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Sample records for care chip study

  1. Control of hyperglycaemia in paediatric intensive care (CHiP: study protocol

    Directory of Open Access Journals (Sweden)

    Percy Deborah

    2010-02-01

    Full Text Available Abstract Background There is increasing evidence that tight blood glucose (BG control improves outcomes in critically ill adults. Children show similar hyperglycaemic responses to surgery or critical illness. However it is not known whether tight control will benefit children given maturational differences and different disease spectrum. Methods/Design The study is an randomised open trial with two parallel groups to assess whether, for children undergoing intensive care in the UK aged ≤ 16 years who are ventilated, have an arterial line in-situ and are receiving vasoactive support following injury, major surgery or in association with critical illness in whom it is anticipated such treatment will be required to continue for at least 12 hours, tight control will increase the numbers of days alive and free of mechanical ventilation at 30 days, and lead to improvement in a range of complications associated with intensive care treatment and be cost effective. Children in the tight control group will receive insulin by intravenous infusion titrated to maintain BG between 4 and 7.0 mmol/l. Children in the control group will be treated according to a standard current approach to BG management. Children will be followed up to determine vital status and healthcare resources usage between discharge and 12 months post-randomisation. Information regarding overall health status, global neurological outcome, attention and behavioural status will be sought from a subgroup with traumatic brain injury (TBI. A difference of 2 days in the number of ventilator-free days within the first 30 days post-randomisation is considered clinically important. Conservatively assuming a standard deviation of a week across both trial arms, a type I error of 1% (2-sided test, and allowing for non-compliance, a total sample size of 1000 patients would have 90% power to detect this difference. To detect effect differences between cardiac and non-cardiac patients, a target sample

  2. Dental Care for Medicaid and CHIP Enrollees

    Science.gov (United States)

    ... FAQs Home › Medicaid › Benefits › Dental Care Dental Care Dental Care Related Resources Learn How to Report the ... services and opportunities and challenges to obtaining care. Dental Benefits for Children in Medicaid Medicaid covers dental ...

  3. Children with Special Health Care Needs in CHIP: Access, Use, and Child and Family Outcomes.

    Science.gov (United States)

    Zickafoose, Joseph S; Smith, Kimberly V; Dye, Claire

    2015-01-01

    To assess how the Children's Health Insurance Program (CHIP) affects outcomes for children with special health care needs (CSHCN). We used data from a survey of parents of recent and established CHIP enrollees conducted from January 2012 through March 2013 as part of a congressionally mandated evaluation of CHIP. We identified CSHCN in the sample using the Child and Adolescent Health Measurement Initiative's CSHCN screener. We compared the health care experiences of established CHIP enrollees to the pre-enrollment experiences of previously uninsured and privately insured recent CHIP enrollees, controlling for observable characteristics. Parents of 4142 recent enrollees and 5518 established enrollees responded to the survey (response rates, 46% recent enrollees and 51% established enrollees). In the 10 survey states, about one-fourth of CHIP enrollees had a special health care need. Compared to being uninsured, parents of CSHCN who were established CHIP enrollees reported greater access to and use of medical and dental care, less difficulty meeting their child's health care needs, fewer unmet needs, and better dental health status for their child. Compared to having private insurance, parents of CSHCN who were established CHIP enrollees reported similar levels of access to and use of medical and dental care and unmet needs, and less difficulty meeting their child's health care needs. CHIP has significant benefits for eligible CSHCN and their families compared to being uninsured and appears to have some benefits compared to private insurance. Copyright © 2015 Academic Pediatric Association. All rights reserved.

  4. STUDY OF CHIP IGNITION AND CHIP MORPHOLOGY AFTER MILLING OF MAGNESIUM ALLOYS

    Directory of Open Access Journals (Sweden)

    Ireneusz Zagórski

    2016-12-01

    Full Text Available The paper analyses the impact of specified technological parameters of milling (vc, fz, ap on time to ignition. Stages leading to chip ignition were analysed. Metallographic images of magnesium chip were presented. No significant difference was observed in time to ignition in different chip fractions. Moreover, the surface of chips was free of products of ignition and signs of strong oxidation.

  5. A volumetric meter chip for point-of-care quantitative detection of bovine catalase for food safety control

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Xingye; Hu, Jie; Choi, Jane Ru; Huang, Yalin; Wang, Xuemin [The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi' an Jiaotong University, Xi' an, 710049 (China); Bioinspired Engineering and Biomechanics Center (BEBC), Xi' an Jiaotong University, Xi' an, 710049 (China); Lu, Tian Jian, E-mail: tjlu@mail.xjtu.edu.cn [Bioinspired Engineering and Biomechanics Center (BEBC), Xi' an Jiaotong University, Xi' an, 710049 (China); Xu, Feng, E-mail: fengxu@mail.xjtu.edu.cn [The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi' an Jiaotong University, Xi' an, 710049 (China); Bioinspired Engineering and Biomechanics Center (BEBC), Xi' an Jiaotong University, Xi' an, 710049 (China)

    2016-09-07

    A volumetric meter chip was developed for quantitative point-of-care (POC) analysis of bovine catalase, a bioindicator of bovine mastitis, in milk samples. The meter chip displays multiplexed quantitative results by presenting the distance of ink bar advancement that is detectable by the naked eye. The meter chip comprises a poly(methyl methacrylate) (PMMA) layer, a double-sided adhesive (DSA) layer and a glass slide layer fabricated by the laser-etching method, which is typically simple, rapid (∼3 min per chip), and cost effective (∼$0.2 per chip). Specially designed “U shape” reaction cells are covered by an adhesive tape that serves as an on-off switch, enabling the simple operation of the assay. As a proof of concept, we employed the developed meter chip for the quantification of bovine catalase in raw milk samples to detect catalase concentrations as low as 20 μg/mL. The meter chip has great potential to detect various target analytes for a wide range of POC applications. - Highlights: • The meter chip is a standalone point-of-care diagnostic tool with visible readouts of quantification results. • A fast and low cost fabrication protocol (~3 min and ~$0.2 per chip) of meter chip was proposed. • The chip may hold the potential for rapid scaning of bovine mastitis in cattle farms for food safety control.

  6. A volumetric meter chip for point-of-care quantitative detection of bovine catalase for food safety control

    International Nuclear Information System (INIS)

    Cui, Xingye; Hu, Jie; Choi, Jane Ru; Huang, Yalin; Wang, Xuemin; Lu, Tian Jian; Xu, Feng

    2016-01-01

    A volumetric meter chip was developed for quantitative point-of-care (POC) analysis of bovine catalase, a bioindicator of bovine mastitis, in milk samples. The meter chip displays multiplexed quantitative results by presenting the distance of ink bar advancement that is detectable by the naked eye. The meter chip comprises a poly(methyl methacrylate) (PMMA) layer, a double-sided adhesive (DSA) layer and a glass slide layer fabricated by the laser-etching method, which is typically simple, rapid (∼3 min per chip), and cost effective (∼$0.2 per chip). Specially designed “U shape” reaction cells are covered by an adhesive tape that serves as an on-off switch, enabling the simple operation of the assay. As a proof of concept, we employed the developed meter chip for the quantification of bovine catalase in raw milk samples to detect catalase concentrations as low as 20 μg/mL. The meter chip has great potential to detect various target analytes for a wide range of POC applications. - Highlights: • The meter chip is a standalone point-of-care diagnostic tool with visible readouts of quantification results. • A fast and low cost fabrication protocol (~3 min and ~$0.2 per chip) of meter chip was proposed. • The chip may hold the potential for rapid scaning of bovine mastitis in cattle farms for food safety control.

  7. An economic evaluation of a chlorhexidine chip for treating chronic periodontitis: the CHIP (chlorhexidine in periodontitis) study.

    Science.gov (United States)

    Henke, C J; Villa, K F; Aichelmann-Reidy, M E; Armitage, G C; Eber, R M; Genco, R J; Killoy, W J; Miller, D P; Page, R C; Polson, A M; Ryder, M I; Silva, S J; Somerman, M J; Van Dyke, T E; Wolff, L F; Evans, C J; Finkelman, R D

    2001-11-01

    The authors previously suggested that an adjunctive, controlled-release chlorhexidine, or CHX, chip may reduce periodontal surgical needs at little additional cost. This article presents an economic analysis of the CHX chip in general dental practice. In a one-year prospective clinical trial, 484 chronic periodontitis patients in 52 general practices across the United States were treated with either scaling and root planing, or SRP, plus any therapy prescribed by treating, unblinded dentists; or SRP plus other therapy as above but including the CHX chip. Economic data were collected from bills, case report forms and 12-month treatment recommendations from blinded periodontist evaluators. Total dental charges were higher for SRP + CHX chip patients vs. SRP patients when CHX chip costs were included (P = .027) but lower when CHX chip costs were excluded (P = .012). About one-half of the CHX chip acquisition cost was offset by savings in other charges. SRP + CHX chip patients were about 50 percent less likely to undergo surgical procedures than were SRP patients (P = .021). At the end of the trial, periodontist evaluators recommended similar additional procedures for both groups: SRP, about 46 percent; maintenance, about 37 percent; surgery, 56 percent for SRP alone and 63 percent for SRP + CHX chip. Adjunctive CHX chip use for general-practice patients with periodontitis increased costs but reduced surgeries over one year. At study's end, periodontists recommended similar additional surgical treatment for both groups. In general practice, routine use of the CHX chip suggests that costs will be partially offset by reduced surgery over at least one year.

  8. Point-of-Care Diagnostics on a Chip

    CERN Document Server

    Westervelt, Robert

    2013-01-01

    The topic of this book is the development of automated and inexpensive tools that transfer medical tests from a specialized clinical laboratory directly to the point of care, using biochip technology. Immediate access to medically relevant biochemical information for doctors and nurses promises to revolutionize patient care and dramatically lower costs. The miniaturization and automation of medical tests are made possible by biochip technology, that integrates advances in integrated circuits, microelectromechanical systems (MEMS), microfluidics, and electronics. The target audience for this book includes engineering and biomedical researchers who would like to develop or apply biochip technology. They can use this book as a review of the field and as a guide for the development of novel biochip technology for point of care medicine. This book can also be used as a teaching tool for engineering and biomedical students, as as well as a reference for physicians and health professionals.

  9. Biosensors in Health Care: The Milestones Achieved in Their Development towards Lab-on-Chip-Analysis

    Directory of Open Access Journals (Sweden)

    Suprava Patel

    2016-01-01

    Full Text Available Immense potentiality of biosensors in medical diagnostics has driven scientists in evolution of biosensor technologies and innovating newer tools in time. The cornerstone of the popularity of biosensors in sensing wide range of biomolecules in medical diagnostics is due to their simplicity in operation, higher sensitivity, ability to perform multiplex analysis, and capability to be integrated with different function by the same chip. There remains a huge challenge to meet the demands of performance and yield to its simplicity and affordability. Ultimate goal stands for providing point-of-care testing facility to the remote areas worldwide, particularly the developing countries. It entails continuous development in technology towards multiplexing ability, fabrication, and miniaturization of biosensor devices so that they can provide lab-on-chip-analysis systems to the community.

  10. Development of a magnetic lab-on-a-chip for point-of-care sepsis diagnosis

    International Nuclear Information System (INIS)

    Schotter, Joerg; Shoshi, Astrit; Brueckl, Hubert

    2009-01-01

    We present design criteria, operation principles and experimental examples of magnetic marker manipulation for our magnetic lab-on-a-chip prototype. It incorporates both magnetic sample preparation and detection by embedded GMR-type magnetoresistive sensors and is optimized for the automated point-of-care detection of four different sepsis-indicative cytokines directly from about 5 μl of whole blood. The sample volume, magnetic particle size and cytokine concentration determine the microfluidic volume, sensor size and dimensioning of the magnetic gradient field generators. By optimizing these parameters to the specific diagnostic task, best performance is expected with respect to sensitivity, analysis time and reproducibility.

  11. A volumetric meter chip for point-of-care quantitative detection of bovine catalase for food safety control.

    Science.gov (United States)

    Cui, Xingye; Hu, Jie; Choi, Jane Ru; Huang, Yalin; Wang, Xuemin; Lu, Tian Jian; Xu, Feng

    2016-09-07

    A volumetric meter chip was developed for quantitative point-of-care (POC) analysis of bovine catalase, a bioindicator of bovine mastitis, in milk samples. The meter chip displays multiplexed quantitative results by presenting the distance of ink bar advancement that is detectable by the naked eye. The meter chip comprises a poly(methyl methacrylate) (PMMA) layer, a double-sided adhesive (DSA) layer and a glass slide layer fabricated by the laser-etching method, which is typically simple, rapid (∼3 min per chip), and cost effective (∼$0.2 per chip). Specially designed "U shape" reaction cells are covered by an adhesive tape that serves as an on-off switch, enabling the simple operation of the assay. As a proof of concept, we employed the developed meter chip for the quantification of bovine catalase in raw milk samples to detect catalase concentrations as low as 20 μg/mL. The meter chip has great potential to detect various target analytes for a wide range of POC applications. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?

    Science.gov (United States)

    Magee, Laura A; von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Helewa, Michael; Hutton, Eileen; Koren, Gideon; Lee, Shoo K; Logan, Alexander G; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G; Moutquin, Jean-Marie

    2016-11-01

    To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of "less tight" (target diastolic blood pressure [dBP] 100 mm Hg) versus "tight" control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for >48 hours) and secondary outcomes (serious maternal complications), birth weight hypertension that was associated with all outcomes examined except for maternal readmission (P=0.20): CHIPS primary outcome, birth weight hypertension and serious maternal complications was seen only in less tight control (P=0.02). Adjustment for preeclampsia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome (Phypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preeclampsia co-occurrence. URL: http://pre-empt.cfri.ca/. Unique identifier: ISRCTN 71416914. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01192412. © 2016 The Authors.

  13. A microfluidic chip for electrochemical conversions in drug metabolism studies

    NARCIS (Netherlands)

    Odijk, Mathieu; Baumann, A.; Lohmann, W.; van den Brink, Floris Teunis Gerardus; Olthuis, Wouter; Karst, U.; van den Berg, Albert

    2009-01-01

    We have designed a microfluidic microreactor chip for electrochemical conversion of analytes, containing a palladium reference electrode and platinum working and counter electrodes. The counter electrode is placed in a separate side-channel on chip to prevent unwanted side-products appearing in the

  14. Interface thermal characteristics of flip chip packages - A numerical study

    International Nuclear Information System (INIS)

    Kandasamy, Ravi; Mujumdar, A.S.

    2009-01-01

    Flip chip ball grid array (FC-BGA) packages are commonly used for high inputs/outputs (I/O) ICs; they have been proven to provide good solutions for a variety of applications to maximize thermal and electrical performance. A fundamental limitation to such devices is the thermal resistance at the top of the package, which is characterized θ JC parameter. The die-to-lid interface thermal resistance is identified as a critical issue for the thermal management of electronic packages. This paper focuses on the effect of the interface material property changes on the interface thermal resistance. The effect of package's junction to case (Theta-JC or θ JC ) thermal performance is investigated for bare die, flat lid and cup lid packages using a validated thermal model. Thermal performance of a cup or flat lid attached and bare die packages were investigated for different interface materials. Improved Theta-JC performance was observed for the large die as compared to the smaller die. Several parametric studies were carried out to understand the effects of interface bond line thickness (BLT), different die sizes, the average void size during assembly and thermal conductivity of interface materials on package thermal resistance

  15. Study on irradiation effects of nucleus electromagnetic pulse on single chip computer system

    International Nuclear Information System (INIS)

    Hou Minsheng; Liu Shanghe; Wang Shuping

    2001-01-01

    Intense electromagnetic pulse, namely nucleus electromagnetic pulse (NEMP), lightning electromagnetic pulse (LEMP) and high power microwave (HPM), can disturb and destroy the single chip computer system. To study this issue, the authors made irradiation experiments by NEMPs generated by gigahertz transversal electromagnetic (GTEM) Cell. The experiments show that shutdown, restarting, communication errors of the single chip microcomputer system would occur when it was irradiated by the NEMPs. Based on the experiments, the cause on the effects on the single chip microcomputer system is discussed

  16. Tin-Silver Alloys for Flip-Chip Bonding Studied with a Rotating Cylinder Electrode

    DEFF Research Database (Denmark)

    Tang, Peter Torben; Pedersen, E.H.; Bech-Nielsen, G.

    1999-01-01

    Electrodeposition of solder for flip-chip bonding is studied in the form of a pyrophosphate/iodide tin-silver alloy bath. The objective is to obtain a uniform alloy composition, with 3.8 At.% silver, over a larger area. This specific alloy will provide an eutectic solder melting at 221°C (or 10°C...... photoresist, have shown a stable and promising alternative to pure tin and tin-lead alloys for flip-chip bonding applications....

  17. Study of cutting speed on surface roughness and chip formation when machining nickel-based alloy

    International Nuclear Information System (INIS)

    Khidhir, Basim A.; Mohamed, Bashir

    2010-01-01

    Nickel- based alloy is difficult-to-machine because of its low thermal diffusive property and high strength at higher temperature. The machinability of nickel- based Hastelloy C-276 in turning operations has been carried out using different types of inserts under dry conditions on a computer numerical control (CNC) turning machine at different stages of cutting speed. The effects of cutting speed on surface roughness have been investigated. This study explores the types of wear caused by the effect of cutting speed on coated and uncoated carbide inserts. In addition, the effect of burr formation is investigated. The chip burr is found to have different shapes at lower speeds. Triangles and squares have been noticed for both coated and uncoated tips as well. The conclusion from this study is that the transition from thick continuous chip to wider discontinuous chip is caused by different types of inserts. The chip burr has a significant effect on tool damage starting in the line of depth-of-cut. For the coated insert tips, the burr disappears when the speed increases to above 150 m/min with the improvement of surface roughness; increasing the speed above the same limit for uncoated insert tips increases the chip burr size. The results of this study showed that the surface finish of nickel-based alloy is highly affected by the insert type with respect to cutting speed changes and its effect on chip burr formation and tool failure

  18. Medicaid/CHIP Program; Medicaid Program and Children's Health Insurance Program (CHIP); Changes to the Medicaid Eligibility Quality Control and Payment Error Rate Measurement Programs in Response to the Affordable Care Act. Final rule.

    Science.gov (United States)

    2017-07-05

    This final rule updates the Medicaid Eligibility Quality Control (MEQC) and Payment Error Rate Measurement (PERM) programs based on the changes to Medicaid and the Children's Health Insurance Program (CHIP) eligibility under the Patient Protection and Affordable Care Act. This rule also implements various other improvements to the PERM program.

  19. Alpha radiation detection using silicon memory chips - preliminary studies

    International Nuclear Information System (INIS)

    Pace, R.; Paix, D.; Haskard, M.

    1993-01-01

    Alpha radiation dosage is an important occupational health factor in the mining of uranium and mineral sands. Alpha radiation induced errors in the data of silicon based memory chips provide the foundation for a new type of sensor, with the potential for affordable and prompt measurement of personal alpha doses. With particular reference to Dynamic Random Access Memories (DRAM) this paper introduces the operating principle of a memory based radiation sensor, which is the error mechanism in silicon integrated circuits. 14 refs., 3 figs

  20. Consumption study and identification of methyl salicylate in spicy cassava chips

    International Nuclear Information System (INIS)

    Nirjana, Marlene; Anggadiredja, Kusnandar; Damayanti, Sophi

    2015-01-01

    Spicy cassava chips is a popular snack. However, some news in electronic media reported addition of balsam which is a banned food additives in that product to give extra spicy flavor. This study aimed to determine ITB students’ pattern of consumption, health problems caused by spicy chips consumption, and knowledge about illicit use of food additives in that product, and identify the main content of balsam namely methyl salicylate in 10 samples of spicy cassava chips taken from inside and outside about ITB campus. A total of 300 questionnaires distributed to ITB students then data processing was performed. Spicy cassava chips sample macerated in 50 mL of methanol for 24 hours at room temperature, filtered and analyzed using gas chromatography capillary column with OV-1, nitrogen carrier gas and flame ionization detector. Based on questionnaires, 292 (97%) of 300 respondents had consumed spicy chips. A total of 247 (85%) from 292 respondents spicy chips consumed less than 3 times a week. A total of 195 respondents (67%) had experienced health problems after eating spicy chips. There were 137 (47%) of the 292 respondents who knew about the illicit addition of food additives into spicy chips; only 35 respondents (12%) who knew about balsam’s addition. There were 126 respondents (43%) who did not pay attention to their health because they will keep eating spicy chips despite the addition of banned food additives. Through the verification of the standard addition method in gas chromatography system with a hydrogen pressure of 1.5 bar, injector temperature 200 °C, detector temperature 230 °C, oven temperature 60 °C for 2 minutes and then increased to 230 °C with rate 6 °C/menit; linearity, limit of detection, limit of quantitation, accuracy, precision, and specificity parameters met the acceptance limits. From 10 spicy cassava chips samples which were analyzed, they did not reveal any content of methyl salicylate. Methyl salicylate contained in the positive

  1. Consumption study and identification of methyl salicylate in spicy cassava chips

    Energy Technology Data Exchange (ETDEWEB)

    Nirjana, Marlene, E-mail: marlenenirjana@gmail.com; Anggadiredja, Kusnandar; Damayanti, Sophi [School of Pharmacy, Institut Teknologi Bandung Jalan Ganesha 10, Bandung 40132 (Indonesia)

    2015-09-30

    Spicy cassava chips is a popular snack. However, some news in electronic media reported addition of balsam which is a banned food additives in that product to give extra spicy flavor. This study aimed to determine ITB students’ pattern of consumption, health problems caused by spicy chips consumption, and knowledge about illicit use of food additives in that product, and identify the main content of balsam namely methyl salicylate in 10 samples of spicy cassava chips taken from inside and outside about ITB campus. A total of 300 questionnaires distributed to ITB students then data processing was performed. Spicy cassava chips sample macerated in 50 mL of methanol for 24 hours at room temperature, filtered and analyzed using gas chromatography capillary column with OV-1, nitrogen carrier gas and flame ionization detector. Based on questionnaires, 292 (97%) of 300 respondents had consumed spicy chips. A total of 247 (85%) from 292 respondents spicy chips consumed less than 3 times a week. A total of 195 respondents (67%) had experienced health problems after eating spicy chips. There were 137 (47%) of the 292 respondents who knew about the illicit addition of food additives into spicy chips; only 35 respondents (12%) who knew about balsam’s addition. There were 126 respondents (43%) who did not pay attention to their health because they will keep eating spicy chips despite the addition of banned food additives. Through the verification of the standard addition method in gas chromatography system with a hydrogen pressure of 1.5 bar, injector temperature 200 °C, detector temperature 230 °C, oven temperature 60 °C for 2 minutes and then increased to 230 °C with rate 6 °C/menit; linearity, limit of detection, limit of quantitation, accuracy, precision, and specificity parameters met the acceptance limits. From 10 spicy cassava chips samples which were analyzed, they did not reveal any content of methyl salicylate. Methyl salicylate contained in the positive

  2. Consumption study and identification of methyl salicylate in spicy cassava chips

    Science.gov (United States)

    Nirjana, Marlene; Anggadiredja, Kusnandar; Damayanti, Sophi

    2015-09-01

    Spicy cassava chips is a popular snack. However, some news in electronic media reported addition of balsam which is a banned food additives in that product to give extra spicy flavor. This study aimed to determine ITB students' pattern of consumption, health problems caused by spicy chips consumption, and knowledge about illicit use of food additives in that product, and identify the main content of balsam namely methyl salicylate in 10 samples of spicy cassava chips taken from inside and outside about ITB campus. A total of 300 questionnaires distributed to ITB students then data processing was performed. Spicy cassava chips sample macerated in 50 mL of methanol for 24 hours at room temperature, filtered and analyzed using gas chromatography capillary column with OV-1, nitrogen carrier gas and flame ionization detector. Based on questionnaires, 292 (97%) of 300 respondents had consumed spicy chips. A total of 247 (85%) from 292 respondents spicy chips consumed less than 3 times a week. A total of 195 respondents (67%) had experienced health problems after eating spicy chips. There were 137 (47%) of the 292 respondents who knew about the illicit addition of food additives into spicy chips; only 35 respondents (12%) who knew about balsam's addition. There were 126 respondents (43%) who did not pay attention to their health because they will keep eating spicy chips despite the addition of banned food additives. Through the verification of the standard addition method in gas chromatography system with a hydrogen pressure of 1.5 bar, injector temperature 200 °C, detector temperature 230 °C, oven temperature 60 °C for 2 minutes and then increased to 230 °C with rate 6 °C/menit; linearity, limit of detection, limit of quantitation, accuracy, precision, and specificity parameters met the acceptance limits. From 10 spicy cassava chips samples which were analyzed, they did not reveal any content of methyl salicylate. Methyl salicylate contained in the positive control

  3. Experimental study of the chip morphology in turning hardened AISI D2 steel

    Energy Technology Data Exchange (ETDEWEB)

    Mhamdi, Mohamed Baccar; Bayraktar, Emin [Supmeca, Paris (France); Salem, Sahbi Ben; Boujelbene, Mohamed [National Engineering School of Tunis, Tunis (Turkey)

    2013-11-15

    The study of local mechanisms of material removal is essential in all problems of shaping by machining. Indeed, the mastery of surfaces generated by cutting requires an understanding of cutting mechanisms. The turning of steels with high mechanical properties using the cutting tool, often called 'hard turning,' is a new technique for the mechanical industry, and hence the need to understand the cutting mechanisms. The steel type EN X160CrMoV12 treated to 62 HRC (cold work tool steel: AISI D2 with a martensite matrix and distribution of primary and secondary carbides) is the subject of this study. Hard turning tests were carried out for this steel at different cutting conditions, with the aim to understand the mechanism of chip formation in order to be able to obtain the optimal cutting conditions. The chips obtained were examined under a microscope. The observation showed that the chip formation is influenced by cutting conditions. The chips contained a white layer, and this layer was examined under scanning electronic microscope (SEM) to study its variation depending on cutting parameters. The study shown, that cutting forces decrease with the increase of cutting speed. However, ANOVA method was used to establish the effect of the cutting conditions on experimental obtained results. Analysis of plastic deformation of the chip and the shear angle was made according to cutting conditions. Finally, a microhardness test was carried out to relate the mechanical properties and the microstructures of white layers.

  4. Polymeric LabChip real-time PCR as a point-of-care-potential diagnostic tool for rapid detection of influenza A/H1N1 virus in human clinical specimens.

    Directory of Open Access Journals (Sweden)

    Hyun-Ok Song

    Full Text Available It is clinically important to be able to detect influenza A/H1N1 virus using a fast, portable, and accurate system that has high specificity and sensitivity. To achieve this goal, it is necessary to develop a highly specific primer set that recognizes only influenza A viral genes and a rapid real-time PCR system that can detect even a single copy of the viral gene. In this study, we developed and validated a novel fluidic chip-type real-time PCR (LabChip real-time PCR system that is sensitive and specific for the detection of influenza A/H1N1, including the pandemic influenza strain A/H1N1 of 2009. This LabChip real-time PCR system has several remarkable features: (1 It allows rapid quantitative analysis, requiring only 15 min to perform 30 cycles of real-time PCR. (2 It is portable, with a weight of only 5.5 kg. (3 The reaction cost is low, since it uses disposable plastic chips. (4 Its high efficiency is equivalent to that of commercially available tube-type real-time PCR systems. The developed disposable LabChip is an economic, heat-transferable, light-transparent, and easy-to-fabricate polymeric chip compared to conventional silicon- or glass-based labchip. In addition, our LabChip has large surface-to-volume ratios in micro channels that are required for overcoming time consumed for temperature control during real-time PCR. The efficiency of the LabChip real-time PCR system was confirmed using novel primer sets specifically targeted to the hemagglutinin (HA gene of influenza A/H1N1 and clinical specimens. Eighty-five human clinical swab samples were tested using the LabChip real-time PCR. The results demonstrated 100% sensitivity and specificity, showing 72 positive and 13 negative cases. These results were identical to those from a tube-type real-time PCR system. This indicates that the novel LabChip real-time PCR may be an ultra-fast, quantitative, point-of-care-potential diagnostic tool for influenza A/H1N1 with a high sensitivity and

  5. Fundamental study of microelectronic chip response under laser ultrasonic-interferometric inspection using C-scan method

    Science.gov (United States)

    Yang, Lei; Gong, Jie; Ume, I. Charles

    2014-02-01

    In modern surface mount packaging technologies, such as flip chips, chip scale packages, and ball grid arrays(BGA), chips are attached to the substrates/printed wiring board (PWB) using solder bump interconnections. The quality of solder bumps between the chips and the substrate/board is difficult to inspect. Laser ultrasonic-interferometric technique was proved to be a promising approach for solder bump inspection because of its noncontact and nondestructive characteristics. Different indicators extracted from received signals have been used to predict the potential defects, such as correlation coefficient, error ratio, frequency shifting, etc. However, the fundamental understanding of the chip behavior under laser ultrasonic inspection is still missing. Specifically, it is not sure whether the laser interferometer detected out-of-plane displacements were due to wave propagation or structural vibration when the chip was excited by pulsed laser. Plus, it is found that the received signals are chip dependent. Both challenges impede the interpretation of acquired signals. In this paper, a C-scan method was proposed to study the underlying phenomenon during laser ultrasonic inspection. The full chip was inspected. The response of the chip under laser excitation was visualized in a movie resulted from acquired signals. Specifically, a BGA chip was investigated to demonstrate the effectiveness of this method. By characterizing signals using discrete wavelet transform(DWT), both ultrasonic wave propagation and vibration were observed. Separation of them was successfully achieved using ideal band-pass filter and visualized in resultant movies, too. The observed ultrasonic waves were characterized and their respective speeds were measured by applying 2-D FFT. The C-scan method, combined with different digital signal processing techniques, was proved to be an very effective methodology to learn the behavior of chips under laser excitation. This general procedure can be

  6. A study of SEU-tolerant latches for the RD53A chip

    CERN Document Server

    Fougeron, Denis

    2018-01-01

    The RD53 collaboration was established to develop the next generation of pixel readout chips needed by ATLAS and CMS at the HL-LHC and requiring extreme rate and radiation tolerance. The 65 nm CMOS process has been adopted in order to satisfy the high level of integration requirement. However, the SEU immunity should be carefully considered for a deep submicron process like the 65 nm. Indeed, the device dimensions are small and the capacitance of the storage nodes becomes very low. A chip prototype including different SEU tolerant structures was designed in a 65 nm technology. Several proton irradiation tests were carried out in order to estimate the SEU tolerance of the proposed structures and the level of improvement comparing with a standard architecture.

  7. Self-driven filter-based blood plasma separator microfluidic chip for point-of-care testing

    International Nuclear Information System (INIS)

    Madadi, Hojjat; Casals-Terré, Jasmina; Mohammadi, Mahdi

    2015-01-01

    There is currently a growing need for lab-on-a-chip devices for use in clinical analysis and diagnostics, especially in the area of patient care. The first step in most blood assays is plasma extraction from whole blood. This paper presents a novel, self-driven blood plasma separation microfluidic chip, which can extract more than 0.1 μl plasma from a single droplet of undiluted fresh human blood (∼5 μl). This volume of blood plasma is extracted from whole blood with high purity (more than 98%) in a reasonable time frame (3 to 5 min), and without the need for any external force. This would be the first step towards the realization of a single-use, self-blood test that does not require any external force or power source to deliver and analyze a fresh whole-blood sample, in contrast to the existing time-consuming conventional blood analysis. The prototypes are manufactured in polydimethylsiloxane that has been modified with a strong nonionic surfactant (Silwet L-77) to achieve hydrophilic behavior. The main advantage of this microfluidic chip design is the clogging delay in the filtration area, which results in an increased amount of extracted plasma (0.1 μl). Moreover, the plasma can be collected in one or more 10 μm-deep channels to facilitate the detection and readout of multiple blood assays. This high volume of extracted plasma is achieved thanks to a novel design that combines maximum pumping efficiency without disturbing the red blood cells’ trajectory through the use of different hydrodynamic principles, such as a constriction effect and a symmetrical filtration mode. To demonstrate the microfluidic chip’s functionality, we designed and fabricated a novel hybrid microdevice that exhibits the benefits of both microfluidics and lateral flow immunochromatographic tests. The performance of the presented hybrid microdevice is validated using rapid detection of thyroid stimulating hormone within a single droplet of whole blood. (paper)

  8. The economic efficiency of forest energy wood chip production in regional use – A case study

    Directory of Open Access Journals (Sweden)

    Dalibor Šafařík

    2013-01-01

    Full Text Available This regional project case study deals with the limiting factors of economic efficiency in the production of forest energy wood chips. The evaluation of production efficiency made use of data obtained from the Lesy města Brna, a.s. (Forest of the City of Brno, Corp., which were subjected to two static methods of investment evaluation: an analysis of the tipping point and determination of the limit of variable costs and a dynamic modified tipping point analysis using cash flow (i.e. cash break even analysis. The results have confirmed an established hypothesis, namely that the decisive factor in the profitability of the production of forest energy wood chips hinges on the costs incurred in the gathering of raw material and the distribution of the produced chips. The results include a further limiting factor: transportation costs to the final consumption location. The output of the study is a recommendation that the concentration of residual forest materials not exceed a distance of 250 m from the place of production to the point of disintegration and that the transport distance of energy chips not exceed 50 km from the place of disintegration to the final consumption point. These limiting values help quantify the full internal costs per cost unit, full internal cost profitability, total revenue profitability and annual profitability expressed in terms of fixed assets depreciation without factoring in financial aid.

  9. Study on boiling heat transfer from diode elements in an integrated circuit chip

    Energy Technology Data Exchange (ETDEWEB)

    Hijikata, Kunio; Nagasaki, Takao; Kurata, Naoki (Tokyo Institute of Technology Faculty of Engineering (Japan))

    1989-02-25

    By temperature measurement of elements in boiling experiments with diodes in an integrated circuit (IC) chip, characteristics of boiling heat transfer from tiny heat generating elements in an IC chip and thermal transfer characteristics of multiple heating elements adjoining positioned were studied. The Package of an IC was removed by acid to expose the IC chip. Electricity is applied to the diode in the IC to study the heat transfer properties. The heat transfer rate from a tiny heating element on an IC is greater than that from the conventional continual heated surface. In the case of heat generation by two adjoining elements, the relationship between the total amount of heat and the temperature of elements shows the same characteristics as in the case with a single element. The boiling heat transfer properties of an element in an IC chip are influenced by such microstructure surrounding the element as the pattern of wiring. Heat transfer increases with the decreasing size of the heating element by the heat transfer to the substrate beneath the element. 10 refs., 15 figs.

  10. Comparative studies on storage and drying of chips and chunks in Norway

    Energy Technology Data Exchange (ETDEWEB)

    Gjoelsjoe, S. (Norwegian Forest Research Inst. (Norway))

    1988-11-01

    Knowledge of sporulation and alteration in moisture content and dry-matter content is essential when trying to determine optimal conditions for storage of wood fuel. The object of this experiment has been to study the progression of these variables in wood fuel of varying sizes. The material used was debranched stemwood of birch. The wood was comminuted up and stored in three different sizes. The sizes were chips (length approx. 3 cm), chunkwood (approx. 8 cm) and firewood (approx. 15 cm). The fuelwood was stored in bines of 10 m{sup 3} with netting floor and netting walls. Six of the bins were covered, the remaining six were without cover. The highest temperature increase was found in chips, particularly during the first stages of storage when temperature reached approximately 30 C. The other fuel sizes had temperature close to ambient temperature. At the start of the test, moisture content was approximately 40 %. By the end of the test the moisture content was below 20% for firewood and chunkwood under cover. The moisture was measured 50 cm from the top and 50 cm from the sidewall of the bin. Whilst chips without cover had a moisture content of more than 60%. Storage under cover resulted in a higher reduction of moisture content than storage without cover. The smaller sizes exhibited the greatest difference in moisture content. The highest dry-matter loss during the storage time was found in chips stored under cover, approximately 1.2% per month. Dry-matter loss was lowest in firewood stored under cover 0.07% per month. Dry-matter loss decreased with increasing size. Spores and dust particles had the highest concentrations in chips and lowest in firewood. (12 refs., 10 figs., 8 tabs.) (au).

  11. Management of Chronic Periodontitis Using Chlorhexidine Chip and Diode Laser-A Clinical Study

    Science.gov (United States)

    Ambooken, Majo; Mathew, Jayan Jacob; Issac, Annie Valayil; Kunju, Ajithkumar Parachalil; Parameshwaran, Renjith Athirkandathil

    2016-01-01

    Introduction The use of adjuncts like chlorhexidine local delivery and diode laser decontamination have been found to improve the clinical outcomes of scaling and root planing in non-surgical periodontal therapy in patients with chronic periodontitis. Aim To evaluate the effects of diode laser and chlorhexidine chip as adjuncts to scaling and root planing in the management of chronic periodontitis. The objective is to evaluate the outcome of chlorhexidine chip and diode laser as adjuncts to scaling and root planing on clinical parameters like Plaque Index, Gingival Index, probing pocket depth and clinical attachment level. Study and Design Department of Periodontics. Randomized clinical trial with split mouth design. Materials and Methods Fifteen chronic periodontitis patients having a probing pocket depth of 5mm-7mm on at least one interproximal site in each quadrant of the mouth were included in the study. After initial treatment, four sites in each patient were randomly subjected to scaling and root planing (control), chlorhexidine chip application (CHX chip group), diode laser (810 nm) decontamination (Diode laser group) or combination of both (Diode laser and chip group). Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline, one month and three months. Statistical analysis Results were statistically analysed using paired T test, one-way ANOVA, Tukey’s HSD test and repeated measure ANOVA. Results Post-treatment, the test and control sites showed a statistically significant reduction in PI, GI, PPD, and CAL. After three months, a mean PPD reduction of 1.47±0.52 mm in control group, 1.40±0.83 mm in diode laser group, 2.67±0.62 mm in CHX group, and 2.80± 0.77 mm in combination group was seen. The mean gain in CAL were 1.47±0.52 mm in the control group, 1.40±0.83 mm in diode laser group, 2.67± 0.49 mm in CHX group and 2.67± 0.82 mm in combination group respectively. The

  12. Atomic structure of machined semiconducting chips: An x-ray absorption spectroscopy study

    Energy Technology Data Exchange (ETDEWEB)

    Paesler, M.; Sayers, D.

    1988-12-01

    X-ray absorption spectroscopy (XAS) has been used to examine the atomic structure of chips of germanium that were produced by single point diamond machining. It is demonstrated that although the local (nearest neighbor) atomic structure is experimentally quite similar to that of single crystal specimens information from more distant atoms indicates the presence of considerable stress. An outline of the technique is given and the strength of XAS in studying the machining process is demonstrated.

  13. Management of Chronic Periodontitis Using Chlorhexidine Chip and Diode Laser-A Clinical Study.

    Science.gov (United States)

    Jose, Kachapilly Arun; Ambooken, Majo; Mathew, Jayan Jacob; Issac, Annie Valayil; Kunju, Ajithkumar Parachalil; Parameshwaran, Renjith Athirkandathil

    2016-04-01

    The use of adjuncts like chlorhexidine local delivery and diode laser decontamination have been found to improve the clinical outcomes of scaling and root planing in non-surgical periodontal therapy in patients with chronic periodontitis. To evaluate the effects of diode laser and chlorhexidine chip as adjuncts to scaling and root planing in the management of chronic periodontitis. The objective is to evaluate the outcome of chlorhexidine chip and diode laser as adjuncts to scaling and root planing on clinical parameters like Plaque Index, Gingival Index, probing pocket depth and clinical attachment level. Department of Periodontics. Randomized clinical trial with split mouth design. Fifteen chronic periodontitis patients having a probing pocket depth of 5mm-7mm on at least one interproximal site in each quadrant of the mouth were included in the study. After initial treatment, four sites in each patient were randomly subjected to scaling and root planing (control), chlorhexidine chip application (CHX chip group), diode laser (810 nm) decontamination (Diode laser group) or combination of both (Diode laser and chip group). Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline, one month and three months. Results were statistically analysed using paired T test, one-way ANOVA, Tukey's HSD test and repeated measure ANOVA. Post-treatment, the test and control sites showed a statistically significant reduction in PI, GI, PPD, and CAL. After three months, a mean PPD reduction of 1.47±0.52 mm in control group, 1.40±0.83 mm in diode laser group, 2.67±0.62 mm in CHX group, and 2.80± 0.77 mm in combination group was seen. The mean gain in CAL were 1.47±0.52 mm in the control group, 1.40±0.83 mm in diode laser group, 2.67± 0.49 mm in CHX group and 2.67± 0.82 mm in combination group respectively. The differences in PPD reduction and CAL gain between control group and CHX chip and combination

  14. Insurance coverage and prenatal care among low-income pregnant women: an assessment of states' adoption of the "Unborn Child" option in Medicaid and CHIP.

    Science.gov (United States)

    Jarlenski, Marian P; Bennett, Wendy L; Barry, Colleen L; Bleich, Sara N

    2014-01-01

    The "Unborn Child" (UC) option provides state Medicaid/Children's Health Insurance Program (CHIP) programs with a new strategy to extend prenatal coverage to low-income women who would otherwise have difficulty enrolling in or would be ineligible for Medicaid. To examine the association of the UC option with the probability of enrollment in Medicaid/CHIP during pregnancy and probability of receiving adequate prenatal care. We use pooled cross-sectional data from the Pregnancy Risk Assessment Monitoring System from 32 states between 2004 and 2010 (n = 81,983). Multivariable regression is employed to examine the association of the UC option with Medicaid/CHIP enrollment during pregnancy among eligible women who were uninsured preconception (n = 45,082) and those who had insurance (but not Medicaid) preconception (n = 36,901). Multivariable regression is also employed to assess the association between the UC option and receipt of adequate prenatal care, measured by the Adequacy of Prenatal Care Utilization Index. Residing in a state with the UC option is associated with a greater probability of Medicaid enrollment during pregnancy relative to residing in a state without the policy both among women uninsured preconception (88% vs. 77%, P option is not significantly associated with receiving adequate prenatal care, among both women with and without insurance preconception. The UC option provides states a key way to expand or simplify prenatal insurance coverage, but further policy efforts are needed to ensure that coverage improves access to high-quality prenatal care.

  15. A System-on-Chip Solution for Point-of-Care Ultrasound Imaging Systems: Architecture and ASIC Implementation.

    Science.gov (United States)

    Kang, Jeeun; Yoon, Changhan; Lee, Jaejin; Kye, Sang-Bum; Lee, Yongbae; Chang, Jin Ho; Kim, Gi-Duck; Yoo, Yangmo; Song, Tai-kyong

    2016-04-01

    In this paper, we present a novel system-on-chip (SOC) solution for a portable ultrasound imaging system (PUS) for point-of-care applications. The PUS-SOC includes all of the signal processing modules (i.e., the transmit and dynamic receive beamformer modules, mid- and back-end processors, and color Doppler processors) as well as an efficient architecture for hardware-based imaging methods (e.g., dynamic delay calculation, multi-beamforming, and coded excitation and compression). The PUS-SOC was fabricated using a UMC 130-nm NAND process and has 16.8 GFLOPS of computing power with a total equivalent gate count of 12.1 million, which is comparable to a Pentium-4 CPU. The size and power consumption of the PUS-SOC are 27×27 mm(2) and 1.2 W, respectively. Based on the PUS-SOC, a prototype hand-held US imaging system was implemented. Phantom experiments demonstrated that the PUS-SOC can provide appropriate image quality for point-of-care applications with a compact PDA size ( 200×120×45 mm(3)) and 3 hours of battery life.

