenAIRE

    Vaingankar, Janhavi Ajit; Chong, Siow Ann; Abdin, Edimansyah; Picco, Louisa; Jeyagurunathan, Anitha; Zhang, Yunjue; Sambasivam, Rajeswari; Chua, Boon Yiang; Ng, Li Ling; Prince, Martin; Subramaniam, Mythily

    2015-01-01

    Background: Few studies have estimated care burden in large, representative, multi-ethnic Asian population-based informal caregivers of older adults with care needs. This study describes informal caregivers’ care participation for a population-based sample of older adults with care needs in Singapore, investigates differences by dementia status, and examines correlates of caregivers’ burden. Methods: Data collected from 693 pairs of older adults, aged 60 to 100 years, having any care needs, a...

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

    CERN Document Server

    Arslan, Oktay

    2012-01-01

    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...

  14. An outreach intervention to implement evidence based practice in residential care: a randomized controlled trial [ISRCTN67855475

    Directory of Open Access Journals (Sweden)

    Weller David

    2004-04-01

    Full Text Available Abstract Background The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting. Methods Twenty facilities took part in a randomized controlled trial with a seven month follow-up period. Two outreach visits were delivered by a pharmacist. At the first a summary of the relevant evidence was provided and at the second detailed audit information was provided about fall rates, psychotropic drug prescribing and stroke risk reduction practices (BP monitoring, aspirin and warfarin use for the facility relevant to the physician. The effect of the interventions was determined via pre- and post-intervention case note audit. Outcomes included change in percentage patients at risk of falling who fell in a three month period prior to follow-up and changes in use of psychotropic medications. Chi-square tests, independent samples t-test, and logistic regression were used in the analysis. Results Data were available from case notes at baseline (n = 897 and seven months follow-up (n = 902, 452 residential care staff were surveyed and 121 physicians were involved with 61 receiving outreach visits. Pre-and post-intervention data were available for 715 participants. There were no differences between the intervention and control groups for the three month fall rate. We were unable to detect statistically significant differences between groups for the psychotropic drug use of the patients before or after the intervention. The exception was significantly greater use of "as required" antipsychotics in the intervention group compared with the control group after the pharmacy intervention (RR = 4.95; 95%CI 1.69–14.50. There was no statistically significant difference between groups for the numbers of patients "at risk of stroke" on aspirin at follow-up. Conclusions While the strategy was well received by the

  15. ISOLATION AND SPECIATION OF CANDIDA FROM CLINICAL SAMPLES IN A TERTIARY CARE HOSPITAL AT KURNOOL, ANDHRAPRADESH, INDIA

    OpenAIRE

    Dasari; Suguneswari; Mahendra; Sisira

    2014-01-01

    : 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 effective...

  16. ISOLATION AND SPECIATION OF CANDIDA FROM CLINICAL SAMPLES IN A TERTIARY CARE HOSPITAL AT KURNOOL, ANDHRAPRADESH, INDIA

    Directory of Open Access Journals (Sweden)

    Dasari

    2014-12-01

    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.

  17. Changing clinical needs of people living with AIDS and receiving home based care in Malawi - the Bangwe Home Based Care Project 2003-2008 - a descriptive study

    Directory of Open Access Journals (Sweden)

    Gondwe Norton

    2010-06-01

    Full Text Available Abstract Background Home based care (HBC has been an important component of the response to the AIDS epidemic in Africa, and particularly so before antiretroviral therapy (ART became available. Has HBC become unnecessary now that ART is available in many African countries? One way to investigate this is to assess the changing need for comprehensive HBC as an ART programme becomes available. The Bangwe HBC programme in Malawi has been collecting data since 2003 before ART became available in 2005/6. Has the introduction of ART changed the clinical needs for HBC? Methods Information obtained at initial assessment and follow up visits of patients receiving HBC were combined to assess case severity, survival and the response to treatment. This information was used to assess trends in mortality and the incidence, duration and severity of common symptoms over a six year period in a defined urban population in Malawi. Results 1266 patients, of whom 1190 were followed up and of whom 652 (55% died, were studied. 282 (25% patients died within two months of being first seen with an improvement between 2003-2005 and 2006-2008 of reduced mortality from 28% to 20%. 341 (27% patients were unable to care for themselves on first assessment and 675 (53% had stage 4 AIDS disease. Most patients had a mix of symptoms at presentation. Self care increased somewhat over the six years although case severity as measured by WHO staging and nutritional status did not. 350 patients were on ART either started before or after initial assessment. There were significant barriers to accessing ART with 156 (51% of 304 stage 3 or 4 patients first assessed in 2007 or 2008 not receiving ART. Over the six year period new HBC cases reduced by 8% and follow up visits increased by 9% a year. Between 4 and 5 people sought HBC for the first time each week from an urban health centre catchment of 100,000, which required 37.3 follow up visits each week. Conclusions Since the availability of

  18. Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation

    Directory of Open Access Journals (Sweden)

    Van Herp Michel

    2009-10-01

    Full Text Available Abstract Background In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. Methods An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection was through a cross-sectional household survey of the catchment areas of 10 public health centres. A questionnaire was used to determine the accuracy of the community-identification method, households' access to health care, and costs of care. Household socioeconomic status was determined by reported expenditures and access to land. Results Financial access to care at the nearest health centre was ensured for 70% of the population. Of the remaining 30%, half experienced financial barriers to access and the other half chose alternative sites of care. The community-based assessment increased the number of people of the population who qualified for fee exemptions to 8.6% but many people who met the indigent criteria did not receive a card. Eighty-eight percent of the population lived under the poverty threshold. Referring to the last sickness episode, 87% of households reported having no money available and 25% risked further impoverishment because of healthcare costs even with the financial support system in place. Conclusion The flat fee policy was found to reduce cost barriers for some households but, given the generalized poverty in the area, the fee still posed a significant financial burden. This report showed the limits of a programme of fee exemption for indigent households and a flat fee for others in a context of widespread poverty.

  19. Simulation of realistic EarthCARE spaceborne Doppler products from ARM ground-based, SPIDER airborne and CRM data

    Science.gov (United States)

    Sy, O. O.; Tanelli, S.; Takahashi, N.; Ohno, Y.; Horie, H.; Kollias, P.

    2011-12-01

    The Cloud-profiling radar on ESA and JAXA's future EarthCARE mission will be the first spaceborne Doppler radar to ever fly [1]. This W-band CPR, which operates at 94.05 GHz, should provide an unprecedented global coverage of vertical-velocity field distribution of the Earth's atmosphere, and therewith a better characterization of dynamic energy transfers in the atmosphere. Prior to EarthCARE's launch, one needs to simulate the Doppler products to be expected from such a CPR, viz. the radar reflectivity and the mean velocity. Our work addresses this need by using existing ground-based and airborne Doppler measurements to generate realistic EarthCARElike spaceborne data. The input to our algorithm consists of actual atmospheric Doppler measurements obtained either from ground-based ARM [2], or from an airborne platform such as SPIDER [3], the Japanese CPR from the National institute od Information and Communications Technologies (NICT). Several corrections are then applied to account for the spacecraft motion as well as the spaceborneantenna characteristics. The realism of the simulated products is also achieved in terms of spatial and temporal resolution. Further, the effects of random fluctuations, noise and finite temporal sampling are included. In addition to highlighting the peculiarities of the generation of Doppler products according to the source of the original input data, our paper will show the corrections that are applied to recover the mean-Doppler velocity, particularly in the presence of aliasing and non-uniform beam-filling contaminations. Several scenarii will be discussed to explore the added value of EarthCARE data at a finer spatial resolution.