  16. Usability of human Infinium MethylationEPIC BeadChip for mouse DNA methylation studies.

    Science.gov (United States)

    Needhamsen, Maria; Ewing, Ewoud; Lund, Harald; Gomez-Cabrero, David; Harris, Robert Adam; Kular, Lara; Jagodic, Maja

    2017-11-15

    The advent of array-based genome-wide DNA methylation methods has enabled quantitative measurement of single CpG methylation status at relatively low cost and sample input. Whereas the use of Infinium Human Methylation BeadChips has shown great utility in clinical studies, no equivalent tool is available for rodent animal samples. We examined the feasibility of using the new Infinium MethylationEPIC BeadChip for studying DNA methylation in mouse. In silico, we identified 19,420 EPIC probes (referred as mEPIC probes), which align with a unique best alignment score to the bisulfite converted reference mouse genome mm10. Further annotation revealed that 85% of mEPIC probes overlapped with mm10.refSeq genes at different genomic features including promoters (TSS1500 and TSS200), 1st exons, 5'UTRs, 3'UTRs, CpG islands, shores, shelves, open seas and FANTOM5 enhancers. Hybridization of mouse samples to Infinium Human MethylationEPIC BeadChips showed successful measurement of mEPIC probes and reproducibility between inter-array biological replicates. Finally, we demonstrated the utility of mEPIC probes for data exploration such as hierarchical clustering. Given the absence of cost and labor convenient genome-wide technologies in the murine system, our findings show that the Infinium MethylationEPIC BeadChip platform is suitable for investigation of the mouse methylome. Furthermore, we provide the "mEPICmanifest" with genomic features, available to users of Infinium Human MethylationEPIC arrays for mouse samples.

  17. Cytotoxicity of cadmium-containing quantum dots based on a study using a microfluidic chip

    International Nuclear Information System (INIS)

    Zheng Xiannuo; Weng Lixing; Tian Jing; Wang Lianhui; Wu Lei; Jin Qinghui; Zhao Jianlong

    2012-01-01

    There is a lack of reliable nanotoxicity assays available for monitoring and quantifying multiple cellular events in cultured cells. In this study, we used a microfluidic chip to systematically investigate the cytotoxicity of three kinds of well-characterized cadmium-containing quantum dots (QDs) with the same core but different shell structures, including CdTe core QDs, CdTe/CdS core–shell QDs, and CdTe/CdS/ZnS core–shell–shell QDs, in HEK293 cells. Using the microfluidic chip combined with fluorescence microscopy, multiple QD-induced cellular events including cell morphology, viability, proliferation, and QD uptake were simultaneously analysed. The three kinds of QDs showed significantly different cytotoxicities. The CdTe QDs, which are highly toxic to HEK293 cells, resulted in remarkable cellular and nuclear morphological changes, a dose-dependent decrease in cell viability, and strong inhibition of cell proliferation; the CdTe/CdS QDs were moderately toxic but did not significantly affect the proliferation of HEK293 cells; while the CdTe/CdS/ZnS QDs had no detectable influence on cytotoxicity with respect to cell morphology, viability, and proliferation. Our data indicated that QD cytotoxicity was closely related to their surface structures and specific physicochemical properties. This study also demonstrated that the microfluidic chip could serve as a powerful tool to systematically evaluate the cytotoxicity of nanoparticles in multiple cellular events. (paper)

  18. Cytotoxicity of cadmium-containing quantum dots based on a study using a microfluidic chip

    Science.gov (United States)

    Zheng, Xiannuo; Tian, Jing; Weng, Lixing; Wu, Lei; Jin, Qinghui; Zhao, Jianlong; Wang, Lianhui

    2012-02-01

    There is a lack of reliable nanotoxicity assays available for monitoring and quantifying multiple cellular events in cultured cells. In this study, we used a microfluidic chip to systematically investigate the cytotoxicity of three kinds of well-characterized cadmium-containing quantum dots (QDs) with the same core but different shell structures, including CdTe core QDs, CdTe/CdS core-shell QDs, and CdTe/CdS/ZnS core-shell-shell QDs, in HEK293 cells. Using the microfluidic chip combined with fluorescence microscopy, multiple QD-induced cellular events including cell morphology, viability, proliferation, and QD uptake were simultaneously analysed. The three kinds of QDs showed significantly different cytotoxicities. The CdTe QDs, which are highly toxic to HEK293 cells, resulted in remarkable cellular and nuclear morphological changes, a dose-dependent decrease in cell viability, and strong inhibition of cell proliferation; the CdTe/CdS QDs were moderately toxic but did not significantly affect the proliferation of HEK293 cells; while the CdTe/CdS/ZnS QDs had no detectable influence on cytotoxicity with respect to cell morphology, viability, and proliferation. Our data indicated that QD cytotoxicity was closely related to their surface structures and specific physicochemical properties. This study also demonstrated that the microfluidic chip could serve as a powerful tool to systematically evaluate the cytotoxicity of nanoparticles in multiple cellular events.

  19. Numerical study on fabricating rectangle microchannel in microfluidic chips by glass molding process

    Science.gov (United States)

    Wang, Tao; Chen, Jing; Zhou, Tianfeng

    2017-09-01

    This paper studied the glass molding process (GMP) for fabricating a typical microstructure of glass microfluidic chips, i. e., rectangle microchannel, on soda-lime glass by finite element method. More than 100 models were established on the platform of Abaqus/Standard. The influence of parameters, i. e., temperature, aspect ratio, side wall angle and friction coefficient on deformation were studied, and the predicted morphology of the molded microchannel were presented as well. The research could provide fundamental experience for optimizing GMP process in the future.

  20. All polymer chip for amperometric studies of transmitter release from large groups of neuronal cells

    DEFF Research Database (Denmark)

    Larsen, Simon T.; Taboryski, Rafael

    2012-01-01

    We present an all polymer electrochemical chip for simple detection of transmitter release from large groups of cultured PC 12 cells. Conductive polymer PEDOT:tosylate microelectrodes were used together with constant potential amperometry to obtain easy-to-analyze oxidation signals from potassium......-induced release of transmitter molecules. The nature of the resulting current peaks is discussed, and the time for restoring transmitter reservoirs is studied. The relationship between released transmitters and potassium concentration was found to fit to a sigmoidal dose–response curve. Finally, we demonstrate...

  1. Health Care Industry Study

    Science.gov (United States)

    2002-01-01

    press conference with President Toledo of Peru on March 23, 2002, President Bush proclaimed, “education, jobs, and health care are the greatest...allow patients with chronic illnesses such as diabetes and high blood pressure to “visit” their doctors “on-line” while in the comfort and privacy of...to maintain a healthy lifestyle. As a result, non-communicable disease such as 10 heart disease, stroke, diabetes , and cancer are prevalent throughout

  2. Price of forest chips decreasing

    International Nuclear Information System (INIS)

    Hakkila, P.

    2001-01-01

    Use of forest chips was studied in 1999 in the national Puuenergia (Wood Energy) research program. Wood combusting heating plants were questioned about are the main reasons restricting the increment of the use of forest chips. Heating plants, which did not use forest chips at all or which used less than 250 m 3 (625 bulk- m 3 ) in 1999 were excluded. The main restrictions for additional use of forest chips were: too high price of forest chips; lack of suppliers and/or uncertainty of deliveries; technical problems of reception and processing of forest chips; insufficiency of boiler output especially in winter; and unsatisfactory quality of chips. The price of forest chips becomes relatively high because wood biomass used for production of forest chips has to be collected from wide area. Heavy equipment has to be used even though small fragments of wood are processed, which increases the price of chips. It is essential for forest chips that the costs can be pressed down because competition with fossil fuels, peat and industrial wood residues is hard. Low market price leads to the situation in which forest owner gets no price of the raw material, the entrepreneurs operate at the limit of profitability and renovation of machinery is difficult, and forest chips suppliers have to sell the chips at prime costs. Price of forest chips has decreased significantly during the past decade. Nominal price of forest chips is now lower than two decades ago. The real price of chips has decreased even more than the nominal price, 35% during the past decade and 20% during the last five years. Chips, made of small diameter wood, are expensive because the price includes the felling costs and harvesting is carried out at thinning lots. Price is especially high if chips are made of delimbed small diameter wood due to increased the work and reduced amount of chips. The price of logging residue chips is most profitable because cutting does not cause additional costs. Recovery of chips is

  3. Study on Improving Thickness Uniformity of Microfluidic Chip Mold in the Electroforming Process

    Directory of Open Access Journals (Sweden)

    Liqun Du

    2016-01-01

    Full Text Available Electroformed microfluidic chip mold faces the problem of uneven thickness, which decreases the dimensional accuracy of the mold, and increases the production cost. To fabricate a mold with uniform thickness, two methods are investigated. Firstly, experiments are carried out to study how the ultrasonic agitation affects the thickness uniformity of the mold. It is found that the thickness uniformity is maximally improved by about 30% after 2 h electroforming under 200 kHz and 500 W ultrasonic agitation. Secondly, adding a second cathode, a method suitable for long-time electroforming is studied by numerical simulation. The simulation results show that with a 4 mm width second cathode used, the thickness uniformity is improved by about 30% after 2 h of electroforming, and that with electroforming time extended, the thickness uniformity is improved more obviously. After 22 h electroforming, the thickness uniformity is increased by about 45%. Finally, by comparing two methods, the method of adding a second cathode is chosen, and a microfluidic chip mold is made with the help of a specially designed second cathode. The result shows that the thickness uniformity of the mold is increased by about 50%, which is in good agreement with the simulation results.

  4. Spectroscopy study of imaging devices based on silicon Pixel Array Detector coupled to VATAGP7 read-out chips

    International Nuclear Information System (INIS)

    Linhart, V; Lacasta, C; Llosa, G; Stankova, V; Burdette, D; Chessi, E; Cochran, E; Honscheid, K; Kagan, H; Weilhammer, P; Cindro, V; Grosicar, B; Mikuz, M; Studen, A; Zontar, D; Clinthorne, N H

    2011-01-01

    Spectroscopic and timing response studies have been conducted on a detector module consisting of a silicon Pixel Array Detector bonded on two VATAGP7 read-out chips manufactured by Gamma-Medica Ideas using laboratory gamma sources and the internal calibration facilities (the calibration system of the read-out chips). The performed tests have proven that the chips have (i) non-linear calibration curves which can be approximated by power functions, (ii) capability to measure the energy of photons with energy resolution better than 2 keV (exact range and resolution depend on experimental setup), (iii) the internal calibration facility which provides 6 out of 16 available internal calibration charges within our region of interest (spanning the Compton edge of 511 keV photons). The peaks induced by the internal calibration facility are suitable for a fit of the calibration curves. However, they are not suitable for measurements of equivalent noise charge because their full width at half maximum varies with their amplitude. These facts indicate that the VATAGP7 chips are useful and precise tools for a wide variety of spectroscopic devices. We have also explored time walk of the module and peaking time of the spectroscopy signals provided by the chips. We have observed that (iv) the time walk is caused partly by the peaking time of the signals provided by the fast shaper of the chips and partly by the timing uncertainty related to the varying position of the photon interaction, (v) the peaking time of the spectroscopy signals provided by the chips increases with increasing pulse height.

  5. Study of silicon chip soldering in high-power transistor housing

    Directory of Open Access Journals (Sweden)

    Vasily S. Anosov

    2017-09-01

    We experimentally assessed the effect of outer housing layer materials and back side chip metallization. For lead-silver soldering of silicon chips, the best housing is that with a nickel outer layer rather than with a gold-plated one, because the resultant thermal resistance is lower and the absence of gold makes the technology cheaper. We obtained a 0.6 K/W thermal resistance for a 24 mm2 chip area.

  6. Organs-on-a-chip: Current applications and consideration points for in vitro ADME-Tox studies.

    Science.gov (United States)

    Ishida, Seiichi

    2018-02-01

    Assay systems using in vitro cultured cells are increasingly applied for evaluation of the efficacy, safety, and toxicity of drug candidates. In vitro cell-based assays have two main applications in the drug discovery process: searching for a compound that is effective against the target disease (seed investigation) and confirmation of safety during use of the identified compounds (safety assessment). Currently available in vitro cell-based assays have been designed to evaluate the efficacy and toxicity in single organs, but the in vivo pharmacokinetics and pharmacodynamics of the administered drug candidates have not been considered. Thus, an evaluation system that interconnects cell culture units, one of which has appropriate drug metabolism activities and the other assesses the efficacy and toxicity of compounds, is needed. Accordingly, the in vitro ADME-Tox culture system known as organs-on-a-chip has been proposed. In this review, after introducing the organs-on-a-chip system, the evaluation of enterohepatic circulation and the gut-liver axis relationship will be presented as an example of the application of the organs-on-a-chip system for ADME studies based on inter-organ network. Additionally, the functions required for the organs-on-a-chip system and the necessity of standardization of cells mounted on the chip system will be discussed. Copyright © 2018 The Japanese Society for the Study of Xenobiotics. Published by Elsevier Ltd. All rights reserved.

  7. Real-time studies of chemical reactions in lab-on-a-chip devices

    NARCIS (Netherlands)

    Brivio, M.

    2005-01-01

    The realization of a lab-on-a-chip system in which chemical reactions are carried out in a continuous flow mode and monitored on-line by a suitable analytical technique is the main topic of this thesis. Two types of a lab-on-a-chip were realized, both using mass spectrometry (MS) as the on-line

  8. Enabling rapid behavioral ecotoxicity studies using an integrated lab-on-a-chip systems

    Science.gov (United States)

    Huang, Yushi; Nugegoda, Dayanthi; Wlodkowic, Donald

    2015-12-01

    Behavioral ecotoxicity tests are gaining an increasing recognition in environmental toxicology. Behavior of sensitive bioindicator species can change rapidly in response to an acute exposure to contaminants and thus has a much higher sensitivity as compared to conventional LC50 mortality tests. Furthermore, behavioral endpoints seems to be very good candidates to develop early-warning biomonitoring systems needed for rapid chemical risk assessment. Behavioral tests are non-invasive, fast, do not harm indicator organisms (behavioural changes are very rapid) and are thus fully compatible with 3R (Replacement - Reduction - Refinement) principle encouraging alternatives to conventional animal testing. These characteristics are essential when designing improved ecotoxicity tests for chemical risk assessment. In this work, we present a pilot development of miniaturized Lab-on-a-Chip (LOC) devices for studying toxin avoidance behaviors of small aquatic crustaceans. As an investigative tool, LOCs represent a new direction that may miniaturize and revolutionize behavioral ecotoxicology. Specifically our innovative microfluidic prototype: (i) enables convening "caging" of specimens for real-time videomicroscopy; (ii) eliminates the evaporative water loss thus providing an opportunity for long-term behavioral studies; (iii) exploits laminar fluid flow under low Reynolds numbers to generate discrete domains and gradients enabling for the first time toxin avoidance studies on small aquatic crustaceans; (iv) integrates off-the-chip mechatronic interfaces and video analysis algorithms for single animal movement analysis. We provide evidence that by merging innovative bioelectronic and biomicrofluidic technologies we can deploy inexpensive and reliable systems for culture, electronic tracking and complex computational analysis of behavior of bioindicator organisms.

  9. Single event upset studies on the CMS tracker APV25 readout chip

    International Nuclear Information System (INIS)

    Noah, E.; Bauer, T.; Bisello, D.; Faccio, F.; Friedl, M.; Fulcher, J.R.; Hall, G.; Huhtinen, M.; Kaminsky, A.; Pernicka, M.; Raymond, M.; Wyss, J.

    2002-01-01

    The microstrip tracker for the CMS experiment at the CERN Large Hadron Collider will be read out using APV25 chips. During high luminosity running the tracker will be exposed to particle fluxes up to 10 7 cm -2 s -1 , which raises concerns that the APV25 could occasionally suffer Single Event Upsets (SEUs). The effect of SEU on the APV25 has been studied to investigate implications for CMS detector operation and from the viewpoint of detailed circuit operation, to improve the understanding of its origin and what factors affect its magnitude. Simulations were performed to reconstruct the effects created by highly ionising particles striking sensitive parts of the circuits, along with consideration of the underlying mechanisms of charge deposition, collection and the consequences. A model to predict the behaviour of the memory circuits in the APV25 has been developed and data collected from dedicated experiments using both heavy ions and hadrons have been shown to support it

  10. Fiber free plug and play on-chip scattering cytometer module – for implementation in microfluidic point of care devices

    DEFF Research Database (Denmark)

    Jensen, Thomas Glasdam; Kutter, Jörg Peter

    2010-01-01

    In this paper, we report on recent progress toward the development of a plug and play on-chip cytometer based on light scattering. By developing a device that does not depend on the critical alignment and cumbersome handling of fragile optical fibers, we approach a device that is suitable for non...

  11. The CHIPS Randomized Controlled Trial (Control of Hypertension in Pregnancy Study): Is Severe Hypertension Just an Elevated Blood Pressure?

    NARCIS (Netherlands)

    Magee, Laura A.; von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E.; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Helewa, Michael; Hutton, Eileen; Koren, Gideon; Lee, Shoo K.; Logan, Alexander G.; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G.; Moutquin, Jean-Marie

    2016-01-01

    To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of less tight (target diastolic blood pressure [dBP] 100 mmHg) versus tight control (target dBP 85

  12. The study of the possibility to use CAMEX chips in collider experiments with short bunch crossing time

    International Nuclear Information System (INIS)

    Aulchenko, V.M.; Chilingarov, A.G.; Serbo, V.V.; Titov, V.M.

    1993-01-01

    The study of the possibility to use CAMEX chips in several systems of the detector KEDR at the e + e - collider VEPP-4M was performed. The relatively short bunch crossing time at VEPP-4M 60 ns leads to some problems with the use of CAMEX in the standard mode. The different ways to overcome these difficulties are investigated and compared. (orig.)

  13. Study on VCSEL laser heating chip in nuclear magnetic resonance gyroscope

    Science.gov (United States)

    Liang, Xiaoyang; Zhou, Binquan; Wu, Wenfeng; Jia, Yuchen; Wang, Jing

    2017-10-01

    In recent years, atomic gyroscope has become an important direction of inertial navigation. Nuclear magnetic resonance gyroscope has a stronger advantage in the miniaturization of the size. In atomic gyroscope, the lasers are indispensable devices which has an important effect on the improvement of the gyroscope performance. The frequency stability of the VCSEL lasers requires high precision control of temperature. However, the heating current of the laser will definitely bring in the magnetic field, and the sensitive device, alkali vapor cell, is very sensitive to the magnetic field, so that the metal pattern of the heating chip should be designed ingeniously to eliminate the magnetic field introduced by the heating current. In this paper, a heating chip was fabricated by MEMS process, i.e. depositing platinum on semiconductor substrates. Platinum has long been considered as a good resistance material used for measuring temperature The VCSEL laser chip is fixed in the center of the heating chip. The thermometer resistor measures the temperature of the heating chip, which can be considered as the same temperature of the VCSEL laser chip, by turning the temperature signal into voltage signal. The FPGA chip is used as a micro controller, and combined with PID control algorithm constitute a closed loop control circuit. The voltage applied to the heating resistor wire is modified to achieve the temperature control of the VCSEL laser. In this way, the laser frequency can be controlled stably and easily. Ultimately, the temperature stability can be achieved better than 100mK.

  14. Comprehensive Study of Microgel Electrode for On-Chip Electrophoretic Cell Sorting

    Science.gov (United States)

    Hattori, Akihiro; Yasuda, Kenji

    2010-06-01

    We have developed an on-chip cell sorting system and microgel electrode for applying electrostatic force in microfluidic pathways in the chip. The advantages of agarose electrodes are 1) current-driven electrostatic force generation, 2) stability against pH change and chemicals, and 3) no bubble formation caused by electrolysis. We examined the carrier ion type and concentration dependence of microgel electrode impedance, and found that CoCl2 has less than 1/10 of the impedance from NaCl, and the reduction of the impedance of NaCl gel electrode was plateaued at 0.5 M. The structure control of the microgel electrode exploiting the surface tension of sol-state agarose was also introduced. The addition of 1% (w/v) trehalose into the microgel electrode allowed the frozen storage of the microgel electrode chip. The experimental results demonstrate the potential of our system and microgel electrode for practical applications in microfluidic chips.

  15. EDGE EFFECT MODELING AND STUDY FOR THREE-CHIP RGB LIGHT-EMITTING DIODES

    Directory of Open Access Journals (Sweden)

    A. I. Podosinnikov

    2015-03-01

    Full Text Available Subject of study. The paper deals with light quality improvement of multi–chip RGB light-emitting diodes (LEDs and luminaries on their basis. In particular, we have studied the issues of the edge effect reducing, which is non–uniformity of color when observing the source of light under different angles as well as non-uniformity of color distribution on the illuminated surface. Methods. Experimental study of the edge effect has been performed, namely, the analysis of the halo at the periphery of the illuminated area and the non–uniformity of area at the surface of the screen illuminated with RGB LEDs with and without light concentrators. Modeling of illumination distribution at various distances from the source for the system containing four RGB LEDs with reflectors by ZEMAX software has been carried out. Assessment of the uniformity for light distribution via calculating the chromaticity coordinates has been performed. Main results. The possibility of modeling application at the stage of a luminary design is shown on the example of RGB LEDs for assessing the efficiency of light flux usage and colorimetric parameters. Suggested method simplifies significantly the design of luminaries and reduces associated costs. Practical relevance. The findings can be used in the design of luminaries based on RGB LEDs, including the ones with secondary optics elements.

  16. Study of a Microfluidic Chip Integrating Single Cell Trap and 3D Stable Rotation Manipulation

    Directory of Open Access Journals (Sweden)

    Liang Huang

    2016-08-01

    Full Text Available Single cell manipulation technology has been widely applied in biological fields, such as cell injection/enucleation, cell physiological measurement, and cell imaging. Recently, a biochip platform with a novel configuration of electrodes for cell 3D rotation has been successfully developed by generating rotating electric fields. However, the rotation platform still has two major shortcomings that need to be improved. The primary problem is that there is no on-chip module to facilitate the placement of a single cell into the rotation chamber, which causes very low efficiency in experiment to manually pipette single 10-micron-scale cells into rotation position. Secondly, the cell in the chamber may suffer from unstable rotation, which includes gravity-induced sinking down to the chamber bottom or electric-force-induced on-plane movement. To solve the two problems, in this paper we propose a new microfluidic chip with manipulation capabilities of single cell trap and single cell 3D stable rotation, both on one chip. The new microfluidic chip consists of two parts. The top capture part is based on the least flow resistance principle and is used to capture a single cell and to transport it to the rotation chamber. The bottom rotation part is based on dielectrophoresis (DEP and is used to 3D rotate the single cell in the rotation chamber with enhanced stability. The two parts are aligned and bonded together to form closed channels for microfluidic handling. Using COMSOL simulation and preliminary experiments, we have verified, in principle, the concept of on-chip single cell traps and 3D stable rotation, and identified key parameters for chip structures, microfluidic handling, and electrode configurations. The work has laid a solid foundation for on-going chip fabrication and experiment validation.

  17. Chips 2020

    CERN Document Server

    2016-01-01

    The release of this second volume of CHIPS 2020 coincides with the 50th anniversary of Moore’s Law, a critical year marked by the end of the nanometer roadmap and by a significantly reduced annual rise in chip performance. At the same time, we are witnessing a data explosion in the Internet, which is consuming 40% more electrical power every year, leading to fears of a major blackout of the Internet by 2020. The messages of the first CHIPS 2020, published in 2012, concerned the realization of quantum steps for improving the energy efficiency of all chip functions. With this second volume, we review these messages and amplify upon the most promising directions: ultra-low-voltage electronics, nanoscale monolithic 3D integration, relevant-data, brain- and human-vision-inspired processing, and energy harvesting for chip autonomy. The team of authors, enlarged by more world leaders in low-power, monolithic 3D, video, and Silicon brains, presents new vistas in nanoelectronics, promising  Moore-like exponential g...

  18. Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial.

    Science.gov (United States)

    Magee, Laura A; von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Gruslin, Andrée; Helewa, Michael; Hutton, Eileen; Lee, Shoo K; Logan, Alexander G; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G; Moutquin, Jean Marie

    2016-07-01

    For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. This was a planned, secondary analysis of data from the 987 women in the CHIPS Trial. Logistic regression was used to examine the impact of 19 candidate predictors on the probability of adverse perinatal (pregnancy loss or high level neonatal care for >48 h, or birthweight hypertension, preeclampsia, or delivery at blood pressure within 1 week before randomization. Continuous variables were represented continuously or dichotomized based on the smaller p-value in univariate analyses. An area-under-the-receiver-operating-curve (AUC ROC) of ≥0.70 was taken to reflect a potentially useful model. Point estimates for AUC ROC were hypertension (0.70, 95% CI 0.67-0.74) and delivery at hypertension develop an elevated blood pressure in pregnancy, or formerly normotensive women develop new gestational hypertension, maternal and current pregnancy clinical characteristics cannot predict adverse outcomes in the index pregnancy. © 2016 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

  19. ANALISIS STUDI KELAYAKAN USAHA BISNIS CASSAVA CHIPS DI PERUMAHAN MARDANI RAYA

    Directory of Open Access Journals (Sweden)

    Utami Gunawati

    2017-10-01

    Full Text Available Berdasarkan hasil survey diperoleh kebutuhan terhadap keripik singkong sebanyak 517 kg di Perumahan Mardani Raya, dengan hasil sebanyak 187 kg berasal dari  Keripik Berkah. Masih terdapat GAP atau permintaan terhadap kebutuhan yang belum terlayani. Diketahui informasi, jumlah potensial pasar minat terhadap keripik singkong cukup banyak untuk melakukan usaha. Perlu diadakan studi kelayakan usaha ditinjau dari aspek produk, pasar/pemasaran, teknis operasi, manajemen SDM, sosial ekonomi, lingkungan, dan finansial untuk menunjukkan kelayakan dari usaha tersebut. Adapun hasil analisis yang dilakukan pada aspek pasar potensial pasar 11.292 kg / bulan = 135.504 kg/tahun dengan pemasaran manfaatkan media social. Aspek produk ada 5 varian rasa dengan kemasan yang terseal dan diberi label merk. Aspek teknis, pemasok supply bahan baku singkong didapat dari 3 alternatif pasar. Aspek Manajemen SDM dibutuhkan 3 tenaga kerja. Dari ekonomi social dapat membuka lapangan kerja dan menambah penghasilan petani singkong. Aspek lingkungan terdapat limbah kulit singkong dapat dijadikan kerupuk kulit singkong. Aspek finansial untuk usaha selama 5 tahun dengan modal awal sebesar Rp. 56.434.317,- Hasil perhitungan terhadap kriteria penilaian investasi didapat nilai NPV sebesar Rp. 730.802.669, yang artinya selisih antara nilai kas yang akan datang dengan nilai investasi bernilai positif. Nilai IRR sebesar 14 %, lebih besar dari discount factor  sebesar 13 %, dan payback period selama 2 tahun 4 bulan. Maka dapat disimpulkan secara keseluruhan usaha bisnis Cassava Chips NR Jaya ini layak untuk dijalankan.

  20. Pressurized thermal and hydrothermal decomposition of algae, wood chip residue, and grape marc: A comparative study

    International Nuclear Information System (INIS)

    Subagyono, Dirgarini J.N.; Marshall, Marc; Jackson, W. Roy; Chaffee, Alan L.

    2015-01-01

    Pressurized thermal decomposition of two marine algae, Pinus radiata chip residue and grape marc using high temperature, high pressure reactions has been studied. The yields and composition of the products obtained from liquefactions under CO of a mixture of biomass and H 2 O (with or without catalyst) were compared with products from liquefaction of dry biomass under N 2 , at different temperatures, gas pressures and for CO runs, water to biomass ratios. Thermochemical reactions of algae produced significantly higher dichloromethane solubles and generally higher product yields to oil and asphaltene than Pinus radiata and grape marc under the reaction conditions used. Furthermore, the biofuels derived from algae contained significant concentrations of aliphatic hydrocarbons as opposed to those from radiata pine and grape marc which were richer in aromatic compounds. The possibility of air transport fuel production from algae thus appears to have considerable advantages over that from radiata pine and grape marc. - Highlights: • Liquefaction of algae gave more oil than that of Pinus radiata and grape marc. • Reactions under CO/H 2 O produced higher yields of oil than N 2 . • Water to biomass ratio had little effect on the yields. • Bio-oil from algae contained substantial amounts of aliphatic hydrocarbons. • Pinus radiata oil was low in N but high in O

  1. Studies for an upgrade of ALICE Inner Tracking System: Pixel chip characterization

    Directory of Open Access Journals (Sweden)

    Park Jonghan

    2017-01-01

    Full Text Available Inner Tracking System (ITS of ALICE is used for vertex determination and tracking. Future heavy-ion program at the LHC aims to run with high luminosity. To address this challenge, upgrade program of ITS is underway, which aims at better position resolution (factor of 3, high detection efficiency (>99%, high-rate readout capabilities (100 kHz for Pb-Pb and moderate radiation hardness (> 700 krad. The new ITS will be composed with 7 layers of silicon pixel chip based on Monolithic Active Pixel Sensor (MAPS technology. The characterization test of various version of prototype chips at different phases of development has been performed. This contribution will provide the main characterization results obtained from the measurements performed at laboratories and using test beam for finalizing the pixel chip specification.

  2. Evaluating care from a care ethical perspective:: A pilot study.

    Science.gov (United States)

    Kuis, Esther E; Goossensen, Anne

    2017-08-01

    Care ethical theories provide an excellent opening for evaluation of healthcare practices since searching for (moments of) good care from a moral perspective is central to care ethics. However, a fruitful way to translate care ethical insights into measurable criteria and how to measure these criteria has as yet been unexplored: this study describes one of the first attempts. To investigate whether the emotional touchpoint method is suitable for evaluating care from a care ethical perspective. An adapted version of the emotional touchpoint interview method was used. Touchpoints represent the key moments to the experience of receiving care, where the patient recalls being touched emotionally or cognitively. Participants and research context: Interviews were conducted at three different care settings: a hospital, mental healthcare institution and care facility for older people. A total of 31 participants (29 patients and 2 relatives) took part in the study. Ethical considerations: The research was found not to be subject to the (Dutch) Medical Research Involving Human Subjects Act. A three-step care ethical evaluation model was developed and described using two touchpoints as examples. A focus group meeting showed that the method was considered of great value for partaking institutions in comparison with existing methods. Reflection and discussion: Considering existing methods to evaluate quality of care, the touchpoint method belongs to the category of instruments which evaluate the patient experience. The touchpoint method distinguishes itself because no pre-defined categories are used but the values of patients are followed, which is an essential issue from a care ethical perspective. The method portrays the insider perspective of patients and thereby contributes to humanizing care. The touchpoint method is a valuable instrument for evaluating care; it generates evaluation data about the core care ethical principle of responsiveness.

  3. Lithic chipped industry of the Jevišovice culture in Moravia. An introductory study

    Czech Academy of Sciences Publication Activity Database

    Kopacz, J.; Šebela, Lubomír

    2010-01-01

    Roč. 2010, č. 51 (2010), s. 69-96 ISSN 1211-7250 Institutional research plan: CEZ:AV0Z80010507 Keywords : Moravia * Jevišovice Culture * Chipped Stone Industry * Aeneolithic Subject RIV: AC - Archeology, Anthropology, Ethnology

  4. A study on oxidation treatment of uranium metal chip under controlling atmosphere for safe storage

    International Nuclear Information System (INIS)

    Kim, Chang Kyu; Ji, Chul Goo; Bae, Sang Oh; Woo, Yoon Myeoung; Kim, Jong Goo; Ha, Yeong Keong

    2011-01-01

    The U metal chips generated in developing nuclear fuel and a gamma radioisotope shield have been stored under immersion of water in KAERI. When the water of the storing vessels vaporizes or drains due to unexpected leaking, the U metal chips are able to open to air. A new oxidation treatment process was raised for a long time safe storage with concepts of drying under vacuum, evaporating the containing water and organic material with elevating temperature, and oxidizing the uranium metal chips at an appropriate high temperature under conditions of controlling the feeding rate of oxygen gas. In order to optimize the oxidation process the uranium metal chips were completely dried at higher temperature than 300 .deg. C and tested for oxidation at various temperatures, which are 300 .deg. C, 400 .deg. C, and 500 .deg. C. When the oxidation temperature was 400 .deg. C, the oxidized sample for 7 hours showed a temperature rise of 60 .deg. C in the self-ignition test. But the oxidized sample for 14 hours revealed a slight temperature rise of 7 .deg. C representing a stable behavior in the self-ignition test. When the temperature was 500 .deg. C, the shorter oxidation for 7 hours appeared to be enough because the self-ignition test represented no temperature rise. By using several chemical analyses such as carbon content determination, X-ray deflection (XRD), Infrared spectra (IR) and Thermal gravimetric analysis (TGA) on the oxidation treated samples, the results of self-ignition test of new oxidation treatment process for U metal chip were interpreted and supported

  5. The GenoChip: A New Tool for Genetic Anthropology

    Science.gov (United States)

    Elhaik, Eran; Greenspan, Elliott; Staats, Sean; Krahn, Thomas; Tyler-Smith, Chris; Xue, Yali; Tofanelli, Sergio; Francalacci, Paolo; Cucca, Francesco; Pagani, Luca; Jin, Li; Li, Hui; Schurr, Theodore G.; Greenspan, Bennett; Spencer Wells, R.

    2013-01-01

    The Genographic Project is an international effort aimed at charting human migratory history. The project is nonprofit and nonmedical, and, through its Legacy Fund, supports locally led efforts to preserve indigenous and traditional cultures. Although the first phase of the project was focused on uniparentally inherited markers on the Y-chromosome and mitochondrial DNA (mtDNA), the current phase focuses on markers from across the entire genome to obtain a more complete understanding of human genetic variation. Although many commercial arrays exist for genome-wide single-nucleotide polymorphism (SNP) genotyping, they were designed for medical genetic studies and contain medically related markers that are inappropriate for global population genetic studies. GenoChip, the Genographic Project’s new genotyping array, was designed to resolve these issues and enable higher resolution research into outstanding questions in genetic anthropology. The GenoChip includes ancestry informative markers obtained for over 450 human populations, an ancient human (Saqqaq), and two archaic hominins (Neanderthal and Denisovan) and was designed to identify all known Y-chromosome and mtDNA haplogroups. The chip was carefully vetted to avoid inclusion of medically relevant markers. To demonstrate its capabilities, we compared the FST distributions of GenoChip SNPs to those of two commercial arrays. Although all arrays yielded similarly shaped (inverse J) FST distributions, the GenoChip autosomal and X-chromosomal distributions had the highest mean FST, attesting to its ability to discern subpopulations. The chip performances are illustrated in a principal component analysis for 14 worldwide populations. In summary, the GenoChip is a dedicated genotyping platform for genetic anthropology. With an unprecedented number of approximately 12,000 Y-chromosomal and approximately 3,300 mtDNA SNPs and over 130,000 autosomal and X-chromosomal SNPs without any known health, medical, or phenotypic

  6. The GenoChip: a new tool for genetic anthropology.

    Science.gov (United States)

    Elhaik, Eran; Greenspan, Elliott; Staats, Sean; Krahn, Thomas; Tyler-Smith, Chris; Xue, Yali; Tofanelli, Sergio; Francalacci, Paolo; Cucca, Francesco; Pagani, Luca; Jin, Li; Li, Hui; Schurr, Theodore G; Greenspan, Bennett; Spencer Wells, R

    2013-01-01

    The Genographic Project is an international effort aimed at charting human migratory history. The project is nonprofit and nonmedical, and, through its Legacy Fund, supports locally led efforts to preserve indigenous and traditional cultures. Although the first phase of the project was focused on uniparentally inherited markers on the Y-chromosome and mitochondrial DNA (mtDNA), the current phase focuses on markers from across the entire genome to obtain a more complete understanding of human genetic variation. Although many commercial arrays exist for genome-wide single-nucleotide polymorphism (SNP) genotyping, they were designed for medical genetic studies and contain medically related markers that are inappropriate for global population genetic studies. GenoChip, the Genographic Project's new genotyping array, was designed to resolve these issues and enable higher resolution research into outstanding questions in genetic anthropology. The GenoChip includes ancestry informative markers obtained for over 450 human populations, an ancient human (Saqqaq), and two archaic hominins (Neanderthal and Denisovan) and was designed to identify all known Y-chromosome and mtDNA haplogroups. The chip was carefully vetted to avoid inclusion of medically relevant markers. To demonstrate its capabilities, we compared the FST distributions of GenoChip SNPs to those of two commercial arrays. Although all arrays yielded similarly shaped (inverse J) FST distributions, the GenoChip autosomal and X-chromosomal distributions had the highest mean FST, attesting to its ability to discern subpopulations. The chip performances are illustrated in a principal component analysis for 14 worldwide populations. In summary, the GenoChip is a dedicated genotyping platform for genetic anthropology. With an unprecedented number of approximately 12,000 Y-chromosomal and approximately 3,300 mtDNA SNPs and over 130,000 autosomal and X-chromosomal SNPs without any known health, medical, or phenotypic

  7. Influence of passivation process on chip performance

    NARCIS (Netherlands)

    Lu, J.; Kovalgin, Alexeij Y.; Schmitz, Jurriaan

    2009-01-01

    In this work, we have studied the performance of CMOS chips before and after a low temperature post-processing step. In order to prevent damage to the IC chips by the post-processing steps, a first passivation layers is needed on top of the IC chips. Two different passivation layer deposition

  8. "NeuroStem Chip": a novel highly specialized tool to study neural differentiation pathways in human stem cells

    Directory of Open Access Journals (Sweden)

    Li Jia-Yi

    2007-02-01

    Full Text Available Abstract Background Human stem cells are viewed as a possible source of neurons for a cell-based therapy of neurodegenerative disorders, such as Parkinson's disease. Several protocols that generate different types of neurons from human stem cells (hSCs have been developed. Nevertheless, the cellular mechanisms that underlie the development of neurons in vitro as they are subjected to the specific differentiation protocols are often poorly understood. Results We have designed a focused DNA (oligonucleotide-based large-scale microarray platform (named "NeuroStem Chip" and used it to study gene expression patterns in hSCs as they differentiate into neurons. We have selected genes that are relevant to cells (i being stem cells, (ii becoming neurons, and (iii being neurons. The NeuroStem Chip has over 1,300 pre-selected gene targets and multiple controls spotted in quadruplicates (~46,000 spots total. In this study, we present the NeuroStem Chip in detail and describe the special advantages it offers to the fields of experimental neurology and stem cell biology. To illustrate the utility of NeuroStem Chip platform, we have characterized an undifferentiated population of pluripotent human embryonic stem cells (hESCs, cell line SA02. In addition, we have performed a comparative gene expression analysis of those cells versus a heterogeneous population of hESC-derived cells committed towards neuronal/dopaminergic differentiation pathway by co-culturing with PA6 stromal cells for 16 days and containing a few tyrosine hydroxylase-positive dopaminergic neurons. Conclusion We characterized the gene expression profiles of undifferentiated and dopaminergic lineage-committed hESC-derived cells using a highly focused custom microarray platform (NeuroStem Chip that can become an important research tool in human stem cell biology. We propose that the areas of application for NeuroStem microarray platform could be the following: (i characterization of the

  9. Adjunctive Effects of A Piscean Collagen-Based Controlled-Release Chlorhexidine Chip in the Treatment of Chronic Periodontitis: A Clinical and Microbiological Study

    Science.gov (United States)

    John, Priya; Lazarus, Flemingson; Selvam, Arul; Prabhuji, Munivenkatappa Lakshmaiah Venkatesh

    2015-01-01

    Introduction PerioChip a bovine origin gelatine based CHX chip has shown beneficial effects in the management of Chronic Periodontitis. A new fish collagen based CHX chip similar to PerioChip is currently available; however this product has not been thoroughly researched. Aim The aim of the present study was to evaluate the effectiveness of a new Piscean collagen-based controlled-release chlorhexidine chip (CHX chip) as an adjunctive therapy to scaling and root planing (SRP). Settings and Design The study was conducted as a randomised, split-mouth, controlled clinical trial at Krishnadevaraya College of Dental Sciences, Bangalore, India. Materials and Methods In a split–mouth study involving 20 sites in 10 patients with chronic periodontitis, control sites received scaling and root planing and test sites received scaling and root planing (SRP) and the intrapocket CHX chip placement as an adjunct. Subgingival plaque samples were collected from both control and test sites at baseline, 11 days and 11 weeks and the anaerobic colony count were assessed. Clinical parameters that were recorded at baseline and 11 weeks were gingival index, Plaque index, Probing pocket depth (PPD), and Clinical attachment level (CAL). Plaque index was recorded additionally at 11 days. Results In the test group there was a statistically significant reduction in the total anaerobic colony count, gingival index and plaque scores from baseline as compared to control sites at all time intervals. An additional 0.8mm reduction in mean probing pocket depth was noted in the test group. Gain in Clinical attachment level was comparable in both groups. Conclusion The adjunctive use of the new collagen-based CHX chip yielded significant antimicrobial benefit accompanied by a reduction in probing depth and a clinical attachment level gain as compared to SRP alone. This suggests that it may be a useful treatment option of nonsurgical periodontal treatment of chronic periodontitis. PMID:26155567

  10. Wide-field synovial fluid imaging using polarized lens-free on-chip microscopy for point-of-care diagnostics of gout (Conference Presentation)

    Science.gov (United States)

    Zhang, Yibo; Lee, Seung Yoon; Zhang, Yun; Furst, Daniel; Fitzgerald, John; Ozcan, Aydogan

    2016-03-01

    Gout and pseudogout are forms of crystal arthropathy caused by monosodium urate (MSU) and calcium pyrophosphate dehydrate (CPPD) crystals in the joint, respectively, that can result in painful joints. Detecting the unique-shaped, birefringent MSU/CPPD crystals in a synovial fluid sample using a compensated polarizing microscope has been the gold-standard for diagnosis since the 1960's. However, this can be time-consuming and inaccurate, especially if there are only few crystals in the fluid. The high-cost and bulkiness of conventional microscopes can also be limiting for point-of-care diagnosis. Lens-free on-chip microscopy based on digital holography routinely achieves high-throughput and high-resolution imaging in a cost-effective and field-portable design. Here we demonstrate, for the first time, polarized lens-free on-chip imaging of MSU and CPPD crystals over a wide field-of-view (FOV ~ 20.5 mm2, i.e., gout and pseudogout. Circularly polarizer partially-coherent light is used to illuminate the synovial fluid sample on a glass slide, after which a quarter-wave-plate and an angle-mismatched linear polarizer are used to analyze the transmitted light. Two lens-free holograms of the MSU/CPPD sample are taken, with the sample rotated by 90°, to rule out any non-birefringent objects within the specimen. A phase-recovery algorithm is also used to improve the reconstruction quality, and digital pseudo-coloring is utilized to match the color and contrast of the lens-free image to that of a gold-standard microscope image to ease the examination by a rheumatologist or a laboratory technician, and to facilitate computerized analysis.

  11. A preliminary study of the deterioration of alder and Douglas-fir chips in outdoor piles.

    Science.gov (United States)

    Ernest. Wright

    1954-01-01

    In the fall of 1952, E. E. Matson of the Pacific Northwest Forest and Range Experiment Station learned that the Fir-Tex Insulating Board Company bf St. Helens, Oregon was considering mixing alder with Douglas-fir chips for outside storage. Since alder heartwood i s more susceptible to decay than that of Douglas-fir, the question arose whether mixing the two might...

  12. Transparent Nanopore Cavity Arrays Enable Highly Parallelized Optical Studies of Single Membrane Proteins on Chip.

    Science.gov (United States)

    Diederichs, Tim; Nguyen, Quoc Hung; Urban, Michael; Tampé, Robert; Tornow, Marc

    2018-06-13

    Membrane proteins involved in transport processes are key targets for pharmaceutical research and industry. Despite continuous improvements and new developments in the field of electrical readouts for the analysis of transport kinetics, a well-suited methodology for high-throughput characterization of single transporters with nonionic substrates and slow turnover rates is still lacking. Here, we report on a novel architecture of silicon chips with embedded nanopore microcavities, based on a silicon-on-insulator technology for high-throughput optical readouts. Arrays containing more than 14 000 inverted-pyramidal cavities of 50 femtoliter volumes and 80 nm circular pore openings were constructed via high-resolution electron-beam lithography in combination with reactive ion etching and anisotropic wet etching. These cavities feature both, an optically transparent bottom and top cap. Atomic force microscopy analysis reveals an overall extremely smooth chip surface, particularly in the vicinity of the nanopores, which exhibits well-defined edges. Our unprecedented transparent chip design provides parallel and independent fluorescent readout of both cavities and buffer reservoir for unbiased single-transporter recordings. Spreading of large unilamellar vesicles with efficiencies up to 96% created nanopore-supported lipid bilayers, which are stable for more than 1 day. A high lipid mobility in the supported membrane was determined by fluorescent recovery after photobleaching. Flux kinetics of α-hemolysin were characterized at single-pore resolution with a rate constant of 0.96 ± 0.06 × 10 -3 s -1 . Here, we deliver an ideal chip platform for pharmaceutical research, which features high parallelism and throughput, synergistically combined with single-transporter resolution.

  13. A genome-wide association study by ImmunoChip reveals potential modifiers in myelodysplastic syndromes.

    Science.gov (United States)

    Danjou, Fabrice; Fozza, Claudio; Zoledziewska, Magdalena; Mulas, Antonella; Corda, Giovanna; Contini, Salvatore; Dore, Fausto; Galleu, Antonio; Di Tucci, Anna Angela; Caocci, Giovanni; Gaviano, Eleonora; Latte, Giancarlo; Gabbas, Attilio; Casula, Paolo; Delogu, Lucia Gemma; La Nasa, Giorgio; Angelucci, Emanuele; Cucca, Francesco; Longinotti, Maurizio

    2016-11-01

    Because different findings suggest that an immune dysregulation plays a role in the pathogenesis of myelodysplastic syndrome (MDS), we analyzed a large cohort of patients from a homogeneous Sardinian population using ImmunoChip, a genotyping array exploring 147,954 single-nucleotide polymorphisms (SNPs) localized in genomic regions displaying some degree of association with immune-mediated diseases or pathways. The population studied included 133 cases and 3,894 controls, and a total of 153,978 autosomal markers and 971 non-autosomal markers were genotyped. After association analysis, only one variant passed the genome-wide significance threshold: rs71325459 (p = 1.16 × 10 -12 ), which is situated on chromosome 20. The variant is in high linkage disequilibrium with rs35640778, an untested missense variant situated in the RTEL1 gene, an interesting candidate that encodes for an ATP-dependent DNA helicase implicated in telomere-length regulation, DNA repair, and maintenance of genomic stability. The second most associated signal is composed of five variants that fall slightly below the genome-wide significance threshold but point out another interesting gene candidate. These SNPs, with p values between 2.53 × 10 -6 and 3.34 × 10 -6 , are situated in the methylene tetrahydrofolate reductase (MTHFR) gene. The most associated of these variants, rs1537514, presents an increased frequency of the derived C allele in cases, with 11.4% versus 4.4% in controls. MTHFR is the rate-limiting enzyme in the methyl cycle and genetic variations in this gene have been strongly associated with the risk of neoplastic diseases. The current understanding of the MDS biology, which is based on the hypothesis of the sequential development of multiple subclonal molecular lesions, fits very well with the demonstration of a possible role for RTEL1 and MTHFR gene polymorphisms, both of which are related to a variable risk of genomic instability. Copyright © 2016 ISEH - International

  14. Supply chains of forest chip production in Finland

    Energy Technology Data Exchange (ETDEWEB)

    Kaerhae, Kalle (Metsaeteho Oy, Helsinki (Finland)), e-mail: kalle.karha@metsateho.fi

    2010-07-15

    The Metsaeteho study investigated how logging residue chips, stump wood chips, and chips from small sized thinning wood and large-sized (rotten) roundwood used by heating and power plants were produced in Finland in 2008. Almost all the major forest chip suppliers in Finland were involved in the study. The total volume of forest chips supplied in 2008 by these suppliers was 6.5 TWh. The study was implemented by conducting an e-mail questionnaire survey and telephone interviews. Research data was collected in March-May 2009. The majority of the logging residue chips and chips from small-sized thinning wood were produced using the roadside chipping supply chain in Finland in 2008. The chipping at plant supply chain was also significant in the production of logging residue chips. 70% of all stump wood chips consumed were comminuted at the plant and 29% at terminals. The role of the terminal chipping supply chain was also significant in the production of chips from logging residues and small-sized wood chips. When producing chips from large-sized (rotten) roundwood, nearly a half of chips were comminuted at plants and more than 40% at terminals

  15. Supply systems of forest chip production in Finland

    Energy Technology Data Exchange (ETDEWEB)

    Kaerhae, K. (Metsaeteho Oy, Helsinki (Finland)), e-mail: kalle.karha@metsateho.fi

    2010-07-01

    The Metsaeteho study investigated how logging residue chips, stump wood chips, and chips from small-diameter thinning wood and large-sized (rotten) roundwood used by heating and power plants were produced in Finland in 2009. Almost all the major forest chip suppliers in Finland were involved in the study. The total volume of forest chips supplied in 2009 by these suppliers was 8,4 TWh. The study was implemented by conducting an e-mail questionnaire survey and telephone interviews. Research data was collected from March-May, 2010. The majority of the logging residue chips and chips from small-diameter thinning wood were produced using the roadside chipping supply system in Finland in 2009. The chipping at plant supply system was also significant in the production of logging residue chips. Nearly 70 % of all stump wood chips consumed were comminuted at the plant and 28 % at terminals. The role of the terminal chipping supply system was also significant in the production of chips from logging residues and small-diameter wood chips. When producing chips from large-sized (rotten) roundwood, similarly roughly 70 % of chips were comminuted at plants and 23 % at terminals. (orig.)

  16. Supply chains of forest chip production in Finland

    Energy Technology Data Exchange (ETDEWEB)

    Kaerhae, K. (Metsaeteho Oy, Helsinki (Finland)), Email: kalle.karha@metsateho.fi

    2009-07-01

    The Metsaeteho study investigated how logging residue chips. stump wood chips, and chips from small-sized thinning wood and large-sized (rotten) roundwood used by heating and power plants were produced in Finland in 2008. Almost all the major forest chip suppliers in Finland were involved in the study. The total volume of forest chips supplied in 2008 by these suppliers was 6,5 TWh. The study was implemented by conducting an e-mail questionnaire survey and telephone interviews. Research data was collected in March-May 2009. The majority of the logging residue chips and chips from small-sized thinning wood were produced using the roadside chipping supply chain in Finland in 2008. The chipping at plant supply chain was also significant in the production of logging residue chips. 70% of all stump wood chips consumed were comminuted at the plant and 29% at terminals. The role of the terminal chipping supply chain was also significant in the production of chips from logging residues and small-sized wood chips. When producing chips from large-sized (rotten) roundwood, nearly a half of chips were comminuted at plants and more than 40 % at terminals. (orig.)

  17. Study of the ALICE Investigator chip in view of the requirements at CLIC

    CERN Document Server

    AUTHOR|(SzGeCERN)754303; Dannheim, Dominik; Fiergolski, Adrian; Van Hoorne, Jacobus Willem; Hynds, Daniel; Klempt, Wolfgang; Nurnberg, Andreas Matthias; Sielewicz, Krzysztof Marek; Snoeys, Walter

    2017-01-01

    CLIC is an option for a future high energy linear $e^{+}e^{−}$ collider at CERN in the post-LHC era. The CLIC machine is designed to reach centre-of-mass energies ranging from a few hundred GeV up to 3 TeV. To achieve high precision measurements, e.g. of the Higgs- width, challenging requirements are imposed on the CLIC detector. A single point tracking resolution of 7 μm and a material budget of 1-2%$X_{0}$ per layer are required for the tracker. Moreover, to suppress background hits from beam-beam interactions, a precise time slicing of hits of 10 ns is needed. To address these requirements, a large area silicon tracker is foreseen for the detector at CLIC. In this context, integrated technologies are promising candidates to achieve large scale production and low material budget. The Investigator chip is a test chip developed for the ALICE Inner Tracking System upgrade, implemented in a 180 nm CMOS process on a high resistivity substrate. It contains various test-matrices with analogue functionality, whi...

  18. Feasibility study of a green energy powered thermoelectric chip based air conditioner for electric vehicles

    International Nuclear Information System (INIS)

    Miranda, Á.G.; Chen, T.S.; Hong, C.W.

    2013-01-01

    Traditional compressed-refrigerant air conditioning systems consume substantial energy that may reduce the driving performance and cruising mileage of electric vehicles considerably. It is crucial to design a new climate control system, using a direct energy conversion principle, to further aid in the commercialization of modern electric vehicles. A solid state air conditioner model consisting on TECs (thermoelectric chips) as the load, DSSCs (dye sensitized solar cells) as the renewable energy source and high power LiBs (lithium-ion batteries) as an energy storage device are considered for a personal mobility vehicle. The power management between the main power net and the solid state air conditioner interface is designed with an outer proportional-integral controller and an inner passivity based current controller with a loss included model for perfect tracking. This model is intended to comprise thermal and electrical elements which can be tunable for performance benchmarking and optimization of a solid state air conditioning system. Dynamic performance simulations of the solid-state air conditioner are performed, alongside guidelines for feasibility. - Highlights: • Alternative model extraction for dye sensitized solar cells. • Improved and computationally fast model for the cabin air temperature dynamics. • Euler–Lagrange loss included modeling of a buck converter. • Loss-included passivity based inner loop current control. • The thermoelectric chip air conditioner is tested in simulated cooling/heating scenarios

  19. Development of a bio-chip dedicated to planetary exploration. First step: resistance studies to space conditions

    International Nuclear Information System (INIS)

    Le Postollec, A.; Dobrijevic, M.; Incerti, S.; Moretto, Ph.; Seznec, H.; Desorgher, L.; Santin, G.; Nieminen, P.; Dartnell, L.; Vandenabeele-Trambouze, O.; Coussot, G.

    2008-02-01

    For upcoming exploration missions, space agencies advocate the development of a new promising technique to search for traces of extent or extinct life: the bio-chip use. A bio-chip is a miniaturized device composed of biological sensitive systems fixed on a solid substrate. As space is a hazardous environment, a main concern relies on the resistance of a bio-chip to a panel of harsh constraints among which the resistance to radiations. Within the framework of the BiOMAS (Bio-chip for Organic Matter Analysis in Space) project, our team is currently developing a bio-chip especially designed for planetary exploration. We present here the methodology adopted and the beginning experiments to select the best constituents, to determine resistance levels and to define well-adapted protection for the bio-chip

  20. PHP47 - Early assessment of highly innovative medical technology: clinical and economical gains of point-of-care applications for measuring potassium concentrations

    NARCIS (Netherlands)

    van de Wetering, G.; Hummel, J. Marjan; van Montfort, Augustinus P.W.P.; Montfoort, A.; IJzerman, Maarten Joost

    2009-01-01

    OBJECTIVES: Innovative point-of-care diagnostics are likely to be having a strong impact on health care. The aim of this study is to conduct an early assessment of point-of-care chips. These chips can detect many particles and, consequently, many product-market combinations can be developed. This

  1. Immobilization of flavan-3-ols onto sensor chips to study their interactions with proteins and pectins by SPR

    International Nuclear Information System (INIS)

    Watrelot, Aude A.; Tran, Dong Tien; Buffeteau, Thierry; Deffieux, Denis

    2016-01-01

    Highlights: • Flavanol-macromolecule interactions were determined using SPR. • Flavanols were chemically modified with a linker bearing a thiol group. • Flavanols were immobilized onto a carboxymethyl dextran surface. • Citrus pectin interacted more with flavanols than apple pectin. • Epicatechin interacted more with BSA than flavanol oligomer. - Abstract: Interactions between plant polyphenols and biomacromolecules such as proteins and pectins have been studied by several methods in solution (e.g. isothermal titration calorimetry, dynamic light scattering, nuclear magnetic resonance and spectrophotometry). Herein, these interactions were investigated in real time by Surface Plasmon Resonance (SPR) analysis after immobilization of flavan-3-ols onto a sensor chip surface. (−)-epicatechin, (+)-catechin and flavan-3-ol oligomers with an average degree of polymerization of 2 and 8 were chemically modified using N-(2-(tritylthio)ethyl)propiolamide in order to introduce a spacer unit onto the catecholic B ring. Modified flavan-3-ols were then immobilized onto a carboxymethylated dextran surface (CM5). Immobilization was validated and further verified by evaluating flavan-3-ol interaction with bovine serum albumin (BSA), poly-L-proline or commercial pectins. BSA was found to have a stronger association with monomeric flavan-3-ols than oligomers. SPR analysis of selected flavan-3-ols immobilized onto CM5 sensor chips showed a stronger association for citrus pectins than apple pectins, regardless of flavan-3-ol degree of polymerization.

  2. Immobilization of flavan-3-ols onto sensor chips to study their interactions with proteins and pectins by SPR

    Energy Technology Data Exchange (ETDEWEB)

    Watrelot, Aude A., E-mail: aude.watrelot@avignon.inra.fr [INRA, UMR408 Sécurité et Qualité des Produits d’Origine Végétale, Domaine St Paul, Site Agroparc, 84914 Avignon (France); Université d’Avignon, UMR408 Sécurité et Qualité des Produits d' Origine Végétale, F-84000 Avignon (France); Tran, Dong Tien [Université de Bordeaux, Institut des Sciences Moléculaires (UMR-CNRS 5255), 351 cours de la Libération, 33405 Talence (France); Institut Européen de Chimie et Biologie (IECB), 2 rue Robert Escarpit, 33607 Pessac (France); Buffeteau, Thierry [Université de Bordeaux, Institut des Sciences Moléculaires (UMR-CNRS 5255), 351 cours de la Libération, 33405 Talence (France); Deffieux, Denis [Université de Bordeaux, Institut des Sciences Moléculaires (UMR-CNRS 5255), 351 cours de la Libération, 33405 Talence (France); Institut Européen de Chimie et Biologie (IECB), 2 rue Robert Escarpit, 33607 Pessac (France); and others

    2016-05-15

    Highlights: • Flavanol-macromolecule interactions were determined using SPR. • Flavanols were chemically modified with a linker bearing a thiol group. • Flavanols were immobilized onto a carboxymethyl dextran surface. • Citrus pectin interacted more with flavanols than apple pectin. • Epicatechin interacted more with BSA than flavanol oligomer. - Abstract: Interactions between plant polyphenols and biomacromolecules such as proteins and pectins have been studied by several methods in solution (e.g. isothermal titration calorimetry, dynamic light scattering, nuclear magnetic resonance and spectrophotometry). Herein, these interactions were investigated in real time by Surface Plasmon Resonance (SPR) analysis after immobilization of flavan-3-ols onto a sensor chip surface. (−)-epicatechin, (+)-catechin and flavan-3-ol oligomers with an average degree of polymerization of 2 and 8 were chemically modified using N-(2-(tritylthio)ethyl)propiolamide in order to introduce a spacer unit onto the catecholic B ring. Modified flavan-3-ols were then immobilized onto a carboxymethylated dextran surface (CM5). Immobilization was validated and further verified by evaluating flavan-3-ol interaction with bovine serum albumin (BSA), poly-L-proline or commercial pectins. BSA was found to have a stronger association with monomeric flavan-3-ols than oligomers. SPR analysis of selected flavan-3-ols immobilized onto CM5 sensor chips showed a stronger association for citrus pectins than apple pectins, regardless of flavan-3-ol degree of polymerization.

  3. ImmunoChip study implicates antigen presentation to T cells in narcolepsy.

    Directory of Open Access Journals (Sweden)

    Juliette Faraco

    Full Text Available Recent advances in the identification of susceptibility genes and environmental exposures provide broad support for a post-infectious autoimmune basis for narcolepsy/hypocretin (orexin deficiency. We genotyped loci associated with other autoimmune and inflammatory diseases in 1,886 individuals with hypocretin-deficient narcolepsy and 10,421 controls, all of European ancestry, using a custom genotyping array (ImmunoChip. Three loci located outside the Human Leukocyte Antigen (HLA region on chromosome 6 were significantly associated with disease risk. In addition to a strong signal in the T cell receptor alpha (TRA@, variants in two additional narcolepsy loci, Cathepsin H (CTSH and Tumor necrosis factor (ligand superfamily member 4 (TNFSF4, also called OX40L, attained genome-wide significance. These findings underline the importance of antigen presentation by HLA Class II to T cells in the pathophysiology of this autoimmune disease.

  4. HuMiChip: Development of a Functional Gene Array for the Study of Human Microbiomes

    Energy Technology Data Exchange (ETDEWEB)

    Tu, Q.; Deng, Ye; Lin, Lu; Hemme, Chris L.; He, Zhili; Zhou, Jizhong

    2010-05-17

    Microbiomes play very important roles in terms of nutrition, health and disease by interacting with their hosts. Based on sequence data currently available in public domains, we have developed a functional gene array to monitor both organismal and functional gene profiles of normal microbiota in human and mouse hosts, and such an array is called human and mouse microbiota array, HMM-Chip. First, seed sequences were identified from KEGG databases, and used to construct a seed database (seedDB) containing 136 gene families in 19 metabolic pathways closely related to human and mouse microbiomes. Second, a mother database (motherDB) was constructed with 81 genomes of bacterial strains with 54 from gut and 27 from oral environments, and 16 metagenomes, and used for selection of genes and probe design. Gene prediction was performed by Glimmer3 for bacterial genomes, and by the Metagene program for metagenomes. In total, 228,240 and 801,599 genes were identified for bacterial genomes and metagenomes, respectively. Then the motherDB was searched against the seedDB using the HMMer program, and gene sequences in the motherDB that were highly homologous with seed sequences in the seedDB were used for probe design by the CommOligo software. Different degrees of specific probes, including gene-specific, inclusive and exclusive group-specific probes were selected. All candidate probes were checked against the motherDB and NCBI databases for specificity. Finally, 7,763 probes covering 91.2percent (12,601 out of 13,814) HMMer confirmed sequences from 75 bacterial genomes and 16 metagenomes were selected. This developed HMM-Chip is able to detect the diversity and abundance of functional genes, the gene expression of microbial communities, and potentially, the interactions of microorganisms and their hosts.

  5. Study of CMOS-SOI Integrated Temperature Sensing Circuits for On-Chip Temperature Monitoring.

    Science.gov (United States)

    Malits, Maria; Brouk, Igor; Nemirovsky, Yael

    2018-05-19

    This paper investigates the concepts, performance and limitations of temperature sensing circuits realized in complementary metal-oxide-semiconductor (CMOS) silicon on insulator (SOI) technology. It is shown that the MOSFET threshold voltage ( V t ) can be used to accurately measure the chip local temperature by using a V t extractor circuit. Furthermore, the circuit's performance is compared to standard circuits used to generate an accurate output current or voltage proportional to the absolute temperature, i.e., proportional-to-absolute temperature (PTAT), in terms of linearity, sensitivity, power consumption, speed, accuracy and calibration needs. It is shown that the V t extractor circuit is a better solution to determine the temperature of low power, analog and mixed-signal designs due to its accuracy, low power consumption and no need for calibration. The circuit has been designed using 1 µm partially depleted (PD) CMOS-SOI technology, and demonstrates a measurement inaccuracy of ±1.5 K across 300 K⁻500 K temperature range while consuming only 30 µW during operation.

  6. A 3D Human Renal Cell Carcinoma-on-a-Chip for the Study of Tumor Angiogenesis.

    Science.gov (United States)

    Miller, Chris P; Tsuchida, Connor; Zheng, Ying; Himmelfarb, Jonathan; Akilesh, Shreeram

    2018-06-01

    Tractable human tissue-engineered 3D models of cancer that enable fine control of tumor growth, metabolism, and reciprocal interactions between different cell types in the tumor microenvironment promise to accelerate cancer research and pharmacologic testing. Progress to date mostly reflects the use of immortalized cancer cell lines, and progression to primary patient-derived tumor cells is needed to realize the full potential of these platforms. For the first time, we report endothelial sprouting induced by primary patient tumor cells in a 3D microfluidic system. Specifically, we have combined primary human clear cell renal cell carcinoma (ccRCC) cells from six independent donors with human endothelial cells in a vascularized, flow-directed, 3D culture system ("ccRCC-on-a-chip"). The upregulation of key angiogenic factors in primary human ccRCC cells, which exhibited unique patterns of donor variation, was further enhanced when they were cultured in 3D clusters. When embedded in the matrix surrounding engineered human vessels, these ccRCC tumor clusters drove potent endothelial cell sprouting under continuous flow, thus recapitulating the critical angiogenic signaling axis between human ccRCC cells and endothelial cells. Importantly, this phenotype was driven by a primary tumor cell-derived biochemical gradient of angiogenic growth factor accumulation that was subject to pharmacological blockade. Our novel 3D system represents a vascularized tumor model that is easy to image and quantify and is fully tunable in terms of input cells, perfusate, and matrices. We envision that this ccRCC-on-a-chip will be valuable for mechanistic studies, for studying tumor-vascular cell interactions, and for developing novel and personalized antitumor therapies. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Can adverse maternal and perinatal outcomes be predicted when blood pressure becomes elevated? Secondary analyses from the CHIPS (Control of Hypertension In Pregnancy Study) randomized controlled trial

    NARCIS (Netherlands)

    Magee, Laura A.; von Dadelszen, Peter; Singer, Joel; Lee, Terry; Rey, Evelyne; Ross, Susan; Asztalos, Elizabeth; Murphy, Kellie E.; Menzies, Jennifer; Sanchez, Johanna; Gafni, Amiram; Gruslin, Andrée; Helewa, Michael; Hutton, Eileen; Lee, Shoo K.; Logan, Alexander G.; Ganzevoort, Wessel; Welch, Ross; Thornton, Jim G.; Moutquin, Jean Marie

    2016-01-01

    Introduction. For women with chronic or gestational hypertension in CHIPS (Control of Hypertension In Pregnancy Study, NCT01192412), we aimed to examine whether clinical predictors collected at randomization could predict adverse outcomes. Material and methods. This was a planned, secondary analysis

  8. Early Bayesian modeling of a potassium lab-on-a-chip for monitoring of heart failure patients at increased risk of hyperkalaemia.

    NARCIS (Netherlands)

    van de Wetering, Gijs; Steuten, Lotte Maria Gertruda; von Birgelen, Clemens; Adang, E.M.; IJzerman, Maarten Joost

    2012-01-01

    Objectives: Innovative point-of-care (POC) diagnostics are likely to have a strong impact on 18 health care. The aim of this study is to conduct an early assessment of a point-of-care chip 19 for the detection of a pathological deviation of the potassium levels in patients at increased 20 risk,

  9. Effect of residual chips on the material removal process of the bulk metallic glass studied by in situ scratch testing inside the scanning electron microscope

    Directory of Open Access Journals (Sweden)

    Hu Huang

    2012-12-01

    Full Text Available Research on material removal mechanism is meaningful for precision and ultra-precision manufacturing. In this paper, a novel scratch device was proposed by integrating the parasitic motion principle linear actuator. The device has a compact structure and it can be installed on the stage of the scanning electron microscope (SEM to carry out in situ scratch testing. Effect of residual chips on the material removal process of the bulk metallic glass (BMG was studied by in situ scratch testing inside the SEM. The whole removal process of the BMG during the scratch was captured in real time. Formation and growth of lamellar chips on the rake face of the Cube-Corner indenter were observed dynamically. Experimental results indicate that when lots of chips are accumulated on the rake face of the indenter and obstruct forward flow of materials, materials will flow laterally and downward to find new location and direction for formation of new chips. Due to similar material removal processes, in situ scratch testing is potential to be a powerful research tool for studying material removal mechanism of single point diamond turning, single grit grinding, mechanical polishing and grating fabrication.

  10. Wax-bonding 3D microfluidic chips

    KAUST Repository

    Gong, Xiuqing; Yi, Xin; Xiao, Kang; Li, Shunbo; Kodzius, Rimantas; Qin, Jianhua; Wen, Weijia

    2013-01-01

    We report a simple, low-cost and detachable microfluidic chip incorporating easily accessible paper, glass slides or other polymer films as the chip materials along with adhesive wax as the recycling bonding material. We use a laser to cut through the paper or film to form patterns and then sandwich the paper and film between glass sheets or polymer membranes . The hot-melt adhesive wax can realize bridge bonding between various materials, for example, paper, polymethylmethacrylate (PMMA) film, glass sheets, or metal plate. The bonding process is reversible and the wax is reusable through a melting and cooling process. With this process, a three-dimensional (3D) microfluidic chip is achievable by vacuating and venting the chip in a hot-water bath. To study the biocompatibility and applicability of the wax-based microfluidic chip, we tested the PCR compatibility with the chip materials first. Then we applied the wax-paper based microfluidic chip to HeLa cell electroporation (EP ). Subsequently, a prototype of a 5-layer 3D chip was fabricated by multilayer wax bonding. To check the sealing ability and the durability of the chip, green fluorescence protein (GFP) recombinant Escherichia coli (E. coli) bacteria were cultured, with which the chemotaxis of E. coli was studied in order to determine the influence of antibiotic ciprofloxacin concentration on the E. coli migration.

  11. Wax-bonding 3D microfluidic chips

    KAUST Repository

    Gong, Xiuqing

    2013-10-10

    We report a simple, low-cost and detachable microfluidic chip incorporating easily accessible paper, glass slides or other polymer films as the chip materials along with adhesive wax as the recycling bonding material. We use a laser to cut through the paper or film to form patterns and then sandwich the paper and film between glass sheets or polymer membranes . The hot-melt adhesive wax can realize bridge bonding between various materials, for example, paper, polymethylmethacrylate (PMMA) film, glass sheets, or metal plate. The bonding process is reversible and the wax is reusable through a melting and cooling process. With this process, a three-dimensional (3D) microfluidic chip is achievable by vacuating and venting the chip in a hot-water bath. To study the biocompatibility and applicability of the wax-based microfluidic chip, we tested the PCR compatibility with the chip materials first. Then we applied the wax-paper based microfluidic chip to HeLa cell electroporation (EP ). Subsequently, a prototype of a 5-layer 3D chip was fabricated by multilayer wax bonding. To check the sealing ability and the durability of the chip, green fluorescence protein (GFP) recombinant Escherichia coli (E. coli) bacteria were cultured, with which the chemotaxis of E. coli was studied in order to determine the influence of antibiotic ciprofloxacin concentration on the E. coli migration.

  12. Primary care providers' experiences caring for complex patients in primary care: a qualitative study.

    Science.gov (United States)

    Loeb, Danielle F; Bayliss, Elizabeth A; Candrian, Carey; deGruy, Frank V; Binswanger, Ingrid A

    2016-03-22

    Complex patients are increasingly common in primary care and often have poor clinical outcomes. Healthcare system barriers to effective care for complex patients have been previously described, but less is known about the potential impact and meaning of caring for complex patients on a daily basis for primary care providers (PCPs). Our objective was to describe PCPs' experiences providing care for complex patients, including their experiences of health system barriers and facilitators and their strategies to enhance provision of effective care. Using a general inductive approach, our qualitative research study was guided by an interpretive epistemology, or way of knowing. Our method for understanding included semi-structured in-depth interviews with internal medicine PCPs from two university-based and three community health clinics. We developed an interview guide, which included questions on PCPs' experiences, perceived system barriers and facilitators, and strategies to improve their ability to effectively treat complex patients. To focus interviews on real cases, providers were asked to bring de-identified clinical notes from patients they considered complex to the interview. Interview transcripts were coded and analyzed to develop categories from the raw data, which were then conceptualized into broad themes after team-based discussion. PCPs (N = 15) described complex patients with multidimensional needs, such as socio-economic, medical, and mental health. A vision of optimal care emerged from the data, which included coordinating care, preventing hospitalizations, and developing patient trust. PCPs relied on professional values and individual care strategies to overcome local and system barriers. Team based approaches were endorsed to improve the management of complex patients. Given the barriers to effective care described by PCPs, individual PCP efforts alone are unlikely to meet the needs of complex patients. To fulfill PCP's expressed concepts of

  13. Pixel detector readout chip

    CERN Multimedia

    1991-01-01

    Close-up of a pixel detector readout chip. The photograph shows an aera of 1 mm x 2 mm containing 12 separate readout channels. The entire chip contains 1000 readout channels (around 80 000 transistors) covering a sensitive area of 8 mm x 5 mm. The chip has been mounted on a silicon detector to detect high energy particles.

  14. Least cost supply strategies for wood chips

    DEFF Research Database (Denmark)

    Möller, Bernd

    The abstract presents a study based on a geographical information system, which produce  cost-supply curves by location for forest woods chips in Denmark.......The abstract presents a study based on a geographical information system, which produce  cost-supply curves by location for forest woods chips in Denmark....

  15. Catalog of Completed Health Care and Dental Care Studies.

    Science.gov (United States)

    1987-12-01

    Army Oral lie ith jaintenanc, AD A0()’ )’rtjr, ur, on 1x--ntal Itealth Status of Army lersonnel Jun 79 Current Dental Officer Practice and Uti ...HCSD Report No. 80-001B) Sep 80 Decentralized Inpatient Pharmacy Service Study AD) A)OU’,()’, (Job Satisfaction Between Pharmacists Perfotm irj Patient...Care Activities and Pharmacists Perfotrninq Dispensary or Supervisory Flinctions): Part C (HCSD Report No. 80-001C) Jun 30 Non-Poductive Factor

  16. Dental Care - Medicaid and Chip

    Data.gov (United States)

    U.S. Department of Health & Human Services — Dental health is an important part of peoples overall health. States are required to provide dental benefits to children covered by Medicaid and the Childrens Health...

  17. Identification of antibiotic resistant bacteria community and a GeoChip based study of resistome in urban watersheds.

    Science.gov (United States)

    Low, Adrian; Ng, Charmaine; He, Jianzhong

    2016-12-01

    Urban watersheds from point sources are potential reservoirs of antibiotic resistance genes (ARGs). However, few studies have investigated urban watersheds of non-point sources. To understand the type of ARGs and bacteria that might carry such genes, we investigated two non-point source urban watersheds with different land-use profiles. Antibiotic resistance levels of two watersheds (R1, R3) were examined using heterotrophic plate counts (HPC) as a culturing method to obtain counts of bacteria resistant to seven antibiotics belonging to different classes (erythromycin, kanamycin, lincomycin, norfloxacin, sulfanilamide, tetracycline and trimethoprim). From the HPC study, 239 antibiotic resistant bacteria were characterized for resistance to more antibiotics. Furthermore, ARGs and antimicrobial biosynthesis genes were identified using GeoChip version 5.0 to elucidate the resistomes of surface waters in watersheds R1 and R3. The HPC study showed that water samples from R1 had significantly higher counts of bacteria resistant to erythromycin, kanamycin, norfloxacin, sulfanilamide, tetracycline and trimethoprim than those from R3 (Analysis of Similarity (ANOSIM), R = 0.557, p antibiotics tested, lincomycin and trimethoprim resistant bacteria are greater in abundances. The 239 antibiotic resistant isolates represent a subset of resistant bacterial populations, including bacteria not previously known for resistance. Majority of the isolates had resistance to ampicillin, vancomycin, lincomycin and trimethoprim. GeoChip revealed similar ARGs in both watersheds, but with significantly higher intensities for tetX and β-lactamase B genes in R1 than R3. The genes with the highest average normalized intensities in R1 and R3 were tetracycline (tet) and fosfomycin (fosA) resistance genes, respectively. The higher abundance of tetX genes in R1 is congruent with the higher abundance of tetracycline resistant HPC observed in R1 samples. Strong correlations (r ≥ 0.8) of efflux

  18. Innovative High-Throughput SAXS Methodologies Based on Photonic Lab-on-a-Chip Sensors: Application to Macromolecular Studies.

    Science.gov (United States)

    Rodríguez-Ruiz, Isaac; Radajewski, Dimitri; Charton, Sophie; Phamvan, Nhat; Brennich, Martha; Pernot, Petra; Bonneté, Françoise; Teychené, Sébastien

    2017-06-02

    The relevance of coupling droplet-based Photonic Lab-on-a-Chip (PhLoC) platforms and Small-Angle X-Ray Scattering (SAXS) technique is here highlighted for the performance of high throughput investigations, related to the study of protein macromolecular interactions. With this configuration, minute amounts of sample are required to obtain reliable statistical data. The PhLoC platforms presented in this work are designed to allow and control an effective mixing of precise amounts of proteins, crystallization reagents and buffer in nanoliter volumes, and the subsequent generation of nanodroplets by means of a two-phase flow. Spectrophotometric sensing permits a fine control on droplet generation frequency and stability as well as on concentration conditions, and finally the droplet flow is synchronized to perform synchrotron radiation SAXS measurements in individual droplets (each one acting as an isolated microreactor) to probe protein interactions. With this configuration, droplet physic-chemical conditions can be reproducibly and finely tuned, and monitored without cross-contamination, allowing for the screening of a substantial number of saturation conditions with a small amount of biological material. The setup was tested and validated using lysozyme as a model of study. By means of SAXS experiments, the proteins gyration radius and structure envelope were calculated as a function of protein concentration. The obtained values were found to be in good agreement with previously reported data, but with a dramatic reduction of sample volume requirements compared to studies reported in the literature.

  19. Top studies relevant to primary care practice.

    Science.gov (United States)

    Perry, Danielle; Kolber, Michael R; Korownyk, Christina; Lindblad, Adrienne J; Ramji, Jamil; Ton, Joey; Allan, G Michael

    2018-04-01

    To summarize 10 high-quality studies from 2017 that have strong relevance to primary care practice. Study selection involved routine literature surveillance by a group of primary care health professionals. This included screening abstracts of important journals and Evidence Alerts, as well as searching the American College of Physicians Journal Club. Topics of the 2017 articles include whether treating subclinical hypothyroidism improves outcomes or symptoms; whether evolocumab reduces cardiovascular disease as well as low-density lipoprotein levels; whether lifestyle interventions reduce medication use in patients with diabetes; whether vitamin D prevents cardiovascular disease, cancer, or upper respiratory tract infections; whether canagliflozin reduces clinical events in patients with diabetes; how corticosteroid injections affect knee osteoarthritis; whether drained abscesses benefit from antibiotic treatment; whether patients with diabetes benefit from bariatric surgery; whether exenatide reduces clinical events in patients with diabetes; and whether tympanostomy tubes affect outcomes in recurrent acute otitis media or chronic otitis media. We provide brief summaries, context where needed, and final recommendations for 10 studies with potential effects on primary care. We also briefly review 5 "runner-up" studies. Research from 2017 produced several high-quality studies in diabetes management. These have demonstrated benefit for alternative therapies and offered evidence not previously available. This year's selection of studies also provided information on a variety of conditions and therapies that are, or might become, more common in primary care settings. Copyright© the College of Family Physicians of Canada.

  20. Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.

    Science.gov (United States)

    Thoumi, Andrea; Udayakumar, Krishna; Drobnick, Elizabeth; Taylor, Andrea; McClellan, Mark

    2015-09-01

    The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases. Project HOPE—The People-to-People Health Foundation, Inc.

  1. A Genome Wide Association Study on Age at First Calving Using High Density Single Nucleotide Polymorphism Chips in Hanwoo (

    Directory of Open Access Journals (Sweden)

    K.-E. Hyeong

    2014-10-01

    Full Text Available Age at first calving is an important trait for achieving earlier reproductive performance. To detect quantitative trait loci (QTL for reproductive traits, a genome wide association study was conducted on the 96 Hanwoo cows that were born between 2008 and 2010 from 13 sires in a local farm (Juk-Am Hanwoo farm, Suncheon, Korea and genotyped with the Illumina 50K bovine single nucleotide polymorphism (SNP chips. Phenotypes were regressed on additive and dominance effects for each SNP using a simple linear regression model after the effects of birth-year-month and polygenes were considered. A forward regression procedure was applied to determine the best set of SNPs for age at first calving. A total of 15 QTL were detected at the comparison-wise 0.001 level. Two QTL with strong statistical evidence were found at 128.9 Mb and 111.1 Mb on bovine chromosomes (BTA 2 and 7, respectively, each of which accounted for 22% of the phenotypic variance. Also, five significant SNPs were detected on BTAs 10, 16, 20, 26, and 29. Multiple QTL were found on BTAs 1, 2, 7, and 14. The significant QTLs may be applied via marker assisted selection to increase rate of genetic gain for the trait, after validation tests in other Hanwoo cow populations.

  2. Bioprinting cell-laden matrigel for radioprotection study of liver by pro-drug conversion in a dual-tissue microfluidic chip

    International Nuclear Information System (INIS)

    Snyder, J E; Hamid, Q; Wang, C; Chang, R; Sun, W; Emami, K; Wu, H

    2011-01-01

    The objective of this paper is to introduce a novel cell printing and microfluidic system to serve as a portable ground model for the study of drug conversion and radiation protection of living liver tissue analogs. The system is applied to study behavior in ground models of space stress, particularly radiation. A microfluidic environment is engineered by two cell types to prepare an improved higher fidelity in vitro micro-liver tissue analog. Cell-laden Matrigel printing and microfluidic chips were used to test radiation shielding to liver cells by the pro-drug amifostine. In this work, the sealed microfluidic chip regulates three variables of interest: radiation exposure, anti-radiation drug treatment and single- or dual-tissue culture environments. This application is intended to obtain a scientific understanding of the response of the multi-cellular biological system for long-term manned space exploration, disease models and biosensors.

  3. Bioprinting cell-laden matrigel for radioprotection study of liver by pro-drug conversion in a dual-tissue microfluidic chip

    Energy Technology Data Exchange (ETDEWEB)

    Snyder, J E; Hamid, Q; Wang, C; Chang, R; Sun, W [Department of Mechanical Engineering, Drexel University, Philadelphia, PA 19104 (United States); Emami, K; Wu, H, E-mail: sunwei@drexel.edu, E-mail: weisun@tsinghua.edu.cn [Radiation Biophysics Lab, NASA Johnson Space Center, Houston, TX 77586 (United States)

    2011-09-15

    The objective of this paper is to introduce a novel cell printing and microfluidic system to serve as a portable ground model for the study of drug conversion and radiation protection of living liver tissue analogs. The system is applied to study behavior in ground models of space stress, particularly radiation. A microfluidic environment is engineered by two cell types to prepare an improved higher fidelity in vitro micro-liver tissue analog. Cell-laden Matrigel printing and microfluidic chips were used to test radiation shielding to liver cells by the pro-drug amifostine. In this work, the sealed microfluidic chip regulates three variables of interest: radiation exposure, anti-radiation drug treatment and single- or dual-tissue culture environments. This application is intended to obtain a scientific understanding of the response of the multi-cellular biological system for long-term manned space exploration, disease models and biosensors.

  4. Prospective associations of coronary heart disease loci in African Americans using the MetaboChip: the PAGE study.

    Directory of Open Access Journals (Sweden)

    Nora Franceschini

    Full Text Available Coronary heart disease (CHD is a leading cause of morbidity and mortality in African Americans. However, there is a paucity of studies assessing genetic determinants of CHD in African Americans. We examined the association of published variants in CHD loci with incident CHD, attempted to fine map these loci, and characterize novel variants influencing CHD risk in African Americans.Up to 8,201 African Americans (including 546 first CHD events were genotyped using the MetaboChip array in the Atherosclerosis Risk in Communities (ARIC study and Women's Health Initiative (WHI. We tested associations using Cox proportional hazard models in sex- and study-stratified analyses and combined results using meta-analysis. Among 44 validated CHD loci available in the array, we replicated and fine-mapped the SORT1 locus, and showed same direction of effects as reported in studies of individuals of European ancestry for SNPs in 22 additional published loci. We also identified a SNP achieving array wide significance (MYC: rs2070583, allele frequency 0.02, P = 8.1 × 10(-8, but the association did not replicate in an additional 8,059 African Americans (577 events from the WHI, HealthABC and GeneSTAR studies, and in a meta-analysis of 5 cohort studies of European ancestry (24,024 individuals including 1,570 cases of MI and 2,406 cases of CHD from the CHARGE Consortium.Our findings suggest that some CHD loci previously identified in individuals of European ancestry may be relevant to incident CHD in African Americans.

  5. Wood chip delivery and research project at Mikkeli region

    International Nuclear Information System (INIS)

    Saksa, T.; Auvinen, P.

    1995-01-01

    In 1994, a large-scale energywood production chain was started as a co-operation project by the Mikkeli city forest office and local forestry societies. Over 60 000 m 3 (about 46 000 MWh of energy) of forest processed chips were delivered to Pursiala heat and power plant in Mikkeli. About 60 % of these chips was whole tree chips from improvement cuttings of young forest stands and the rest was logging waste chips from regeneration cutting areas. The average total delivery costs of forest processed chips after reduction of energywood and other subsidies were approximately 51 FIM/m 3 (68 FIM/MWh) for the whole tree chips and 40 FIM/m 3 (53 FIM/MWh) for logging waste chips. The delivery costs of wood chips could compete with those of fuel peat only in the most favourable cases. The resources of forest processed chips were studied on the basis of forestry plans. According to the study, there is enough raw material for permanent, large-scale delivery of forest processed chips (up to 250 000 m 3 /a) in the forests located at a distance of under 40 road kilometers from the Pursiala heat and power plant. The following project stages will involve further development of the wood chip delivery chain logistics, as well as improvement of logging and chipping equipment and methods in energywood and logging waste production. Also the effects of wood energy production on the economy and environment of the whole Mikkeli region will be studied. (author)

  6. Energy dissipation effects on imaging of soft materials by dynamic atomic force microscopy: A DNA-chip study

    Energy Technology Data Exchange (ETDEWEB)

    Phaner-Goutorbe, M., E-mail: magali.phaner@ec-lyon.fr [Université de Lyon, Institut des Nanotechnologies de Lyon (INL) UMR CNRS 5270, Ecole Centrale de Lyon, 36 Avenue Guy de Collongue, 69134 Ecully (France); Iazykov, M. [Université de Lyon, laboratoire de Physique, Ecole Normale Supérieure de Lyon, 46 allée d' Italie 69364 Lyon cedex 07 (France); Villey, R. [Université de Lyon, Institut des Nanotechnologies de Lyon (INL) UMR CNRS 5270, Ecole Centrale de Lyon, 36 Avenue Guy de Collongue, 69134 Ecully (France); Université de Lyon, laboratoire de Physique de la Matière Condensée et Nanostructures, Université Claude Bernard Lyon 1, Domaine Scientifique de la Doua, Bâtiment Léon Brillouin 43 boulevard du 11 Novembre 1918, F 69622 Villeurbanne (France); Sicard, D.; Robach, Y. [Université de Lyon, Institut des Nanotechnologies de Lyon (INL) UMR CNRS 5270, Ecole Centrale de Lyon, 36 Avenue Guy de Collongue, 69134 Ecully (France)

    2013-05-01

    Using amplitude-mode AFM (AM-AFM), we have obtained valuable information during these recent years through the study of amplitude and phase shift dependence on tip–sample separation, leading to a comprehensive understanding of the interaction processes. Two imaging regimes, attractive and repulsive, have been identified and a relationship between phase and dissipative energy was established, providing information on observed material properties. Most of the previous studies have concerned model systems: either hard or soft materials. In this paper, we present the analysis of a mixed system of soft structures on a hard substrate. This is a DNA chip for biological applications consisting of oligonucleotides covalently linked by a layer of silane to a silicon substrate. A detailed study of amplitude-phase curves as a function of the tip–sample separation allowed us to define the best experimental conditions to obtain specific information: we got reliable conditions to minimize noise during topographic imaging and an understanding of the processes of energy dissipation involved in the DNA breaking for DNA arrays. By calculating the energy dissipated as a function of the amplitude of oscillation, we have demonstrated a transition from an energy dissipation process governed by localized viscoelastic interactions (due to the soft layer) to a process governed by extended irreversible deformations (due to the hard substrate). Highlights: ► Amplitude mode AFM analysis of a DNA array is presented. ► Reliable conditions for noise minimization on topographic images are presented. ► Phase, amplitude vs distance curves are analyzed for different setpoint amplitudes. ► Energy dissipation processes are described from viscoelasticity to DNA breaking.