  20. A proactive, data-based determination of the standard of medical care in pediatrics.

    Science.gov (United States)

    Meadow, W; Lantos, J

    1998-04-01

    opinions were wrong and slanted toward the outcome known to be desired (namely, a shorter elapsed time). ER physicians (median estimated time to antibiotic administration [AB-TIME] = 46 minutes) and ID physicians (median estimated AB-TIME = 80 minutes) consistently underestimated the actual median value of AB-TIME determined by chart review (120 minutes). From the judicial perspective such potential flaws in expert testimony are assumed to be equally distributed among experts. All admissible evidence is a priori of equal weight until a jury decides otherwise. The standard of medical care is created anew by expert testimony in each individual case, disappearing, like Brigadoon, upon resolution of the dispute. However, to anyone but a lawyer, the standard of medical care must exist as something outside the courtroom testimony of experts, and if it does exist, it should be easily described so that expert testimony can be judged more (or less) accurate in depicting it. We contend that medical care is not a single behavior that conforms to or deviates from an idiosyncratic and retrospectively determined standard, but rather a distribution of behaviors in response to a variety of medical circumstances. For a given scenario, each of several possible responses can be ascribed a relative frequency based on empirical data, and the consequent normal curve depicts the totality of medical care. Substandard care then falls out neatly as behaviors lying outside the large majority of cases. Juries would be empowered (as they are currently) to determine exactly where on this curve substandard care lies, but at least the debate would share the same description of reality. Recent US Supreme Court guidelines regarding expert testimony provide an opportunity to expand the use of databases in medical negligence cases. The Court restricted expert testimony to "scientific knowledge ... based on generating hypotheses and testing them to see if they can be falsified ... (ABSTRACT TRUNCATED) PMID

  1. 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

    2007-05-01

    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.

  2. Managing and caring for distressed and disturbed service users: the thoughts and feelings experienced by a sample of English mental health nurses.

    Science.gov (United States)

    Chambers, M; Kantaris, X; Guise, V; Välimäki, M

    2015-06-01

    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

  3. 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)

    2016-03-15

    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.

  4. Validating the Knowledge in a Computer-Based Consultant for Nursing Care

    OpenAIRE

    Cuddigan, Janet E.; Norris, Joan; Ryan, Sheila A.; Evans, Steven

    1987-01-01

    An adaptation of the Turing Test was used to evaluate the knowledge of a computer based expert system, the COMMES-Nursing Protocol Consultant (NPC), which provides decision support for nursing care planning. A panel of nurses (n=106) with expertise in specific content domains or quality assurance compared nursing protocols written by the computer consultant with protocols written by qualified human nurse consultants, evaluating them on criteria of relevance, comprehension, accuracy, currency,...

  5. Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis

    OpenAIRE

    Scales, Damon C.; Thiruchelvam, Deva; Kiss, Alexander; Sibbald, William J; Donald A Redelmeier

    2008-01-01

    Introduction Intensive care unit (ICU) admission for bone marrow transplant recipients immediately following transplantation is an ominous event, yet the survival of these patients with subsequent ICU admissions is unknown. Our objective was to determine the long-term outcome of bone marrow transplant recipients admitted to an ICU during subsequent hospitalizations. Methods We conducted a population-based cohort analysis of all adult bone marrow transplant recipients who received subsequent I...

  6. Rolling capital: managing investments in a value-based care world.

    Science.gov (United States)

    Jasuta, Lynette

    2016-06-01

    The importance of capital planning is increasing as the healthcare industry moves toward value-based care. Replacing unwieldy and inflexible traditional capital planning processes with a rolling capital planning approach can result in: Greater standardization, facilitating better strategic planning across the whole system. Reduced labor intensity in the planning and budgeting process. Reduced costs through being able to plan better for replacement purchases and take advantage of group purchasing and bundling opportunities. Increased transparency in the decision-making process. PMID:27451571

  7. Dental care protocol based on visual supports for children with autism spectrum disorders

    OpenAIRE

    Cagetti, Maria Grazia; Mastroberardino, Stefano; Campus, Guglielmo; Olivari, Benedetta; Faggioli, Raffaella; Lenti, Carlo; Strohmenger, Laura

    2015-01-01

    Background Subjects with Autism Spectrum Disorders (ASDs) have often difficulties to accept dental treatments. The aim of this study is to propose a dental care protocol based on visual supports to facilitate children with ASDs to undergo to oral examination and treatments. Material and Methods 83 children (age range 6-12 years) with a signed consent form were enrolled; intellectual level, verbal fluency and cooperation grade were evaluated. Children were introduced into a four stages path in...

  8. Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation

    OpenAIRE

    Van Herp Michel; Bachy Catherine; Reid Tony; Ponsar Frederique; Lambert-Evans Sophie; Philips Mit

    2009-01-01

    Abstract Background In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households. Methods An evaluation was carried out in 2005 to assess the impact of this project. Primary data collection...

  9. Evidence-Based care in nursing: Het voordeel van de twijfel

    OpenAIRE

    Dekker - van Doorn, C.M.

    2015-01-01

    Is Evidence-based care een 'hippe hype' van voorbijgaande aard of een serieuze poging om de zorg voor patiënten aantoonbaar te verbeteren? De zorg verandert inhoudelijk en ook de organisatie van zorg verandert. Demografische ontwikkelingen en technologische ontwikkelingen zorgen voor veel veranderingen in de gezondheidszorg. Ook de grenzen tussen zorgorganisaties vervagen. Meerdere instellingen, zowel intramurale als extramurale instellingen, zijn betrokken bij de zorgverlening om zo goed mog...

  10. The evidence base for professional and self-care prevention - caries, erosion and sensitivity

    OpenAIRE

    Twetman, Svante

    2015-01-01

    Background The aim of this conference paper was to examine the evidence base for primary and secondary prevention of dental caries, erosions and dentin hypersensitivity through professional and self-care measures. Methods A mapping of systematic reviews (SR) of literature was carried out in PubMed and the Cochrane library through April 2014 using established MeSH-terms and disease-related search words in various combinations. The search was restricted to SR's published in English or Scandinav...

  11. Older adults’ home- and community-based care service use and residential transitions: a longitudinal study

    OpenAIRE

    Chen Ya-Mei; Berkowitz Bobbie

    2012-01-01

    Abstract Background As Home-and Community-Based Services (HCBS), such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and...

  12. Systematic review of pre-hospital outcomes for evidence-based evaluation of ambulance service care

    OpenAIRE

    Phung, Viet-Hai; Coster, Joanne; Wilson, Richard; Turner, Janette; Booth, Andrew; Siriwardena, A Niroshan

    2013-01-01

    Background: Ambulance service performance measurement has previously focused on response times and survival (particularly from out-of-hospital cardiac arrest). The PhOEBE (Pre-hospital Outcomes for Evidence Based Evaluation) project is a 5-year research programme which aims to develop new ways of measuring the performance, quality and impact of ambulance service care. As part of this programme we conducted a systematic review of the international literature on quality measures and outcomes re...