  7. UW VLSI chip tester

    Science.gov (United States)

    McKenzie, Neil

    1989-12-01

    We present a design for a low-cost, functional VLSI chip tester. It is based on the Apple MacIntosh II personal computer. It tests chips that have up to 128 pins. All pin drivers of the tester are bidirectional; each pin is programmed independently as an input or an output. The tester can test both static and dynamic chips. Rudimentary speed testing is provided. Chips are tested by executing C programs written by the user. A software library is provided for program development. Tests run under both the Mac Operating System and A/UX. The design is implemented using Xilinx Logic Cell Arrays. Price/performance tradeoffs are discussed.

  8. Recycling melting process of the zirconium alloy chips

    International Nuclear Information System (INIS)

    Reis, Luis A.M. dos; Mucsi, Cristiano S.; Tavares, Luiz A.P.; Alencar, Maicon C.; Gomes, Maurilio P.; Barbosa, Luzinete P.; Rossi, Jesualdo L.

    2017-01-01

    Pressurized water reactors (PWR) commonly use 235 U enriched uranium dioxide pellets as a nuclear fuel, these are assembled and stacked in zirconium alloy tubes and end caps (M5, Zirlo, Zircaloy). During the machining of these components large amounts of chips are generated which are contaminated with cutting fluid. Its storage presents safety and environmental risks due to its pyrophoric and reactive nature. Recycling industry shown interest in its recycling due to its strategic importance. This paper presents a study on the recycling process and the results aiming the efficiency in the cleaning process; the quality control; the obtaining of the pressed electrodes and finally the melting in a Vacuum Arc Remelting furnace (VAR). The recycling process begins with magnetic separation of possible ferrous alloys chips contaminant, the washing of the cutting fluid that is soluble in water, washing with an industrial degreaser, followed by a rinse with continuous flow of water under high pressure and drying with hot air. The first evaluation of the process was done by an Energy Dispersive X-rays Fluorescence Spectrometry (EDXRFS) showed the presence of 10 wt. % to 17 wt. % of impurities due the mixing with stainless steel machining chips. The chips were then pressed in a custom-made matrix of square section (40 x 40 mm - 500 mm in length), resulting in electrodes with 20% of apparent density of the original alloy. The electrode was then melted in a laboratory scale VAR furnace at the CCTM-IPEN, producing a massive ingot with 0.8 kg. It was observed that the samples obtained from Indústrias Nucleares do Brasil (INB) are supposed to be secondary scrap and it is suggested careful separation in the generation of this material. The melting of the chips is possible and feasible in a VAR furnace which reduces the storage volume by up to 40 times of this material, however, it is necessary to correct the composition of the alloy for the melting of these ingots. (author)

  9. High-throughput on-chip in vivo neural regeneration studies using femtosecond laser nano-surgery and microfluidics

    Science.gov (United States)

    Rohde, Christopher B.; Zeng, Fei; Gilleland, Cody; Samara, Chrysanthi; Yanik, Mehmet F.

    2009-02-01

    In recent years, the advantages of using small invertebrate animals as model systems for human disease have become increasingly apparent and have resulted in three Nobel Prizes in medicine or chemistry during the last six years for studies conducted on the nematode Caenorhabditis elegans (C. elegans). The availability of a wide array of species-specific genetic techniques, along with the transparency of the worm and its ability to grow in minute volumes make C. elegans an extremely powerful model organism. We present a suite of technologies for complex high-throughput whole-animal genetic and drug screens. We demonstrate a high-speed microfluidic sorter that can isolate and immobilize C. elegans in a well-defined geometry, an integrated chip containing individually addressable screening chambers for incubation and exposure of individual animals to biochemical compounds, and a device for delivery of compound libraries in standard multiwell plates to microfluidic devices. The immobilization stability obtained by these devices is comparable to that of chemical anesthesia and the immobilization process does not affect lifespan, progeny production, or other aspects of animal health. The high-stability enables the use of a variety of key optical techniques. We use this to demonstrate femtosecond-laser nanosurgery and three-dimensional multiphoton microscopy. Used alone or in various combinations these devices facilitate a variety of high-throughput assays using whole animals, including mutagenesis and RNAi and drug screens at subcellular resolution, as well as high-throughput high-precision manipulations such as femtosecond-laser nanosurgery for large-scale in vivo neural degeneration and regeneration studies.

  10. Study of the influence of micro-oxygenation and oak chip maceration on wine composition using an electronic tongue and chemical analysis

    Energy Technology Data Exchange (ETDEWEB)

    Rudnitskaya, A., E-mail: alisa.rudnitskaya@gmail.com [Chemistry Department, University of Aveiro, Aveiro 3810-193 (Portugal); Chemistry Department, St. Petersburg University, St. Petersburg 199034 (Russian Federation); Schmidtke, L.M., E-mail: lschmidtke@csu.edu.au [National Wine and Grape Industry Centre, School of Agricultural and Wine Science, Charles Sturt University, Wagga Wagga, New South Wales 2678 (Australia); Delgadillo, I. [Chemistry Department, University of Aveiro, Aveiro 3810-193 (Portugal); Legin, A. [Chemistry Department, St. Petersburg University, St. Petersburg 199034 (Russian Federation); Scollary, G. [School of Chemistry, University of Melbourne, Victoria 3010 (Australia)

    2009-05-29

    The influence of micro-oxygenation (MOX) and maceration with oak chips treatments on wine was studied on wine samples from three vintages produced in the Yarra Valley, Australia. A full factorial design was employed where two factors (MOX and oak chips treatments) had two levels and one factor (vintage) had three levels. Three replicated treatments were run for each factor's setting. Wine samples were analysed using conventional laboratory methods with respect to the phenolic wine compounds and colour attributes since the phenolic fraction of wine is most affected by both MOX and oak maceration treatments. The same wine samples were measured with an electronic tongue based on potentiometric chemical sensors. The significance of treatments and vintage effects on wine phenolic compounds was assessed using ANOVA and ANOVA-Simultaneous Component Analysis (ASCA). Cross-validation was used for the ASCA sub-model optimisations and permutation test for evaluations of the significance of the factors. Main effects of vintage and maceration with oak chips were found to be significant for both physicochemical and the ET data. Main effect of MOX treatment was also found significant for the physicochemical parameters. The largest effect on the phenolic composition of wine was due to its vintage, which accounted for 70% and 33% of total variance in the physicochemical and ET data respectively. The ET was calibrated with respect to the total phenolic content, colour density and hue and chemical ages 1 and 2 and could predict these parameters of wine with good precision.

  11. A study of 23 unicameral bone cysts of the calcaneus: open chip allogeneic bone graft versus percutaneous injection of bone powder with autogenous bone marrow.

    Science.gov (United States)

    Park, Il-Hyung; Micic, Ivan Dragoljub; Jeon, In-Ho

    2008-02-01

    The treatment of unicameral bone cyst varies from percutaneous needle biopsy, aspiration and local injection of steroid, autologous bone marrow, or demineralized bone matrix to curettage and open bone-grafting. The purpose of this study was to compare the results of open chip allogeneic bone graft versus percutaneous injection of demineralized bone powder with autogenous bone marrow in management of calcaneal cysts. Twenty-three calcaneal unicameral cysts in 20 patients were treated. Lyophilized irradiated chip allogeneic bone (CAB) and autogenous bone marrow were used for treatment of 13 cysts in 11 patients, and 10 cysts in 9 patients were treated with percutaneous injection of irradiated allogeneic demineralized bone powder (DBP) and autogenous bone marrow. There were 11 males and 9 female patients with mean age of 17 years. The patients were followed for an average of 49.4 months. Complete healing was achieved in 9 cysts treated with chip allogeneic bone and in 5 cysts treated with powdered bone. Four cysts treated with CAB and 3 cysts treated with DBP healed with a defect. Two cysts treated with powdered bone and autogenous bone marrow were classified as persistent. No infections or pathological fractures were observed during the followup period. Percutaneous injection of a mixture of allogeneic bone powder with autogenous bone marrow is a minimal invasive method and could be an effective alternative in the treatment of unicameral calcaneal bone cysts. The postoperative morbidity was low, the hospital stay was brief, and patient's comfort for unrestricted activity was enhanced.

  12. Study of the influence of micro-oxygenation and oak chip maceration on wine composition using an electronic tongue and chemical analysis

    International Nuclear Information System (INIS)

    Rudnitskaya, A.; Schmidtke, L.M.; Delgadillo, I.; Legin, A.; Scollary, G.

    2009-01-01

    The influence of micro-oxygenation (MOX) and maceration with oak chips treatments on wine was studied on wine samples from three vintages produced in the Yarra Valley, Australia. A full factorial design was employed where two factors (MOX and oak chips treatments) had two levels and one factor (vintage) had three levels. Three replicated treatments were run for each factor's setting. Wine samples were analysed using conventional laboratory methods with respect to the phenolic wine compounds and colour attributes since the phenolic fraction of wine is most affected by both MOX and oak maceration treatments. The same wine samples were measured with an electronic tongue based on potentiometric chemical sensors. The significance of treatments and vintage effects on wine phenolic compounds was assessed using ANOVA and ANOVA-Simultaneous Component Analysis (ASCA). Cross-validation was used for the ASCA sub-model optimisations and permutation test for evaluations of the significance of the factors. Main effects of vintage and maceration with oak chips were found to be significant for both physicochemical and the ET data. Main effect of MOX treatment was also found significant for the physicochemical parameters. The largest effect on the phenolic composition of wine was due to its vintage, which accounted for 70% and 33% of total variance in the physicochemical and ET data respectively. The ET was calibrated with respect to the total phenolic content, colour density and hue and chemical ages 1 and 2 and could predict these parameters of wine with good precision.

  13. Study on the Thermal Resistance of Multi-chip Module High Power LED Packaging Heat Dissipation System

    Directory of Open Access Journals (Sweden)

    Kailin Pan

    2014-10-01

    Full Text Available Thermal resistance is a key technical index which indicates the thermal management of multi-chip module high power LED (MCM-LED packaging heat dissipation system. In this paper, the prototype structure of MCM-LED packaging heat dissipation system is proposed to study the reliable thermal resistance calculation method. In order to analyze the total thermal resistance of the MCM-LED packaging heat dissipation system, three kinds of thermal resistance calculation method including theoretical calculation, experimental testing and finite element simulation are developed respectively. Firstly, based on the thermal resistance network model and the principle of steady state heat transfer, the theoretical value of total thermal resistance is 6.111 K/W through sum of the thermal resistance of every material layer in the major direction of heat flow. Secondly, the thermal resistance experiment is carried out by T3Ster to obtain the experimental result of total thermal resistance, and the value is 6.729 K/W. Thirdly, a three-dimensional finite element model of MCM-LED packaging heat dissipation system is established, and the junction temperature experiment is also performed to calculated the finite element simulated result of total thermal resistance, the value is 6.99 K/W. Finally, by comparing the error of all the three kinds of result, the error of total thermal resistance between the theoretical value and experimental result is 9.2 %, and the error of total thermal resistance between the experimental result and finite element simulation is only about -3.9 %, meanwhile, the main reason of each error is discussed respectively.

  14. ALICE chip processor

    CERN Multimedia

    Maximilien Brice

    2003-01-01

    This tiny chip provides data processing for the time projection chamber on ALICE. Known as the ALICE TPC Read Out (ALTRO), this device was designed to minimize the size and power consumption of the TPC front end electronics. This single chip contains 16 low-power analogue-to-digital converters with six million transistors of digital processing and 8 kbits of data storage.

  15. The impact of CHIP premium increases on insurance outcomes among CHIP eligible children.

    Science.gov (United States)

    Nikolova, Silviya; Stearns, Sally

    2014-03-03

    Within the United States, public insurance premiums are used both to discourage private health policy holders from dropping coverage and to reduce state budget costs. Prior research suggests that the odds of having private coverage and being uninsured increase with increases in public insurance premiums. The aim of this paper is to test effects of Children's Health Insurance Program (CHIP) premium increases on public insurance, private insurance, and uninsurance rates. The fact that families just below and above a state-specific income cut-off are likely very similar in terms of observable and unobservable characteristics except the premium contribution provides a natural experiment for estimating the effect of premium increases. Using 2003 Medical Expenditure Panel Survey (MEPS) merged with CHIP premiums, we compare health insurance outcomes for CHIP eligible children as of January 2003 in states with a two-tier premium structure using a cross-sectional regression discontinuity methodology. We use difference-in-differences analysis to compare longitudinal insurance outcomes by December 2003. Higher CHIP premiums are associated with higher likelihood of private insurance. Disenrollment from CHIP in response to premium increases over time does not increase the uninsurance rate. When faced with higher CHIP premiums, private health insurance may be a preferable alternative for CHIP eligible families with higher incomes. Therefore, competition in the insurance exchanges being formed under the Affordable Care Act could enhance choice.

  16. Pricing and promotion effects on low-fat vending snack purchases: the CHIPS Study.

    Science.gov (United States)

    French, S A; Jeffery, R W; Story, M; Breitlow, K K; Baxter, J S; Hannan, P; Snyder, M P

    2001-01-01

    OBJECTIVES: This study examined the effects of pricing and promotion strategies on purchases of low-fat snacks from vending machines. METHODS: Low-fat snacks were added to 55 vending machines in a convenience sample of 12 secondary schools and 12 worksites. Four pricing levels (equal price, 10% reduction, 25% reduction, 50% reduction) and 3 promotional conditions (none, low-fat label, low-fat label plus promotional sign) were crossed in a Latin square design. Sales of low-fat vending snacks were measured continuously for the 12-month intervention. RESULTS: Price reductions of 10%, 25%, and 50% on low-fat snacks were associated with significant increases in low-fat snack sales; percentages of low-fat snack sales increased by 9%, 39%, and 93%, respectively. Promotional signage was independently but weakly associated with increases in low-fat snack sales. Average profits per machine were not affected by the vending interventions. CONCLUSIONS: Reducing relative prices on low-fat snacks was effective in promoting lower-fat snack purchases from vending machines in both adult and adolescent populations. PMID:11189801

  17. Advanced flip chip packaging

    CERN Document Server

    Lai, Yi-Shao; Wong, CP

    2013-01-01

    Advanced Flip Chip Packaging presents past, present and future advances and trends in areas such as substrate technology, material development, and assembly processes. Flip chip packaging is now in widespread use in computing, communications, consumer and automotive electronics, and the demand for flip chip technology is continuing to grow in order to meet the need for products that offer better performance, are smaller, and are environmentally sustainable. This book also: Offers broad-ranging chapters with a focus on IC-package-system integration Provides viewpoints from leading industry executives and experts Details state-of-the-art achievements in process technologies and scientific research Presents a clear development history and touches on trends in the industry while also discussing up-to-date technology information Advanced Flip Chip Packaging is an ideal book for engineers, researchers, and graduate students interested in the field of flip chip packaging.

  18. Caring Teaching as a Moral Practice: An Exploratory Study on Perceived Dimensions of Caring Teaching

    Directory of Open Access Journals (Sweden)

    Khalil Gholami

    2012-01-01

    Full Text Available Caring teaching is a conceptual framework used to gain an insight into the moral aspect of teaching. Using a quantitative research approach, we studied 556 teachers in order to explore their perceived dimensions of caring teaching. Drawing on existing literature, we found that caring teaching has been elaborated in line with two broad concepts: personal care and academic care. Considering these concepts, we developed the Caring Teaching Scale with which we identified four dimensions of caring teaching: the nurturing of a student's character, didactical bias, awareness, and respectful didactics. A meta-analysis reflection suggests that the nurturing of students' characters and awareness represent personal care while didactical bias and respectful didactics call for academic care. Further analysis showed that these teachers attached more pedagogical value to personal care. Controlling for two demographic variables, we found statistically significant differences with regard to gender and caring teaching.

  19. Study of a novel cell lysis method with titanium dioxide for Lab-on-a-Chip devices.

    Science.gov (United States)

    Wan, Weijie; Yeow, John T W

    2011-06-01

    In this paper, a novel method is proposed and demonstrated to be able to lyse gram-negative (E. coli) bacteria cells for Lab-on-a-Chip applications. The proposed method incorporates using titanium dioxide particles as photocatalysts and a miniaturized UV LED array as an excitation light source to perform cell lysis on microchips. The experimental result demonstrates the feasibility of the proposed prototype device. The working device suggests an inexpensive, easy to be fabricated and effective way for microchip cell lysis. The miniaturized UV LED array and the microchip with a reaction chamber can be easily integrated with other functional components to form a customized whole Lab-on-a-Chip system.

  20. Prospective study on quality of newborn care

    Directory of Open Access Journals (Sweden)

    N Khanam

    2013-12-01

    Full Text Available Background: Quality of services provided by health care provider, the closest health functionary to the community has impact on neonatal mortality. Aims: Study on quality of newborn care in rural areas.  Settings and Design: This is a prospective study in the field practice areas of J.N. Medical College and areas under primary health centre of public health care system in Wardha district.  Methods and Material: Modified quality check list on the basis of PHC MAP module guidelines for assessing the quality of service-module 6-user’s guide was prepared. Face to face interview with 205 (group-A/104 nos + group-B/101 nos mother of newborn was method to collected information in three postnatal visits.  Statistical analysis: Quality (verbal response of each service was quantified as acceptable, average and worst.  Quality of both the groups was compared by calculating P-value after utilizing Z-test.  Results: Over all acceptable quality of medical history was 30.03%, physical examination was 21.73%, preventive service was 91.17% and counseling was 24.83%. Significant difference between two groups were found on history taking for (cry, breathing and body movement of baby, recording weight and counseling regarding exclusive breast feeding for first 6 month of life. Worst quality in this study were observed in history for anything applying to eyes, umbilical cord stump and complication of baby for which appropriate management was taken. Except for weight recording and examination of head and fontanels all other variables under physical examination were not acceptable. Counseling regarding high risk condition of baby was only 13.66%. Conclusion: Existing newborn services except immunization is inadequate and needs to be strengthened especially physical examination and counseling services. 

  1. CHIPS: A New Way to Monitor Colonias Along the United States-Mexico Border

    Science.gov (United States)

    Parcher, Jean W.; Humberson, Delbert G.

    2007-01-01

    Colonias, which are unincorporated border settlements in the United States, have emerged in rural areas without the governance and services normally provided by local government. Colonia residents live in poverty and lack adequate health care, potable water, and sanitation systems. These conditions create substantial health risks for colonias and surrounding communities. By 2001, more than 1,400 colonias were identified in Texas. Cooperation with the U.S. Department of Housing and Urban Development, Offices of the Texas Attorney General, Secretary of State, and the Texas Water Development Board has allowed the U.S. Geological Survey (USGS) to improve colonia Geographic Information System (GIS) boundaries and develop the Colonia Health, Infrastructure, and Platting Status tool (CHIPS). Together, the GIS boundaries and CHIPS aid the Texas government in prioritizing the limited funds that are available for infrastructure improvement. CHIPS's report generator can be tailored to the needs of the user, providing either broad or specific output. For example, a congressman could use CHIPS to list colonias with wastewater issues in a specific county, whereas a health researcher could list all colonias without clinical access. To help cities along the United States-Mexico border manage issues related to colonias growth, CHIPS will become publicly available in an Internet-enabled GIS as part of a cooperative study between the USGS, the U.S. Department of Housing and Urban Development, and the Mexican Instituto Nacional de Estadistica Geografia e Informatica.

  2. Fabrication of dielectrophoretic microfluidic chips using a facile screen-printing technique for microparticle trapping

    International Nuclear Information System (INIS)

    Wee, Wei Hong; Kadri, Nahrizul Adib; Pingguan-Murphy, Belinda; Li, Zedong; Hu, Jie; Xu, Feng; Li, Fei

    2015-01-01

    Trapping of microparticles finds wide applications in numerous fields. Microfluidic chips based on a dielectrophoresis (DEP) technique hold several advantages for trapping microparticles, such as fast result processing, a small amount of sample required, high spatial resolution, and high accuracy of target selection. There is an unmet need to develop DEP microfluidic chips on different substrates for different applications in a low cost, facile, and rapid way. This study develops a new facile method based on a screen-printing technique for fabrication of electrodes of DEP chips on three types of substrates (i.e. polymethyl-methacrylate (PMMA), poly(ethylene terephthalate) and A4 paper). The fabricated PMMA-based DEP microfluidic chip was selected as an example and successfully used to trap and align polystyrene microparticles in a suspension and cardiac fibroblasts in a cell culture solution. The developed electrode fabrication method is compatible with different kinds of DEP substrates, which could expand the future application field of DEP microfluidic chips, including new forms of point-of care diagnostics and trapping circulating tumor cells. (paper)

  3. Iranian women and care providers' perceptions of equitable prenatal care: A qualitative study.

    Science.gov (United States)

    Gheibizadeh, Mahin; Abedi, Heidar Ali; Mohammadi, Easa; Abedi, Parvin

    2016-06-01

    Equity as a basic human right builds the foundation of all areas of primary healthcare, especially prenatal care. However, it is unclear how pregnant women and their care providers perceive the equitable prenatal care. This study aimed to explore Iranian women's and care providers' perceptions of equitable prenatal care. In this study, a qualitative approach was used. Individual in-depth unstructured interviews were conducted with a purposeful sample of pregnant women and their care providers. Data were analyzed using inductive content analysis method. A total of 10 pregnant women and 10 prenatal care providers recruited from six urban health centers across Ahvaz, a south western city in Iran, were participated in the study. The study was approved by the Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences. The ethical principles of voluntary participation, confidentiality, and anonymity were considered. Analysis of participants' interviews resulted in seven themes: guideline-based care, time-saving care, nondiscriminatory care, privacy-respecting care, affordable comprehensive care, effective client-provider relationships, and caregivers' competency. The findings explain the broader and less discussed dimensions of equitable care that are valuable information for the realization of equity in care. Understanding and focusing on these dimensions will help health policy-makers in designing more equitable healthcare services for pregnant women. © The Author(s) 2015.

  4. Interprofessional collaboration regarding patients' care plans in primary care : a focus group study into influential factors

    NARCIS (Netherlands)

    Stephanie Anna Lenzen; Trudy van der Weijden; Anna Beurskens; Marloes Amantia van Bokhoven; Ramon Daniëls; Jerôme Jean Jacques van Dongen

    2016-01-01

    Background: The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding

  5. Interprofessional collaboration regarding patients' care plans in primary care: a focus group study into influential factors

    NARCIS (Netherlands)

    Dongen, J.J. van; Lenzen, S.A.; Bokhoven, M.A. van; Daniels, R.; Weijden, T.T. van der; Beurskens, A.

    2016-01-01

    BACKGROUND: The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding

  6. Family Child Care Licensing Study, 1997.

    Science.gov (United States)

    Children's Foundation, Washington, DC.

    This report details the findings of an annual survey of state child care regulatory agencies. The survey gathered data on both small family child care homes and group or large family child care homes in each of the 50 states, the District of Columbia, Puerto Rico and the Virgin Islands. The report's introduction lists the survey categories and…

  7. Study of Early Child Care and Youth Development (SECCYD)

    Science.gov (United States)

    ... Facebook Twitter Pinterest Email Print NICHD Study of Early Child Care and Youth Development (SECCYD) Sunsetted/For Reference ... page is not being updated . The Study of Early Child Care and Youth Development (SECCYD) began as the ...

  8. A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs.

    Science.gov (United States)

    Flores, Glenn; Lin, Hua; Walker, Candy; Lee, Michael; Portillo, Alberto; Henry, Monica; Fierro, Marco; Massey, Kenneth

    2016-03-22

    Minority children have the highest US uninsurance rates; Latino and African-American children account for 53 % of uninsured American children, despite comprising only 48 % of the total US child population. The study aim was to examine parental awareness of and the reasons for lacking health insurance in Medicaid/CHIP-eligible minority children, and the impact of the children's uninsurance on health, access to care, unmet needs, and family financial burden. For this cross-sectional study, a consecutive series of uninsured, Medicaid/CHIP-eligible Latino and African-American children was recruited at 97 urban Texas community sites, including supermarkets, health fairs, and schools. Measures/outcomes were assessed using validated instruments, and included sociodemographic characteristics, uninsurance duration, reasons for the child being uninsured, health status, special healthcare needs, access to medical and dental care, unmet needs, use of health services, quality of care, satisfaction with care, out-of-pocket costs of care, and financial burden. The mean time uninsured for the 267 participants was 14 months; 5 % had never been insured. The most common reason for insurance loss was expired and never reapplied (30 %), and for never being insured, high insurance costs. Only 49 % of parents were aware that their uninsured child was Medicaid/CHIP eligible. Thirty-eight percent of children had suboptimal health, and 2/3 had special healthcare needs, but 64 % have no primary-care provider; 83 % of parents worry about their child's health more than others. Unmet healthcare needs include: healthcare, 73 %; mental healthcare, 70 %; mobility aids/devices, 67 %; dental, 61 %; specialty care, 57 %; and vision, 46 %. Due to the child's health, 35 % of parents had financial problems, 23 % cut work hours, and 10 % ceased work. Higher proportions of Latinos lack primary-care providers, and higher proportions of African-Americans experience family financial burden. Half of parents

  9. Medicaid CHIP ESPC Database

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Environmental Scanning and Program Characteristic (ESPC) Database is in a Microsoft (MS) Access format and contains Medicaid and CHIP data, for the 50 states and...

  10. Embedded software design and programming of multiprocessor system-on-chip simulink and system C case studies

    CERN Document Server

    Popovici, Katalin; Jerraya, Ahmed A; Wolf, Marilyn

    2010-01-01

    Current multimedia and telecom applications require complex, heterogeneous multiprocessor system on chip (MPSoC) architectures with specific communication infrastructure in order to achieve the required performance. Heterogeneous MPSoC includes different types of processing units (DSP, microcontroller, ASIP) and different communication schemes (fast links, non standard memory organization and access).Programming an MPSoC requires the generation of efficient software running on MPSoC from a high level environment, by using the characteristics of the architecture. This task is known to be tediou

  11. Parents' experiences with neonatal home care following initial care in the neonatal intensive care unit: a phenomenological hermeneutical interview study.

    Science.gov (United States)

    Dellenmark-Blom, Michaela; Wigert, Helena

    2014-03-01

    A descriptive study of parents' experiences with neonatal home care following initial care in the neonatal intensive care unit. As survival rates improve among premature and critically ill infants with an increased risk of morbidity, parents' responsibilities for neonatal care grow in scope and degree under the banner of family-centred care. Concurrent with medical advances, new questions arise about the role of parents and the experience of being provided neonatal care at home. An interview study with a phenomenological hermeneutic approach. Parents from a Swedish neonatal (n = 22) home care setting were extensively interviewed within one year of discharge. Data were collected during 2011-2012. The main theme of the findings is that parents experience neonatal home care as an inner emotional journey, from having a child to being a parent. This finding derives from three themes: the parents' experience of leaving the hospital milieu in favour of establishing independent parenthood, maturing as a parent and processing experiences during the period of neonatal intensive care. This study suggests that neonatal home care is experienced as a care structure adjusted to incorporate parents' needs following discharge from a neonatal intensive care unit. Neonatal home care appears to bridge the gap between hospital and home, supporting the family's adaptation to life in the home setting. Parents become empowered to be primary caregivers, having nurse consultants serving the needs of the whole family. Neonatal home care may therefore be understood as the implementation of family-centred care during the transition from NICU to home. © 2013 John Wiley & Sons Ltd.

  12. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

    Science.gov (United States)

    2012-01-01

    Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and

  13. Seeking Humanizing Care in Patient-Centered Care Process: A Grounded Theory Study.

    Science.gov (United States)

    Cheraghi, Mohammad Ali; Esmaeili, Maryam; Salsali, Mahvash

    Patient-centered care is both a goal in itself and a tool for enhancing health outcomes. The application of patient-centered care in health care services globally however is diverse. This article reports on a study that sought to introduce patient-centered care. The aim of this study is to explore the process of providing patient-centered care in critical care units. The study used a grounded theory method. Data were collected on 5 critical care units in Tehran University of Medical Sciences. Purposive and theoretical sampling directed the collection of data using 29 semistructured interviews with 27 participants (nurses, patients, and physician). Data obtained were analyzed according to the analysis stages of grounded theory and constant comparison to identify the concepts, context, and process of the study. The core category of this grounded theory is "humanizing care," which consisted of 4 interrelated phases, including patient acceptance, purposeful patient assessment and identification, understanding patients, and patient empowerment. A core category of humanizing care integrated the theory. Humanizing care was an outcome and process. Patient-centered care is a dynamic and multifaceted process provided according to the nurses' understanding of the concept. Patient-centered care does not involve repeating routine tasks; rather, it requires an all-embracing understanding of the patients and showing respect for their values, needs, and preferences.

  14. Self-care among healthcare social workers: An exploratory study.

    Science.gov (United States)

    Miller, J Jay; Lianekhammy, Joann; Pope, Natalie; Lee, Jacquelyn; Grise-Owens, Erlene

    2017-01-01

    Despite growing interest in self-care, few studies have explicitly examined the self-care practices of healthcare social workers. This exploratory study investigated self-care among practitioners (N = 138) in one southeastern state. Overall, data suggest that healthcare social workers only moderately engaged in self-care. Additionally, analyses revealed significant differences in self-care practices by financial stability, overall health, and licensure status, respectively. Interestingly, perceived health status and current financial situation were significant predictors for overall self-care practices. After a brief review of the literature, this narrative will explicate findings, elucidate discussion points, identify salient implications, and conclude with areas for future research.

  15. Organizational home care models across Europe: A cross sectional study.

    Science.gov (United States)

    Van Eenoo, Liza; van der Roest, Henriëtte; Onder, Graziano; Finne-Soveri, Harriet; Garms-Homolova, Vjenka; Jonsson, Palmi V; Draisma, Stasja; van Hout, Hein; Declercq, Anja

    2018-01-01

    Decision makers are searching for models to redesign home care and to organize health care in a more sustainable way. The aim of this study is to identify and characterize home care models within and across European countries by means of structural characteristics and care processes at the policy and the organization level. At the policy level, variables that reflected variation in health care policy were included based on a literature review on the home care policy for older persons in six European countries: Belgium, Finland, Germany, Iceland, Italy, and the Netherlands. At the organizational level, data on the structural characteristics and the care processes were collected from 36 home care organizations by means of a survey. Data were collected between 2013 and 2015 during the IBenC project. An observational, cross sectional, quantitative design was used. The analyses consisted of a principal component analysis followed by a hierarchical cluster analysis. Fifteen variables at the organizational level, spread across three components, explained 75.4% of the total variance. The three components made it possible to distribute home care organizations into six care models that differ on the level of patient-centered care delivery, the availability of specialized care professionals, and the level of monitoring care performance. Policy level variables did not contribute to distinguishing between home care models. Six home care models were identified and characterized. These models can be used to describe best practices. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Using conjoint and cluster analysis in developing new product for micro, small and medium enterprises (SMEs) based on customer preferences (Case study: Lampung province's banana chips)

    Science.gov (United States)

    Kosasih, Wilson; Salomon, Lithrone Laricha; Hutomo, Reynaldo

    2017-08-01

    This paper discusses the development of new products of Micro, Small and Medium Entreprises (SMEs) to identify what attributes are considered by consumers, as well as combinations of attributes that need to be analyzed into the main preferences of consumers. The purpose of this research is to increase the added value and competitiveness of SMEs through product innovation. The object of this study is banana chips produced by SMEs from the province of Lampung which it considered to be unique souvenirs of the province. The research data were collected by distributing questionnaires in Jakarta which has heterogeneous population, in order to develop banana chip's marketing and increase its market share in Indonesia. Data processing was performed using conjoint analysis and cluster analysis. Segmentation was performed using conjoint analysis based on the importance level of attributes and part-worth of level attributes of each cluster. Finally, characteristics and consumer preferences of each cluster will be a consideration in determining the product development and marketing strategies.

  17. Effective factors in providing holistic care: a qualitative study.

    Science.gov (United States)

    Zamanzadeh, Vahid; Jasemi, Madineh; Valizadeh, Leila; Keogh, Brian; Taleghani, Fariba

    2015-01-01

    Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software. Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  18. Decision-making process in elderly care : an explorative study

    NARCIS (Netherlands)

    Visser, Leenke; de Jong, Dirk Johan

    2015-01-01

    Current many changes are taking place in the elderly care: care is changing from supply-oriented to demand driven, problems have to be more serious than previously to get a placement in a nursing home, furthermore the demand for heavier care will increase due to ageing. The aim of this study is to

  19. Meaning of caring in pediatric intensive care unit from the perspective of parents: A qualitative study.

    Science.gov (United States)

    Mattsson, Janet Yvonne; Arman, Maria; Castren, Maaret; Forsner, Maria

    2014-12-01

    When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment. © The Author(s) 2013.

  20. Aeromedical Evacuation Enroute Critical Care Validation Study

    Science.gov (United States)

    2015-02-27

    percentile TP, suggesting that TPs assumed complex postures to accomplish patient care tasks. The findings suggest that ergonomic specifications...bending has been associated with back pain (Guo, 2002). Enhanced medical treatment capabilities (e.g., enroute critical care nurses [ECCN...heights, including ergonomic factors such as medic stance and stability and the medic’s ability to maneuver into challenging work angles. The light

  1. Wood chips procurement and research project at the Mikkeli region

    International Nuclear Information System (INIS)

    Saksa, T.; Auvinen, P.

    1996-01-01

    In 1993-94, a large-scale energywood production chain started as a co-operation project by the Mikkeli city forest office and local forestry societies. In 1995 over 115 000 m 3 (about 85 000 MWh of energy) of wood chips were delivered to Pursiala heat and power plant in Mikkeli. About 75 % of these chips was forest processed chips. About 70 % of the forest processed chips was whole tree chips from improvement cuttings of young forest stands and the rest was logging waste chips from regeneration cutting areas. The average total delivery costs of forest processed chips after reduction of energywood and other subsidies were approximately 45 FIM/m 3 (60 FIM/MWh) for the whole tree chips and 38 FIM/m 3 (50 FIM/MWh) for logging waste chips. The delivery costs of forest processed chips could meet the target of Bioenergy Research Programme (45 FIM/MWh) only in the most favourable cases. In an average the delivery costs were about 9 FIM/MWh more than the price obtained when sold to the heat and power plant. However the wood chip production created 27 new jobs and the increase of income to the local economy was about 2.2 milj. FIM /year. The local communities got new tax revenue about 3 FIM/MWh. The gain for the forestry was approximated to be 5 - 6 FIM/MWh. The resources of forest processed chips were studied on the basis of stand measurements. According to the study the most remarkable energywood resources were in young thinning stands on Oxalis-Myrtillus and Myrtillus forest site types. On Oxalis-Myrtillus type almost every and on Myrtillus type every second stand included energywood more than 40 m 3 /ha

  2. Optimal selection of TLD chips

    International Nuclear Information System (INIS)

    Phung, P.; Nicoll, J.J.; Edmonds, P.; Paris, M.; Thompson, C.

    1996-01-01

    Large sets of TLD chips are often used to measure beam dose characteristics in radiotherapy. A sorting method is presented to allow optimal selection of chips from a chosen set. This method considers the variation

  3. Introducing Pharmaceutical Care to Primary Care in Iceland—An Action Research Study

    Directory of Open Access Journals (Sweden)

    Anna Bryndis Blondal

    2017-04-01

    Full Text Available Even though pharmaceutical care is not a new concept in pharmacy, its introduction and development has proved to be challenging. In Iceland, general practitioners are not familiar with pharmaceutical care and additionally no such service is offered in pharmacies or primary care settings. Introducing pharmaceutical care in primary care in Iceland is making great efforts to follow other countries, which are bringing the pharmacist more into patient care. General practitioners are key stakeholders in this endeavor. The aim of this study was to introduce pharmacist-led pharmaceutical care into primary care clinics in Iceland in collaboration with general practitioners by presenting different setting structures. Action research provided the framework for this research. Data was collected from pharmaceutical care interventions, whereby the pharmaceutical care practitioner ensures that each of a patient’s medications is assessed to determine if it is appropriate, effective, safe, and that the patient can take medicine as expected. Sources of data included pharmaceutical care notes on patients, researcher’s notes, meetings, and interviews with general practitioners over the period of the study. The study ran from September 2013 to October 2015. Three separate semi-structured in-depth interviews were conducted with five general practitioners from one primary health care clinic in Iceland at different time points throughout the study. Pharmaceutical care was provided to elderly patients (n = 125 before and between general practitioners’ interviews. The study setting was a primary care clinic in the Reykjavik area and the patients’ homes. Results showed that the GPs’ knowledge about pharmacist competencies as healthcare providers and their potential in patient care increased. GPs would now like to have access to a pharmacist on a daily basis. Direct contact between the pharmacist and GPs is better when working in the same physical space

  4. Does prenatal care benefit maternal health? A study of post-partum maternal care use.

    Science.gov (United States)

    Liu, Tsai-Ching; Chen, Bradley; Chan, Yun-Shan; Chen, Chin-Shyan

    2015-10-01

    Most studies on prenatal care focus on its effects on infant health, while studying less about the effects on maternal health. Using the Longitudinal Health Insurance claims data in Taiwan in a recursive bivariate probit model, this study examines the impact of adequate prenatal care on the probability of post-partum maternal hospitalization during the first 6 months after birth. The results show that adequate prenatal care significantly reduces the probability of post-partum maternal hospitalization among women who have had vaginal delivery by 43.8%. This finding suggests that the benefits of prenatal care may have been underestimated among women with vaginal delivery. Timely and adequate prenatal care not only creates a positive impact on infant health, but also yields significant benefits for post-partum maternal health. However, we do not find similar benefits of prenatal care for women undergoing a cesarean section. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Smart vision chips: An overview

    Science.gov (United States)

    Koch, Christof

    1994-01-01

    This viewgraph presentation presents four working analog VLSI vision chips: (1) time-derivative retina, (2) zero-crossing chip, (3) resistive fuse, and (4) figure-ground chip; work in progress on computing motion and neuromorphic systems; and conceptual and practical lessons learned.

  6. Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

    Science.gov (United States)

    Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

    2017-01-01

    Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

  7. Rationing critical care medicine: recent studies and current trends.

    Science.gov (United States)

    Ward, Nicholas S

    2005-12-01

    This paper reviews the literature on the rationing of critical care resources. Although much has been written about the concept of rationing, there have been few scientific studies as to its prevalence. A recent meta-analysis reviewed all previously published studies on rationing access to intensive care units but little is known about practices within the intensive care unit. Much literature in the past few years has focused on the growing use of critical care resources and projections for the future. Several authors suggest there may be a crisis in financial or personnel resources if some rationing does not take place. Other papers have argued that the methods of rationing critical care previously proposed, such as limiting the care of dying patients or using cost-effectiveness analysis to determine care, may not be effective or viewed as ethical by some. Finally, several recent papers review how critical care is practiced and allocated in India and Asian countries that already practice open rationing in their health care systems. There is currently no published evidence that overt rationing is taking place in critical care medicine. There is growing evidence that in the future, the need for critical care may outstrip financial resources unless some form of rationing takes place. It is also clear from the literature that choosing how to ration critical care will be a difficult task.

  8. Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study.

    Science.gov (United States)

    Lotz, Julia D; Jox, Ralf J; Borasio, Gian Domenico; Führer, Monika

    2015-03-01

    Pediatric advance care planning differs from the adult setting in several aspects, including patients' diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals' perspective. We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. Perceived problems with pediatric advance care planning relate to professionals' discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor's advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers. © The Author(s) 2014.

  9. Designing a Care Pathway Model - A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway.

    Science.gov (United States)

    Oosterholt, Robin I; Simonse, Lianne Wl; Boess, Stella U; Vehmeijer, Stephan Bw

    2017-03-09

    Although the clinical attributes of total hip arthroplasty (THA) care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. The outpatient THA care pathway enables patients to be discharged on the day of surgery, shortening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi-structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1) and mobilisation & discharge (4). The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. The design addressed existing problems and is an optimisation of the case hospital's pathway. The network of actors consists of the patient (1), radiologist (1), anaesthetist (1), nurse specialist (1), pharmacist (1), orthopaedic surgeon (1,4), physiotherapist (1,4), nurse (4), doctor (4) and patient application (1,4). The critical value exchanges include patient preparation (mental and practical), patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

  10. Implementing a stepped-care approach in primary care: results of a qualitative study

    Directory of Open Access Journals (Sweden)

    Franx Gerdien

    2012-01-01

    Full Text Available Abstract Background Since 2004, 'stepped-care models' have been adopted in several international evidence-based clinical guidelines to guide clinicians in the organisation of depression care. To enhance the adoption of this new treatment approach, a Quality Improvement Collaborative (QIC was initiated in the Netherlands. Methods Alongside the QIC, an intervention study using a controlled before-and-after design was performed. Part of the study was a process evaluation, utilizing semi-structured group interviews, to provide insight into the perceptions of the participating clinicians on the implementation of stepped care for depression into their daily routines. Participants were primary care clinicians, specialist clinicians, and other healthcare staff from eight regions in the Netherlands. Analysis was supported by the Normalisation Process Theory (NPT. Results The introduction of a stepped-care model for depression to primary care teams within the context of a depression QIC was generally well received by participating clinicians. All three elements of the proposed stepped-care model (patient differentiation, stepped-care treatment, and outcome monitoring, were translated and introduced locally. Clinicians reported changes in terms of learning how to differentiate between patient groups and different levels of care, changing antidepressant prescribing routines as a consequence of having a broader treatment package to offer to their patients, and better working relationships with patients and colleagues. A complex range of factors influenced the implementation process. Facilitating factors were the stepped-care model itself, the structured team meetings (part of the QIC method, and the positive reaction from patients to stepped care. The differing views of depression and depression care within multidisciplinary health teams, lack of resources, and poor information systems hindered the rapid introduction of the stepped-care model. The NPT

  11. A Method to Study the Epigenetic Chromatin States of Rare Hematopoietic Stem and Progenitor Cells; MiniChIP–Chip

    Directory of Open Access Journals (Sweden)

    Weishaupt Holger

    2010-01-01

    Full Text Available Abstract Dynamic chromatin structure is a fundamental property of gene transcriptional regulation, and has emerged as a critical modulator of physiological processes during cellular differentiation and development. Analysis of chromatin structure using molecular biology and biochemical assays in rare somatic stem and progenitor cells is key for understanding these processes but poses a great challenge because of their reliance on millions of cells. Through the development of a miniaturized genome-scale chromatin immunoprecipitation method (miniChIP–chip, we have documented the genome-wide chromatin states of low abundant populations that comprise hematopoietic stem cells and immediate progeny residing in murine bone marrow. In this report, we describe the miniChIP methodology that can be used for increasing an understanding of the epigenetic mechanisms underlying hematopoietic stem and progenitor cell function. Application of this method will reveal the contribution of dynamic chromatin structure in regulating the function of other somatic stem cell populations, and how this process becomes perturbed in pathological conditions. Additional file 1 Click here for file

  12. Cryogenic on-chip multiplexer for the study of quantum transport in 256 split-gate devices

    International Nuclear Information System (INIS)

    Al-Taie, H.; Kelly, M. J.; Smith, L. W.; Xu, B.; Griffiths, J. P.; Beere, H. E.; Jones, G. A. C.; Ritchie, D. A.; Smith, C. G.; See, P.