  13. Music-based interventions in palliative cancer care: a review of quantitative studies and neurobiological literature

    OpenAIRE

    Archie, Patrick; Bruera, Eduardo; Cohen, Lorenzo

    2013-01-01

    Purpose This study aimed to review quantitative literature pertaining to studies of music-based interventions in palliative cancer care and to review the neurobiological literature that may bare relevance to the findings from these studies. Methods A narrative review was performed, with particular emphasis on RCTs, meta-analyses, and systematic reviews. The Cochrane Library, Ovid, PubMed, CINAHL Plus, PsycINFO, and ProQuest were searched for the subject headings music, music therapy, cancer, ...

  14. Consultations with general practitioners on patient safety measures based on routinely collected data in primary care

    OpenAIRE

    Tsang, C; Majeed, A; Aylin, P

    2012-01-01

    OBJECTIVES To gauge the opinions of doctors working, or interested, in general practice on monitoring patient safety using administrative data. The findings will inform the development of routinely collected data-based patient safety indicators in general practice and elsewhere in primary care. DESIGN Non-systematic participant recruitment, using personal contacts and colleagues' recommendations. SETTING Face-to-face consultations at participants' places of work, between June 2010 a...

  15. Teamwork in skull base surgery: An avenue for improvement in patient care

    OpenAIRE

    McLaughlin, Nancy; Ricardo L. Carrau; Daniel F. Kelly; Prevedello, Daniel M.; Kassam, Amin B.

    2013-01-01

    Background: During the past several decades, numerous centers have acquired significant expertise in the treatment of skull base pathologies. Favorable outcomes are not only due to meticulous surgical planning and execution, but they are also related to the collaborative efforts of multiple disciplines. We review the impact of teamwork on patient care, elaborate on the key processes for successful teamwork, and discuss its challenges. Methods: Pubmed and Medline databases were searched for pu...

  16. Estimating leptospirosis incidence using hospital-based surveillance and a population-based health care utilization survey in Tanzania.

    Directory of Open Access Journals (Sweden)

    Holly M Biggs

    Full Text Available BACKGROUND: The incidence of leptospirosis, a neglected zoonotic disease, is uncertain in Tanzania and much of sub-Saharan Africa, resulting in scarce data on which to prioritize resources for public health interventions and disease control. In this study, we estimate the incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a population-based household health care utilization survey in two districts in the Kilimanjaro Region of Tanzania and identified leptospirosis cases at two hospital-based fever sentinel surveillance sites in the Kilimanjaro Region. We used multipliers derived from the health care utilization survey and case numbers from hospital-based surveillance to calculate the incidence of leptospirosis. A total of 810 households were enrolled in the health care utilization survey and multipliers were derived based on responses to questions about health care seeking in the event of febrile illness. Of patients enrolled in fever surveillance over a 1 year period and residing in the 2 districts, 42 (7.14% of 588 met the case definition for confirmed or probable leptospirosis. After applying multipliers to account for hospital selection, test sensitivity, and study enrollment, we estimated the overall incidence of leptospirosis ranges from 75-102 cases per 100,000 persons annually. CONCLUSIONS/SIGNIFICANCE: We calculated a high incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania, where leptospirosis incidence was previously unknown. Multiplier methods, such as used in this study, may be a feasible method of improving availability of incidence estimates for neglected diseases, such as leptospirosis, in resource constrained settings.

  17. Fostering critical thinking skills: a strategy for enhancing evidence based wellness care

    Directory of Open Access Journals (Sweden)

    Jamison Jennifer R

    2005-09-01

    Full Text Available Abstract Chiropractic has traditionally regarded itself a wellness profession. As wellness care is postulated to play a central role in the future growth of chiropractic, the development of a wellness ethos acceptable within conventional health care is desirable. This paper describes a unit which prepares chiropractic students for the role of "wellness coaches". Emphasis is placed on providing students with exercises in critical thinking in an effort to prepare them for the challenge of interfacing with an increasingly evidence based health care system. Methods This case study describes how health may be promoted and disease prevented through development of personalized wellness programs. As critical thinking is essential to the provision of evidence based wellness care, diverse learning opportunities for developing and refining critical thinking skills have been created. Three of the learning opportunities are an intrinsic component of the subject and, taken together, contributed over 50% of the final grade of the unit. They include a literature review, developing a client wellness contract and peer evaluation. In addition to these 3 compulsory exercises, students were also given an opportunity to develop their critical appraisal skills by undertaking voluntary self- and unit evaluation. Several opportunities for informal self-appraisal were offered in a structured self-study guide, while unit appraisal was undertaken by means of a questionnaire and group discussion at which the Head of School was present. Results Formal assessment showed all students capable of preparing a wellness program consistent with current thinking in contemporary health care. The small group of students who appraised the unit seemed to value the diversity of learning experiences provided. Opportunities for voluntary unit and self-appraisal were used to varying degrees. Unit evaluation provided useful feedback that led to substantial changes in unit structure

  18. Adapting evidence-based, cognitive-behavioral interventions for anxiety for use with adults in integrated primary care settings.

    Science.gov (United States)

    Shepardson, Robyn L; Funderburk, Jennifer S; Weisberg, Risa B

    2016-06-01

    Evidence-based treatments for adult patients with anxiety are greatly needed within primary care settings. Psychotherapy protocols, including those for cognitive-behavioral therapy (CBT), are often disorder-specific and were developed for specialty mental health settings, rendering them infeasible in primary care. Behavioral health consultants (BHCs) integrated into primary care settings are uniquely positioned to provide anxiety treatment. However, due to the dearth of empirically supported brief treatments for anxiety, BHCs are tasked with adapting existing treatments for use in primary care, which is quite challenging due to the abbreviated format and population-based approach to care. CBT protocols are highly effective in the treatment of anxiety and fit well with the self-management emphasis of integrated primary care. We review the rationale and procedure for 6 evidence-based CBT intervention techniques (psycho-education, mindfulness and acceptance-based behavioral techniques, relaxation training, exposure, cognitive restructuring, and behavioral activation) that can be adapted for use in the brief format typical of integrated primary care. We offer tips based on our clinical experience, highlight resources (e.g., handouts, websites, apps), and discuss 2 case examples to aid BHCs in their everyday practice. Our goal is to provide BHCs with practical knowledge that will facilitate the use of evidence-based interventions to improve the treatment of anxiety in primary care settings. (PsycINFO Database Record PMID:27064434

  19. The impact of market-based 'reform' on cultural values in health care.

    Science.gov (United States)