    2013-01-01

    We present a multiplexing scheme for the measurement of large numbers of mesoscopic devices in cryogenic systems. The multiplexer is used to contact an array of 256 split gates on a GaAs/AlGaAs heterostructure, in which each split gate can be measured individually. The low-temperature conductance of split-gate devices is governed by quantum mechanics, leading to the appearance of conductance plateaux at intervals of 2e 2 /h. A fabrication-limited yield of 94% is achieved for the array, and a “quantum yield” is also defined, to account for disorder affecting the quantum behaviour of the devices. The quantum yield rose from 55% to 86% after illuminating the sample, explained by the corresponding increase in carrier density and mobility of the two-dimensional electron gas. The multiplexer is a scalable architecture, and can be extended to other forms of mesoscopic devices. It overcomes previous limits on the number of devices that can be fabricated on a single chip due to the number of electrical contacts available, without the need to alter existing experimental set ups

  13. The experience of intensive care nurses caring for patients with delirium: A phenomenological study.

    Science.gov (United States)

    LeBlanc, Allana; Bourbonnais, Frances Fothergill; Harrison, Denise; Tousignant, Kelly

    2018-02-01

    The purpose of this research was to seek to understand the lived experience of intensive care nurses caring for patients with delirium. The objectives of this inquiry were: 1) To examine intensive care nurses' experiences of caring for adult patients with delirium; 2) To identify factors that facilitate or hinder intensive care nurses caring for these patients. This study utilised an interpretive phenomenological approach as described by van Manen. Individual conversational interviews were conducted with eight intensive care nurses working in a tertiary level, university-affiliated hospital in Canada. The essence of the experience of nurses caring for patients with delirium in intensive care was revealed to be finding a way to help them come through it. Six main themes emerged: It's Exhausting; Making a Picture of the Patient's Mental Status; Keeping Patients Safe: It's aReally Big Job; Everyone Is Unique; Riding It Out With Families and Taking Every Experience With You. The findings contribute to an understanding of how intensive care nurses help patients and their families through this complex and distressing experience. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Recycling melting process of the zirconium alloy chips

    Energy Technology Data Exchange (ETDEWEB)

    Reis, Luis A.M. dos; Mucsi, Cristiano S.; Tavares, Luiz A.P.; Alencar, Maicon C.; Gomes, Maurilio P.; Barbosa, Luzinete P.; Rossi, Jesualdo L., E-mail: luisreis.09@gmail.com, E-mail: csmucsi@gmail.com [Instituto de Pesquisas Energéticas e Nucleares (IPEN/CNEN-SP), São Paulo, SP (Brazil)

    2017-07-01

    Pressurized water reactors (PWR) commonly use {sup 235}U enriched uranium dioxide pellets as a nuclear fuel, these are assembled and stacked in zirconium alloy tubes and end caps (M5, Zirlo, Zircaloy). During the machining of these components large amounts of chips are generated which are contaminated with cutting fluid. Its storage presents safety and environmental risks due to its pyrophoric and reactive nature. Recycling industry shown interest in its recycling due to its strategic importance. This paper presents a study on the recycling process and the results aiming the efficiency in the cleaning process; the quality control; the obtaining of the pressed electrodes and finally the melting in a Vacuum Arc Remelting furnace (VAR). The recycling process begins with magnetic separation of possible ferrous alloys chips contaminant, the washing of the cutting fluid that is soluble in water, washing with an industrial degreaser, followed by a rinse with continuous flow of water under high pressure and drying with hot air. The first evaluation of the process was done by an Energy Dispersive X-rays Fluorescence Spectrometry (EDXRFS) showed the presence of 10 wt. % to 17 wt. % of impurities due the mixing with stainless steel machining chips. The chips were then pressed in a custom-made matrix of square section (40 x 40 mm - 500 mm in length), resulting in electrodes with 20% of apparent density of the original alloy. The electrode was then melted in a laboratory scale VAR furnace at the CCTM-IPEN, producing a massive ingot with 0.8 kg. It was observed that the samples obtained from Indústrias Nucleares do Brasil (INB) are supposed to be secondary scrap and it is suggested careful separation in the generation of this material. The melting of the chips is possible and feasible in a VAR furnace which reduces the storage volume by up to 40 times of this material, however, it is necessary to correct the composition of the alloy for the melting of these ingots. (author)

  15. Study protocol: identifying and delivering point-of-care information to improve care coordination.

    Science.gov (United States)

    Hysong, Sylvia J; Che, Xinxuan; Weaver, Sallie J; Petersen, Laura A

    2015-10-19

    The need for deliberately coordinated care is noted by many national-level organizations. The Department of Veterans Affairs (VA) recently transitioned primary care clinics nationwide into Patient Aligned Care Teams (PACTs) to provide more accessible, coordinated, comprehensive, and patient-centered care. To better serve this purpose, PACTs must be able to successfully sequence and route interdependent tasks to appropriate team members while also maintaining collective situational awareness (coordination). Although conceptual frameworks of care coordination exist, few explicitly articulate core behavioral markers of coordination or the related information needs of team members attempting to synchronize complex care processes across time for a shared patient population. Given this gap, we partnered with a group of frontline primary care personnel at ambulatory care sites to identify the specific information needs of PACT members that will enable them to coordinate their efforts to provide effective, coordinated care. The study has three objectives: (1) development of measurable, prioritized point-of-care criteria for effective PACT coordination; (2) identifying the specific information needed at the point of care to optimize coordination; and (3) assessing the effect of adopting the aforementioned coordination standards on PACT clinicians' coordination behaviors. The study consists of three phases. In phase 1, we will employ the Productivity Measurement and Enhancement System (ProMES), a structured approach to performance measure creation from industrial/organizational psychology, to develop coordination measures with a design team of 6-10 primary care personnel; in phase 2, we will conduct focus groups with the phase 1 design team to identify point-of-care information needs. Phase 3 is a two-arm field experiment (n PACT = 28/arm); intervention arm PACTs will receive monthly feedback reports using the measures developed in phase 1 and attend brief monthly

  16. The Chinese family-centered care survey for adult intensive care unit: A psychometric study.

    Science.gov (United States)

    Wang, Wen-Ling; Feng, Jui-Ying; Wang, Chi-Jen; Chen, Jing-Huei

    2016-02-01

    This study aimed to develop a family-centered care survey for Chinese adult intensive care units and to establish the survey's psychometric properties. Family-centered care (FCC) is widely recognized as an ideal model of care. Few studies have explored FCC perceptions among family members of adult critical care patients in Asian countries, and no Chinese FCC measurement has been developed. An English version of the 3-factor family-centered care survey for adult intensive care units (FCCS-AICU) was translated into Chinese using a modified back translation procedure. Based on the literature review, two additional concepts, information and empowerment, were added to the Chinese FCCS-AICU. The psychometric properties of the Chinese FCCS-AICU were determined with 249 family members from a medical center in Taiwan and were tested for construct and convergent validity, and internal consistency. Both the monolingual and bilingual equivalence tests of the English and Chinese versions of the 3-factor FCCS-AICU were supported. Exploratory factor analysis supported the 5-factor structure of the Chinese FCCS-AICU with a total explained variance of 58.34%. The Chinese FCCS-AICU was correlated with the Chinese Critical Care Family Needs Inventory. Internal consistency, determined by Cronbach's α, for the overall scale was .94. The Chinese FCCS-AICU is a valid and reliable tool for measuring perceptions of FCC by family members of adult intensive care patients within Chinese-speaking communities. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study.

    Science.gov (United States)

    Xiao, Roy; Miller, Jacob A; Zafirau, William J; Gorodeski, Eiran Z; Young, James B

    2018-04-01

    As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population. A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 at a single tertiary care institution to assess healthcare utilization after discharge with home health care. Control patients discharged with "self-care" were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up readmission and death. Multivariable linear and Cox proportional hazards regression were used to adjust for covariates. Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Cassava chips quality as influenced by cultivar, blanching time and ...

    African Journals Online (AJOL)

    Currently, fried cassava chips and crisps are increasingly being consumed as snacks; and fried cassava chips are produced by street processors. The quality and safety of these products is not known, therefore, the current study was to establish the influence of cassava cultivar, blanching time and slice thickness on quality ...

  19. Case Study: "Care" as a Political Winner

    Directory of Open Access Journals (Sweden)

    Meredith Loomis Quinlan

    2017-03-01

    Full Text Available Through face-to-face conversations and open-ended questions designed to elicit stories and deeper interactions, the Michigan People’s Campaign (MPC may have altered voting patterns more effectively than using traditional electoral engagement strategies. During the 2016 election, by campaigning on issues of family care, MPC helped elect a progressive state house candidate in a Downriver Detroit district that Republican presidential candidate Donald Trump carried by over 6,000 votes.

  20. Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study.

    Science.gov (United States)

    Long, Theodore; Chaiyachati, Krisda; Bosu, Olatunde; Sircar, Sohini; Richards, Bradley; Garg, Megha; McGarry, Kelly; Solomon, Sonja; Berman, Rebecca; Curry, Leslie; Moriarty, John; Huot, Stephen

    2016-12-01

    Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices. This was a qualitative study based on semi-structured, in-person interviews. Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed. We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis. We completed 24 interviews (12 second-year residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program. Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue

  1. A reliability and utility study of the Care Dependency Scale

    NARCIS (Netherlands)

    Dijkstra, A.; Buist, G.; Moorer, P.; Dassen, T.

    2000-01-01

    The purpose of this study was to examine the reliability and utility of the Care Dependency Scale (CDS). This 15-item scale has been developed recently for assessing the care dependency of demented or menially handicapped inpatients. Data for this study were collected from 153 demented and 139

  2. Core attitudes of professionals in palliative care: a qualitative study.

    Science.gov (United States)

    Simon, Steffen T; Ramsenthaler, Christina; Bausewein, Claudia; Krischke, Norbert; Geiss, Gerlinde

    2009-08-01

    Self-awareness of one's own reactions towards patients and their relatives is of paramount importance for all professionals in palliative care. 'Core attitude' describes the way in which a person perceives himself and the world, and forms the basis for his actions and thoughts. The aim of this study is to explore what core attitude means for palliative care professionals and whether there is a specific core attitude in palliative care. Qualitative study with 10 face-to-face in-depth interviews with experts in palliative care (nurses, physicians, social workers, psychologists, chaplain) in Germany. Core attitude in palliative care can be best described with the following three domains: 1) personal characteristics; 2) experience of care; and 3) competence in care. Authenticity is the most important characteristic of professionals, along with honesty and mindfulness. Core attitude primarily becomes apparent in the relationship with the patient. Perception and listening are key competences. The experts emphasized the universality of the core attitude in the care of ill people. They stressed the importance and relevance of teaching core attitudes in palliative care education. In the field of palliative care, core attitude consists predominately of authenticity, manifests itself in relationships, and requires a high degree of perceptiveness.

  3. Pushing boundaries-culture-sensitive care in oncology and palliative care: a qualitative study.

    Science.gov (United States)

    Schrank, Beate; Rumpold, Tamara; Amering, Michaela; Masel, Eva Katharina; Watzke, Herbert; Schur, Sophie

    2017-06-01

    In increasingly globalized societies, patient-centered cancer care requires culture-sensitive approaches in order to ensure patients well-being. While migrant patients' needs are frequently reported in the literature, staff members' perception of work with migrant patients, associated challenges, or individual work approaches are largely unknown. This study addresses this research gap through qualitative exploration of experiences of multicultural health care professionals in supportive oncology and palliative care, working with patients from different cultural backgrounds. This study aims to understand staff experience of the impact of culture on cancer care. This study was conducted at the Medical University of Vienna, including staff from different settings of oncology and palliative care, in different professional positions, and with a range of individual migration backgrounds. Semistructured interviews were conducted with 21 staff members working with patients from different cultural backgrounds. Interviews explored views on the impact of culture on care were audio-taped, transcribed, and analyzed using a rigorous method of thematic analysis, enhanced with grounded theory techniques. Interviews revealed 4 key topics: culture-specific differences, assumed reasons for differences, consequences of multicultural care, and tools for culture-sensitive care. Strategies to better deal with migrant patients and their families were suggested to improve work satisfaction amongst staff. This study identifies relevant staff challenges in work with migrant patients. Concrete suggestions for improvement include measures on an organizational level, team level, and personal tools. The suggested measures are applicable to improve work satisfaction and culture-sensitive care not only in cancer care but also in other areas of medicine. Copyright © 2016 John Wiley & Sons, Ltd.

  4. Microfluidic "Pouch" Chips for Immunoassays and Nucleic Acid Amplification Tests.

    Science.gov (United States)

    Mauk, Michael G; Liu, Changchun; Qiu, Xianbo; Chen, Dafeng; Song, Jinzhao; Bau, Haim H

    2017-01-01

    Microfluidic cassettes ("chips") for processing and analysis of clinical specimens and other sample types facilitate point-of-care (POC) immunoassays and nucleic acid based amplification tests. These single-use test chips can be self-contained and made amenable to autonomous operation-reducing or eliminating supporting instrumentation-by incorporating laminated, pliable "pouch" and membrane structures for fluid storage, pumping, mixing, and flow control. Materials and methods for integrating flexible pouch compartments and diaphragm valves into hard plastic (e.g., acrylic and polycarbonate) microfluidic "chips" for reagent storage, fluid actuation, and flow control are described. We review several versions of these pouch chips for immunoassay and nucleic acid amplification tests, and describe related fabrication techniques. These protocols thus offer a "toolbox" of methods for storage, pumping, and flow control functions in microfluidic devices.

  5. The concept of care complexity: a qualitative study

    Directory of Open Access Journals (Sweden)

    Milena Guarinoni

    2015-12-01

    Full Text Available Background: Hospital organisations based on the level of care intensity have clearly revealed a concept, that of care complexity, which has been widely used for decades in the healthcare field. Despite its wide use, this concept is still poorly defined and it is often confused with and replaced by similar concepts such as care intensity or workload. This study aims to describe the meaning of care complexity as perceived by nurses in their day-to-day experience of hospital clinical care, rehabilitation, home care, and organisation. Design and methods: Fifteen interviews were conducted with nurses belonging to clinical-care areas and to heterogeneous organisational areas. The interview was of an unstructured type. The participants were selected using a propositional methodology. Colaizzi’s descriptive phenomenological method was chosen for the analysis of the interviews. Results: The nurses who were interviewed predominantly perceive the definition of care complexity as coinciding with that of workload. Nevertheless, the managerial perspective does not appear to be exclusive, as from the in-depth interviews three fundamental themes emerge that are associated with the concept of care complexity: the patient, the nurse and the organisation. Conclusions: The study highlights that care complexity consists of both quantitative and qualitative aspects that do not refer only to the organisational dimension. The use of the terminology employed today should be reconsidered: it appears to be inappropriate to talk of measurement of care complexity, as this concept also consists of qualitative – thus not entirely quantifiable – aspects referring to the person being cared for. In this sense, reference should instead be made to the evaluation of care complexity, which would also constitute a better and more complete basis for defining the nursing skills required in professional nursing practice.

  6. Identifying Professional Competencies of the Flip-Chip Packaging Engineer in Taiwan

    Science.gov (United States)

    Guu, Y. H.; Lin, Kuen-Yi; Lee, Lung-Sheng

    2014-01-01

    This study employed a literature review, expert interviews, and a questionnaire survey to construct a set of two-tier competencies for a flip-chip packaging engineer. The fuzzy Delphi questionnaire was sent to 12 flip-chip engineering experts to identify professional competencies that a flip-chip packaging engineer must have. Four competencies,…

  7. Preservation of forest wood chips

    Energy Technology Data Exchange (ETDEWEB)

    Kofman, P.D.; Thomsen, I.M.; Ohlsson, C.; Leer, E.; Ravn Schmidt, E.; Soerensen, M.; Knudsen, P.

    1999-01-01

    As part of the Danish Energy Research Programme on biomass utilisation for energy production (EFP), this project concerns problems connected to the handling and storing of wood chips. In this project, the possibility of preserving wood chips of the Norway Spruce (Picea Abies) is addressed, and the potential improvements by anaerobic storage are tested. Preservation of wood chips aims at reducing dry matter losses from extensive heating during storage and to reduce production of fungal spores. Fungal spores pose a health hazards to workers handling the chips. Further the producers of wood chips are interested in such a method since it would enable them to give a guarantee for the delivery of homogeneous wood chips also during the winter period. Three different types of wood chips were stored airtight and further one of these was stored in accordance with normal practise and use as reference. The results showed that airtight storage had a beneficial impact on the quality of the chips: no redistribution of moisture, low dry matter losses, unfavourable conditions for microbial activity of most fungi, and the promotion of yeasts instead of fungi with airborne spores. Likewise the firing tests showed that no combustion problems, and no increased risk to the environment or to the health of staff is caused by anaerobic storage of wood chips. In all, the tests of the anaerobic storage method of forest wood chips were a success and a large-scale test of the method will be carried out in 1999. (au)

  8. Transition from specialist to primary diabetes care: A qualitative study of perspectives of primary care physicians

    Directory of Open Access Journals (Sweden)

    Liddy Clare

    2009-06-01

    Full Text Available Abstract Background The growing prevalence of diabetes and heightened awareness of the benefits of early and intensive disease management have increased service demands and expectations not only of primary care physicians but also of diabetes specialists. While research has addressed issues related to referral into specialist care, much less has been published about the transition from diabetes specialists back to primary care. Understanding the concerns of family physicians related to discharge of diabetes care from specialist centers can support the development of strategies that facilitate this transition and result in broader access to limited specialist services. This study was undertaken to explore primary care physician (PCP perspectives and concerns related to reassuming responsibility for diabetes care after referral to a specialized diabetes center. Methods Qualitative data were collected through three focus groups. Sessions were audio-taped and transcribed verbatim. Data were coded and sorted with themes identified using a constant comparison method. The study was undertaken through the regional academic referral center for adult diabetes care in Ottawa, Canada. Participants included 22 primary care physicians representing a variety of referral frequencies, practice types and settings. Results Participants described facilitators and barriers to successful transition of diabetes care at the provider, patient and systems level. Major facilitators included clear communication of a detailed, structured plan of care, ongoing access to specialist services for advice or re-referral, continuing education and mentoring for PCPs. Identified provider barriers were gaps in PCP knowledge and confidence related to diabetes treatment, excessive workload and competing time demands. Systems deterrents included reimbursement policies for health professionals and inadequate funding for diabetes medications and supplies. At the PCP-patient interface

  9. Lab-on a-Chip

    Science.gov (United States)

    1999-01-01

    Labs on chips are manufactured in many shapes and sizes and can be used for numerous applications, from medical tests to water quality monitoring to detecting the signatures of life on other planets. The eight holes on this chip are actually ports that can be filled with fluids or chemicals. Tiny valves control the chemical processes by mixing fluids that move in the tiny channels that look like lines, connecting the ports. Scientists at NASA's Marshall Space Flight Center (MSFC) in Huntsville, Alabama designed this chip to grow biological crystals on the International Space Station (ISS). Through this research, they discovered that this technology is ideally suited for solving the challenges of the Vision for Space Exploration. For example, thousands of chips the size of dimes could be loaded on a Martian rover looking for biosignatures of past or present life. Other types of chips could be placed in handheld devices used to monitor microbes in water or to quickly conduct medical tests on astronauts. The portable, handheld Lab-on-a Chip Application Development Portable Test System (LOCAD-PTS) made its debut flight aboard Discovery during the STS-116 mission launched December 9, 2006. The system allowed crew members to monitor their environment for problematic contaminants such as yeast, mold, and even E.coli, and salmonella. Once LOCAD-PTS reached the ISS, the Marshall team continued to manage the experiment, monitoring the study from a console in the Payload Operations Center at MSFC. The results of these studies will help NASA researchers refine the technology for future Moon and Mars missions. (NASA/MSFC/D.Stoffer)

  10. Amdahl 470 Chip Package

    CERN Multimedia

    1975-01-01

    In the late 70s the larger IBM computers were water cooled. Amdahl, an IBM competitor, invented an air cooling technology for it's computers. His company worked hard, developing a computer that was faster and less expensive than the IBM System/360 mainframe computer systems. This object contains an actual Amdahl series 470 computer logic chip with an air cooling device mounted on top. The package leads and cooling tower are gold-plated.

  11. Silicon Chip-to-Chip Mode-Division Multiplexing

    DEFF Research Database (Denmark)

    Baumann, Jan Markus; Porto da Silva, Edson; Ding, Yunhong

    2018-01-01

    A chip-to-chip mode-division multiplexing connection is demonstrated using a pair of multiplexers/demultiplexers fabricated on the silicon-on-insulator platform. Successful mode multiplexing and demultiplexing is experimentally demonstrated, using the LP01, LP11a and LP11b modes.......A chip-to-chip mode-division multiplexing connection is demonstrated using a pair of multiplexers/demultiplexers fabricated on the silicon-on-insulator platform. Successful mode multiplexing and demultiplexing is experimentally demonstrated, using the LP01, LP11a and LP11b modes....

  12. Study protocol: The Intensive Care Outcome Network ('ICON' study

    Directory of Open Access Journals (Sweden)

    Barber Vicki S

    2008-06-01

    Full Text Available Abstract Background Extended follow-up of survivors of ICU treatment has shown many patients suffer long-term physical and psychological consequences that affect their health-related quality of life. The current lack of rigorous longitudinal studies means that the true prevalence of these physical and psychological problems remains undetermined. Methods/Design The ICON (Intensive Care Outcome Network study is a multi-centre, longitudinal study of survivors of critical illness. Patients will be recruited prior to hospital discharge from 20–30 ICUs in the UK and will be assessed at 3, 6, and 12 months following ICU discharge for health-related quality of life as measured by the Short Form-36 (SF-36 and the EuroQoL (EQ-5D; anxiety and depression as measured by the Hospital Anxiety and Depression Scale (HADS; and post traumatic stress disorder (PTSD symptoms as measured by the PTSD Civilian Checklist (PCL-C. Postal questionnaires will be used. Discussion The ICON study will create a valuable UK database detailing the prevalence of physical and psychological morbidity experienced by patients as they recover from critical illness. Knowledge of the prevalence of physical and psychological morbidity in ICU survivors is important because research to generate models of causality, prognosis and treatment effects is dependent on accurate determination of prevalence. The results will also inform economic modelling of the long-term burden of critical illness. Trial Registration ISRCTN69112866

  13. A Longitudinal Study of Usability in Health Care

    DEFF Research Database (Denmark)

    Kjeldskov, Jesper; Skov, Mikael B.; Stage, Jan

    2010-01-01

    We report from a longitudinal laboratory-based usability evaluation of a health care information system. The purpose of the study was to inquire into the nature of usability problems experienced by novice and expert users, and to see to what extend usability problems of a health care information...... system may or may not disappear over time, as the nurses get more familiar with it-if time heals poor design? As our method for studying this, we conducted a longitudinal study with two key studies. A usability evaluation was conducted with novice users when an electronic patient record system was being......, we discuss implications for evaluating usability in health care....

  14. Antenatal and obstetric care in Afghanistan--a qualitative study among health care receivers and health care providers.

    Science.gov (United States)

    Rahmani, Zuhal; Brekke, Mette

    2013-05-06

    Despite attempts from the government to improve ante- and perinatal care, Afghanistan has once again been labeled "the worst country in which to be a mom" in Save the Children's World's Mothers' Report. This study investigated how pregnant women and health care providers experience the existing antenatal and obstetric health care situation in Afghanistan. Data were obtained through one-to-one semi-structured interviews of 27 individuals, including 12 women who were pregnant or had recently given birth, seven doctors, five midwives, and three traditional birth attendants. The interviews were carried out in Kabul and the village of Ramak in Ghazni Province. Interviews were taped, transcribed, and analyzed according to the principles of Giorgi's phenomenological analysis. Antenatal care was reported to be underused, even when available. Several obstacles were identified, including a lack of knowledge regarding the importance of antenatal care among the women and their families, financial difficulties, and transportation problems. The women also reported significant dissatisfaction with the attitudes and behavior of health personnel, which included instances of verbal and physical abuse. According to the health professionals, poor working conditions, low salaries, and high stress levels contributed to this matter. Personal contacts inside the hospital were considered necessary for receiving high quality care, and bribery was customary. Despite these serious concerns, the women expressed gratitude for having even limited access to health care, especially treatment provided by a female doctor. Health professionals were proud of their work and enjoyed the opportunity to help their community. This study identified several obstacles which must be addressed to improve reproductive health in Afghanistan. There was limited understanding of the importance of antenatal care and a lack of family support. Financial and transportation problems led to underuse of available care

  15. Demand of elderly people for residential care: an exploratory study

    NARCIS (Netherlands)

    van Bilsen, P.; Hamers, J.; Groot, W.; Spreeuwenberg, C.

    2006-01-01

    Background: Because of the rapid aging population, the demand for residential care exceeds availability. This paper presents the results of a study that focuses on the demand of elderly people for residential care and determinants (elderly people's personal characteristics, needs and resources) that

  16. Biostability of an implantable glucose sensor chip

    Science.gov (United States)

    Fröhlich, M.; Birkholz, M.; Ehwald, K. E.; Kulse, P.; Fursenko, O.; Katzer, J.

    2012-12-01

    Surface materials of an implantable microelectronic chip intended for medical applications were evaluated with respect to their long-term stability in bio-environments. The sensor chip shall apply in a glucose monitor by operating as a microviscosimeter according to the principle of affinity viscosimetry. A monolithic integration of a microelectromechanical system (MEMS) into the sensor chip was successfully performed in a combined 0.25 μm CMOS/BiCMOS technology. In order to study material durability and biostability of the surfaces, sensor chips were exposed to various in vitro and in vivo tests. Corrosional damage of SiON, SiO2 and TiN surfaces was investigated by optical microscopy, ellipsometry and AFM. The results served for optimizing the Back-end-of-Line (BEoL) stack, from which the MEMS was prepared. Corrosion of metal lines could significantly be reduced by improving the topmost passivation layer. The experiments revealed no visible damage of the actuator or other functionally important MEMS elements. Sensor chips were also exposed to human body fluid for three month by implantation into the abdomen of a volunteer. Only small effects were observed for layer thickness and Ra roughness after explantation. In particular, TiN as used for the actuator beam showed no degradation by biocorrosion. The highest degradation rate of about 50 nm per month was revealed for the SiON passivation layer. These results suggest that the sensor chip may safely operate in subcutaneous tissue for a period of several months.

  17. Biostability of an implantable glucose sensor chip

    International Nuclear Information System (INIS)

    Fröhlich, M; Ehwald, K E; Kulse, P; Fursenko, O; Katzer, J; Birkholz, M

    2012-01-01

    Surface materials of an implantable microelectronic chip intended for medical applications were evaluated with respect to their long-term stability in bio-environments. The sensor chip shall apply in a glucose monitor by operating as a microviscosimeter according to the principle of affinity viscosimetry. A monolithic integration of a microelectromechanical system (MEMS) into the sensor chip was successfully performed in a combined 0.25 μm CMOS/BiCMOS technology. In order to study material durability and biostability of the surfaces, sensor chips were exposed to various in vitro and in vivo tests. Corrosional damage of SiON, SiO 2 and TiN surfaces was investigated by optical microscopy, ellipsometry and AFM. The results served for optimizing the Back-end-of-Line (BEoL) stack, from which the MEMS was prepared. Corrosion of metal lines could significantly be reduced by improving the topmost passivation layer. The experiments revealed no visible damage of the actuator or other functionally important MEMS elements. Sensor chips were also exposed to human body fluid for three month by implantation into the abdomen of a volunteer. Only small effects were observed for layer thickness and R a roughness after explantation. In particular, TiN as used for the actuator beam showed no degradation by biocorrosion. The highest degradation rate of about 50 nm per month was revealed for the SiON passivation layer. These results suggest that the sensor chip may safely operate in subcutaneous tissue for a period of several months.

  18. Decapsulation Method for Flip Chips with Ceramics in Microelectronic Packaging

    Science.gov (United States)

    Shih, T. I.; Duh, J. G.

    2008-06-01

    The decapsulation of flip chips bonded to ceramic substrates is a challenging task in the packaging industry owing to the vulnerability of the chip surface during the process. In conventional methods, such as manual grinding and polishing, the solder bumps are easily damaged during the removal of underfill, and the thin chip may even be crushed due to mechanical stress. An efficient and reliable decapsulation method consisting of thermal and chemical processes was developed in this study. The surface quality of chips after solder removal is satisfactory for the existing solder rework procedure as well as for die-level failure analysis. The innovative processes included heat-sink and ceramic substrate removal, solder bump separation, and solder residue cleaning from the chip surface. In the last stage, particular temperatures were selected for the removal of eutectic Pb-Sn, high-lead, and lead-free solders considering their respective melting points.

  19. Reagent-loaded plastic microfluidic chips for detecting homocysteine

    International Nuclear Information System (INIS)

    Suk, Ji Won; Jang, Jae-Young; Cho, Jun-Hyeong

    2008-01-01

    This report describes the preliminary study on plastic microfluidic chips with pre-loaded reagents for detecting homocysteine (Hcy). All reagents needed in an Hcy immunoassay were included in a microfluidic chip to remove tedious assay steps. A simple and cost-effective bonding method was developed to realize reagent-loaded microfluidic chips. This technique uses an intermediate layer between two plastic substrates by selectively patterning polydimethylsiloxane (PDMS) on the embossed surface of microchannels and fixing the substrates under pressure. Using this bonding method, the competitive immunoassay for SAH, a converted form of Hcy, was performed without any damage to reagents in chips, and the results showed that the fluorescent signal from antibody antigen binding decreased as the SAH concentration increased. Based on the SAH immunoassay, whole immunoassay steps for Hcy detection were carried out in plastic microfluidic chips with all necessary reagents. These experiments demonstrated the feasibility of the Hcy immunoassay in microfluidic devices

  20. The work and challenges of care managers in the implementation of collaborative care: A qualitative study.

    Science.gov (United States)

    Overbeck, G; Kousgaard, M B; Davidsen, A S

    2018-04-01

    WHAT IS KNOWN ON THE SUBJECT?: In collaborative care models between psychiatry and general practice, mental health nurses are used as care managers who carry out the treatment of patients with anxiety or depression in general practice and establish a collaborating relationship with the general practitioner. Although the care manager is the key person in the collaborative care model, there is little knowledge about this role and the challenges involved in it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study shows that before the CMs could start treating patients in a routine collaborative relationship with GPs, they needed to carry out an extensive amount of implementation work. This included solving practical problems of location and logistics, engaging GPs in the intervention, and tailoring collaboration to meet the GP's particular preferences. Implementing the role requires high commitment and an enterprising approach on the part of the care managers. The very experienced mental health nurses of this study had these skills. However, the same expertise cannot be presumed in a disseminated model. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When introducing new collaborative care interventions, the care manager role should be well defined and be well prepared, especially as regards the arrival of the care manager in general practice, and supported during implementation by a coordinated leadership established in collaboration between hospital psychiatry and representatives from general practice. Introduction In collaborative care models for anxiety and depression, the care manager (CM), often a mental health nurse, has a key role. However, the work and challenges related to this role remain poorly investigated. Aim To explore CMs' experiences of their work and the challenges they face when implementing their role in a collaborative care intervention in the Capital Region of Denmark. Methods Interviews with eight CMs, a group interview with five CMs and a recording

  1. Do governance choices matter in health care networks?: an exploratory configuration study of health care networks

    Science.gov (United States)

    2013-01-01

    Background Health care networks are widely used and accepted as an organizational form that enables integrated care as well as dealing with complex matters in health care. However, research on the governance of health care networks lags behind. The research aim of our study is to explore the type and importance of governance structure and governance mechanisms for network effectiveness. Methods The study has a multiple case study design and covers 22 health care networks. Using a configuration view, combinations of network governance and other network characteristics were studied on the level of the network. Based on interview and questionnaire data, network characteristics were identified and patterns in the data looked for. Results Neither a dominant (or optimal) governance structure or mechanism nor a perfect fit among governance and other characteristics were revealed, but a number of characteristics that need further study might be related to effective networks such as the role of governmental agencies, legitimacy, and relational, hierarchical, and contractual governance mechanisms as complementary factors. Conclusions Although the results emphasize the situational character of network governance and effectiveness, they give practitioners in the health care sector indications of which factors might be more or less crucial for network effectiveness. PMID:23800334

  2. Interprofessional collaboration regarding patients' care plans in primary care: a focus group study into influential factors.

    Science.gov (United States)

    van Dongen, Jerôme Jean Jacques; Lenzen, Stephanie Anna; van Bokhoven, Marloes Amantia; Daniëls, Ramon; van der Weijden, Trudy; Beurskens, Anna

    2016-05-28

    The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding interprofessional collaboration related to care plan development in primary care. A qualitative study, including four semi-structured focus group interviews (n = 4). In total, a heterogeneous group of experts (n = 16) and health care professionals (n = 15) participated. Participants discussed viewpoints, barriers, and facilitators regarding interprofessional collaboration related to care plan development. The data were analysed by means of inductive content analysis. The findings show a variety of factors influencing the interprofessional collaboration in developing a care plan. Factors can be divided into 5 key categories: (1) patient-related factors: active role, self-management, goals and wishes, membership of the team; (2) professional-related factors: individual competences, domain thinking, motivation; (3) interpersonal factors: language differences, knowing each other, trust and respect, and motivation; (4) organisational factors: structure, composition, time, shared vision, leadership and administrative support; and (5) external factors: education, culture, hierarchy, domain thinking, law and regulations, finance, technology and ICT. Improving interprofessional collaboration regarding care plan development calls for an integral approach including patient- and professional related factors, interpersonal, organisational, and external factors. Further, the leader of the team seems to play a key role in watching the patient perspective, organising and coordinating interprofessional collaborations, and guiding the team through developments. The results of this study can be used as input for developing tools and interventions targeted at executing and improving interprofessional

  3. HOME CARE NURSES’ ROLES IN ENHANCING QUALITY OF NURSING CARE FOR PATIENTS AT HOME: A PHENOMENOLOGICAL STUDY

    OpenAIRE

    Titan Ligita

    2017-01-01

    Background: Provision of health care service at home is one of the advanced forms of care for patients being discharged from hospitalization. Little is known about the experience of nurses providing home care services through a nursing home-care model especially in Indonesian context. Objective: This study aims to explore the experience in order to increase understanding on the form of home care provision, and consequently the nurses may understand the form of home care globally. Metho...

  4. Lab-on-a-Chip Systems for Biomedical and Environmental Monitoring

    NARCIS (Netherlands)

    Gardeniers, Johannes G.E.; van den Berg, Albert

    2003-01-01

    During the last decade, pocket-size analytical equipment based on the "lab-on-a-chip" approach has become available. These chips, in combination with portable electronic equipment, are applicable in e.g. "point-of-care" ion analysis of body fluids, forensics, identification of explosives, tracking

  5. Lab-on-a-Chip systems for biomedical and environmental monitoring

    NARCIS (Netherlands)

    Gardeniers, Johannes G.E.; van den Berg, Albert

    2004-01-01

    During the last decade, pocket-sized analytical equipment based on the lab-on-a-chip approach has become available. These chips, in combination with portable electronic equipment, are applicable in, for example, point-of-care ion analysis of body fluids, forensics, identification of explosives,

  6. Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands.

    NARCIS (Netherlands)

    Perdok, H.; Jans, S.; Verhoeven, C.; Henneman, L.; Wiegers, T.; Mol, B.W.; Schellevis, F.; Jonge, A. de

    2016-01-01

    Background: This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care. Methods: Qualitative study using

  7. Effective factors in providing holistic care: A qualitative study

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh

    2015-01-01

    Full Text Available Background: Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses′ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. Materials and Methods: A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  8. Comparative study of 2 oral care protocols in intensive care units.

    Science.gov (United States)

    Ory, Jérôme; Raybaud, Evelyne; Chabanne, Russell; Cosserant, Bernard; Faure, Jean Sébastien; Guérin, Renaud; Calvet, Laure; Pereira, Bruno; Mourgues, Charline; Guelon, Dominique; Traore, Ousmane

    2017-03-01

    The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates. This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored. A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002). Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  9. Opto-electronic DNA chip-based integrated card for clinical diagnostics.

    Science.gov (United States)

    Marchand, Gilles; Broyer, Patrick; Lanet, Véronique; Delattre, Cyril; Foucault, Frédéric; Menou, Lionel; Calvas, Bernard; Roller, Denis; Ginot, Frédéric; Campagnolo, Raymond; Mallard, Frédéric

    2008-02-01

    Clinical diagnostics is one of the most promising applications for microfluidic lab-on-a-chip or lab-on-card systems. DNA chips, which provide multiparametric data, are privileged tools for genomic analysis. However, automation of molecular biology protocol and use of these DNA chips in fully integrated systems remains a great challenge. Simplicity of chip and/or card/instrument interfaces is amongst the most critical issues to be addressed. Indeed, current detection systems for DNA chip reading are often complex, expensive, bulky and even limited in terms of sensitivity or accuracy. Furthermore, for liquid handling in the lab-on-cards, many devices use complex and bulky systems, either to directly manipulate fluids, or to ensure pneumatic or mechanical control of integrated valves. All these drawbacks prevent or limit the use of DNA-chip-based integrated systems, for point-of-care testing or as a routine diagnostics tool. We present here a DNA-chip-based protocol integration on a plastic card for clinical diagnostics applications including: (1) an opto-electronic DNA-chip, (2) fluid handling using electrically activated embedded pyrotechnic microvalves with closing/opening functions. We demonstrate both fluidic and electric packaging of the optoelectronic DNA chip without major alteration of its electronical and biological functionalities, and fluid control using novel electrically activable pyrotechnic microvalves. Finally, we suggest a complete design of a card dedicated to automation of a complex biological protocol with a fully electrical fluid handling and DNA chip reading.

  10. Patient autonomy and advance care planning: a qualitative study of oncologist and palliative care physicians' perspectives.

    Science.gov (United States)

    Johnson, Stephanie B; Butow, Phyllis N; Kerridge, Ian; Tattersall, Martin H N

    2018-02-01

    Patients' are encouraged to participate in advance care planning (ACP) in order to enhance their autonomy. However, controversy exists as to what it means to be autonomous and there is limited understanding of how social and structural factors may influence cancer patients' ability to exercise their autonomy. The objective of this study is to explore oncologists' and palliative care physicians' understanding of patient autonomy, how this influences reported enactment of decision-making at the end of life (EOL), and the role of ACP in EOL care. Qualitative semi-structured interviews were conducted with consultant oncologists (n = 11) and palliative medicine doctors (n = 7) working in oncology centres and palliative care units across Australia. We found that doctors generally conceptualized autonomy in terms of freedom from interference but that there was a profound disconnect between this understanding of autonomy and clinical practice in EOL decision-making. The clinicians in our study privileged care, relationships and a 'good death' above patient autonomy, and in practice were reluctant to 'abandon' their patients to total non-interference in decision-making. Patient autonomy in healthcare is bounded, as while patients were generally encouraged to express their preferences for care, medical norms about the quality and 'reasonableness' of care, the availability of services and the patients' family relationships act to enhance or limit patients' capacity to realize their preferences. While for many, this disconnect between theory and practice did not diminish the rhetorical appeal of ACP; for others, this undermined the integrity of ACP, as well as its relevance to care. For some, ACP had little to do with patient autonomy and served numerous other ethical, practical and political functions. The ethical assumptions regarding patient autonomy embedded in academic literature and policy documents relating to ACP are disconnected from the realities of clinical care

  11. Improving Diabetes Care in the Military Primary Care Clinic: Case Study Review

    Science.gov (United States)

    2016-03-23

    This research study combines qualitative and quantitative methodology in reflectively exploring positive case studies to ascertain strategies that...enabled patients to engage in self-management. Moreover, this study seeks to better understand how applying the ADA Standards of Care in a military

  12. [Comparative study of burnout in Intensive Care and Emergency Care nursing staff].

    Science.gov (United States)

    Ríos Risquez, M I; Godoy Fernández, C; Peñalver Hernández, F; Alonso Tovar, A R; López Alcaraz, F; López Romera, A; Garnés González, S; Salmerón Saura, E; López Real, M D; Ruiz Sánchez, R; Simón Domingo, P; Manzanera Nicolás, J L; Menchón Almagro, M A; Liébanas Bellón, R

    2008-01-01

    To assess and compare the burnout level between Intensive Care Unit and Emergency Unit, and study its association with the sociodemographic and work characteristics of the professionals surveyed. Cross-sectional, descriptive study. Emplacement. Intensive Care Unit of the university hospital Morales Meseguer, Murcia-Spain. STUDIED SAMPLE: 97 nursing professionals: 55 professionals belong to the Emergency Department, and 42 professionals belong to the Intensive Care Department. Two evaluation tools were used: a sociodemographic and work survey, and the Maslach Burnout Inventory, 1986. Quantitative variables expressed as mean +/- SD compared with the Student's T test and qualitative variables compared with the chi2 test. SPSS 12.0(c). The comparative analysis of the burnout dimensions shows that emotional exhaustion level is significantly higher in the intensive care service than in the emergency one (25.45 +/- 11.15 vs 22.09 +/- 10.99) p burnout dimensions do not show significant differences between both departments. The masculine gender obtains a higher score in the depersonalization dimension of burnout (10.12 +/- 5.38) than female one (6.7 +/- 5.21) p burnout levels are moderate to high among the nursing professionals studied. A total of 5.15% of the sample studied achieves a high score in the three dimensions of the burnout syndrome. The intensive care professionals are the most vulnerable to suffering high levels of emotional exhaustion, and the masculine gender is more susceptible to depersonalization attitudes.

  13. Competencies of specialised wound care nurses: a European Delphi study.

    Science.gov (United States)

    Eskes, Anne M; Maaskant, Jolanda M; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A; Ubbink, Dirk T; Vermeulen, Hester

    2014-12-01

    Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries as to the competencies for specialised wound care nurses that meet international professional expectations and educational systems. Wound care experts including doctors, wound care nurses, lecturers, managers and head nurses were invited to contribute to an e-Delphi study. They completed online questionnaires based on the Canadian Medical Education Directives for Specialists framework. Suggested competencies were rated on a 9-point Likert scale. Consensus was defined as an agreement of at least 75% for each competence. Response rates ranged from 62% (round 1) to 86% (rounds 2 and 3). The experts reached consensus on 77 (80%) competences. Most competencies chosen belonged to the domain 'scholar' (n = 19), whereas few addressed those associated with being a 'health advocate' (n = 7). Competencies related to professional knowledge and expertise, ethical integrity and patient commitment were considered most important. This consensus on core competencies for specialised wound care nurses may help achieve a more uniform definition and education for specialised wound care nurses. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  14. Embedding care management in the medical home: a case study.

    Science.gov (United States)

    Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D

    2014-04-01

    Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.

  15. Shared Care of Childhood Cancer Survivors: A Telemedicine Feasibility Study.

    Science.gov (United States)

    Costello, Aimee G; Nugent, Bethany D; Conover, Noelle; Moore, Amanda; Dempsey, Kathleen; Tersak, Jean M

    2017-12-01

    With an increasing number of childhood cancer survivors (CCSs), determining the best model of survivorship transition care is becoming a growing priority. Shared care between pediatric oncology and adult primary care is often necessary, making survivorship a time of transition, but effective standard models are lacking. We sought to provide a more integrated approach to transition using telemedicine. Recruited primary care provider/CCS dyads were instructed to log-in to a password-protected virtual meeting room using telemedicine equipment at the time or a regularly scheduled office visit. Dyads were joined by a pediatric survivorship clinic team member who conducted the telemedicine portion of the transition visit, which consisted of the review of an individualized treatment summary and care plan. Postquestionnaires were developed to evaluate key points such as fund of knowledge, satisfaction with the visit, and effectiveness of this electronic tool. There were 19 transition visits conducted, 13 of which used the telemedicine equipment as planned. Those that did not use the equipment were primarily unable to due to technical difficulties. Postquestionnaires were overall positive, confirming increased knowledge, comfort and abilities, and patient satisfaction in survivorship care. Negative comments were primarily related to equipment difficulties. A gap still remains in helping CCSs transition from oncology to primary care and this pilot study offered insights into how we might better bridge that gap through the use of telemedicine. Further research is needed to refine the transition process for CCSs, including evaluation and testing models for standard of care.

  16. The effect of location and facility demand on the marginal cost of delivered wood chips from energy crops: A case study of the state of Tennessee

    International Nuclear Information System (INIS)

    Graham, R.L.; Liu, W.; Downing, M.; Noon, C.; Daly, M.; Moore, A.