    Curtin, L L

    1999-12-01

    The many issues managed care poses for providers and health networks are crystallized in the moral problems occasioned by its shifting of the financial risks of care from insurer to provider. The issues occasioned by market-based reform include: the problems presented by clashes between public expectations and payer restrictions; the corporatization of health service delivery and the cultural shift from humanitarian endeavor to business enterprise the depersonalization of treatment as time and money constraints stretch resources, and the culture rewards efficient "business-like" behavior the underfunding of care for the poor and uninsured, even as these populations grow the restructuring of care and reengineering of healthcare roles as the emphasis shifts from quality of care to conservation of resources rapid mergers of both health plans and institutional providers with all the inherent turmoil as rules change, services are eliminated, and support services are minimized to save money the unhealthy competition inherent in market-based reform that posits profit taking and market share as the measures of successful performance the undermining of the professional ethic of advocacy the use of incentives that pander to greed and self-interest. The costs of sophisticated technologies and the ongoing care of increasingly fragile patients have pulled many other elements into what previously were considered "privileged" professional interactions. The fact that very few citizens indeed could pay out-of-pocket for the treatment and ongoing care they might need led to social involvement (few people remember that both widespread health insurance and public programs are relatively recent phenomena--only about 30 years old). However, whether in tax dollars or insurance premiums, other people's money is being spent on the patient's care. Clearly, those "other people" never intended to give either the patient or the professional open-ended access to their collective pocketbooks

  20. Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey

    Directory of Open Access Journals (Sweden)

    Vikum Eirik

    2012-08-01

    Full Text Available Abstract Background In this study we investigated the distribution of self-reported health care utilisation by education and household income in a county population in Norway, in a universal public health care system based on ideals of equal access for all according to need, and not according to wealth. Methods The study included 24,147 women and 20,608 men aged 20 years and above in the third Nord-Trøndelag Health Survey (HUNT 3 of 2006–2008. Income-related horizontal inequity was estimated through concentration indexes, and inequity by both education and income was estimated as risk ratios through conventional regression. Results We found no overall pro-rich or pro-educated socioeconomic gradient in needs-adjusted utilisation of general practitioner or inpatient care. However, we found overall pro-rich and pro-educated inequity in utilisation of both private medical specialists and hospital outpatient care. For these services there were large differences in levels of inequity between younger and older men and women. Conclusion In contrast with recent studies from Norway, we found pro-rich and pro-educated social inequalities in utilisation of hospital outpatient services and not only private medical specialists. Utilisation of general practitioner and inpatient services, which have low access threshold or are free of charge, we found to be equitable.

  1. Barriers and facilitators to replicating an evidence-based palliative care model.

    Science.gov (United States)

    Davis, E Maxwell; Jamison, Paula; Brumley, Richard; Enguídanos, Susan

    2006-01-01

    Recognition of the difficulties involved in replicating evidence- based interventions is well documented in the literature within the medical field. Promising research findings are often not translated into practice, and if they are, there is a significant time gap between study conclusion and practice adoption. The purpose of this article is to describe the barriers and facilitators encountered by two managed care organizations while replicating an evidence-based end of life in-home palliative care model. Using Diffusion of Innovation Theory as a theoretical framework, results from focus groups and interviews with the project's clinical, administrative and research teams are presented and recommendations made for improving translational efforts. The process of replicating the end of life in-home palliative care model clearly illustrated the key elements required for successfully diffusing innovation. These key elements include marketing and communication, leadership, organizational support and training and mentorship. This qualitative process study provides clear, real world perspectives of the myriad of challenges encountered in replicating an evidence-based project. PMID:16803742

  2. Implementing evidence-based interventions in health care: application of the replicating effective programs framework

    Directory of Open Access Journals (Sweden)

    Pincus Harold A

    2007-12-01

    Full Text Available Abstract Background We describe the use of a conceptual framework and implementation protocol to prepare effective health services interventions for implementation in community-based (i.e., non-academic-affiliated settings. Methods The framework is based on the experiences of the U.S. Centers for Disease Control and Prevention (CDC Replicating Effective Programs (REP project, which has been at the forefront of developing systematic and effective strategies to prepare HIV interventions for dissemination. This article describes the REP framework, and how it can be applied to implement clinical and health services interventions in community-based organizations. Results REP consists of four phases: pre-conditions (e.g., identifying need, target population, and suitable intervention, pre-implementation (e.g., intervention packaging and community input, implementation (e.g., package dissemination, training, technical assistance, and evaluation, and maintenance and evolution (e.g., preparing the intervention for sustainability. Key components of REP, including intervention packaging, training, technical assistance, and fidelity assessment are crucial to the implementation of effective interventions in health care. Conclusion REP is a well-suited framework for implementing health care interventions, as it specifies steps needed to maximize fidelity while allowing opportunities for flexibility (i.e., local customizing to maximize transferability. Strategies that foster the sustainability of REP as a tool to implement effective health care interventions need to be developed and tested.

  3. Photoacoustic spectroscopy-based detector for measuring benzene and toluene concentration in gas and liquid samples

    International Nuclear Information System (INIS)

    Here we present a novel instrument for on-line, automatic measurement of benzene and toluene concentration in gas and liquid samples produced in the natural gas industry. Operation of the instrument is based on the collection of analytes on an adsorbent, separation using a chromatographic column and detection by near-infrared diode laser-based photoacoustic spectroscopy. Sample handling, measurement and data evaluation are carried out fully automatically, using an integrated, programmable electronic unit. The instrument was calibrated in the laboratory for natural gas, nitrogen and liquid glycol samples, and tested under field conditions at a natural gas dehydration unit of the MOL Hungarian Oil and Gas Company. Minimum detectable concentrations (3σm−1) were found to be 2.5 µg l−1 for benzene and 4 µg l−1 for toluene in gas samples, while 1.5 mg l−1 for benzene and 3 mg l−1 for toluene in liquid samples, which is suitable for measuring benzene and toluene concentration in natural gas and glycol samples occurring at natural gas dehydration plants

  4. Lessons from prenatal care provider-based recruitment into the National Children’s Study

    Directory of Open Access Journals (Sweden)

    James M. Robbins

    2015-09-01

    Full Text Available In response to recruitment difficulties experienced by the National Children’s Study, alternatives to the door-to-door recruitment method were pilot tested. This report describes outcomes, successes, and challenges of recruiting women through prenatal care providers in Benton County, Arkansas, USA. Eligible women residing in 14 randomly selected geographic segments were recruited. Data were collected during pregnancy, at birth, and at 3, 6, 9, 12, 18, and 24 months postpartum. Participants were compared to non-enrolled eligible women through birth records. Of 6402 attempts to screen for address eligibility, 468 patients were potentially eligible. Of 221 eligible women approached to participate, 151 (68% enrolled in the 21-year study. Enrolled women were similar to non-enrolled women in age, marital status, number of prenatal care visits, and gestational age and birth weight of the newborn. Women enrolled from public clinics were more likely to be Hispanic, lower educated, younger and unmarried than those enrolled from private clinics. Sampling geographic areas from historical birth records failed to produce expected equivalent number of births across segments. Enrollment of pregnant women from prenatal care providers was successful.

  5. A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill.

    OpenAIRE

    Hughes, S. L.; Cummings, J.; Weaver, F; Manheim, L; Braun, B.; Conrad, K

    1992-01-01

    All admissions to a 1,100-bed Department of Veterans Affairs (VA) hospital were screened to identify 171 terminally ill patients with informal caregivers who were then randomly assigned to VA hospital-based team home care (HBHC, N = 85) or customary care (N = 86). Patient functioning, and patient and caregiver morale and satisfaction with care were measured at baseline, one month, and six months. Health services utilization was monitored over the six-month study period and converted to cost. ...

  6. Health Care Consumption during Pregnancy in relation to Maternal Body Mass Index : A Swedish Population Based Observational Study

    OpenAIRE

    Lindholm, Elisabeth S.; Daniel Altman; Margareta Norman; Marie Blomberg

    2015-01-01

    Objective. To assess whether antenatal health care consumption is associated with maternal body mass index (BMI). Design. A register based observational study. Methods. The Swedish Medical Birth Register, the Maternal Health Care Register, and the Inpatient Register were used to determine antenatal health care consumption according to BMI categories for primiparous women with singleton pregnancies, from 2006 to 2008, n = 71,638. Pairwise comparisons among BMI groups are obtained post hoc by T...

  7. A social marketing approach to implementing evidence-based practice in VHA QUERI: the TIDES depression collaborative care model

    OpenAIRE

    Parker Louise E; Hagigi Fred; Luck Jeff; Yano Elizabeth M; Rubenstein Lisa V; Kirchner JoAnn E

    2009-01-01

    Abstract Collaborative care models for depression in primary care are effective and cost-effective, but difficult to spread to new sites. Translating Initiatives for Depression into Effective Solutions (TIDES) is an initiative to promote evidence-based collaborative care in the U.S. Veterans Health Administration (VHA). Social marketing applies marketing techniques to promote positive behavior change. Described in this paper, TIDES used a social marketing approa...

  8. Networked Estimation for Event-Based Sampling Systems with Packet Dropouts

    Directory of Open Access Journals (Sweden)

    Young Soo Suh

    2009-04-01

    Full Text Available This paper is concerned with a networked estimation problem in which sensor data are transmitted over the network. In the event-based sampling scheme known as level-crossing or send-on-delta (SOD, sensor data are transmitted to the estimator node if the difference between the current sensor value and the last transmitted one is greater than a given threshold. Event-based sampling has been shown to be more efficient than the time-triggered one in some situations, especially in network bandwidth improvement. However, it cannot detect packet dropout situations because data transmission and reception do not use a periodical time-stamp mechanism as found in time-triggered sampling systems. Motivated by this issue, we propose a modified event-based sampling scheme called modified SOD in which sensor data are sent when either the change of sensor output exceeds a given threshold or the time elapses more than a given interval. Through simulation results, we show that the proposed modified SOD sampling significantly improves estimation performance when packet dropouts happen.

  9. Efficient Bayes-Adaptive Reinforcement Learning using Sample-Based Search

    CERN Document Server

    Guez, Arthur; Dayan, Peter

    2012-01-01

    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.

  10. Calibrating passive sampling and passive dosing techniques to lipid based concentrations

    DEFF Research Database (Denmark)

    Mayer, Philipp; Schmidt, Stine Nørgaard; Annika, A.;

    2011-01-01

    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...... experiments. Both these equilibrium partitioning approaches are normally calibrated to freely dissolved aqueous concentrations (Cfree), which often are considered the effective concentration for partitioning, bioconcentration and toxicity. In the present studies we extend the calibration of such methods...... 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...

  11. Analysis of Sampled Fiber Bragg Grating Based on the Photonic Crystal Theory

    Institute of Scientific and Technical Information of China (English)

    ZHU Dan-dan

    2009-01-01

    One of the most basic characteristics of photonic crystal is frequency band gap.When defects are introduced into the periodic photonic crystal,a number of defect modes appear in the stop band.In this paper,we exploit transfer matrix method based on photonic crystal theory,and assume the sampled fiber Bragg grating as one-dimensional dual photonic crystal with a large size defect.Characteristics of the sampled fiber Bragg grating are analyzed.Experimental results show that the sampled fiber Bragg grating has many reflective peaks.Its reflectivity,center wavelength,reflective peak intervals and band width all change with the grating parameters,including grating length,duty ratio of the material with high dielectric constant,and index modulation depth and period.Results agree with the conventional couple mode theory which can be used when analyzing other characteristics of the sampled fiber Bragg grating or applying it into practice.

  12. Sampling optimization method based on color difference analysis for printer characterization

    Science.gov (United States)

    Liu, Juhua; Yi, Yaohua; Su, Hai; Yuan, Yuan; Miao, Minjing

    2013-07-01

    A sampling optimization method based on color difference analysis was proposed in this paper. Firstly, three color sets--respectively a super set used to simulate the whole CMYK color space, a test set for characterization accuracy verification and an initial characterization set were defined and created. Secondly, the colorimetric values of test set can be predicted according to the characterization results of the current characterization set. Thirdly, by analyzing the color difference of test set, 10% samples with larger color difference were selected as the larger color difference set to carry on optimization. After that, the samples in the super set which are closest to the larger color difference set were found and added to the characterization set. Finally, cyclic optimization was conducted until the characterization accuracy meets the given requirements. Experimental results showed a significant reduction in the number of samples with an improvement of characterization accuracy.

  13. Reconstruction of seismic data with missing traces based on local random sampling and curvelet transform

    Science.gov (United States)

    Liu, Wei; Cao, Siyuan; Li, Guofa; He, Yuan

    2015-04-01

    It is likely to yield seismic data with missing traces in field data acquisition, however, the subsequent processing requires complete seismic data; therefore, it is more necessary to reconstruct missing traces in seismic data. The reconstruction of seismic data becomes a sparse optimization problem based on sparsity of seismic data in curvelet transform domain and the gradient projection algorithm is employed to solve it. To overcome the limitations of uncontrolled random sampling, the local random sampling is presented in the paper; it can not only control the size of the sampling gaps effectively, but also keep the randomness of the sampling. The numerical modeling shows that the reconstructed result of local random sampling is better than that of traditional random sampling and jitter sampling. In addition, the proposed approach is also applied to pre-stack shot gather and stacked section, the field examples indicate that this method is effective and applicable for the reconstruction of seismic data with missing traces again. Furthermore, this approach can provide satisfactory result for the following processing on seismic data.

  14. Prevalence and Cognitive Bases of Subjective Memory Complaints in Older Adults: Evidence from a Community Sample

    OpenAIRE

    Thomas Fritsch; McClendon, McKee J.; Wallendal, Maggie S.; Hyde, Trevor F.; Larsen, Janet D.

    2014-01-01

    Objectives. To estimate the prevalence of subjective memory complaints (SMCs) in a sample of community-dwelling, older adults and to examine cognitive bases of these complaints. Participants. 499 community-dwelling adults, 65 and older. Measurements. A telephone survey consisting of cognitive tests and clinical and sociodemographic variables. SMCs were based on subjects' evaluations and subjects' perceptions of others' evaluations. Analysis. Logistic regression was used to model the risk fo...

  15. Effect of a staffing strategy based on voluntary increase in working hours on quality of patient care in a hospital in KwaZulu-Natal

    Directory of Open Access Journals (Sweden)

    J. McIntosh

    2009-09-01

    Full Text Available Two of the issues facing the South African Health Care System are the shortage of nursing staff and a lack of adequate skills to provide quality patient care. The hospital under study experienced a critical shortage of applications from professional registered nurses, consequently a staffing strategy was implemented to overcome the shortage of nurses and to maintain quality patient care. The strategy introduced encouraged nurses to voluntarily work an additional ten hours per week with remuneration. A non-experimental, descriptive design with a quantitative approach was applied to investigate the effect of a staffing strategy aimed at improving the quality of care in a hospital in Kwa-Zulu Natal based on voluntarily increasing staff working hours. The investigation compared the quality of nursing care before and after the implementation of the staffing strategy through retrospective audits of randomly selected patient files 372 (11% of the total population of 400 files were audited. A random sample of 4 boxes each containing a 100 patient files, of a total of 34 boxes, was selected from the hospital filing system. Descriptive statistical analyses were performed and correlations between various variables using the Chi-square test. No statistically significant differences (p<0.05 were found between the quality of nursing care before and after the implementation of the management strategy, even though deterioration of results after the implementation was observed. The study shows that the quality of nursing care in most wards deteriorated after implementation. The staffing strategy failed to improve or maintain the quality of nursing care.