    1995-01-01

    Cost-supply curves for delivered wood chips from short rotation woody crops were calculated for 21 regularly-spaced locations spanning the state of Tennessee. These curves were used to systematically evaluate the combined effects of location and facility demand on wood chip feedstock costs in Tennessee. The cost-supply curves were developed using BRAVO, a GIS-based decision support system which calculates marginal cost of delivering wood chips to a specific location given road network maps and maps of farmgate prices and supplies of woody chips from short rotation energy crops. Marginal costs of delivered chips varied by both facility location in the state and facility demand. Marginal costs were lowest in central Tennessee unless the facility demand was greater than 2.7 million dry Mg per year (3 million dry tons per year) in which case west Tennessee was the lowest cost region. Marginal costs rose rapidly with increasing facility demand in the mountainous eastern portion of the state. Transportation costs accounted for 18 to 29% of the delivered cost and ranged between $8 and $18/dry Mg ($7 and $16/dry ton). Reducing the expected farmer participation rate from 100% to 50% or 25% dramatically raised the marginal costs of feedstock supply in the east and central regions of the state. The analysis demonstrates the need to use geographically-specific information when projecting the potential costs and supplies of biomass feedstock

  17. Maintaining patients' dignity during clinical care: a qualitative interview study.

    Science.gov (United States)

    Lin, Yea-Pyng; Tsai, Yun-Fang

    2011-02-01

    This article is a report of a study undertaken to understand how nurses maintain patients' dignity in clinical practice. Dignity is a core concept in nursing care and maintaining patients' dignity is critical to their recovery. In Western countries, measures to maintain dignity in patients' care include maintaining privacy of the body, providing spatial privacy, giving sufficient time, treating patients as a whole person and allowing patients to have autonomy. However, this is an under-studied topic in Asian countries. For this qualitative descriptive study, data were collected in Taiwan in 2009 using in-depth interviews with a purposive sample of 30 nurses from a teaching hospital in eastern Taiwan. The audiotaped interviews were transcribed verbatim and analysed using content analysis. Nurses' measures to maintain dignity in patient care were captured in five themes: respect, protecting privacy, emotional support, treating all patients alike and maintaining body image. Participants did not mention beneficence, a crucial element achieved through the professional care of nurses that can enhance the recovery of patients. In-service education to help nurses enhance dignity in patient care should emphasize emotional support, maintaining body image and treating all patients alike. Our model for maintaining dignity in patient care could be used to develop a clinical care protocol for nurses to use in clinical practice. © 2010 Blackwell Publishing Ltd.

  18. Using wound care algorithms: a content validation study.

    Science.gov (United States)

    Beitz, J M; van Rijswijk, L

    1999-09-01

    Valid and reliable heuristic devices facilitating optimal wound care are lacking. The objectives of this study were to establish content validation data for a set of wound care algorithms, to identify their associated strengths and weaknesses, and to gain insight into the wound care decision-making process. Forty-four registered nurse wound care experts were surveyed and interviewed at national and regional educational meetings. Using a cross-sectional study design and an 83-item, 4-point Likert-type scale, this purposive sample was asked to quantify the degree of validity of the algorithms' decisions and components. Participants' comments were tape-recorded, transcribed, and themes were derived. On a scale of 1 to 4, the mean score of the entire instrument was 3.47 (SD +/- 0.87), the instrument's Content Validity Index was 0.86, and the individual Content Validity Index of 34 of 44 participants was > 0.8. Item scores were lower for those related to packing deep wounds (P valid and reliable definitions. The wound care algorithms studied proved valid. However, the lack of valid and reliable wound assessment and care definitions hinders optimal use of these instruments. Further research documenting their clinical use is warranted. Research-based practice recommendations should direct the development of future valid and reliable algorithms designed to help nurses provide optimal wound care.

  19. [A case study on duty of care in professional nursing].

    Science.gov (United States)

    Huang, Hui-Man; Liao, Chi-Chun

    2013-08-01

    Nurses are expected to discharge their duty of care effectively and professionally to prevent medical negligence. Only three articles have previously focused on medical negligence. Duty of care and medical negligence in nursing are topics that have been neglected in Taiwan. (1) Classify the duty of care of professional nurses; (2) Investigate the facts and disputes in the current case; (3) Clarify the legal issues involved with regard to duty-of-care violations in the current case; (4) Explore the causal relationships in a legal context between nurses' duty-of-care violations and patient harm / injury. Literature analysis and a case study are used to analyze Supreme Court Verdict No.5550 (2010). Duty of care for nursing professionals may be classified into seven broad categories. Each category has its distinct correlatives. In nursing practice, every nursing behavior has a corresponding duty. In this case, the case study nurse did not discharge her obstetric professional duty and failed to inform the doctor in a timely manner. Negligence resulted in prenatal death and the case study nurse was found guilty. In order to prevent committing a crime, nurses should gain a better understanding of their duty of care and adequately discharge these duties in daily practice.

  20. Telephone Care Management of Fall Risk:: A Feasibility Study.

    Science.gov (United States)

    Phelan, Elizabeth A; Pence, Maureen; Williams, Barbara; MacCornack, Frederick A

    2017-03-01

    Care management has been found to be more effective than usual care for some chronic conditions, but few studies have tested care management for prevention of elder falls. This study aimed to assess the feasibility and preliminary efficacy of telephone care management of older adults presenting for medical attention due to a fall. The setting was an independent practice association in western Washington serving 1,300 Medicare Advantage-insured patients. Patients aged ≥65 years treated for a fall in an emergency department or their primary care provider's office were contacted via telephone by a care manager within 48 hours of their fall-related visit and invited to participate in a telephone-administered interview to identify modifiable fall risk factors and receive recommendations and follow-up to address identified risk factors. Data from care manager records, patient medical records, and healthcare claims for the first 6 months (November 2009-April 2010) of program implementation were analyzed in 2011. The feasibility of screening and management of fall risk factors over the telephone and the effect on medically attended falls were assessed. Twenty-two patients eligible for fall care management were reached and administered the protocol. Administration took 15-20 minutes and integrated easily with the care manager's other responsibilities. Follow-through on recommendations varied, from 45% for those for whom exercise participation was recommended to 100% for other recommendations. No medically attended falls occurred over 6 months of follow-up. Telephone care management of fall risk appears feasible and may reduce falls requiring medical attention. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Experiment list: SRX122496 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available || chip antibody=Rel || treatment=LPS || time=120 min || chip antibody manufacturer 1=Santa Cruz || chip ant...ibody catalog number 1=sc-71 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc

  2. Materials for microfluidic chip fabrication.

    Science.gov (United States)

    Ren, Kangning; Zhou, Jianhua; Wu, Hongkai

    2013-11-19

    Through manipulating fluids using microfabricated channel and chamber structures, microfluidics is a powerful tool to realize high sensitive, high speed, high throughput, and low cost analysis. In addition, the method can establish a well-controlled microenivroment for manipulating fluids and particles. It also has rapid growing implementations in both sophisticated chemical/biological analysis and low-cost point-of-care assays. Some unique phenomena emerge at the micrometer scale. For example, reactions are completed in a shorter amount of time as the travel distances of mass and heat are relatively small; the flows are usually laminar; and the capillary effect becomes dominant owing to large surface-to-volume ratios. In the meantime, the surface properties of the device material are greatly amplified, which can lead to either unique functions or problems that we would not encounter at the macroscale. Also, each material inherently corresponds with specific microfabrication strategies and certain native properties of the device. Therefore, the material for making the device plays a dominating role in microfluidic technologies. In this Account, we address the evolution of materials used for fabricating microfluidic chips, and discuss the application-oriented pros and cons of different materials. This Account generally follows the order of the materials introduced to microfluidics. Glass and silicon, the first generation microfluidic device materials, are perfect for capillary electrophoresis and solvent-involved applications but expensive for microfabriaction. Elastomers enable low-cost rapid prototyping and high density integration of valves on chip, allowing complicated and parallel fluid manipulation and in-channel cell culture. Plastics, as competitive alternatives to elastomers, are also rapid and inexpensive to microfabricate. Their broad variety provides flexible choices for different needs. For example, some thermosets support in-situ fabrication of

  3. Introducing Namaste Care to the hospital environment: a pilot study.

    Science.gov (United States)

    St John, Kimberley; Koffman, Jonathan

    2017-10-01

    The rising prevalence of dementia is impacting on acute hospitals and placing increased expectations on health and social care professionals to improve the support and services they are delivering. It has been recommended that good practice in dementia care relies on adopting a palliative approach to care and meeting people's physical, psychological, social and spiritual needs. Increased dementia training for staff that includes initiatives that promote dignity; enhancing communication skills and recognizing that a person with dementia may be approaching the end of their lives are needed. Our study aim was to explore whether Namaste Care is an acceptable and effective service for people with advanced dementia being cared for on an acute hospital ward. This was an exploratory qualitative interview, pilot study. Individual, semi-structured, face-to-face interviews were conducted with hospital healthcare staff working in an area of the hospital where Namaste Care had been implemented. Data were analysed using the framework approach. Eight interviews were completed with members of the multidisciplinary ward team. Two themes were identified: (I) difficulties establishing relationships with people with dementia in hospital (subthemes: lack of time and resources, lack of confidence leading to fear and anxiety); (II) the benefits of a Namaste Care service in an acute hospital setting (subthemes: a reduction in agitated behavior; connecting and communicating with patients with dementia using the senses; a way of showing people with dementia they are cared for and valued). This small-scale study indicates that Namaste Case has the potential to improve the quality of life of people with advanced dementia being cared for in an acute hospital setting. However, further research is required to explore more specifically its benefits in terms of improved symptom management and wellbeing of people with dementia on acute hospitals wards.

  4. An Approach to measuring Integrated Care within a Maternity Care System: Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study

    Science.gov (United States)

    Valentijn, Pim P.; Hitzert, Marit; Hermus, Marieke A.A.; Franx, Arie; de Vries, Raymond G.; Wiegers, Therese A.; Bruijnzeels, Marc A.

    2017-01-01

    Introduction: Integrated care is considered to be a means to reduce costs, improve the quality of care and generate better patient outcomes. At present, little is known about integrated care in maternity care systems. We developed questionnaires to examine integrated care in two different settings, using the taxonomy of the Rainbow Model of Integrated Care. The aim of this study was to explore the validity of these questionnaires. Methods: We used data collected between 2013 and 2015 from two studies: the Maternity Care Network Study (634 respondents) and the Dutch Birth Centre Study (56 respondents). We assessed the feasibility, discriminative validity, and reliability of the questionnaires. Results: Both questionnaires showed good feasibility (overall missing rate 0.70). Between-subgroups post-hoc comparisons showed statistically significant differences on integration profiles between regional networks (on all items, dimensions of integration and total integration score) and birth centres (on 50% of the items and dimensions of integration). Discussion: Both questionnaires are feasible and can discriminate between sites with different integration profiles in The Netherlands. They offer an opportunity to better understand integrated care as one step in understanding the complexity of the concept. PMID:28970747

  5. Taiwanese women's experiences of hospital midwifery care: a phenomenological study.

    Science.gov (United States)

    Kuo, Su-Chen; Wu, Cheng Jing; Mu, Pei-Fan

    2010-08-01

    to explore women's experiences in interaction with their midwives during their antenatal checks and during labour. a qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews. All interviews were transcribed verbatim. Data were analysed using Colaizzi's method for data analysis. the homes of the study participants in the district of a Taipei (Taiwan) teaching hospital. a purposive sample of 11 Taiwanese women, one primipara, and 10 multiparae, who were one to three months post-childbirth at the time of interview. five major themes revealed the essence of women's experiences of their interaction with a midwife during pregnancy and childbirth: (1) being respected, (2) being accompanied, (3) trust, (4) being satisfied, and (5) professional competence. the women recognised the service model of the midwife; they treasured their mutual relationships and the benefits that women derived from midwifery care during childbirth. In Taiwan, the government is mandated to offer midwifery models of care in hospitals, and to allow women to choose different types of care provider. an awareness of women's experiences will help identify the caring behaviours as recognised by the women and may help health-care professionals provide better support and care for women during the pregnancy and childbirth periods. These findings can serve as references for future midwifery practice models and improvements in quality of care. Crown Copyright 2008. Published by Elsevier Ltd. All rights reserved.

  6. Acrylamide formation in plantain (Musa paradisiaca) chips influenced by different ripening stages: A correlation study with respect to reducing sugars, amino acids and phenolic content.

    Science.gov (United States)

    Shamla, L; Nisha, P

    2017-05-01

    The effect of ripening on the formation of acrylamide in deep fried plantain chips made from Nendran variety (Musa paradisiaca) was investigated. The precursors of acrylamide formation, reducing sugars (glucose and fructose) and ten major amino acids, were quantified during different stages of ripening using HPLC and correlated with acrylamide formation. The total phenolic content and total flavonoid content were also estimated and correlated with acrylamide formation. Both glucose and fructose increased during ripening and demonstrated a positive correlation on formation of acrylamide (correlation coefficient of r=0.95 and 0.94 respectively (p0.05). The decreased levels of phenolic content during ripening of plantain were negatively correlated with acrylamide formation in the deep fried chips prepared. Thus the selection of proper ripening stage renders reduced formation of acrylamide in plantain chips to a reasonable extend. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Atom chips: mesoscopic physics with cold atoms

    International Nuclear Information System (INIS)

    Krueger, P.; Wildermuth, S.; Hofferberth, S.; Haller, E.; GAllego Garcia, D.; Schmiedmayer, J.

    2005-01-01

    Full text: Cold neutral atoms can be controlled and manipulated in microscopic potentials near surfaces of atom chips. These integrated micro-devices combine the known techniques of atom optics with the capabilities of well established micro- and nanofabrication technology. In analogy to electronic microchips and integrated fiber optics, the concept of atom chips is suitable to explore the domain of mesoscopic physics with matter waves. We use current and charge carrying structures to form complex potentials with high spatial resolution only microns from the surface. In particular, atoms can be confined to an essentially one-dimensional motion. In this talk, we will give an overview of our experiments studying the manipulation of both thermal atoms and BECs on atom chips. First experiments in the quasi one-dimensional regime will be presented. These experiments profit from strongly reduced residual disorder potentials caused by imperfections of the chip fabrication with respect to previously published experiments. This is due to our purely lithographic fabrication technique that proves to be advantageous over electroplating. We have used one dimensionally confined BECs as an ultra-sensitive probe to characterize these potentials. These smooth potentials allow us to explore various aspects of the physics of degenerate quantum gases in low dimensions. (author)

  8. Study on the functional improvement of the CARE system

    International Nuclear Information System (INIS)

    Han, Seung Jae; Nam, K. W.; Kim, D. I.; Kim, D. S.; Kim, S. H.; Kang, W. S.; Kim, B. H.

    2003-12-01

    The CARE system was developed in order to protect the public during nuclear emergency in Korea by KINS staffs with cooperation of other concerned organizations. In this study, some improvements to be considered for effective operation of CARE system were drawn. In 2002, Emergency Technical Advisory Center was constructed. Following the function of this center, the CARE system should be enforced for effective analysis of the nuclear power plant operation and the severe accident as well as for another areas such as radiological accidents and physical protection. The modules in this system shall be expanded to analysis of broader radiological accidents by long-range consequences modelling and so on

  9. Chips with everything

    CERN Document Server

    CERN. Geneva

    2007-01-01

    In March 1972, Sir Robin Saxby gave a talk to the Royal Television Society called 'TV and Chips' about a 'state of the art' integrated circuit, containing 50 resistors and 50 transistors. Today's 'state of the art' chips contain up to a billion transistors. This enormous leap forward illustrates how dramatically the semiconductor industry has evolved in the past 34 years. The next 10 years are predicted to bring times of turbulent change for the industry, as more and more digital devices are used around the world. In this talk, Sir Robin will discuss the history of the Microchip Industry in parallel with ARM's history, demonstrating how a small European start-up can become a world player in the IT sector. He will also present his vision of important applications and developments in the next 20 years that are likely to become even more pervasive than the mobile phone is today, and will provide anecdotes and learning points from his own experience at ARM. About ARM: Sir Robin and a group of designers from Acorn...

  10. Satisfaction with palliative care after stroke: a prospective cohort study.

    Science.gov (United States)

    Blacquiere, Dylan; Bhimji, Khadija; Meggison, Hilary; Sinclair, John; Sharma, Michael

    2013-09-01

    The determinants of satisfaction for families of acute stroke patients receiving palliative care have not been extensively studied. We surveyed families to determine how they perceived palliative care after stroke. Families of patients palliated after ischemic stroke, intracerebral, or subarachnoid hemorrhage were approached. Four weeks after the patient's death, families were administered the After-Death Bereaved Family Member Interview to determine satisfaction with the care provided. Fifteen families participated. Families were most satisfied with participation in decision making and least satisfied with attention to emotional needs. In stroke-specific domains, families had less satisfaction with artificial feeding, hydration, and communication. Overall satisfaction was high (9.04 out of 10). Families of patients receiving palliative care at our institution showed generally high satisfaction with palliation after stroke; specific domains were identified for improvement. Further study in larger populations is required.

  11. Brain-oriented care in the NICU: a case study.

    Science.gov (United States)

    Bader, Lisa

    2014-01-01

    With the advances of technology and treatment in the field of neonatal care, researchers can now study how the brains of preterm infants are different from full-term infants. The differences are significant, and the outcomes are poor overall for premature infants as a whole. Caregivers at the bedside must know that every interaction with the preterm infant affects brain development-it is critical to the developmental outcome of the infant. The idea of neuroprotection is not new to the medical field but is a fairly new idea to the NICU. Neuroprotection encompasses all interventions that promote normal development of the brain. The concept of brain-oriented care is a necessary extension of developmental care in the NICU. By following the journey of 26-week preterm twin infants through a case study, one can better understand the necessity of brain-oriented care at the bedside.

  12. Radiotherapy care experience: an anthropological study

    International Nuclear Information System (INIS)

    Hoarau, H.; Hubert, A.; Kantor, G.; Dilhuydy, J.M.; Germain, C.; Barreau, C.; Dilhuydy, J.M.

    2000-01-01

    An anthropological study has been carried out in order to evaluate the need expressed by patients undergoing radiotherapy treatment. The study was mostly qualitative and based on the radiotherapy experiences of 13 women with breast cancer and six men with head and neck cancer. A 24-year-old female anthropologist spent one year in the department of radiotherapy at the Bergonie Institute in Bordeaux. She collected data on patients' needs through the observation of their experience of treatment and personal interviews. These were put in context, analyzed both by qualitative and quantitative methods. The results pointed out the need for more information on the different steps of treatment and the patient's need 'for a smile'front the medical team; in other words, emphatic support. (author)

  13. Concepts of person-centred care: a framework analysis of five studies in daily care practices

    Directory of Open Access Journals (Sweden)

    Margreet

    2016-11-01

    Full Text Available Background: Person-centred care is used as a term to indicate a ‘made to measure’ approach in care. But what does this look like in daily practice? The person-centred nursing framework developed by McCormack and McCance (2010 offers specific concepts but these are still described in rather general terms. Empirical studies, therefore, could help to clarify them and make person-centredness more tangible for nurses. Aims: This paper describes how a framework analysis aimed to clarify the concepts described in the model of McCormack and McCance in order to guide professionals using them in practice. Methods: Five separate empirical studies focusing on older adults in the Netherlands were used in the framework analysis. The research question was: ‘How are concepts of person-centred care made tangible where empirical data are used to describe them?’ Analysis was done in five steps, leading to a comparison between the description of the concepts and the empirical significance found in the studies. Findings: Suitable illustrations were found for the majority of concepts. The results show that an empirically derived specification emerges from the data. In the concept of ‘caring relationship’ for example, it is shown that the personal character of each relationship is expressed by what the nurse and the older person know about each other. Other findings show the importance of values being present in care practices. Conclusions: The framework analysis shows that concepts can be clarified when empirical studies are used to make person-centred care tangible so nurses can understand and apply it in practice. Implications for practice: The concepts of the person-centred nursing framework are recognised when: Nurses know unique characteristics of the person they care for and what is important to them, and act accordingly Nurses use values such as trust, involvement and humour in their care practice Acknowledgement of emotions and compassion create

  14. Biosensors-on-chip: a topical review

    International Nuclear Information System (INIS)

    Chen, Sensen; Shamsi, Mohtashim H

    2017-01-01

    This review will examine the integration of two fields that are currently at the forefront of science, i.e. biosensors and microfluidics. As a lab-on-a-chip (LOC) technology, microfluidics has been enriched by the integration of various detection tools for analyte detection and quantitation. The application of such microfluidic platforms is greatly increased in the area of biosensors geared towards point-of-care diagnostics. Together, the merger of microfluidics and biosensors has generated miniaturized devices for sample processing and sensitive detection with quantitation. We believe that microfluidic biosensors (biosensors-on-chip) are essential for developing robust and cost effective point-of-care diagnostics. This review is relevant to a variety of disciplines, such as medical science, clinical diagnostics, LOC technologies including MEMs/NEMs, and analytical science. Specifically, this review will appeal to scientists working in the two overlapping fields of biosensors and microfluidics, and will also help new scientists to find their directions in developing point-of-care devices. (topical review)

  15. Designing a mixed methods study in primary care.

    Science.gov (United States)

    Creswell, John W; Fetters, Michael D; Ivankova, Nataliya V

    2004-01-01

    Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations. We first identified criteria from the social and behavioral sciences to analyze mixed methods studies in primary care research. We then used the criteria to evaluate 5 mixed methods investigations published in primary care research journals. Of the 5 studies analyzed, 3 included a rationale for mixing based on the need to develop a quantitative instrument from qualitative data or to converge information to best understand the research topic. Quantitative data collection involved structured interviews, observational checklists, and chart audits that were analyzed using descriptive and inferential statistical procedures. Qualitative data consisted of semistructured interviews and field observations that were analyzed using coding to develop themes and categories. The studies showed diverse forms of priority: equal priority, qualitative priority, and quantitative priority. Data collection involved quantitative and qualitative data gathered both concurrently and sequentially. The integration of the quantitative and qualitative data in these studies occurred between data analysis from one phase and data collection from a subsequent phase, while analyzing the data, and when reporting the results. We recommend instrument-building, triangulation, and data transformation models for mixed methods designs as useful frameworks to add rigor to investigations in primary care. We also discuss the limitations of our study and the need for future research.

  16. Practices in Human Dignity in Palliative Care: A Qualitative Study.

    Science.gov (United States)

    Akin Korhan, Esra; Üstün, Çağatay; Uzelli Yilmaz, Derya

    Respecting and valuing an individual's existential dignity forms the basis of nursing and medical practice and of nursing care. The objective of the study was to determine the approach to human dignity that nurses and physicians have while providing palliative care. This qualitative study was performed using a phenomenological research design. In-depth semistructured interviews were conducted in 9 nurses and 5 physicians with human dignity approach in palliative care. Following the qualitative Colaizzi method of analyzing the data, the statements made by the nurses and physicians during the interviews were grouped under 8 categories. Consistent with the questionnaire format, 8 themes and 43 subthemes of responses were determined describing the human dignity of the nurse and the physicians. The results of the study showed that in some of the decisions and practices of the nurses giving nursing care and physicians giving medical care to palliative care patients, while they displayed ethically sensitive behavior, on some points, they showed approaches that violated human dignity and showed lack of awareness of ethical, medical, and social responsibilities.

  17. Primary care and communication in shared cancer care: A Qualitative Study

    Science.gov (United States)

    Sada, Yvonne; Street, Richard L.; Singh, Hardeep; Shada, Rachel; Naik, Aanand D.

    2013-01-01

    Objective To explore perceptions of primary care physicians’ (PCPs) and oncologists’ roles, responsibilities, and patterns of communication related to shared cancer care in three integrated health systems that used electronic health records (EHRs). Study design Qualitative study. Methods We conducted semi-structured interviews with ten early stage colorectal cancer patients and fourteen oncologists and PCPs. Sample sizes were determined by thematic saturation. Dominant themes and codes were identified and subsequently applied to all transcripts. Results Physicians reported that EHRs improved communication within integrated systems, but communication with physicians outside their system was still difficult. PCPs expressed uncertainty about their role during cancer care, even though medical oncologists emphasized the importance of co-morbidity control during cancer treatment. Both patients and physicians described additional roles for PCPs, including psychological distress support and behavior modification. Conclusions Integrated systems that use EHRs likely facilitate shared cancer care through improved PCP-oncologist communication. However, strategies to facilitate a more active role for PCPs in managing co-morbidities, psychological distress and behavior modification, as well as to overcome communication challenges between physicians not practicing within the same integrated system, are still needed to improve shared cancer care. PMID:21615196

  18. HOME CARE NURSES’ ROLES IN ENHANCING QUALITY OF NURSING CARE FOR PATIENTS AT HOME: A PHENOMENOLOGICAL STUDY

    Directory of Open Access Journals (Sweden)

    Titan Ligita

    2017-08-01

    Full Text Available Background: Provision of health care service at home is one of the advanced forms of care for patients being discharged from hospitalization. Little is known about the experience of nurses providing home care services through a nursing home-care model especially in Indonesian context. Objective: This study aims to explore the experience in order to increase understanding on the form of home care provision, and consequently the nurses may understand the form of home care globally. Methods: This study employed a phenomenological design and performed interview in the process of data collection. Data were analysed by using content analysis. Results: The main contexts of home care nurse experiences were generated. There were definition and role of home care nurses, the involvement of family members in the provision of care, the facilitating and hindering factors contributed to home care provision as well as manual on providing home care nursing. Conclusion: The implication from this study is that nursing care should be given to the patients continuously and consequently the need for family involvement is important. Additionally, in providing the home care, a proper manual is needed by home care nurses as the guidance to give best quality of care to patients.

  19. End of Life Care

    Science.gov (United States)

    ... Related Topics Choosing Wisely Join our e-newsletter! Aging & Health A to Z End of Life Care ... be used. Ice chips, popsicles, moist swabs, or artificial saliva can help prevent the mouth from becoming ...

  20. The Study of Frequency Self Care Strategies against Auditory Hallucinations

    Directory of Open Access Journals (Sweden)

    Mahin Nadem

    2012-03-01

    Full Text Available Background: In schizophrenic clients, self-care strategies against auditory hallucinations can decrease disturbances results in hallucination. This study was aimed to assess frequency of self-care strategies against auditory hallucinations in paranoid schizophrenic patients, hospitalized in Shafa Hospital.Materials and Method: This was a descriptive study on 201 patients with paranoid schizophrenia hospitalized in psychiatry unit with convenience sampling in Rasht. The gathered data consists of two parts, first unit demographic characteristic and the second part, self- report questionnaire include 38 items about self-care strategies.Results: There were statistically significant relationship between demographic variables and knowledg effect and self-care strategies against auditory hallucinaions. Sex with phisical domain p0.07, marriage status with cognitive domain (p>0.07 and life status with behavioural domain (p>0.01. 53.2% of reported type of our auditory hallucinations were command hallucinations, furtheremore the most effective self-care strategies against auditory hallucinations were from physical domain and substance abuse (82.1% was the most effective strategies in this domain.Conclusion: The client with paranoid schizophrenia used more than physical domain strategies against auditory hallucinaions and this result highlight need those to approprait nursing intervention. Instruction and leading about selection the effective self-care strategies against auditory ha

  1. Hardware-Enabled Security Through On-Chip Reconfigurable Fabric

    Science.gov (United States)

    2016-02-05

    level language (SystemC) instead of in RTL such as Verilog and VHDL . To evaluate our approach, we implemented a set of monitors including soft...techniques can be implemented after chip fabrication. The study showed that such programmable architectures can indeed support a broad range of run- time...accelerators where security techniques can be implemented after chip fabrication. The study showed that such programmable architectures can indeed support a

  2. Ambivalent implications of health care information systems: a study in the Brazilian public health care system

    Directory of Open Access Journals (Sweden)

    João Porto de Albuquerque

    2011-01-01

    Full Text Available This article evaluates social implications of the "SIGA" Health Care Information System (HIS in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

  3. Molecular Structure Effects of [NR,222][Tf2N] Ionic Liquids on Their Flow Properties in the Microfluidic Chip Reactor – a Complete Validation Study.

    Czech Academy of Sciences Publication Activity Database

    Klusoň, Petr; Stavárek, Petr; Pěnkavová, Věra; Vychodilová, Hana; Hejda, Stanislav; Vlček, Dalibor; Bendová, Magdalena

    2017-01-01

    Roč. 111, JAN (2017), s. 57-66 ISSN 0255-2701 R&D Projects: GA ČR GA15-04790S Institutional support: RVO:67985858 Keywords : ionic liquids * microfluidic chip * reynolds number Subject RIV: CI - Industrial Chemistry, Chemical Engineering OBOR OECD: Chemical process engineering Impact factor: 2.234, year: 2016

  4. Patient preferences for future care--how can Advance Care Planning become embedded into dementia care: a study protocol.

    Science.gov (United States)

    Robinson, Louise; Bamford, Claire; Beyer, Fiona; Clark, Alexa; Dickinson, Claire; Emmet, Charlotte; Exley, Catherine; Hughes, Julian; Robson, Lesley; Rousseau, Nikki

    2010-01-12

    People living with a long term condition may wish to be able to plan ahead, so that if in future they cannot make decisions, their wishes about their care will be known; this process is termed Advance Care Planning (ACP). In dementia, guidance stipulates that ACP discussions should take place whilst the person still has capacity to make decisions. However there is a lack of evidence on the effectiveness of ACP in influencing patient choice and resource use. The aims of this study are to determine the effectiveness of ACP in dementia care, identify the factors which facilitate the process in practice and provide a better understanding of the views and experiences of key stakeholders in order to inform clinical practice. The four phase project comprises a systematic review (Phase 1) and a series of qualitative studies (Phases 2 and 3), with data collection via focus groups and individual interviews with relevant stakeholders including people with dementia and their carers, health and social care professionals and representatives from voluntary organisations and the legal profession. The conduct of the systematic review will follow current best practice guidance. In phases 2 and 3, focus groups will be employed to seek the perspectives of the professionals; individual interviews will be carried out with people with dementia and their carers. Data from Phases 1, 2 and 3 will be synthesised in a series of team workshops to develop draft guidance and educational tools for implementing ACP in practice (Phase 4). In the UK, there is little published research on the effectiveness of ACP, despite its introduction into policy. This study was designed to explore in greater depth how ACP can best be carried out in routine practice. It affords the opportunity to develop both a theoretical and practical understanding of an area which both patients and professionals may find emotionally challenging. Importantly the study will also develop practical tools, which are grounded in

  5. Pelly Crossing wood chip boiler

    Energy Technology Data Exchange (ETDEWEB)

    1985-03-11

    The Pelly wood chip project has demonstrated that wood chips are a successful fuel for space and domestic water heating in a northern climate. Pelly Crossing was chosen as a demonstration site for the following reasons: its extreme temperatures, an abundant local supply of resource material, the high cost of fuel oil heating and a lack of local employment. The major obstacle to the smooth operation of the boiler system was the poor quality of the chip supply. The production of poor quality chips has been caused by inadequate operation and maintenance of the chipper. Dull knives and faulty anvil adjustments produced chips and splinters far in excess of the one centimetre size specified for the system's design. Unanticipated complications have caused costs of the system to be higher than expected by approximately $15,000. The actual cost of the project was approximately $165,000. The first year of the system's operation was expected to accrue $11,600 in heating cost savings. This estimate was impossible to confirm given the system's irregular operation and incremental costs. Consistent operation of the system for a period of at least one year plus the installation of monitoring devices will allow the cost effectiveness to be calculated. The wood chip system's impact on the environment was estimated to be minimal. Wood chip burning was considered cleaner and safer than cordwood burning. 9 refs., 6 figs., 6 tabs.

  6. Reactive transport at the pore-scale: Geological Labs on Chip studies (GLoCs) for CO2 storage in saline aquifers

    Science.gov (United States)

    Azaroual, M. M.; Lassin, A., Sr.; André, L., Sr.; Devau, N., Sr.; Leroy, P., Sr.

    2017-12-01

    The near well bore of CO2 injection in saline aquifer is the main sensitive part of the targeted carbone storage reservoirs. The recent development of microfluidics tools mimicking porous media of geological reservoirs allowed studying physical, physico-chemical and thermodynamic mechanisms. We used the GLoCs "Geological Labs on Chip" to study dynamic and reactive transport processes at the pore scale induced by the CO2 geological storage. The present work is a first attempt to reproduce, by reactive transport modeling, an experiment of calcium carbonate precipitation during the co-injection of two aqueous solutions in a GLoC device. For that purpose, a new kinetics model, based on the transition-state-theory and on surface complexation modeling, was developed to describe the co-precipitation of amorphous calcium carbonate (ACC) and calcite. ACC precipitates and creates surface complexation sites from which calcite can nucleate and create new surface complexation sites. When the kinetics of calcite precipitation are fast enough, the consumption of matter leads to the dissolution of ACC. The modeling results were first compared to batch experiments (from the literature) and then applied with success to dynamic experiment observations carried out on a GLoC device (from the literature). On the other hand, we evaluated the solubility of CO2 in capillary waters that increases between 5 to 10 folds for reservoir conditions (200 bar and 100°C) compared to the bulk water. The GLoCs tools started to address an excellent and much finer degree of processes control (reactive transport processes, mixing effects, minerals precipitation and dissolution kinetics, etc.) thanks to in situ analysis and characterization techniques, allowing access in real time to relevant properties. Current investigations focus on key parameters influencing the flowing dynamics and trapping mechanisms (relative permeability, capillary conditions, kinetics of dissolution and precipitation of minerals).

  7. Single chip camera active pixel sensor

    Science.gov (United States)

    Shaw, Timothy (Inventor); Pain, Bedabrata (Inventor); Olson, Brita (Inventor); Nixon, Robert H. (Inventor); Fossum, Eric R. (Inventor); Panicacci, Roger A. (Inventor); Mansoorian, Barmak (Inventor)

    2003-01-01

    A totally digital single chip camera includes communications to operate most of its structure in serial communication mode. The digital single chip camera include a D/A converter for converting an input digital word into an analog reference signal. The chip includes all of the necessary circuitry for operating the chip using a single pin.

  8. Ultra-thin chip technology and applications

    CERN Document Server

    2010-01-01

    Ultra-thin chips are the "smart skin" of a conventional silicon chip. This book shows how very thin and flexible chips can be fabricated and used in many new applications in microelectronics, microsystems, biomedical and other fields. It provides a comprehensive reference to the fabrication technology, post processing, characterization and the applications of ultra-thin chips.

  9. Real-time PCR Machine System Modeling and a Systematic Approach for the Robust Design of a Real-time PCR-on-a-Chip System

    Directory of Open Access Journals (Sweden)

    Da-Sheng Lee

    2010-01-01

    Full Text Available Chip-based DNA quantification systems are widespread, and used in many point-of-care applications. However, instruments for such applications may not be maintained or calibrated regularly. Since machine reliability is a key issue for normal operation, this study presents a system model of the real-time Polymerase Chain Reaction (PCR machine to analyze the instrument design through numerical experiments. Based on model analysis, a systematic approach was developed to lower the variation of DNA quantification and achieve a robust design for a real-time PCR-on-a-chip system. Accelerated lift testing was adopted to evaluate the reliability of the chip prototype. According to the life test plan, this proposed real-time PCR-on-a-chip system was simulated to work continuously for over three years with similar reproducibility in DNA quantification. This not only shows the robustness of the lab-on-a-chip system, but also verifies the effectiveness of our systematic method for achieving a robust design.

  10. Palliative care team visits. Qualitative study through participant observation.

    Science.gov (United States)

    Alfaya Góngora, Maria Del Mar; Bueno Pernias, Maria José; Hueso Montoro, César; Guardia Mancilla, Plácido; Montoya Juárez, Rafael; García Caro, Maria Paz

    2016-03-30

    To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants. A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room) were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed. The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources. Home visits from basic palliative care teams play an important role in patient and family well-being. The visits seem to focus on controlling symptoms and are conditioned by available resources.

  11. Nursing praxis, compassionate caring and interpersonal relations: an observational study.

    Science.gov (United States)

    Fry, Margaret; MacGregor, Casimir; Ruperto, Kate; Jarrett, Kate; Wheeler, Janet; Fong, Jacqueline; Fetchet, Wendy

    2013-05-01

    The Clinical Initiative Nurse (CIN) is a role that requires experienced emergency nurses to assess, initiate diagnostic tests, treat and manage a range of patient conditions. The CIN role is focused on the waiting room and to 'communicate the wait', initiate diagnostics or treatment and follow-up for waiting room patients. We aim to explore what emergency nurses' do in their extended practice role in observable everyday life in the emergency department (ED). The paper argues that compassionate caring is a core nursing skill that supports CIN interpersonal relations, despite the role's highly clinical nature. Sixteen non-participant observations were undertaken in three EDs in New South Wales, Australia. Nurses were eligible for inclusion if they had two years of emergency experience and had worked in the CIN role for more than one year. All CIN's that were observed were highly experienced with a minimum three year ED experience. The CIN observations revealed how compassionate caring was utilised by CIN's to quickly build a therapeutic relationship with patients and colleagues, and helped to facilitate core communication and interpersonal skills. While the CIN role was viewed as extended practice, the role relied heavily on compassionate care to support interpersonal relationships and to actualise extended practice care. The study supports the contribution made by emergency nurses and demonstrates how compassionate caring is central to nursing praxis. This paper also demonstrates that the CIN role utilises a complex mix between advanced clinical skills and compassion that supports interpersonal and therapeutic relationships. Further research is needed to understand how compassionate care can be optimised within nursing praxis and the duty of care between nurses and patients, nurses and other health care professionals so that future healthcare goals can be realised. Copyright © 2013 College of Emergency Nursing Australasia Ltd. All rights reserved.

  12. Understanding delayed access to antenatal care: a qualitative interview study

    Science.gov (United States)

    2014-01-01

    Background Delayed access to antenatal care ('late booking’) has been linked to increased maternal and fetal mortality and morbidity. The aim of this qualitative study was to understand why some women are late to access antenatal care. Methods 27 women presenting after 19 completed weeks gestation for their first hospital booking appointment were interviewed, using a semi-structured format, in community and maternity hospital settings in South Yorkshire, United Kingdom. Interviews were transcribed verbatim and entered onto NVivo 8 software. An interdisciplinary, iterative, thematic analysis was undertaken. Results The late booking women were diverse in terms of: age (15–37 years); parity (0–4); socioeconomic status; educational attainment and ethnicity. Three key themes relating to late booking were identified from our data: 1) 'not knowing’: realisation (absence of classic symptoms, misinterpretation); belief (age, subfertility, using contraception, lay hindrance); 2) 'knowing’: avoidance (ambivalence, fear, self-care); postponement (fear, location, not valuing care, self-care); and 3) 'delayed’ (professional and system failures, knowledge/empowerment issues). Conclusions Whilst vulnerable groups are strongly represented in this study, women do not always fit a socio-cultural stereotype of a 'late booker’. We report a new taxonomy of more complex reasons for late antenatal booking than the prevalent concepts of denial, concealment and disadvantage. Explanatory sub-themes are also discussed, which relate to psychological, empowerment and socio-cultural factors. These include poor reproductive health knowledge and delayed recognition of pregnancy, the influence of a pregnancy 'mindset’ and previous pregnancy experience, and the perceived value of antenatal care. The study also highlights deficiencies in early pregnancy diagnosis and service organisation. These issues should be considered by practitioners and service commissioners in order to promote

  13. Linking patient satisfaction with nursing care: the case of care rationing - a correlational study

    Science.gov (United States)

    2014-01-01

    Background Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses’ perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. The aims of the study were: a) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses’ perceptions of their practice environment while adjusting for patient and nurse characteristics. b) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across rationing levels. Methods A descriptive, correlational design was employed. Participants in this study included 352 patients and 318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were used: the BERNCA scale for rationing of care, the RPPE scale to explore nurses’ perceptions of their work environment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The statistical analysis included the use of Kendall’s correlation coefficient to explore a possible relationship between the variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together with organizational characteristics on patient satisfaction. Results The mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0–3), the overall mean of RPPE was 2.76 (SD = 0.32, range = 1.28 – 3.69) and the two scales were significantly correlated (τ = −0.234, p patient satisfaction, even after controlling for nurse and patient characteristics. The results from the adjusted regression models showed that even at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction. Conclusions The results support the relationships between

  14. Patients' expectations of osteopathic care: a qualitative study.

    Science.gov (United States)

    Cross, Vinette; Leach, C M Janine; Fawkes, Carol A; Moore, Ann P

    2015-10-01

    Research has shown that patients' expectations of health care and health-care practitioners are complex and may have a significant impact on outcomes of care. Little is known about the expectations of osteopathic patients. To explore osteopathic patients' expectations of private sector care. Focus groups and individual interviews with purposively selected patients; this was the qualitative phase of a mixed methods study, the final phase being a patient survey. A total of 34 adult patients currently attending for treatment at private osteopathic practices across the United Kingdom. Focus group discussions and individual interviews around expectations before, during and after osteopathic care. Thematic analysis of text data to identify topics raised by patients and to group these into broad themes. Many components of expectation were identified. A preliminary conceptual framework describing the way the therapeutic encounter is approached in osteopathy comprised five themes: individual agency, professional expertise, customer experience, therapeutic process and interpersonal relationship. The components of expectation identified in this phase of the study provided potential question topics for the survey questionnaire in the subsequent phase of the investigation. The model developed in this study may add a new perspective to existing evidence on expectations. Further research is recommended to test the findings both within private practice and the National Health Service. © 2013 John Wiley & Sons Ltd.

  15. Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study).

    Science.gov (United States)

    Pels, Anouk; Mol, Ben Willem J; Singer, Joel; Lee, Terry; von Dadelszen, Peter; Ganzevoort, Wessel; Asztalos, Elizabeth; Magee, Laura A

    2018-06-01

    For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight 48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. URL: https://www.isrctn.com. Unique identifier: ISRCTN71416914. © 2018 The Authors.

  16. The study on force, surface integrity, tool life and chip on laser assisted machining of inconel 718 using Nd:YAG laser source.

    Science.gov (United States)

    Venkatesan, K

    2017-07-01

    Inconel 718, a high-temperature alloy, is a promising material for high-performance aerospace gas turbine engines components. However, the machining of the alloy is difficult owing to immense shear strength, rapid work hardening rate during turning, and less thermal conductivity. Hence, like ceramics and composites, the machining of this alloy is considered as difficult-to-turn materials. Laser assisted turning method has become a promising solution in recent years to lessen cutting stress when materials that are considered difficult-to-turn, such as Inconel 718 is employed. This study investigated the influence of input variables of laser assisted machining on the machinability aspect of the Inconel 718. The comparison of machining characteristics has been carried out to analyze the process benefits with the variation of laser machining variables. The laser assisted machining variables are cutting speeds of 60-150 m/min, feed rates of 0.05-0.125 mm/rev with a laser power between 1200 W and 1300 W. The various output characteristics such as force, roughness, tool life and geometrical characteristic of chip are investigated and compared with conventional machining without application of laser power. From experimental results, at a laser power of 1200 W, laser assisted turning outperforms conventional machining by 2.10 times lessening in cutting force, 46% reduction in surface roughness as well as 66% improvement in tool life when compared that of conventional machining. Compared to conventional machining, with the application of laser, the cutting speed of carbide tool has increased to a cutting condition of 150 m/min, 0.125 mm/rev. Microstructural analysis shows that no damage of the subsurface of the workpiece.