  16. Challenges for the adoption of evidence-based maternity care in Turkey.

    Science.gov (United States)

    Turan, Janet Molzan; Bulut, Ayşen; Nalbant, Hacer; Ortayli, Nuriye; Erbaydar, Tuğrul

    2006-05-01

    Evidence-based medicine is an important tool for improving the quality of maternity care. However, getting providers to change their practices may not be an easy or rapid process, and other factors, in addition to knowledge of the literature, may be important. This study documents the current state of obstetric practices at three maternity hospitals in Istanbul, Turkey, and identifies attitudes, social pressures, and perceptions that, according to the theory of planned behavior, may pose challenges for adoption of evidence-based practices. Data were collected through interviews with administrators, examination of hospital statistics, provider and client interviews, and structured observations of maternity care. Practices that did not follow current guidelines included routine episiotomy, not allowing companionship during labor, use of procedures to speed up labor without indications, routine enema, restriction of mobility, restriction of oral fluids, supine position for delivery, and non-use of active management of the third stage of labor. The findings indicate that providers had negative attitudes about some recommended practices, while they had positive attitudes towards some ineffective and/or harmful practices. We identified social pressure to comply with practices recommended by supervisors and peers, as well as the belief that limited resources affect maternity care providers, opportunities to perform evidence-based procedures. An underlying problem was the failure to involve women in decision-making regarding their own maternity care. In addition to informing providers about the evidence, it seems necessary to develop standard protocols, improve physical conditions, and implement behavior interventions that take into account provider attitudes, social pressures, and beliefs. PMID:16289786

  17. Single-Sample Face Recognition Based on Intra-Class Differences in a Variation Model

    Directory of Open Access Journals (Sweden)

    Jun Cai

    2015-01-01

    Full Text Available In this paper, a novel random facial variation modeling system for sparse representation face recognition is presented. Although recently Sparse Representation-Based Classification (SRC has represented a breakthrough in the field of face recognition due to its good performance and robustness, there is the critical problem that SRC needs sufficiently large training samples to achieve good performance. To address these issues, we challenge the single-sample face recognition problem with intra-class differences of variation in a facial image model based on random projection and sparse representation. In this paper, we present a developed facial variation modeling systems composed only of various facial variations. We further propose a novel facial random noise dictionary learning method that is invariant to different faces. The experiment results on the AR, Yale B, Extended Yale B, MIT and FEI databases validate that our method leads to substantial improvements, particularly in single-sample face recognition problems.

  18. Single-Sample Face Recognition Based on Intra-Class Differences in a Variation Model

    Science.gov (United States)

    Cai, Jun; Chen, Jing; Liang, Xing

    2015-01-01

    In this paper, a novel random facial variation modeling system for sparse representation face recognition is presented. Although recently Sparse Representation-Based Classification (SRC) has represented a breakthrough in the field of face recognition due to its good performance and robustness, there is the critical problem that SRC needs sufficiently large training samples to achieve good performance. To address these issues, we challenge the single-sample face recognition problem with intra-class differences of variation in a facial image model based on random projection and sparse representation. In this paper, we present a developed facial variation modeling systems composed only of various facial variations. We further propose a novel facial random noise dictionary learning method that is invariant to different faces. The experiment results on the AR, Yale B, Extended Yale B, MIT and FEI databases validate that our method leads to substantial improvements, particularly in single-sample face recognition problems. PMID:25580904

  19. 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.;

    2004-01-01

    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 PCR assay (gel electrophoresis detection) were performed by the receiving laboratories. Aliquots of BPW enrichment cultures were sent to the participants, who analyzed them using a thermal lysis procedure followed by a validated Salmonella-specific PCR assay. The results were reported as negative...... 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...

  20. An improved, PCR-based strategy for the detection of Trypanosoma cruzi in human blood samples.

    Science.gov (United States)

    Ribeiro-dos-Santos, G; Nishiya, A S; Sabino, E C; Chamone, D F; Saez-Alquézar, A

    1999-10-01

    Attempts were made to improve the PCR-based detection of Trypanosoma cruzi in blood samples, primarily for screening blood donors. Samples were obtained from candidate donors who were reactive in one or two of three serological tests for Chagas disease (and therefore considered 'indeterminate') or in all three tests (3+). Each sample was then examined using three different, PCR-based techniques: 'PCR-I' (in which the target DNA is a nuclear repetitive sequence); 'PCR-II' [amplifying a conserved region of the T. cruzi kinetoplast DNA (kDNA)]; and 'PCR-III' (a new strategy in which the target kDNA is amplified by 'nested' PCR). Among the samples from 3+ individuals, PCR-I, PCR-II and PCR-III amplified two (3.8%) out of 52, four (4.5%) out of 88, and 27 (25.7%) out of 105 samples tested, respectively. Seven, 69 and 70 samples from 'indeterminate' subjects were tested by PCR-I, PCR-II and PCR-III, respectively; there was not a single positive result by PCR-I or PCR-II, but three (4.3%) of the samples tested by PCR-III were positive. In a reconstruction experiment, in conditions in which PCR-I and PCR-II could not detect 10,000 parasites/ml, PCR-III was able to detect one parasite/ml. Although all three PCR-based strategies examined had rather poor sensitivities, PCR-III was far more sensitive than PCR-I or PCR-II. PMID:10715696

  1. Using Load Balancing to Scalably Parallelize Sampling-Based Motion Planning Algorithms

    KAUST Repository

    Fidel, Adam

    2014-05-01

    Motion planning, which is the problem of computing feasible paths in an environment for a movable object, has applications in many domains ranging from robotics, to intelligent CAD, to protein folding. The best methods for solving this PSPACE-hard problem are so-called sampling-based planners. Recent work introduced uniform spatial subdivision techniques for parallelizing sampling-based motion planning algorithms that scaled well. However, such methods are prone to load imbalance, as planning time depends on region characteristics and, for most problems, the heterogeneity of the sub problems increases as the number of processors increases. In this work, we introduce two techniques to address load imbalance in the parallelization of sampling-based motion planning algorithms: an adaptive work stealing approach and bulk-synchronous redistribution. We show that applying these techniques to representatives of the two major classes of parallel sampling-based motion planning algorithms, probabilistic roadmaps and rapidly-exploring random trees, results in a more scalable and load-balanced computation on more than 3,000 cores. © 2014 IEEE.

  2. Reinforcing Sampling Distributions through a Randomization-Based Activity for Introducing ANOVA

    Science.gov (United States)

    Taylor, Laura; Doehler, Kirsten

    2015-01-01

    This paper examines the use of a randomization-based activity to introduce the ANOVA F-test to students. The two main goals of this activity are to successfully teach students to comprehend ANOVA F-tests and to increase student comprehension of sampling distributions. Four sections of students in an advanced introductory statistics course…

  3. 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

    2005-01-01

    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.

  4. 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...

  5. Newborn care practices in rural Bangladesh: Implications for the adaptation of kangaroo mother care for community-based interventions.

    Science.gov (United States)

    Hunter, Erin C; Callaghan-Koru, Jennifer A; Al Mahmud, Abdullah; Shah, Rashed; Farzin, Azadeh; Cristofalo, Elizabeth A; Akhter, Sadika; Baqui, Abdullah H

    2014-12-01

    Bangladesh has one of the world's highest rates of low birth weight along with prevalent traditional care practices that leave newborns highly vulnerable to hypothermia, infection, and early death. We conducted formative research to explore existing newborn care practices in rural Bangladesh with an emphasis on thermal protection, and to identify potential facilitators, barriers, and recommendations for the community level delivery of kangaroo mother care (CKMC). Forty in-depth interviews and 14 focus group discussions were conducted between September and December 2012. Participants included pregnant women and mothers, husbands, maternal and paternal grandmothers, traditional birth attendants, village doctors, traditional healers, pharmacy men, religious leaders, community leaders, and formal healthcare providers. Audio recordings were transcribed and translated into English, and the textual data were analyzed using the Framework Approach. We find that harmful newborn care practices, such as delayed wrapping and early initiation of bathing, are changing as more biomedical advice from formal healthcare providers is reaching the community through word-of-mouth and television campaigns. While the goal of CKMC was relatively easily understood and accepted by many of the participants, logistical and to a lesser extent ideological barriers exist that may keep the practice from being adopted easily. Women feel a sense of inevitable responsibility for household duties despite the desire to provide the best care for their new babies. Our findings showed that participants appreciated CKMC as an appropriate treatment method for ill babies, but were less accepting of it as a protective method of caring for seemingly healthy newborns during the first few days of life. Participants highlighted the necessity of receiving help from family members and witnessing other women performing CKMC with positive outcomes if they are to adopt the behavior themselves. Focusing intervention

  6. Case and Relation (CARE based Page Rank Algorithm for Semantic Web Search Engines

    Directory of Open Access Journals (Sweden)

    N. Preethi

    2012-05-01

    Full Text Available Web information retrieval deals with a technique of finding relevant web pages for any given query from a collection of documents. Search engines have become the most helpful tool for obtaining useful information from the Internet. The next-generation Web architecture, represented by the Semantic Web, provides the layered architecture possibly allowing data to be reused across application. The proposed architecture use a hybrid methodology named Case and Relation (CARE based Page Rank algorithm which uses past problem solving experience maintained in the case base to form a best matching relations and then use them for generating graphs and spanning forests to assign a relevant score to the pages.

  7. Technology-Based Innovations in Child Maltreatment Prevention Programs: Examples from SafeCare®

    OpenAIRE

    Melissa Cowart-Osborne; Matthew Jackson; Elizabeth Chege; Evander Baker; Daniel Whitaker; Shannon Self-Brown

    2014-01-01

    Each year, hundreds of thousands of children in the U.S. are victims of child maltreatment. Experts recommend behavioral, skill-based parent training programs as a strategy for the prevention of child abuse and neglect. These programs can be enhanced using innovative technology strategies. This paper presents a brief history of the use of technology in SafeCare®, a home visiting program shown to prevent child neglect and physical abuse, and highlights current work that takes a technology-base...

  8. A Pilot Test of the Everyday Stressors Index–Spanish Version in a Sample of Hispanic Women Attending Prenatal Care

    Science.gov (United States)

    Gómez, María L.; Ashford, Kristin; Linares, Ana M.; Hall, Lynne A.

    2016-01-01

    Background and Purpose Prenatal and postpartum psychosocial stress are associated with adverse pregnancy outcomes. Hispanic women experience higher levels of stress during pregnancy. This pilot study assessed the psychometric characteristics of the Everyday Stressors Index-Spanish (ESI-S) version. Methods Secondary analysis in a convenience sample, n = 51 women. Results The ESI-S showed adequate internal consistency (Cronbach’s alpha = .86). Two factors accounted for 40% of the item variance. The greatest sources of stress were “having too many responsibilities” and “not enough money for basics”. Higher levels of stressors were associated with older age, living without a partner, and working part or full time. The ESI-S was positively correlated with measures of perinatal depression. Conclusions Findings support the reliability and validity of the newly translated ESI-S. PMID:26673774

  9. Female genital cutting: an evidence-based approach to clinical management for the primary care physician.

    Science.gov (United States)

    Hearst, Adelaide A; Molnar, Alexandra M

    2013-06-01

    The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue. PMID:23726401

  10. Technology-Based Innovations in Child Maltreatment Prevention Programs: Examples from SafeCare®

    Directory of Open Access Journals (Sweden)

    Melissa Cowart-Osborne

    2014-08-01

    Full Text Available Each year, hundreds of thousands of children in the U.S. are victims of child maltreatment. Experts recommend behavioral, skill-based parent training programs as a strategy for the prevention of child abuse and neglect. These programs can be enhanced using innovative technology strategies. This paper presents a brief history of the use of technology in SafeCare®, a home visiting program shown to prevent child neglect and physical abuse, and highlights current work that takes a technology-based hybrid approach to SafeCare delivery. With this unique approach, the provider brings a tablet computer to each session, and the parent interacts with the software to receive psychoeducation and modeling of target skills. The provider and parent then work together to practice the targeted skills until mastery is achieved. Initial findings from ongoing research of both of these strategies indicate that they show potential for improving engagement and use of positive parenting skills for parents and ease of implementation for providers. Future directions for technology enhancements in SafeCare are also presented.

  11. Designing health care environments: Part I. Basic concepts, principles, and issues related to evidence-based design.

    Science.gov (United States)

    Cesario, Sandra K

    2009-06-01

    A 2001 Institute of Medicine report captured the nation's attention regarding the dangers that can result from the health care environment. This report, fueled by the need for new facilities to be constructed, led to an explosion of research that now links the physical structure and design of health care facilities to the health and well-being of patients, nurses, other health care workers, and visitors. Continuing nursing education that highlights the importance of evidence-based design has been associated with measurable improvement in health care facilities' clinical outcomes, economic performance, employee productivity, customer satisfaction, and cultural congruency. Three major categories of outcomes can be impacted by evidence-based design: stress reduction, safety, and overall health care quality and ecology. In this article, Part I of a two-part series, the basic concepts, principles, and issues related to evidence-based design are introduced. Part II will describe continuing education programs available for nurses. PMID:19639918

  12. What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic

    Directory of Open Access Journals (Sweden)

    Aznida Firzah Abdul Aziz

    2013-01-01

    Full Text Available Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care-driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long-term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1-year post treatment. Clinical outcomes included stroke risk factor(s control, depression according to Patient Health Questionnaire (PHQ9, and level of independence using Barthel Index (BI. Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t-tests or Wilcoxon-signed rank test. Significance level was set at 0.05. Results: Ninety-one patients were analyzed. Their mean age was 62.9 [standard deviation (SD 10.9] years, mean stroke episodes were 1.30 (SD 0.5. The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0 months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007, while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06. Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2−100 to 90.5 (range: 27−100 (Z = 2.34, P = 0.01. Median PHQ9 scores decreased from 4.0 (range: 0−22 to 3.0 (range: 0−19 though the change was not significant (Z= −0.744, P = 0.457. Conclusions: Primary care-driven long-term stroke care services yield favorable outcomes for blood pressure control and functional level.