  17. The study on force, surface integrity, tool life and chip on laser assisted machining of inconel 718 using Nd:YAG laser source

    Directory of Open Access Journals (Sweden)

    K. Venkatesan

    2017-07-01

    Full Text Available Inconel 718, a high-temperature alloy, is a promising material for high-performance aerospace gas turbine engines components. However, the machining of the alloy is difficult owing to immense shear strength, rapid work hardening rate during turning, and less thermal conductivity. Hence, like ceramics and composites, the machining of this alloy is considered as difficult-to-turn materials. Laser assisted turning method has become a promising solution in recent years to lessen cutting stress when materials that are considered difficult-to-turn, such as Inconel 718 is employed. This study investigated the influence of input variables of laser assisted machining on the machinability aspect of the Inconel 718. The comparison of machining characteristics has been carried out to analyze the process benefits with the variation of laser machining variables. The laser assisted machining variables are cutting speeds of 60–150 m/min, feed rates of 0.05–0.125 mm/rev with a laser power between 1200 W and 1300 W. The various output characteristics such as force, roughness, tool life and geometrical characteristic of chip are investigated and compared with conventional machining without application of laser power. From experimental results, at a laser power of 1200 W, laser assisted turning outperforms conventional machining by 2.10 times lessening in cutting force, 46% reduction in surface roughness as well as 66% improvement in tool life when compared that of conventional machining. Compared to conventional machining, with the application of laser, the cutting speed of carbide tool has increased to a cutting condition of 150 m/min, 0.125 mm/rev. Microstructural analysis shows that no damage of the subsurface of the workpiece.

  18. Prospective associations of coronary heart disease loci in African Americans using the MetaboChip : The PAGE study

    NARCIS (Netherlands)

    N. Franceschini (Nora); Hu, Y. (Yijuan); A. Reiner (Alexander); S. Buyske (Steven); M.A. Nalls (Michael); L.R. Yanek (Lisa); Y. Li (Yun); L.A. Hindorff (Lucia A); Cole, S.A. (Shelley A.); Howard, B.V. (Barbara V.); J.M. Stafford (Jeanette M.); C. Carty (Cara); P. Sethupathy (Praveen); Martin, L.W. (Lisa W.); D.Y. Lin (Dan); Johnson, K.C. (Karen C.); L.C. Becker (Lewis); K.E. North (Kari); A. Dehghan (Abbas); J.C. Bis (Joshua); Y. Liu (YongMei); P. Greenland (Philip); J.E. Manson (Joann); Maeda, N. (Nobuyo); M.E. Garcia (M.); T.B. Harris (Tamara); D.M. Becker (Diane); C.J. O'Donnell (Christopher); G. Heiss (Gerardo); C. Kooperberg (Charles); E.A. Boerwinkle (Eric)

    2014-01-01

    textabstractBackground: Coronary heart disease (CHD) is a leading cause of morbidity and mortality in African Americans. However, there is a paucity of studies assessing genetic determinants of CHD in African Americans. We examined the association of published variants in CHD loci with incident CHD,

  19. Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

    Science.gov (United States)

    Rocha, T A H; da Silva, N C; Amaral, P V; Barbosa, A C Q; Rocha, J V M; Alvares, V; de Almeida, D G; Thumé, E; Thomaz, E B A F; de Sousa Queiroz, R C; de Souza, M R; Lein, A; Toomey, N; Staton, C A; Vissoci, J R N; Facchini, L A

    2017-12-01

    Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). Cross-sectional ecological study. Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  20. Politics and care: a study of Czech Americans within Leininger's theory of culture care diversity and universality.

    Science.gov (United States)

    Miller, J

    1997-01-01

    The domain of inquiry for this study was the influence of the American political environmental context on professional and generic care patterns, expressions, and meanings of Czech American immigrants. The purpose of the research was to document, describe, interpret, and analyze the diversities and universalities of professional and generic care for this cultural group, to provide culturally congruent care to Czech Americans, and to explicate the role of politics as an influence on care patterns, health, and well being. The researcher's former transcultural ethnonursing study in Prague, Czechoslovakia in 1991 served as a stimulus for this in-depth study on politics and care. Twelve key and twenty general informants were interviewed. Five major themes were identified. The researcher discovered that the capitalist economic market structure of the United States influenced informant lifeways in all dimensions of Leininger's Theory of Culture Care Diversity and Universality, as depicted in the Sunrise Model. Specific care patterns discovered included care as choice, care as responsibility, and care as helping each other. Findings related to professional and generic care supported researcher predictions that generic culture care patterns would be important to immigrants. Provisions for culturally congruent nursing care were articulated based on research findings.

  1. Various on-chip sensors with microfluidics for biological applications.

    Science.gov (United States)

    Lee, Hun; Xu, Linfeng; Koh, Domin; Nyayapathi, Nikhila; Oh, Kwang W

    2014-09-12

    In this paper, we review recent advances in on-chip sensors integrated with microfluidics for biological applications. Since the 1990s, much research has concentrated on developing a sensing system using optical phenomena such as surface plasmon resonance (SPR) and surface-enhanced Raman scattering (SERS) to improve the sensitivity of the device. The sensing performance can be significantly enhanced with the use of microfluidic chips to provide effective liquid manipulation and greater flexibility. We describe an optical image sensor with a simpler platform for better performance over a larger field of view (FOV) and greater depth of field (DOF). As a new trend, we review consumer electronics such as smart phones, tablets, Google glasses, etc. which are being incorporated in point-of-care (POC) testing systems. In addition, we discuss in detail the current optical sensing system integrated with a microfluidic chip.

  2. Various On-Chip Sensors with Microfluidics for Biological Applications

    Directory of Open Access Journals (Sweden)

    Hun Lee

    2014-09-01

    Full Text Available In this paper, we review recent advances in on-chip sensors integrated with microfluidics for biological applications. Since the 1990s, much research has concentrated on developing a sensing system using optical phenomena such as surface plasmon resonance (SPR and surface-enhanced Raman scattering (SERS to improve the sensitivity of the device. The sensing performance can be significantly enhanced with the use of microfluidic chips to provide effective liquid manipulation and greater flexibility. We describe an optical image sensor with a simpler platform for better performance over a larger field of view (FOV and greater depth of field (DOF. As a new trend, we review consumer electronics such as smart phones, tablets, Google glasses, etc. which are being incorporated in point-of-care (POC testing systems. In addition, we discuss in detail the current optical sensing system integrated with a microfluidic chip.

  3. Detection and classification of ebola on microfluidic chips

    Science.gov (United States)

    Lin, Xue; Jin, Xiangyu; Fan, Yunqian; Huang, Qin; Kou, Yue; Zu, Guo; Huang, Shiguang; Liu, Xiaosheng; Huang, Guoliang

    2016-10-01

    Point-of-care testing (POCT) for an infectious diseases is the prerequisite to control of the disease and limitation of its spread. A microfluidic chip for detection and classification of four strains of Ebola virus was developed and evaluated. This assay was based on reverse transcription loop-mediated isothermal amplification (RT-LAMP) and specific primers for Ebola Zaire virus, Ebola Sudan virus, Ebola Tai Forest virus and Ebola Bundibugyo virus were designed. The sensitivity of the microfluidic chip was under 103 copies per milliliter, as determined by ten repeated tests. This assay is unique in its ability to enable diagnosis of the Ebola infections and simultaneous typing of Ebola virus on a single chip. It offers short reaction time, ease of use and high specificity. These features should enable POCT in remote area during outbreaks of Ebola virus.

  4. Radioactivity changes during burning of peat and chip

    International Nuclear Information System (INIS)

    Hedvall, R.; Erlandsson, B.; Mattsson, S.

    1985-01-01

    The increasing use of peat and chip as fuel materials in fossil-fuel power plants has resulted in the need for information about the change in radionuclides concentration in fuel after combustion. The paper describes a study of natural radionuclides from the uranium- and the thorium series and 40 K, as well as fission products from atmospheric nuclear explosions, in ashes from five peat and chip fuelled power plants in Sweden

  5. A review of costing methodologies in critical care studies.

    Science.gov (United States)

    Pines, Jesse M; Fager, Samuel S; Milzman, David P

    2002-09-01

    Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. We performed a narrative review of published costing studies in critical care during the past 6 years. A total of 282 articles were found, of which 68 met our search criteria. They involved a mean of 508 patients (range, 20-13,907). A total of 92.6% of the studies (63 of 68) used traditional cost analysis, whereas the remaining 7.4% (5 of 68) used cost-effectiveness analysis. None (0 of 68) used cost-benefit analysis or cost-utility analysis. A total of 36.7% (25 of 68) used hospital charges as a surrogate for actual costs. Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques. Copyright 2002, Elsevier Science (USA). All rights reserved.

  6. [Wood manufacture and dioxins: a case prospective study on maintenance of boilers powered by wood chips and shavings].

    Science.gov (United States)

    Vitelli, Marco; Paciaccioni, Daniele

    2014-01-01

    to verify if a carpenter using wood scraps, treated or not, to operate the heating system may involve an exposure to dioxins in a given target of workers. the research was structured on literature sources analysis, study on field of the most relevant exposure, occurs through sampling. The results were recorded and plotted, and compared with the data available in literature. the study has involved maintenance workers of the heating system by means of wood refuse incineration. These workers were informed of the methods and aims of the sample. the results confirm a potential exposure to ash containing dioxins, presumably also in other similar situations, in this case not even evaluated by the employer. the average exposure to the light ash during the maintenance operations of the plant dust abatement in emissive phase is about 5 mg/m(3), with a consequent exposure to dioxins inferred, at about 20 pg. operators are exposed to dioxins: this implies that in some operations it is crucial to review the risk assessment and consequently the measures on prevention and health protection to activate.

  7. Magnetically engineered smart thin films: toward lab-on-chip ultra-sensitive molecular imaging.

    Science.gov (United States)

    Hassan, Muhammad A; Saqib, Mudassara; Shaikh, Haseeb; Ahmad, Nasir M; Elaissari, Abdelhamid

    2013-03-01

    Magnetically responsive engineered smart thin films of nanoferrites as contrast agent are employed to develop surface based magnetic resonance imaging to acquire simple yet fast molecular imaging. The work presented here can be of significant potential for future lab-on-chip point-of-care diagnostics from the whole blood pool on almost any substrates to reduce or even prevent clinical studies involve a living organism to enhance the non-invasive imaging to advance the '3Rs' of work in animals-replacement, refinement and reduction.

  8. Gene-chip studies of adipogenesis-regulated microRNAs in mouse primary adipocytes and human obesity

    Directory of Open Access Journals (Sweden)

    Gallagher Iain J

    2011-03-01

    Full Text Available Abstract Background Adipose tissue abundance relies partly on the factors that regulate adipogenesis, i.e. proliferation and differentiation of adipocytes. While components of the transcriptional program that initiates adipogenesis is well-known, the importance of microRNAs in adipogenesis is less well studied. We thus set out to investigate whether miRNAs would be actively modulated during adipogenesis and obesity. Methods Several models exist to study adipogenesis in vitro, of which the cell line 3T3-L1 is the most well known, albeit not the most physiologically appropriate. Thus, as an alternative, we produced EXIQON microarray of brown and white primary murine adipocytes (prior to and following differentiation to yield global profiles of miRNAs. Results We found 65 miRNAs regulated during in vitro adipogenesis in primary adipocytes. We evaluated the similarity of our responses to those found in non-primary cell models, through literature data-mining. When comparing primary adipocyte profiles, with those of cell lines reported in the literature, we found a high degree of difference in 'adipogenesis' regulated miRNAs suggesting that the model systems may not be accurately representing adipogenesis. The expression of 10 adipogenesis-regulated miRNAs were studied using real-time qPCR and then we selected 5 miRNAs, that showed robust expression, were profiled in subcutaneous adipose tissue obtained from 20 humans with a range of body mass indices (BMI, range = 21-48, and all samples have U133+2 Affymetrix profiles provided. Of the miRNAs tested, mir-21 was robustly expressed in human adipose tissue and positively correlated with BMI (R2 = 0.49, p Conclusion In conclusion, we provide a preliminary analysis of miRNAs associated with primary cell in vitro adipogenesis and demonstrate that the inflammation-associated miRNA, mir-21 is up-regulated in subcutaneous adipose tissue in human obesity. Further, we provide a novel transcriptomics database of

  9. Patient's Satisfaction with Health Care: a Questionnaire Study of Different Aspects of Care.

    Science.gov (United States)

    Spasojevic, Nada; Hrabac, Boris; Huseinagic, Senad

    2015-08-01

    To determine the influence of sociodemographic factors on patients´ satisfaction with health care system. In a cross-sectional study, 1,995 patients from 12 municipalities of Zenica-Doboj Canton were interviewed after a visit to the practice. Individual interviews were conducted and the questionnaire was made on the basis of EUROPEP (European Task Force on Patient Evaluations of General Practice Care) standardized questionnaire. Out of the total number patients, 47.1% were females, 47.9% were from urban population and median of age was 42.0 years (IQR = 30.0 to 53.0 years). The rural population was more likely to buy drugs for medical treatment (p buy drugs for medical treatment (p = 0.001), to buy parenteral injections in primary care practice (p buy drugs for medical treatment (p = 0.004); more likely to buy parenteral injections in primary care practice (p < 0.001). The following variables: gender, age, overall perception of health status and financial status appear to be predictors of patients´ satisfaction.

  10. Antenatal care strengthening for improved quality of care in Jimma, Ethiopia: an effectiveness study.

    Science.gov (United States)

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe; Tilahun, Abebech; Friis, Henrik; Rasch, Vibeke

    2015-04-11

    Interventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems and increased overall user satisfaction with ANC) were distal project outcomes. The process of implementation was documented in monthly supervision reports. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. The continued attention to the ANC provision during implementation stimulated increased priority of ANC among health care providers. The organizational structure of the facilities and lack of continuity in care provision turned out to be a major challenge for implementation. There was a positive effect of the intervention on health education on danger signs during pregnancy (OR: 3.9, 95% CI: 2.6;5.7), laboratory testing (OR for blood tests other than HIV 2.9, 95% CI: 1.9;4.5), health problem identification (OR 1.8, 95% CI: 1.1;3.1), and satisfaction with the service (OR: 0

  11. Tunable on chip optofluidic laser

    DEFF Research Database (Denmark)

    Bakal, Avraham; Vannahme, Christoph; Kristensen, Anders

    2016-01-01

    On chip tunable laser is demonstrated by realizing a microfluidic droplet array. The periodicity is controlled by the pressure applied to two separate inlets, allowing to tune the lasing frequency over a broad spectral range.......On chip tunable laser is demonstrated by realizing a microfluidic droplet array. The periodicity is controlled by the pressure applied to two separate inlets, allowing to tune the lasing frequency over a broad spectral range....

  12. Designing A Mixed Methods Study In Primary Care

    Science.gov (United States)

    Creswell, John W.; Fetters, Michael D.; Ivankova, Nataliya V.

    2004-01-01

    BACKGROUND Mixed methods or multimethod research holds potential for rigorous, methodologically sound investigations in primary care. The objective of this study was to use criteria from the literature to evaluate 5 mixed methods studies in primary care and to advance 3 models useful for designing such investigations. METHODS We first identified criteria from the social and behavioral sciences to analyze mixed methods studies in primary care research. We then used the criteria to evaluate 5 mixed methods investigations published in primary care research journals. RESULTS Of the 5 studies analyzed, 3 included a rationale for mixing based on the need to develop a quantitative instrument from qualitative data or to converge information to best understand the research topic. Quantitative data collection involved structured interviews, observational checklists, and chart audits that were analyzed using descriptive and inferential statistical procedures. Qualitative data consisted of semistructured interviews and field observations that were analyzed using coding to develop themes and categories. The studies showed diverse forms of priority: equal priority, qualitative priority, and quantitative priority. Data collection involved quantitative and qualitative data gathered both concurrently and sequentially. The integration of the quantitative and qualitative data in these studies occurred between data analysis from one phase and data collection from a subsequent phase, while analyzing the data, and when reporting the results. DISCUSSION We recommend instrument-building, triangulation, and data transformation models for mixed methods designs as useful frameworks to add rigor to investigations in primary care. We also discuss the limitations of our study and the need for future research. PMID:15053277

  13. Dementia care mapping to support staff in the care of people with intellectual disability and dementia: a feasibility study

    NARCIS (Netherlands)

    Schaap, Feija; Dijkstra, Geke; Fokkens, Andrea; Reijneveld, Sijmen; Finnema, Evelyn

    2018-01-01

    Background: The number of people with intellectual disability and dementia in-creases; this combination causes behavioural changes. Dementia Care Mapping (DCM) supports staff in dementia care in nursing homes and may be useful in intel-lectual disability-care. This qualitative study examines the

  14. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups : A case study

    NARCIS (Netherlands)

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, H.J.M.

    2015-01-01

    Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two

  15. A cluster randomized controlled trial on the effects and costs of advance care planning in elderly care: study protocol

    NARCIS (Netherlands)

    I.J. Korfage; B.J. Hammes; J. Severijnen; S. Polinder; A. van der Heide; A. Overbeek; F.E. Witkamp; E. Hansen - van der Meer; L.J. Jabbarian; P. Billekens; S.J. Swart; J.A.C. Rietjens

    2015-01-01

    Abstract Background: Currently, health care and medical decision-making at the end of life for older people are often insufficiently patient-centred. In this trial we study the effects of Advance Care Planning (ACP), a formalised process of timely communication about care preferences at the end of

  16. A cluster randomized controlled trial on the effects and costs of advance care planning in elderly care: Study protocol

    NARCIS (Netherlands)

    I.J. Korfage (Ida); J.A.C. Rietjens (Judith); A. Overbeek (Anouk); L.J. Jabbarian (Lea J.); P. Billekens (Pascalle); B.J. Hammes (Bernard J.); E. Hansen-Van Der Meer (Ellen); S. Polinder (Suzanne); J. Severijnen (Johan); S.J. Swart (Siebe); F.E. Witkamp (Frederika); A. van der Heide (Agnes)

    2015-01-01

    textabstractBackground: Currently, health care and medical decision-making at the end of life for older people are often insufficiently patient-centred. In this trial we study the effects of Advance Care Planning (ACP), a formalised process of timely communication about care preferences at the end

  17. Teleconsultation for integrated palliative care at home: A qualitative study

    NARCIS (Netherlands)

    van Gurp, J.; van Selm, M.; van Leeuwen, E.; Vissers, K.; Hasselaar, J.

    2016-01-01

    Background: Interprofessional consultation contributes to symptom control for home-based palliative care patients and improves advance care planning. Distance and travel time, however, complicate the integration of primary care and specialist palliative care. Expert online audiovisual

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

    Science.gov (United States)

    Wang, Ning; Yu, Ping; Hailey, David

    2015-08-01

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

  19. Intensive care medicine trainees' perception of professionalism: a qualitative study.

    NARCIS (Netherlands)

    Mook, W.N. van; Grave, W.S. De; Gorter, S.L.; Zwaveling, J.H.; Schuwirth, L.W.; Vleuten, C.P.M. van der

    2011-01-01

    The Competency-Based Training program in Intensive Care Medicine in Europe identified 12 competency domains. Professionalism was given a prominence equal to technical ability. However, little information pertaining to fellows' views on professionalism is available. A nationwide qualitative study was

  20. Transforming Cultures of Care: A Case Study in Organizational Change

    Science.gov (United States)

    Purvis, Karyn; Cross, David; Jones, Daren; Buff, Gary

    2012-01-01

    The authors report on a small organizational case study highlighting the dimensions of trauma-informed care, the processes of organizational change, and the growth of caregiver expertise. The article is framed by the notion of caregiving cultures, which refers to the beliefs, languages, and practices of caregivers and caregiving organizations.…

  1. Children in care (CIC): A Danish longitudinal study

    DEFF Research Database (Denmark)

    Egelund, Tine; Hestbæk, Anne-Dorthe

    This paper presents results describing what characterizes young, Danish children in care and their parents, and, furthermore, discusses social policy implications of the complex psychosocial disadvantages influencing the families. The paper is based on a longitudinal study of all Danish children......, born in 1995, who currently are or formerly have been placed in care. The first data collection was conducted in the spring 2003, where the children were 7-8 years of age. It is the intention to follow up the children every third year during childhood, adolescence, and adult life. At each new data...

  2. Challenges for Infants’ Home Care: a Qualitative Study

    Directory of Open Access Journals (Sweden)

    Zeinab Hemati

    2016-06-01

    Full Text Available Background Home care is an acceptable strategy for the relationship between family and healthcare team and implementation of healthcare interventions, and infants’ nurses could play an important role in enhancing the capability of families and promoting child health in this area. This study examined challenges facing infants’ home care from nurses’ viewpoints in Iranian culture.Materials and MethodsA qualitative design was used to explain challenges facing infants’ home care from nurses’ viewpoints. Participants included 20 nurses’ working in the neonatal units of University hospitals in Isfahan, Iran in 2015. Data collection was done by interviewing nurses working in neonatal units of Shahid Beheshti and Alzahra hospitals. All the data were analyzed by qualitative content analysis.ResultsFour main categories of “The need to warn the community ", “culture",” need for security " and ” legal support" were extracted from the participants' explanations, indicating the dimensions of Challenges for Infants’ Home Care.Conclusion Nursing policy makers and managers are able to help to facilitate home care and improve the infants’ health through correcting the infrastructure and eliminating current obstacles.

  3. Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands.

    Science.gov (United States)

    Perdok, Hilde; Jans, Suze; Verhoeven, Corine; Henneman, Lidewij; Wiegers, Therese; Mol, Ben Willem; Schellevis, François; de Jonge, Ank

    2016-07-26

    This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care. Qualitative study using interviews and focus groups from November 2012 to February 2013 in the Netherlands. Seventeen purposively selected stakeholder representatives participated in individual semi-structured interviews and 21 in focus groups. One face-to-face focus group included a combined group of midwives, obstetricians and a paediatrician involved in maternity care. Two online focus groups included a group of primary care midwives and a group of clinical midwives respectively. Thematic analysis was performed using Atlas.ti. Two researchers independently coded the interview and focus group transcripts by means of a mind map and themes and relations between them were described. Three main themes were identified with regard to integrating maternity care: client-centred care, continuity of care and task shifting between professionals. Opinions differed regarding the optimal maternity care organisation model. Participants considered the current payment structure an inhibiting factor, whereas a new modified payment structure based on the actual amount of work performed was seen as a facilitating factor. Both midwives and obstetricians indicated that they were afraid to loose autonomy. An integrated maternity care system may improve client-centred care, provide continuity of care for women during labour and birth and include a shift of responsibilities between health care providers. However, differences of opinion among professionals and other stakeholders with regard to the optimal maternity care organisation model may complicate the implementation of integrated care. Important factors for a successful implementation of integrated maternity care are an appropriate payment structure and maintenance of the autonomy of

  4. Student midwives' perceptions on the organisation of maternity care and alternative maternity care models in the Netherlands - a qualitative study.

    Science.gov (United States)

    Warmelink, J Catja; de Cock, T Paul; Combee, Yvonne; Rongen, Marloes; Wiegers, Therese A; Hutton, Eileen K

    2017-01-11

    A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care. This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded and analysed. Students felt that inevitably there will be a change in the organisation of maternity care, and they were open to change. Participants indicated that good collaboration between professions, including a shared system of maternity notes and guidelines, and mutual trust and respect were important aspects of any alternative model. The students indicated that client-centered care and the safeguarding of the physiological, normalcy approach to pregnancy and birth should be maintained in any alternative model. Students expressed worries that the role of midwives in intrapartum care could become redundant, and thus they are motivated to take on new roles and competencies, so they can ensure their own role in intrapartum care. Final year student midwives recognise that change in the organisation of maternity care is inevitable and have an open attitude towards changes if they include good collaboration, client-centred care and safeguards for normal physiological birth. The graduating

  5. The German MultiCare-study: Patterns of multimorbidity in primary health care – protocol of a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Schäfer Ingmar

    2009-08-01

    Full Text Available Abstract Background Multimorbidity is a highly frequent condition in older people, but well designed longitudinal studies on the impact of multimorbidity on patients and the health care system have been remarkably scarce in numbers until today. Little is known about the long term impact of multimorbidity on the patients' life expectancy, functional status and quality of life as well as health care utilization over time. As a consequence, there is little help for GPs in adjusting care for these patients, even though studies suggest that adhering to present clinical practice guidelines in the care of patients with multimorbidity may have adverse effects. Methods/Design The study is designed as a multicentre prospective, observational cohort study of 3.050 patients aged 65 to 85 at baseline with at least three different diagnoses out of a list of 29 illnesses and syndromes. The patients will be recruited in approx. 120 to 150 GP surgeries in 8 study centres distributed across Germany. Information about the patients' morbidity will be collected mainly in GP interviews and from chart reviews. Functional status, resources/risk factors, health care utilization and additional morbidity data will be assessed in patient interviews, in which a multitude of well established standardized questionnaires and tests will be performed. Discussion The main aim of the cohort study is to monitor the course of the illness process and to analyse for which reasons medical conditions are stable, deteriorating or only temporarily present. First, clusters of combinations of diseases/disorders (multimorbidity patterns with a comparable impact (e.g. on quality of life and/or functional status will be identified. Then the development of these clusters over time will be analysed, especially with regard to prognostic variables and the somatic, psychological and social consequences as well as the utilization of health care resources. The results will allow the development of an

  6. Neuro-ophthalmological conditions: Study of the clinical care pathway.

    Science.gov (United States)

    Layat, I; Challe, G; LeHoang, P; Bodaghi, B; Touitou, V

    2017-06-01

    Neuro-ophthalmologic conditions require specialized multidisciplinary management, both medical and surgical, for patients affected by visual loss due to nervous system disease. The primary goal of this study is to define the specificity of neuro-ophthalmology within the realm of visual health. The secondary goal is to review clinical care pathways by studying the organization of management, in terms of accessibility to care and personalization of the care pathway. A field study was carried out from February to June 2015, within the ophthalmology service of the Pitié-Salpêtrière University Medical Center in Paris. A 30-minute interview with the patient before or after his or her neuro-ophthalmology consultation was performed, to describe the clinical care pathway. The medical records of interviewed patients were also analyzed. Seventeen care pathways (10 women and 7 men) were reviewed. The mean age at appearance of visual involvement was 44.5 years (±8.4 years). If we exclude 3 patients over 66 years and retired, 35.71% were active, 35.71% were disabled, and 28.57% were on sick leave. Ten patients (58.82%) met the criteria for admission to long-term care. The first step had been carried out by local private practitioners. The first physician seen was the general medicine physician (59%), then the private ophthalmologist on an emergency basis (17%). On average, patients went through 8 steps during their care pathway (from 6 to 10 steps) and 14 medical departments were involved. The study showed collaboration with the other services of the University Hospital Department of Vision and Disabilities (notably with the Fondation Rothschild, the Quinze-Vingts National Ophthalmology Hospital, and the Fondation Sainte-Marie). In addition to rehabilitation services, health care professionals participating in the outpatient care of the patients included an orthoptist (11.7%), a psychologist (11.7%), and an optician specializing in low vision for visual aids. Finally

  7. The process of care in integrative health care settings - a qualitative study of US practices.

    Science.gov (United States)

    Grant, Suzanne J; Bensoussan, Alan

    2014-10-23

    There is a lack of research on the organisational operations of integrative healthcare (IHC) practices. IHC is a therapeutic strategy integrating conventional and complementary medicine in a shared context to administer individualized treatment. To better understand the process of care in IHC - the way in which patients are triaged and treatment plans are constructed, interviews were conducted with integrative health care leaders and practitioners in the US. Semi-structured interviews were conducted with a pragmatic group of fourteen leaders and practitioners from nine different IHC settings. All interviews were conducted face-to-face with the exception of one phone interview. Questions focussed on understanding the "process of care" in an integrative healthcare setting. Deductive categories were formed from the aims of the study, focusing on: organisational structure, processes of care (subcategories: patient intake, treatment and charting, use of guidelines or protocols), prevalent diseases or conditions treated, and the role of research in the organisation. The similarities and differences of the ITH entities emerged from this process. On an organisational level, conventional and CM services and therapies were co-located in all nine settings. For patients, this means there is more opportunity for 'seamless care'. Shared information systems enabled easy communication using internal messaging or email systems, and shared patient intake information. But beyond this infrastructure alignment for integrative health care was less supported. There were no use of protocols or guidelines within any centre, no patient monitoring mechanism beyond that which occurred within one-on-one appointments. Joint planning for a patient treatment was typically ad hoc through informal mechanisms. Additional duties typically come at a direct financial cost to fee-for-service practitioners. In contrast, service delivery and the process of care within hospital inpatient services followed

  8. On-Chip Magnetorelaxometry Using Planar Hall Effect Magnetic Field Sensors

    DEFF Research Database (Denmark)

    Østerberg, Frederik Westergaard

    In recent years there has been an increasing interest in developing lab-on-a-chip devices that potentially can be used as point-of-care biosensors. The advantage of point-of-care biosensors is that they can analyze samples obtained from patients immediately, cutting away the time needed for sending...... the sample to a laboratory for analysis. Many different read out techniques can be used for point-of-care biosensors, among these are magnetic readouts, which are especially interesting because most biological samples are non-magnetic. The goal of this thesis is to explore the possibilities and limitations...... signals by a factor of six compared to the cross sensor without significant noise being added to the measurements. A study varying the concentration of magnetic beads with a nominal diameter of 40 nm shows that the hydrodynamic diameters can be extracted reliably for concentrations down to 64 _g...

  9. Patient preferences for future care - how can Advance Care Planning become embedded into dementia care: a study protocol

    Science.gov (United States)

    2010-01-01

    Background People living with a long term condition may wish to be able to plan ahead, so that if in future they cannot make decisions, their wishes about their care will be known; this process is termed Advance Care Planning (ACP). In dementia, guidance stipulates that ACP discussions should take place whilst the person still has capacity to make decisions. However there is a lack of evidence on the effectiveness of ACP in influencing patient choice and resource use. The aims of this study are to determine the effectiveness of ACP in dementia care, identify the factors which facilitate the process in practice and provide a better understanding of the views and experiences of key stakeholders in order to inform clinical practice. Methods/Design The four phase project comprises a systematic review (Phase 1) and a series of qualitative studies (Phases 2 and 3), with data collection via focus groups and individual interviews with relevant stakeholders including people with dementia and their carers, health and social care professionals and representatives from voluntary organisations and the legal profession. The conduct of the systematic review will follow current best practice guidance. In phases 2 and 3, focus groups will be employed to seek the perspectives of the professionals; individual interviews will be carried out with people with dementia and their carers. Data from Phases 1, 2 and 3 will be synthesised in a series of team workshops to develop draft guidance and educational tools for implementing ACP in practice (Phase 4). Discussion In the UK, there is little published research on the effectiveness of ACP, despite its introduction into policy. This study was designed to explore in greater depth how ACP can best be carried out in routine practice. It affords the opportunity to develop both a theoretical and practical understanding of an area which both patients and professionals may find emotionally challenging. Importantly the study will also develop

  10. Patient preferences for future care - how can Advance Care Planning become embedded into dementia care: a study protocol

    Directory of Open Access Journals (Sweden)

    Exley Catherine

    2010-01-01

    Full Text Available Abstract Background People living with a long term condition may wish to be able to plan ahead, so that if in future they cannot make decisions, their wishes about their care will be known; this process is termed Advance Care Planning (ACP. In dementia, guidance stipulates that ACP discussions should take place whilst the person still has capacity to make decisions. However there is a lack of evidence on the effectiveness of ACP in influencing patient choice and resource use. The aims of this study are to determine the effectiveness of ACP in dementia care, identify the factors which facilitate the process in practice and provide a better understanding of the views and experiences of key stakeholders in order to inform clinical practice. Methods/Design The four phase project comprises a systematic review (Phase 1 and a series of qualitative studies (Phases 2 and 3, with data collection via focus groups and individual interviews with relevant stakeholders including people with dementia and their carers, health and social care professionals and representatives from voluntary organisations and the legal profession. The conduct of the systematic review will follow current best practice guidance. In phases 2 and 3, focus groups will be employed to seek the perspectives of the professionals; individual interviews will be carried out with people with dementia and their carers. Data from Phases 1, 2 and 3 will be synthesised in a series of team workshops to develop draft guidance and educational tools for implementing ACP in practice (Phase 4. Discussion In the UK, there is little published research on the effectiveness of ACP, despite its introduction into policy. This study was designed to explore in greater depth how ACP can best be carried out in routine practice. It affords the opportunity to develop both a theoretical and practical understanding of an area which both patients and professionals may find emotionally challenging. Importantly the

  11. Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study.

    Science.gov (United States)

    Lin, Pei-Chao; Hsieh, Mei-Hui; Chen, Meng-Chin; Yang, Yung-Mei; Lin, Li-Chan

    2018-02-01

    The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self-report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16-item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276-285. © 2017 Japan Geriatrics Society.

  12. Natural course of care dependency in residents of long-term care facilities: prospective follow-up study.

    Science.gov (United States)

    Caljouw, Monique A A; Cools, Herman J M; Gussekloo, Jacobijn

    2014-05-22

    Insight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality. A prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile range 79-88) years participated. At baseline, 6 and 12 months, care dependency was assessed by the nursing staff with the Care Dependency Scale (CDS), range 15-75 points. Since the median CDS score differed between men and women (47.5 vs. 43.0, P = 0.013), CDS groups (low, middle and high) were based on gender-specific 33% of CDS scores at baseline and 6 months. At baseline, the CDS groups differed in median length of stay on the ward, urine incontinence and dementia (all P dependency status, predicted an increase in care dependency over time. The majority of residents were stable in their care dependency status over two subsequent 6-month periods. Highly care dependent residents showed an increased mortality risk. Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options.

  13. Microengineered physiological biomimicry: organs-on-chips.

    Science.gov (United States)

    Huh, Dongeun; Torisawa, Yu-suke; Hamilton, Geraldine A; Kim, Hyun Jung; Ingber, Donald E

    2012-06-21

    Microscale engineering technologies provide unprecedented opportunities to create cell culture microenvironments that go beyond current three-dimensional in vitro models by recapitulating the critical tissue-tissue interfaces, spatiotemporal chemical gradients, and dynamic mechanical microenvironments of living organs. Here we review recent advances in this field made over the past two years that are focused on the development of 'Organs-on-Chips' in which living cells are cultured within microfluidic devices that have been microengineered to reconstitute tissue arrangements observed in living organs in order to study physiology in an organ-specific context and to develop specialized in vitro disease models. We discuss the potential of organs-on-chips as alternatives to conventional cell culture models and animal testing for pharmaceutical and toxicology applications. We also explore challenges that lie ahead if this field is to fulfil its promise to transform the future of drug development and chemical safety testing.

  14. Perspective: Fabrication of integrated organ-on-a-chip via bioprinting.

    Science.gov (United States)

    Yang, Qingzhen; Lian, Qin; Xu, Feng

    2017-05-01

    Organ-on-a-chip has emerged as a powerful platform with widespread applications in biomedical engineering, such as pathology studies and drug screening. However, the fabrication of organ-on-a-chip is still a challenging task due to its complexity. For an integrated organ-on-a-chip, it may contain four key elements, i.e., a microfluidic chip, live cells/microtissues that are cultured in this chip, components for stimulus loading to mature the microtissues, and sensors for results readout. Recently, bioprinting has been used for fabricating organ-on-a-chip as it enables the printing of multiple materials, including biocompatible materials and even live cells in a programmable manner with a high spatial resolution. Besides, all four elements for organ-on-a-chip could be printed in a single continuous procedure on one printer; in other words, the fabrication process is assembly free. In this paper, we discuss the recent advances of organ-on-a-chip fabrication by bioprinting. Light is shed on the printing strategies, materials, and biocompatibility. In addition, some specific bioprinted organs-on-chips are analyzed in detail. Because the bioprinted organ-on-a-chip is still in its early stage, significant efforts are still needed. Thus, the challenges presented together with possible solutions and future trends are also discussed.

  15. Design and Development of a Portable Metal Chip Baler using A System Design Approach

    Directory of Open Access Journals (Sweden)

    Hassan Mohd Fahrul

    2017-01-01

    Full Text Available A large amount of metal chips at workplace will result in untidy and unsafe condition thus measurements of safety are needed in some industries, where the metal chips will be collected and put into a container until the volume is sufficient to be recycled. Due to that reason, the metal chips require a lot of spaces for storage before going to recycle. In this study, a portable metal chip baler as a device for compacting those metal chips is presented based on a system approach of engineering design. Basically, the system design evolves through four phases of development that are started from conceptual design, preliminary system design, detail design and development to system test and evaluation. The portable metal chip baler uses current technology such as pneumatic cylinder to compress the metal chips so that the system capable to operate efficiently. The output from this system is the metal chips are compacted into a block shape and a working prototype was developed to prove the concept of the system. As a summary, the conceptual design of portable metal chip baler was proven and was presented using the philosophy of the systems design approach. This tool may assists workers especially in the Small-Medium Enterprise (SME manufacturing industries, school or universities’ workshops for managing metal chips easily and systematically.

  16. Are Staffing, Work Environment, Work Stressors, and Rationing of Care Related to Care Workers' Perception of Quality of Care? A Cross-Sectional Study.

    Science.gov (United States)

    Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René

    2015-10-01

    To describe care worker-reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care. Cross-sectional study. National, randomly selected sample of Swiss nursing homes, stratified according to language region and size. A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013. Care worker-reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale-Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care. Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36-8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08-4.15); less stress due to workload (OR 0.71, 95% CI 0.55-0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24-0.49); and less rationing of social care (OR 0.80, 95% CI 0.69-0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care. Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  17. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study.

    Science.gov (United States)

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, Bert

    2015-08-21

    Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model was used to study the relationship between context factors, mechanisms and outcomes. Dutch integrated care involves care groups, bundled payments, patient involvement, health professional cooperation and task substitution, evidence-based care protocols and a shared clinical information system. Community involvement is not (yet) part of Dutch integrated care. Barriers to the implementation of integrated care included insufficient integration between the patient databases, decreased earnings for some health professionals, patients' insufficient medical and policy-making expertise, resistance by general practitioner assistants due to perceived competition, too much care provided by practice nurses instead of general practitioners and the funding system incentivising the provision of care exactly as described in the care protocols. Facilitators included performance monitoring via the care chain information system, increased earnings for some health professionals, increased focus on self-management, innovators in primary and secondary care, diabetes nurses acting as integrators and financial incentives for guideline adherence. Economic and political context and health IT-related barriers were discussed as the most problematic areas of integrated care implementation. The implementation of integrated care led to improved communication and cooperation but also to insufficient and unnecessary care provision and deteriorated preconditions for person-centred care. Dutch integrated diabetes care is still a

  18. [Relations between research and clinical care in co-management studies with mental health care users].

    Science.gov (United States)

    Palombini, Analice de Lima; Onocko-Campos, Rosana Teresa; Silveira, Marília; Gonçalves, Laura Lamas Martins; Zanchet, Lívia; Xavier, Maria Angélica Zamora; de Castro e Marques, Cecília

    2013-10-01

    This paper is derived from the experience of conducting research with mental health users (not about them, nor for them), analyzing aspects of a study in which different ways of structuring the relationship between clinical practice and research were put into play, thereby questioning the boundaries and ethical issues involved. The clinical practice and research fields that are dealt with are studied with the input of authors who, on the basis of institutional analysis, propose the idea of interventional research, and in the context of public health, revert to the concept of broadened clinical care. The relationship between these two terms - interventional research and broadened clinical care - is based on the notion of subjectivity that operates within the scope of public health and which culminates in the concept of autonomy. Lastly, co-management is proposed as a strategy based on which the different actors involved in conducting research and exercising clinical care can collectively build working principles that are both therapeutic and ethical.

  19. Drug utilization study in a burn care unit of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Santoshkumar R Jeevangi

    2011-03-01

    Full Text Available Objective: To evaluate drug utilization and associated costs for the treatment of patients admitted in burn care unit of a tertiary care hospital. Methods: A prospective cross sectional study was conducted for a period of 15 months at Basaweshwara Teaching and General Hospital (BTGH, Gulbarga and the data collected was analyzed for various drug use indicators. Results: A total of 100 prescriptions were collected with 44% belonging to males and 56% to females. The average number of drugs per prescription ranged from 4.5 to 9.5. 9.5% of generics and 92% of essential drugs were prescribed. The opioid analgesics and sedatives were prescribed to all the patients who were admitted in burn care unit. The (Defined daily dose DDD/1 000/day for amikacin (359 was the highest followed by diclofenac sodium (156, pantoprazole (144, diazepam (130, ceftazidime (124, tramadol (115, ceftriaxone (84 and for paracetamol (4 which was the lowest. Conclusions: Significant amount of the money was spent on procurement of drugs. Most of the money was spent on prescribed antibiotics. The prescription of generic drugs should be promoted, for cost effective treatment. Hence the results of the present study indicate that there is a considerable scope for improvement in the prescription pattern.

  20. [Patient-related complexity in nursing care - Collective case studies in the acute care hospital].

    Science.gov (United States)

    Gurtner, Caroline; Spirig, Rebecca; Staudacher, Diana; Huber, Evelyn

    2018-06-04

    Patient-related complexity in nursing care - Collective case studies in the acute care hospital Abstract. Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. We investigated the phenomenon of patient-related complexity from the point of view of nurses and clinical nurse specialists in an acute care hospital. In the context of a collective case study design, nurses and clinical nurse specialists assessed the complexity of nursing situations with a questionnaire. Subsequently, we interviewed nurses and clinical nurse specialists about their evaluation of patient-related complexity. In a within-case-analysis we summarized data inductively to create case narratives. By means of a cross-case-analysis we compared the cases with regard to deductively derived characteristics. The four cases exemplarily showed that the degree of complexity depends on the controllability and predictability of clinical problems. Additionally, complexity increases or decreases, according to patients' individual resources. Complex patient situations demand professional expertise, experience, communicative competencies and the ability for reflection. Beginner nurses would benefit from support and advice by experienced nurses to develop these skills.

  1. Illness and risk behaviour in health care students studying abroad.

    Science.gov (United States)

    Angelin, Martin; Evengård, Birgitta; Palmgren, Helena

    2015-07-01

    The numbers of university students studying abroad increase every year. These students are not tourists as their studies require different types of travel that expose them to different risks. Moreover, health care students (HCSs) may be exposed to even greater risks according to their travel destinations and itineraries. Clearly, research-based pre-travel advice is needed. This study reports on a prospective survey conducted from April 2010 to January 2014 of health care and non-health care students from Swedish universities in Umeå, Stockholm and Gothenburg studying abroad. Of the 393 students included in the study, 85% responded. Over half (55%) were HCSs. Pre-travel health information was received by 79% and information on personal safety by 49% of HCSs. The rate of illness during travel was 52%. Health care students more often travelled to developing regions and were at increased risk for travellers' diarrhoea. One in 10 experienced theft and 3% were involved in traffic accidents. One in five met a new sexual partner during travel and 65% of these practised safe sex. Half of all participants increased their alcohol consumption while abroad; high alcohol consumption was associated with increased risk for being a victim of theft, as well as for meeting a new sexual partner during travel. University authorities are responsible for the safety and well-being of students studying abroad. This study supplies organisers and students with epidemiological data that will help improve pre-travel preparation and increase student awareness of the potential risks associated with studying abroad. © 2015 John Wiley & Sons Ltd.

  2. Characterizing Rat PNS Electrophysiological Response to Electrical Stimulation Using in vitro Chip-Based Human Investigational Platform (iCHIP)

    Energy Technology Data Exchange (ETDEWEB)

    Khani, Joshua [Georgetown Univ., Washington, DC (United States); Prescod, Lindsay [Georgetown Univ., Washington, DC (United States); Enright, Heather [Georgetown Univ., Washington, DC (United States); Felix, Sarah [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Osburn, Joanne [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Wheeler, Elizabeth [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Kulp, Kris [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2015-08-18

    Ex vivo systems and organ-on-a-chip technology offer an unprecedented approach to modeling the inner workings of the human body. The ultimate goal of LLNL’s in vitro Chip-based Human Investigational Platform (iCHIP) is to integrate multiple organ tissue cultures using microfluidic channels, multi-electrode arrays (MEA), and other biosensors in order to effectively simulate and study the responses and interactions of the major organs to chemical and physical stimulation. In this study, we focused on the peripheral nervous system (PNS) component of the iCHIP system. Specifically we sought to expound on prior research investigating the electrophysiological response of rat dorsal root ganglion cells (rDRGs) to chemical exposures, such as capsaicin. Our aim was to establish a protocol for electrical stimulation using the iCHIP device that would reliably elicit a characteristic response in rDRGs. By varying the parameters for both the stimulation properties – amplitude, phase width, phase shape, and stimulation/ return configuration – and the culture conditions – day in vitro and neural cell types - we were able to make several key observations and uncover a potential convention with a minimal number of devices tested. Future work will seek to establish a standard protocol for human DRGs in the iCHIP which will afford a portable, rapid method for determining the effects of toxins and novel therapeutics on the PNS.