  13. Evaluation of Internet-Based Technology for Supporting Self-Care: Problems Encountered by Patients and Caregivers When Using Self-Care Applications

    NARCIS (Netherlands)

    Nijland, Nicol; Gemert-Pijnen, van Julia; Boer, Henk; Steehouder, Michael F.; Seydel, Erwin R.

    2008-01-01

    Background: Prior studies have shown that many patients are interested in Internet-based technology that enables them to control their own care. As a result, innovative eHealth services are evolving rapidly, including self-assessment tools and secure patient-caregiver email communication. It is inte

  14. Growth monitoring in the evolution of clinic based health care through a community based action program.

    Science.gov (United States)

    Chaudhuri, S N

    1988-01-01

    In Calcutta, India a voluntary organization was established in 1975 called the Child in Need Institute (CINI) in order to nutritionally rehabilitate the poor. CINI detected malnutrition by utilizing "weight for age" charts and treated malnutrition with food supplements. Women must purchase a growth card to enter the program. Patients are registered, weighed and plotted, given on ort demonstration, educated in health and nutrition, shown supplementary feeding techniques, given a health check up and immunizations, and are given antenatal care. The growth card is referred to at all stages of the care, which causes mothers to realize that it is very important to their health. CINI eventually established mobile clinics run by women's groups. 50% of all children under 3 participate monthly and 30% more participate at 2-3 month intervals. Mothers are more willing to correct the nutrition of their children when they understand the growth charts. The India Institute of Medical Sciences in 1986 assessed the KAP (knowledge, awareness, performance) of 132 village mothers. They found significant appreciation for growth monitoring. Mothers have also become more aware of the importance of sanitation, frequent feeding, and clean water. The growth chart is a tool, but is also viewed as a symbol of the activities of CINI. PMID:3391668

  15. [Climacteric women: a proposal for nursing clinical care based on Freirean ideas].

    Science.gov (United States)

    Vidal, Cláudia Rejane Pinheiro Maciel; Miranda, Karla Corrêa Lima; Pinheiro, Patrícia Neyva da Costa; Rodrigues, Dafne Paiva

    2012-01-01

    The study aims to discuss the concepts of caring and education and propose a strategy for health education as a possibility for clinical nursing care for women in menopause based on the educational principles of Paulo Freire. Over the years, different paradigms of Health Education are conditioned by different strategies, many of them reductionists, which require questioning and implementation of more integral and participatory actions. From this thought, we seek an opportunity for education that includes the "Other" in their complexity, enabling the women in their climacteric phase can also be assisted in full. In this scenario, we visualize the principles of Paulo Freire as a framework to guide this development; it shows a dialectic education, solidarity, without arrogance, articulating the scientific knowledge and popular knowledge, translating his method in a collective work. PMID:23258690

  16. An Intelligent Architecture for Multi-Agent Based m-Health Care System

    Directory of Open Access Journals (Sweden)

    Mayuri Gund#1 , Snehal Andhalkar*2 , Prof. Dipti Patil#3, Dr. V.M.Wadhai#4

    2011-04-01

    Full Text Available In this paper, we propose a multi-agent based mobile health monitoring system which is the combination of a wireless medical sensor module with data mining techniques. Mobile Health Care is the application of mobile computing technologies for improving communication among patients, physicians, and other health care workers. Here we separate Association rule exploration into two data groups: 1 Real time sensory data collected from patient’s body 2 Historical data collected in past. This system collects the diagnosis patterns, classifies them into normal and emergency terms and declares emergency by comparing the two data groups as mentioned earlier. Thus suggests methods to analyze and model patterns of patient’s normal and emergency status.

  17. 3D web based learning of medical equipment employed in intensive care units.

    Science.gov (United States)

    Cetin, Aydın

    2012-02-01

    In this paper, both synchronous and asynchronous web based learning of 3D medical equipment models used in hospital intensive care unit have been described over the moodle course management system. 3D medical equipment models were designed with 3ds Max 2008, then converted to ASE format and added interactivity displayed with Viewpoint-Enliven. 3D models embedded in a web page in html format with dynamic interactivity-rotating, panning and zooming by dragging a mouse over images-and descriptive information is embedded to 3D model by using xml format. A pilot test course having 15 h was applied to technicians who is responsible for intensive care unit at Medical Devices Repairing and Maintenance Center (TABOM) of Turkish High Specialized Hospital. PMID:20703738

  18. Comparing Early Childhood Education and Care from a Rights-based Approach

    Directory of Open Access Journals (Sweden)

    Ana Ancheta Arrabal

    2015-06-01

    Full Text Available This paper pretends to examine how the equal right to quality education and care in the phase of early childhood is developed in different policies, particularly within the processes for the inclusion of children in situations of social risk and exclusion in the European systems of Early Childhood Education and Care (ECEC. Extracted from the findings of the author’s PhD, the following pages include some of the main characteristics, as well as the outcomes and the conclusions of the study, which are briefly described, comprising the structure of a comparison on the ECEC policies between three representative countries in Europe. The work attended to the previous studies on early childhood describing ECEC throughout western European societies, to analyse their impact in equity of opportunity considering ECEC as the long life learning base, and discussing its implications for the inter-generational exclusion, in searching policy recommendations to enhance ECEC and child well-being. 

  19. [Smart card systems in health care (protection, key-functions, divided data bases, applications)].

    Science.gov (United States)

    Simon, P

    1999-04-25

    Barely more than 15 years have passed since electronic memory cards appeared, their popularity has grown rapidly (first of all as a cash-saving device and later for other purposes, as well). This is due also to the growing interest towards development of the intelligence of information systems for the follow-up of patients' health condition and medical care in countries with a highly developed health and insurance system (need for the creation of data bases divided for individuals) and also to their commitment towards a better control of the quality and costs of health care. We can come to the conclusion that the aim of research, development and the creation of systems in health informatics is to prevent illness and to give a direct informatic support to medical and nursing activity carried out in the patients' interests. The smart card and the surrounding application systems are certainly the appropriate means for the achievement of these aims. PMID:10344142

  20. Chronic care management of globesity: promoting healthier lifestyles in traditional and mHealth based settings

    Directory of Open Access Journals (Sweden)

    Gianluca eCastelnuovo

    2015-10-01

    Full Text Available Obesity and being overweight could be real chronic conditions above all if there are other complications such as type 2 diabetes, cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer and various psychosocial and psychopathological disorders,. Due to the multifactorial etiology of obesity, evidence-based interventions to improve weight loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. There are significant limitations in this multidisciplinary chronic care management of obesity, most notably those regarding costs and long-term adherence and efficacy. Programs including eHealth platforms and new technologies could overcome limitations connected to the traditional in-patient chronic care management of obesity, thus providing promising opportunities in enhancing weight reduction and reducing complications in terms of long-term efficacy and effectiveness across clinical, organizational, and economic perspectives.