  3. A feasibility study of the provision of a personalized interdisciplinary audiovisual summary to facilitate care transfer care at hospital discharge: Care Transfer Video (CareTV).

    Science.gov (United States)

    Newnham, Harvey H; Gibbs, Harry H; Ritchie, Edward S; Hitchcock, Karen I; Nagalingam, Vathy; Hoiles, Andrew; Wallace, Ed; Georgeson, Elizabeth; Holton, Sara

    2015-04-01

    To assess the feasibility and patient acceptance of a personalized interdisciplinary audiovisual record to facilitate effective communication with patients, family, carers and other healthcare workers at hospital discharge. Descriptive pilot study utilizing a study-specific patient feedback questionnaire conducted from October 2013 to June 2014. Twenty General Medical inpatients being discharged from an Acute General Medical Ward in a metropolitan teaching hospital. Audiovisual record of a CareTV filmed at the patient's bedside by a consultant-led interdisciplinary team, within 24 h prior to discharge from the ward, provided immediately for the patient to take home. Patient surveys were completed within 2 weeks of discharge. Technical quality, utilization, acceptability, patient satisfaction and recall of diagnosis, medication changes and post-discharge review arrangements. All patients had watched their CareTV either alone or in the presence of a variety of others: close family, their GP, a medical specialist, friends or other health personnel. Participating patients had good understanding of the video content and recall of their diagnosis, medication changes and post-discharge plans. Patient feedback was overwhelmingly positive. In the context of a General Medical Unit with extensive experience in interdisciplinary bedside rounding and teamwork, CareTV is simple to implement, inexpensive, technically feasible, requires minimal staff training and is acceptable to patients. The results of this pilot study will inform and indicate the feasibility of conducting a larger randomized control trial of the impact of CareTV on patient satisfaction, medication adherence and recall of key information, and primary healthcare provider satisfaction. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  4. Chipping operations and efficiency in different operational environments

    Energy Technology Data Exchange (ETDEWEB)

    Roeser, D.; Mola-Yudego, B.; Prinz, R.; Emer, B.; Sikanen, L., e-mail: dominik.roser@metla.fi

    2012-11-01

    This research analyses the productivity of energy wood chipping operations at several sites in Austria and Finland. The aim of the work is to examine the differences in productivity and the effects of the operational environment for the chipping of bioenergy at the roadside. Furthermore, the study quantifies the effects of different variables such as forest energy assortments, tree species, sieve size and machines on the overall productivity of chipping. The results revealed that there are significant differences in the chipping productivity in Austria and Finland which are largely based on the use of different sieve sizes. Furthermore, the different operational environments in both countries, as well as the characteristics of the raw material also seem to have an effect on productivity. In order to improve the chipping productivity, particularly in Central European conditions, all relevant stakeholders need to work jointly to find solutions that will allow a greater variation of chip size. Furthermore, in the future more consideration has to be given to the close interlinkage between the chipper, crane and grapple. As a result, investments costs can be optimized and operational costs and stress on the machines reduced. (orig.)

  5. Chip cleaning and regeneration for electrochemical sensor arrays

    Energy Technology Data Exchange (ETDEWEB)

    Bhalla, Vijayender [Biochemistry Department ' G.Moruzzi' , University of Bologna, Via Irnerio 48, 40126 Bologna (Italy); Carrara, Sandro, E-mail: sandro.carrara@epfl.c [Biochemistry Department ' G.Moruzzi' , University of Bologna, Via Irnerio 48, 40126 Bologna (Italy); Stagni, Claudio [Department DEIS, University of Bologna, viale Risorgimento 2, 40136 Bologna (Italy); Samori, Bruno [Biochemistry Department ' G.Moruzzi' , University of Bologna, Via Irnerio 48, 40126 Bologna (Italy)

    2010-04-02

    Sensing systems based on electrochemical detection have generated great interest because electronic readout may replace conventional optical readout in microarray. Moreover, they offer the possibility to avoid labelling for target molecules. A typical electrochemical array consists of many sensing sites. An ideal micro-fabricated sensor-chip should have the same measured values for all the equivalent sensing sites (or spots). To achieve high reliability in electrochemical measurements, high quality in functionalization of the electrodes surface is essential. Molecular probes are often immobilized by using alkanethiols onto gold electrodes. Applying effective cleaning methods on the chip is a fundamental requirement for the formation of densely-packed and stable self-assembly monolayers. However, the available well-known techniques for chip cleaning may not be so reliable. Furthermore, it could be necessary to recycle the chip for reuse. Also in this case, an effective recycling technique is required to re-obtain well cleaned sensing surfaces on the chip. This paper presents experimental results on the efficacy and efficiency of the available techniques for initial cleaning and further recycling of micro-fabricated chips. Piranha, plasma, reductive and oxidative cleaning methods were applied and the obtained results were critically compared. Some interesting results were attained by using commonly considered cleaning methodologies. This study outlines oxidative electrochemical cleaning and recycling as the more efficient cleaning procedure for electrochemical based sensor arrays.

  6. Exploring interprofessional, interagency multimorbidity care: case study based observational research

    Science.gov (United States)

    McKinlay, Eileen M.; Morgan, Sonya J.; Gray, Ben V.; Macdonald, Lindsay M.; Pullon, Susan R.H.

    2017-01-01

    Background The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. PMID

  7. Volunteering in dementia care – a Norwegian phenomenological study

    Directory of Open Access Journals (Sweden)

    Söderhamn U

    2012-02-01

    Full Text Available Ulrika Söderhamn1, Bjørg Landmark2,3, Live Aasgaard2, Hilde Eide3, Olle Söderhamn11Center for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; 2Institute of Research and Development for Nursing and Care Services, Municipality of Drammen, Drammen, Norway; 3Faculty of Health Sciences, Buskerud University College, Drammen, NorwayIntroduction: The number of people suffering from dementia will increase dramatically in the future, and this will be a great challenge and concern for health care services. It is assumed that volunteers will strengthen community health care services more in the future than they do today.Aim: The aim of this study was to elucidate lived experiences of working as a volunteer in an activity center with adapted activities for home-dwelling people with early stage dementia.Methods: Qualitative interviews were implemented in a group of nine female volunteers from an activity center in southern Norway. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method. Results: Volunteering in an activity center for home-dwelling people with early stage dementia was reported to provide experiences of being useful and feeling satisfied with performing a good job. It was an advantage for the volunteers to have had experiences from life in general, but also as a health professional or as being the next of kin of a dementia sufferer. It was important for the volunteers to focus on the dementia sufferer and show caring behavior, and interaction with and the appreciation of the health care professionals were also important. The volunteers were motivated by being able to have influence and participate in the planning of the work, to be a part of the social setting, and to learn. However, for some volunteers it was difficult to adjust to an appropriate role.Conclusion: In order to promote volunteering in a caring context, mutual

  8. THE CARE OF NURSING TO THE FAMILY: A BIBLIOGRAPHICAL STUDY

    Directory of Open Access Journals (Sweden)

    Klever Souza Silva

    2004-08-01

    Full Text Available The objective of this study was to identify the scientific article about the care of nursing to the family,published in periodic of Brazilian nursing, index-linked article survey to the LILACS, in the period of 1993 the 2003,and to analyze them how much to the concept and composition of the families, systematization and proposals ofaction of nursing and formation and qualification of the authors. In the results we find in 10 years (1993-2003, 9publications concerning nursing in family. Where we can find the predominance of works that focus thesystematization and proposals of action, evidencing of a general form, a lack of studies in the area of nursing infamily, where the Program of Health of the Family appears as principal source of promotion of care of nursing tothe family and motivation for studies that approach this thematic one. All research had had as authorship nursesdoctors, masters and specialists, which acted as professors.

  9. Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania

    Directory of Open Access Journals (Sweden)

    Kessy Flora

    2011-05-01

    Full Text Available Abstract Background The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. Methods Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. Results The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". Conclusions Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker

  10. A Validation Study of Homeopathic Prescribing and Patient Care Indicators

    Directory of Open Access Journals (Sweden)

    Munmun Koley

    2014-10-01

    Full Text Available A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H, Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items and patient care indicators (5 items. Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791. The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations – Pearson's r from 0.58 (95% CI: 0.52-0.65 to 0.74 (95% CI: 0.69-0.78. The patient care indicators, except item 2, showed acceptable correlations – Pearson's r from 0.40 (95% CI: 0.31-0.48 to 0.82 (95% CI: 0.78-0.85. The instrument also showed high discriminant validity (prescribing indicators P<0.0001 and patient care indicators P<0.0001. Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.

  11. A Validation Study of Homeopathic Prescribing and Patient Care Indicators

    Science.gov (United States)

    Koley, Munmun; Saha, Subhranil; Ghosh, Shubhamoy; Nag, Goutam; Kundu, Monojit; Mondal, Ramkumar; Purkait, Rajib; Patra, Supratim

    2014-01-01

    A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H), Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items) and patient care indicators (5 items). Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791). The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations – Pearson's r from 0.58 (95% CI: 0.52-0.65) to 0.74 (95% CI: 0.69-0.78). The patient care indicators, except item 2, showed acceptable correlations – Pearson's r from 0.40 (95% CI: 0.31-0.48) to 0.82 (95% CI: 0.78-0.85). The instrument also showed high discriminant validity (prescribing indicators P < 0.0001 and patient care indicators P < 0.0001). Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development. PMID:25379474

  12. Complications to evaluate adult trauma care: An expert consensus study.

    Science.gov (United States)

    Moore, Lynne; Lauzier, François; Stelfox, Henry Thomas; Le Sage, Natalie; Bourgeois, Gilles; Clément, Julien; Shemilt, Michèle; Turgeon, Alexis F

    2014-08-01

    Complications affect up to 37% of patients hospitalized for injury and increase mortality, morbidity, and costs. One of the keys to controlling complications for injury admissions is to monitor in-hospital complication rates. However, there is no consensus on which complications should be used to evaluate the quality of trauma care. The objective of this study was to develop a consensus-based list of complications that can be used to assess the acute phase of adult trauma care. We used a three-round Web-based Delphi survey among experts in the field of trauma care quality with a broad range of clinical expertise and geographic diversity. The main outcome measure was median importance rating on a 5-point Likert scale (very low to very high); complications with a median of 4 or greater and no disagreement were retained. A secondary measure was the perceived quality of information on each complication available in patient files. Of 19 experts invited to participate, 17 completed the first (brainstorming) round and 16 (84%) completed all rounds. Of 73 complications generated in Round 1, a total of 25 were retained including adult respiratory distress syndrome, hospital-acquired pneumonia, sepsis, acute renal failure, deep vein thrombosis, pulmonary embolism, wound infection, decubitus ulcers, and delirium. Of these, 19 (76%) were perceived to have high-quality or very high-quality information in patient files by more than 50% of the panel members. This study proposes a consensus-based list of 25 complications that can be used to evaluate the quality of acute adult trauma care. These complications can be used to develop an informative and actionable quality indicator to evaluate trauma care with the goal of decreasing rates of hospital complications and thus improving patient outcomes and resource use. DRG International Classification of Diseases codes are provided.

  13. A single chip with multiple talents

    CERN Multimedia

    Francesco Poppi

    2010-01-01

    The Medipix chips developed at CERN are being used in a variety of fields: from medicine to education and back to high-tech engineering. The scene is set for a bright future for this versatile technology.   The Medipix chip. It didn’t take long for a brilliant team of physicists and engineers who were working on pixel detectors for the LHC to realize that the technology had great potential in medical imaging. This was the birth of the Medipix project. Fifteen years later, with the collaboration of 18 research institutes, the team has produced an advanced version of the initial ideas: Medipix3 is a device that can measure very accurately the position and energy of the photons (one by one) that hit the associated detector. Radiography and computed tomography (CT) use X-ray photons to study the human body. The different energies of the photons in the beam can be thought of as the colours of the X-ray spectrum. This is why the use of Medipix3 chips in such diagnostic techniques is referred...

  14. Older Persons’ Transitions in Care (OPTIC: a study protocol

    Directory of Open Access Journals (Sweden)

    Cummings Greta G

    2012-12-01

    Full Text Available Abstract Background Changes in health status, triggered by events such as infections, falls, and geriatric syndromes, are common among nursing home (NH residents and necessitate transitions between NHs and Emergency Departments (EDs. During transitions, residents frequently experience care that is delayed, unnecessary, not evidence-based, potentially unsafe, and fragmented. Furthermore, a high proportion of residents and their family caregivers report substantial unmet needs during transitions. This study is part of a program of research whose overall aim is to improve quality of care for frail older adults who reside in NHs. The purpose of this study is to identify successful transitions from multiple perspectives and to identify organizational and individual factors related to transition success, in order to inform improvements in care for frail elderly NH residents during transitions to and from acute care. Specific objectives are to: 1. define successful and unsuccessful elements of transitions from multiple perspectives; 2. develop and test a practical tool to assess transition success; 3. assess transition processes in a discrete set of transfers in two study sites over a one year period; 4. assess the influence of organizational factors in key practice locations, e.g., NHs, emergency medical services (EMS, and EDs, on transition success; and 5. identify opportunities for evidence-informed management and quality improvement decisions related to the management of NH – ED transitions. Methods/Design This is a mixed-methods observational study incorporating an integrated knowledge translation (IKT approach. It uses data from multiple levels (facility, care unit, individual and sources (healthcare providers, residents, health records, and administrative databases. Discussion Key to study success is operationalizing the IKT approach by using a partnership model in which the OPTIC governance structure provides for team decision-makers and

  15. A qualitative study on hypertensive care behavior in primary health care settings in Malaysia

    Directory of Open Access Journals (Sweden)

    Shima R

    2014-11-01

    Full Text Available Razatul Shima,1,3 Mohd Hairi Farizah,1,2 Hazreen Abdul Majid1,2 1Department of Social and Preventive Medicine; 2Centre for Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3Ministry of Health Malaysia, Putrajaya, Malaysia Purpose: The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes in primary health clinic settings. Patients and methods: A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis.Results: There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups.Conclusion: Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their

  16. Studying integrated health care systems with a structurationist approach

    Science.gov (United States)

    Demers, Louis; Arseneault, Stéphane; Couturier, Yves

    2010-01-01

    Introduction To implement an integrated health care system is not an easy task and to ensure its sustainability is yet more difficult. Aim Discuss how a structurationist approach can shed light on the stakes of these processes and guide the managers of such endeavours. Theory and method Structuration theory [1] has been used by numerous authors to cast new light on complex organizational phenomena. One of the central tenets of this theory is that social systems, such as integrated health care systems, are recurrent social practices across time-space and are characterized by structural properties which simultaneously constrain and enable the constitutive social actors who reproduce and transform the system through their practices. We will illustrate our theoretical standpoint with empirical material gathered during the study of an integrated health care system for the frail elderly in Quebec, Canada. This system has been implemented in 1997 and is still working well in 2010. Results and conclusion To implement an integrated health care system that is both effective and sustainable, its managers must shrewdly allow for the existing system and progressively introduce changes in the way managers and practitioners at work in the system view their role and act on a daily basis.

  17. Cache-aware network-on-chip for chip multiprocessors

    Science.gov (United States)

    Tatas, Konstantinos; Kyriacou, Costas; Dekoulis, George; Demetriou, Demetris; Avraam, Costas; Christou, Anastasia

    2009-05-01

    This paper presents the hardware prototype of a Network-on-Chip (NoC) for a chip multiprocessor that provides support for cache coherence, cache prefetching and cache-aware thread scheduling. A NoC with support to these cache related mechanisms can assist in improving systems performance by reducing the cache miss ratio. The presented multi-core system employs the Data-Driven Multithreading (DDM) model of execution. In DDM thread scheduling is done according to data availability, thus the system is aware of the threads to be executed in the near future. This characteristic of the DDM model allows for cache aware thread scheduling and cache prefetching. The NoC prototype is a crossbar switch with output buffering that can support a cache-aware 4-node chip multiprocessor. The prototype is built on the Xilinx ML506 board equipped with a Xilinx Virtex-5 FPGA.

  18. Atom chip gravimeter

    Science.gov (United States)

    Schubert, Christian; Abend, Sven; Gebbe, Martina; Gersemann, Matthias; Ahlers, Holger; Müntinga, Hauke; Matthias, Jonas; Sahelgozin, Maral; Herr, Waldemar; Lämmerzahl, Claus; Ertmer, Wolfgang; Rasel, Ernst

    2016-04-01

    Atom interferometry has developed into a tool for measuring rotations [1], accelerations [2], and testing fundamental physics [3]. Gravimeters based on laser cooled atoms demonstrated residual uncertainties of few microgal [2,4] and were simplified for field applications [5]. Atomic gravimeters rely on the interference of matter waves which are coherently manipulated by laser light fields. The latter can be interpreted as rulers to which the position of the atoms is compared. At three points in time separated by a free evolution, the light fields are pulsed onto the atoms. First, a coherent superposition of two momentum states is produced, then the momentum is inverted, and finally the two trajectories are recombined. Depending on the acceleration the atoms experienced, the number of atoms detected in the output ports will change. Consequently, the acceleration can be determined from the output signal. The laser cooled atoms with microkelvin temperatures used in state-of-the-art gravimeters impose limits on the accuracy [4]. Therefore, ultra-cold atoms generated by Bose-Einstein condensation and delta-kick collimation [6,7] are expected to be the key for further improvements. These sources suffered from a low flux implying an incompatible noise floor, but a competitive performance was demonstrated recently with atom chips [8]. In the compact and robust setup constructed for operation in the drop tower [6] we demonstrated all steps necessary for an atom chip gravimeter with Bose-Einstein condensates in a ground based operation. We will discuss the principle of operation, the current performance, and the perspectives to supersede the state of the art. The authors thank the QUANTUS cooperation for contributions to the drop tower project in the earlier stages. This work is supported by the German Space Agency (DLR) with funds provided by the Federal Ministry for Economic Affairs and Energy (BMWi) due to an enactment of the German Bundestag under grant numbers DLR 50WM

  19. Usage and Quality of Formal Child Care Services Experienced by Infants and Toddlers in Foster and Kinship Care: An Australian Study

    Science.gov (United States)

    Wise, Sarah

    2018-01-01

    This research uses data from the Early Childhood in Foster and Kinship Care (ECIFKC) study to identify the proportion of young children, under 2 years of age, in foster and kinship care who use formal child care; weekly hours of child care; predictors of weekly hours of child care; and quality of care experienced. The sample for these analyses…

  20. Experiment list: SRX214075 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available age=Undifferentiated || treatment=Overexpress Sox17EK-V5 tagged || cell line=KH2 || chip antibody 1=none || chip antibody manufacture...r 1=none || chip antibody 2=V5 || chip antibody manufacture

  1. Experiment list: SRX122523 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ntibody=Irf2 || treatment=LPS || time=60 min || chip antibody manufacturer 1=Abcam || chip antibody catalog ...number 1=ab65048 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-498 http://

  2. Experiment list: SRX122414 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ntibody=Junb || treatment=LPS || time=30 min || chip antibody manufacturer 1=Abcam || chip antibody catalog ...number 1=ab28838 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-46 http://d

  3. Experiment list: SRX214071 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available Undifferentiated || treatment=Overexpress Sox2-V5 tagged || cell line=KH2 || chip antibody 1=none || chip antibody manufacture...r 1=none || chip antibody 2=V5 || chip antibody manufacturer 2=

  4. Experiment list: SRX214086 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available entiated || cell line=KH2 || chip antibody 1=none || chip antibody manufacturer 1=none || chip antibody 2=none || chip antibody manuf...acturer 2=none http://dbarchive.biosciencedbc.jp/kyushu-

  5. Experiment list: SRX122485 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available antibody=Atf3 || treatment=LPS || time=120 min || chip antibody manufacturer 1=Santa Cruz || chip antibody ...catalog number 1=sc-188 || chip antibody manufacturer 2=Abcam || chip antibody catalog number 2=ab70005-100

  6. Experiment list: SRX122521 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ntibody=Irf2 || treatment=LPS || time=30 min || chip antibody manufacturer 1=Abcam || chip antibody catalog ...number 1=ab65048 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-498 http://

  7. Experiment list: SRX122417 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ntibody=Junb || treatment=LPS || time=60 min || chip antibody manufacturer 1=Abcam || chip antibody catalog ...number 1=ab28838 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-46 http://d

  8. Experiment list: SRX122520 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ntibody=Irf2 || treatment=LPS || time=30 min || chip antibody manufacturer 1=Abcam || chip antibody catalog ...number 1=ab65048 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-498 http://

  9. Experiment list: SRX122413 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available antibody=Junb || treatment=LPS || time=120 min || chip antibody manufacturer 1=Abcam || chip antibody catalo...g number 1=ab28838 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-46 http:/

  10. Experiment list: SRX122412 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available antibody=Junb || treatment=LPS || time=120 min || chip antibody manufacturer 1=Abcam || chip antibody catalo...g number 1=ab28838 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-46 http:/

  11. Experiment list: SRX122406 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available antibody=Irf1 || treatment=LPS || time=0 min || chip antibody manufacturer 1=Abcam || chip antibody catalog... number 1=ab52520 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-640 http:/

  12. Experiment list: SRX122415 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ntibody=Junb || treatment=LPS || time=30 min || chip antibody manufacturer 1=Abcam || chip antibody catalog ...number 1=ab28838 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-46 http://d

  13. Experiment list: SRX214074 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ge=Undifferentiated || treatment=Overexpress Sox17EK-V5 tagged || cell line=KH2 || chip antibody 1=none || chip antibody manufacture...r 1=none || chip antibody 2=V5 || chip antibody manufacture

  14. Experiment list: SRX214072 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available e=Undifferentiated || treatment=Overexpress Sox2KE-V5 tagged || cell line=KH2 || chip antibody 1=none || chip antibody manufacture...r 1=none || chip antibody 2=V5 || chip antibody manufacture

  15. Experiment list: SRX214067 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available fferentiated || cell line=F9 || chip antibody 1=Pou5f1/Oct4 || chip antibody manufacture...r 1=Santa Cruz || chip antibody 2=none || chip antibody manufacturer 2=none http://dbarchive.bioscien

  16. Experiment list: SRX122416 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available ntibody=Junb || treatment=LPS || time=60 min || chip antibody manufacturer 1=Abcam || chip antibody catalog ...number 1=ab28838 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-46 http://d

  17. Experiment list: SRX122565 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available antibody=Stat2 || treatment=LPS || time=0 min || chip antibody manufacturer 1=Abcam || chip antibody catalog... number 1=ab53149 || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2=sc-839 http:/

  18. Machinery for Forest Chip Production in Finland in 2007 and in the Future

    Energy Technology Data Exchange (ETDEWEB)

    Kaerhae, Kalle (Metsaeteho Oy, P.O. Box 101, FI-00171 Helsinki (Finland))

    2008-10-15

    Metsaeteho Oy's study consisted of a survey of the production machinery for forest chips used by energy plants in 2007. The major forest chip suppliers in Finland were involved in the study. In addition, the machinery and equipment stocked by the manufacturers and vendors of energy wood harvester heads, stump lifting devices, and chippers were also surveyed. The study provided also an estimate of future machinery requirements for forest chip production in Finland. The study estimated that a total of 1,100 machine and truck units were employed in the production of forest chips for energy plants in 2007. A total of 770 machine and truck units were contracted for the major forest chip suppliers in 2007. Increasing forest chip consumption will considerable increase the demand for additional forest chip production resources in the future. If the consumption of forest chips by energy plants in 2015 reaches 15 TWh, i.e. about 7.5 mill. m3, then the forest machine and truck requirement will be over 1,700 units. The corresponding machinery requirement at an energy plant with a forest chip consumption of 25 TWh (approx. 12.5 mill. m3), will be close to 2,300 machine and truck units

  19. Chromatin immunoprecipitation (ChIP) of plant transcription factors followed by sequencing (ChIP-SEQ) or hybridization to whole genome arrays (ChIP-CHIP)

    NARCIS (Netherlands)

    Kaufmann, K.; Muiño, J.M.; Østerås, M.; Farinelli, L.; Krajewski, P.; Angenent, G.C.

    2010-01-01

    Chromatin immunoprecipitation (ChIP) is a powerful technique to study interactions between transcription factors (TFs) and DNA in vivo. For genome-wide de novo discovery of TF-binding sites, the DNA that is obtained in ChIP experiments needs to be processed for sequence identification. The sequences

  20. Chip compacting press; Jido kirikuzu asshukuki

    Energy Technology Data Exchange (ETDEWEB)

    Oura, K. [Yuken Kogyo Co. Ltd., Kanagawa (Japan)

    1998-08-15

    The chips exhausted from various machine tools are massy, occupy much space and make working environment worse by staying added cutting oil to lower part. The chips are exhausted as a result of machining and have not constant quality. Even if used material is same the chips have various shapes and properties by kinds and machining methods of used machine tools, and are troublesome materials from a standpoint of their treatment. Pressing and solidification of the chips have frequently been tried. A chip compacting press introduced in this paper, a relatively cheap chip compacting press aimed for relatively small scale chip treatment, and has such characteristics and effects as follows. Chips are pressed and solidified by each raw material, so fractional management can be easily conducted. As casting metal chips and curled chips of iron and aluminum can be pressed to about 1/3 to 1/5 and about 1/40, respectively, space saving can be conducted. Chip compacting pressing upgrades its transporting efficiency to make possible to reduce its transporting cost. As chip solidification controls its oxidation and most cutting oil are removed, chips are easy to recycle. 2 figs., 1 tab.

  1. Microfluidic Organ-on-a-Chip Models of Human IntestineSummary

    Directory of Open Access Journals (Sweden)

    Amir Bein

    Full Text Available Microfluidic organ-on-a-chip models of human intestine have been developed and used to study intestinal physiology and pathophysiology. In this article, we review this field and describe how microfluidic Intestine Chips offer new capabilities not possible with conventional culture systems or organoid cultures, including the ability to analyze contributions of individual cellular, chemical, and physical control parameters one-at-a-time; to coculture human intestinal cells with commensal microbiome for extended times; and to create human-relevant disease models. We also discuss potential future applications of human Intestine Chips, including how they might be used for drug development and personalized medicine. Keywords: Organs-on-Chips, Gut-on-a-Chip, Intestine-on-a-Chip, Microfluidic

  2. Energy Harvesting Chip and the Chip Based Power Supply Development for a Wireless Sensor Network

    Science.gov (United States)

    Lee, Dasheng

    2008-01-01

    In this study, an energy harvesting chip was developed to scavenge energy from artificial light to charge a wireless sensor node. The chip core is a miniature transformer with a nano-ferrofluid magnetic core. The chip embedded transformer can convert harvested energy from its solar cell to variable voltage output for driving multiple loads. This chip system yields a simple, small, and more importantly, a battery-less power supply solution. The sensor node is equipped with multiple sensors that can be enabled by the energy harvesting power supply to collect information about the human body comfort degree. Compared with lab instruments, the nodes with temperature, humidity and photosensors driven by harvested energy had variation coefficient measurement precision of less than 6% deviation under low environmental light of 240 lux. The thermal comfort was affected by the air speed. A flow sensor equipped on the sensor node was used to detect airflow speed. Due to its high power consumption, this sensor node provided 15% less accuracy than the instruments, but it still can meet the requirement of analysis for predicted mean votes (PMV) measurement. The energy harvesting wireless sensor network (WSN) was deployed in a 24-hour convenience store to detect thermal comfort degree from the air conditioning control. During one year operation, the sensor network powered by the energy harvesting chip retained normal functions to collect the PMV index of the store. According to the one month statistics of communication status, the packet loss rate (PLR) is 2.3%, which is as good as the presented results of those WSNs powered by battery. Referring to the electric power records, almost 54% energy can be saved by the feedback control of an energy harvesting sensor network. These results illustrate that, scavenging energy not only creates a reliable power source for electronic devices, such as wireless sensor nodes, but can also be an energy source by building an energy efficient

  3. Energy Harvesting Chip and the Chip Based Power Supply Development for a Wireless Sensor Network

    Directory of Open Access Journals (Sweden)

    Dasheng Lee

    2008-12-01

    Full Text Available In this study, an energy harvesting chip was developed to scavenge energy from artificial light to charge a wireless sensor node. The chip core is a miniature transformer with a nano-ferrofluid magnetic core. The chip embedded transformer can convert harvested energy from its solar cell to variable voltage output for driving multiple loads. This chip system yields a simple, small, and more importantly, a battery-less power supply solution. The sensor node is equipped with multiple sensors that can be enabled by the energy harvesting power supply to collect information about the human body comfort degree. Compared with lab instruments, the nodes with temperature, humidity and photosensors driven by harvested energy had variation coefficient measurement precision of less than 6% deviation under low environmental light of 240 lux. The thermal comfort was affected by the air speed. A flow sensor equipped on the sensor node was used to detect airflow speed. Due to its high power consumption, this sensor node provided 15% less accuracy than the instruments, but it still can meet the requirement of analysis for predicted mean votes (PMV measurement. The energy harvesting wireless sensor network (WSN was deployed in a 24-hour convenience store to detect thermal comfort degree from the air conditioning control. During one year operation, the sensor network powered by the energy harvesting chip retained normal functions to collect the PMV index of the store. According to the one month statistics of communication status, the packet loss rate (PLR is 2.3%, which is as good as the presented results of those WSNs powered by battery. Referring to the electric power records, almost 54% energy can be saved by the feedback control of an energy harvesting sensor network. These results illustrate that, scavenging energy not only creates a reliable power source for electronic devices, such as wireless sensor nodes, but can also be an energy source by building an

  4. Energy Harvesting Chip and the Chip Based Power Supply Development for a Wireless Sensor Network.

    Science.gov (United States)

    Lee, Dasheng

    2008-12-02

    In this study, an energy harvesting chip was developed to scavenge energy from artificial light to charge a wireless sensor node. The chip core is a miniature transformer with a nano-ferrofluid magnetic core. The chip embedded transformer can convert harvested energy from its solar cell to variable voltage output for driving multiple loads. This chip system yields a simple, small, and more importantly, a battery-less power supply solution. The sensor node is equipped with multiple sensors that can be enabled by the energy harvesting power supply to collect information about the human body comfort degree. Compared with lab instruments, the nodes with temperature, humidity and photosensors driven by harvested energy had variation coefficient measurement precision of less than 6% deviation under low environmental light of 240 lux. The thermal comfort was affected by the air speed. A flow sensor equipped on the sensor node was used to detect airflow speed. Due to its high power consumption, this sensor node provided 15% less accuracy than the instruments, but it still can meet the requirement of analysis for predicted mean votes (PMV) measurement. The energy harvesting wireless sensor network (WSN) was deployed in a 24-hour convenience store to detect thermal comfort degree from the air conditioning control. During one year operation, the sensor network powered by the energy harvesting chip retained normal functions to collect the PMV index of the store. According to the one month statistics of communication status, the packet loss rate (PLR) is 2.3%, which is as good as the presented results of those WSNs powered by battery. Referring to the electric power records, almost 54% energy can be saved by the feedback control of an energy harvesting sensor network. These results illustrate that, scavenging energy not only creates a reliable power source for electronic devices, such as wireless sensor nodes, but can also be an energy source by building an energy efficient

  5. Real-time PCR Machine System Modeling and a Systematic Approach for the Robust Design of a Real-time PCR-on-a-Chip System

    OpenAIRE

    Lee, Da-Sheng

    2010-01-01

    Chip-based DNA quantification systems are widespread, and used in many point-of-care applications. However, instruments for such applications may not be maintained or calibrated regularly. Since machine reliability is a key issue for normal operation, this study presents a system model of the real-time Polymerase Chain Reaction (PCR) machine to analyze the instrument design through numerical experiments. Based on model analysis, a systematic approach was developed to lower the variation of DN...

  6. Impact of Collaborative Care on Absenteeism for Depressed Employees Seen in Primary Care Practices: A Retrospective Cohort Study.

    Science.gov (United States)

    Adaji, Akuh; Newcomb, Richard D; Wang, Zhen; Williams, Mark

    2018-01-01

    The impact of "real world" collaborative care on depression and absenteeism for depressed employees seen in primary care practices using objective employer absence data. A retrospective cohort study comparing depressed employees seen in primary care practices who enrolled for a "real world" collaborative care program to practice as usual (PAU) on objective absence days and depression response and remission at 6, and 12-month time periods. Absence days were more in the collaborative care group compared with the PAU group at 3 and 6 months but at 12 months the difference was no longer statistically significant. Collaborative care led to better response and remission depression scores compared with PAU at 12 months. Collaborative care led to faster improvement in depression symptoms but did not translate to less time away from work.

  7. Health status of UK care home residents: a cohort study.

    Science.gov (United States)

    Gordon, Adam Lee; Franklin, Matthew; Bradshaw, Lucy; Logan, Pip; Elliott, Rachel; Gladman, John R F

    2014-01-01

    UK care home residents are often poorly served by existing healthcare arrangements. Published descriptions of residents' health status have been limited by lack of detail and use of data derived from surveys drawn from social, rather than health, care records. to describe in detail the health status and healthcare resource use of UK care home residents a 180-day longitudinal cohort study of 227 residents across 11 UK care homes, 5 nursing and 6 residential, selected to be representative for nursing/residential status and dementia registration. Barthel index (BI), Mini-mental state examination (MMSE), Neuropsychiatric index (NPI), Mini-nutritional index (MNA), EuroQoL-5D (EQ-5D), 12-item General Health Questionnaire (GHQ-12), diagnoses and medications were recorded at baseline and BI, NPI, GHQ-12 and EQ-5D at follow-up after 180 days. National Health Service (NHS) resource use data were collected from databases of local healthcare providers. out of a total of 323, 227 residents were recruited. The median BI was 9 (IQR: 2.5-15.5), MMSE 13 (4-22) and number of medications 8 (5.5-10.5). The mean number of diagnoses per resident was 6.2 (SD: 4). Thirty per cent were malnourished, 66% had evidence of behavioural disturbance. Residents had contact with the NHS on average once per month. residents from both residential and nursing settings are dependent, cognitively impaired, have mild frequent behavioural symptoms, multimorbidity, polypharmacy and frequently use NHS resources. Effective care for such a cohort requires broad expertise from multiple disciplines delivered in a co-ordinated and managed way.

  8. The trajectory of experience of critical care nurses in providing end-of-life care: A qualitative descriptive study.

    Science.gov (United States)

    Ong, Keh Kiong; Ting, Kit Cheng; Chow, Yeow Leng

    2018-01-01

    To understand the perceptions of critical care nurses towards providing end-of-life care. There has been an increasing interest in end-of-life care in the critical care setting. In Singapore, approximately half of deaths in the hospital occur during critical care. While nurses are well positioned to provide end-of-life care to patients and their family members, they faced barriers to providing end-of-life care. Also, providing end-of-life care has profound positive and negative psychological effects on nurses, with the latter being more prominent. Qualitative descriptive design. Data collection was performed in a medical intensive care unit of a public tertiary hospital in Singapore. Ten registered nurses were purposively sampled and interviewed individually using a semi-structured interview guide. A codebook was developed to guide coding, and data were thematically analysed. Rigour was maintained. Nurses went through a trajectory of experience. They experienced the culture of care and developed dissatisfaction with it. The tension shaped their perception and meaning of life and death, and they developed mechanisms to reach resolution. This study provides insight on nurses' perception as a trajectory of experience and raised several implications on clinical practice, policy and research. There is a need to alleviate the tension nurses face and to facilitate coming to terms with the tension by improving the culture of care and supporting nurses. Nurses could be involved more in decision-making and empowered to start end-of-life care conversations within the team and with family members. Communication with family members and between nurses and doctors could be improved. Support for nurses providing end-of-life care could be enhanced through promoting social networks, education and bereavement support. Further research is needed to explore ways to support and empower nurses to provide end-of-life care in critical care. © 2017 John Wiley & Sons Ltd.

  9. Factors affecting midwives' confidence in intrapartum care: a phenomenological study.

    Science.gov (United States)

    Bedwell, Carol; McGowan, Linda; Lavender, Tina

    2015-01-01

    midwives are frequently the lead providers of care for women throughout labour and birth. In order to perform their role effectively and provide women with the choices they require midwives need to be confident in their practice. This study explores factors which may affect midwives' confidence in their practice. hermeneutic phenomenology formed the theoretical basis for the study. Prospective longitudinal data collection was completed using diaries and semi-structured interviews. Twelve midwives providing intrapartum care in a variety of settings were recruited to ensure a variety of experiences in different contexts were captured. the principal factor affecting workplace confidence, both positively and negatively, was the influence of colleagues. Perceived autonomy and a sense of familiarity could also enhance confidence. However, conflict in the workplace was a critical factor in reducing midwives' confidence. Confidence was an important, but fragile, phenomenon to midwives and they used a variety of coping strategies, emotional intelligence and presentation management to maintain it. this is the first study to highlight both the factors influencing midwives' workplace confidence and the strategies midwives employed to maintain their confidence. Confidence is important in maintaining well-being and workplace culture may play a role in explaining the current low morale within the midwifery workforce. This may have implications for women's choices and care. Support, effective leadership and education may help midwives develop and sustain a positive sense of confidence. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. 42 CFR 456.143 - Content of medical care evaluation studies.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.143 Section 456.143 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...: Medical Care Evaluation Studies § 456.143 Content of medical care evaluation studies. Each medical care...

  11. Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study.

    Science.gov (United States)

    Sjögren, Karin; Lindkvist, Marie; Sandman, Per-Olof; Zingmark, Karin; Edvardsson, David

    2017-01-01

    Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. A cross-sectional design was used. Residents ( n  = 1460) and staff ( n  = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents . Descriptive and comparative statistics, independent samples t-test, Chi 2 test, Eta Squared and Phi coefficient were used to analyse data. Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.

  12. Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study.

    Science.gov (United States)

    Song, Hummy; Ryan, Molly; Tendulkar, Shalini; Fisher, Josephine; Martin, Julia; Peters, Antoinette S; Frolkis, Joseph P; Rosenthal, Meredith B; Chien, Alyna T; Singer, Sara J

    Team-based care is essential for delivering high-quality, comprehensive, and coordinated care. Despite considerable research about the effects of team-based care on patient outcomes, few studies have examined how team dynamics relate to provider outcomes. The aim of this study was to examine relationships among team dynamics, primary care provider (PCP) clinical work satisfaction, and patient care coordination between PCPs in 18 Harvard-affiliated primary care practices participating in Harvard's Academic Innovations Collaborative. First, we administered a cross-sectional survey to all 548 PCPs (267 attending clinicians, 281 resident physicians) working at participating practices; 65% responded. We assessed the relationship of team dynamics with PCPs' clinical work satisfaction and perception of patient care coordination between PCPs, respectively, and the potential mediating effect of patient care coordination on the relationship between team dynamics and work satisfaction. In addition, we embedded a qualitative evaluation within the quantitative evaluation to achieve a convergent mixed methods design to help us better understand our findings and illuminate relationships among key variables. Better team dynamics were positively associated with clinical work satisfaction and quality of patient care coordination between PCPs. Coordination partially mediated the relationship between team dynamics and satisfaction for attending clinicians, suggesting that higher satisfaction depends, in part, on better teamwork, yielding more coordinated patient care. We found no mediating effects for resident physicians. Qualitative results suggest that sources of satisfaction from positive team dynamics for PCPs may be most relevant to attending clinicians. Improving primary care team dynamics could improve clinical work satisfaction among PCPs and patient care coordination between PCPs. In addition to improving outcomes that directly concern health care providers, efforts to

  13. A qualitative study explaining nurses' perceptions of quality care for older people in long-term care settings in Ireland.

    Science.gov (United States)

    Murphy, Kathy

    2007-03-01

    The aim of this research was to explore nurses' perceptions of the attributes of quality care and the factors that facilitate or hinder high-quality nursing care in long-term care. The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors have been identified, it is difficult to determine key factors from current research. The study was a qualitative exploration of nurses' perceptions of quality care for older people and the factors that facilitate or hinder quality care. It involved 20 interviews with nurses. Respondents were asked to illustrate their accounts with examples from practice. This phase of the research was guided by the principles of hermeneutic phenomenology and the analysis process by Van Manen. The findings indicated that nurses perceived quality care for older people in Ireland as holistic, individualized and focused on promoting independence and choice. The research revealed, however, that care in many practice areas was not individualized, patient choice and involvement in decision making was limited and some areas engendered dependency. While staffing was identified as a factor which had an impact on the provision of patient choice, other issues, such as the motivation of staff, the role of the ward manager and the dominance of routine were also highlighted. There is a need to review organizational approaches to care, develop patient centred approaches to care and provide educational support for managers. This research focuses on care for older people; it helps practitioners identify key factors in the provision of quality care for older people living in long-term care.

  14. Taking good care of myself: a qualitative study on self-care behavior among Chinese persons with a permanent colostomy.

    Science.gov (United States)

    Tao, Hui; Songwathana, Praneed; Isaramalai, Sang-arun; Wang, Qingxi

    2014-12-01

    In Chinese culture, as a possible consequence of Confucianism, caring for the sick is considered a moral obligation of family members, while self-care is only the basis of fulfilling filial piety. This qualitative study aims to explore the self-care behavior among persons with a permanent colostomy in a Chinese cultural context of emphasizing the role of family caregiving. Data from in-depth interviews with seven Chinese adults at a university hospital in southwest China were analyzed using content analysis. Informants' self-care behavior was characterized by "taking good care of myself," which underlined individuals' efforts to manage colostomy-related impacts involving: (i) taking care of my colostomy with a proper degree of independence; (ii) taking care of my life by dealing with limitations; (iii) taking care of my mood in a positive way. Findings revealed that informants' self-care behavior was linked to their Confucian beliefs in family obligations, and also influenced by a happy-go-lucky outlook of life, a likely product of Taoism. The information is useful for nurses to design a culturally appropriate care plan to improve self-care behavior and proper family caregiving. © 2014 Wiley Publishing Asia Pty Ltd.

  15. Differences between early and late involvement of palliative home care in oncology care: A focus group study with palliative home care teams.

    Science.gov (United States)

    Dhollander, Naomi; Deliens, Luc; Van Belle, Simon; De Vleminck, Aline; Pardon, Koen

    2018-05-01

    To date, no randomised controlled trials on the integration of specialised palliative home care into oncology care have been identified. Information on whether existing models of integrated care are applicable to the home care system and how working procedures and skills of the palliative care teams might require adaptation is missing. To gain insight into differences between early and late involvement and the effect on existing working procedures and skills as perceived by palliative home care teams. Qualitative study - focus group interviews. Six palliative home care teams in Flanders, Belgium. Participants included physicians, nurses and psychologists. Differences were found concerning (1) reasons for initiation, (2) planning of care process, (3) focus on future goals versus problems, (4) opportunity to provide holistic care, (5) empowerment of patients and (6) empowerment of professional caregivers. A shift from a medical approach to a more holistic approach is the most noticeable. Being involved earlier also results in a more structured follow-up and in empowering the patient to be part of the decision-making process. Early involvement creates the need for transmural collaboration, which leads to the teams taking on more supporting and coordinating tasks. Being involved earlier leads to different tasks and working procedures and to the need for transmural collaboration. Future research might focus on the development of an intervention model for the early integration of palliative home care into oncology care. To develop this model, components of existing models might need to be adapted or extended.

  16. Underweight and malnutrition in home care: A multicenter study.

    Science.gov (United States)

    Lahmann, Nils A; Tannen, Antje; Suhr, Ralf

    2016-10-01

    This study aimed to provide representative figures about the prevalence of underweight and malnutrition among home care clients, and to determine the associated risk factors and the provided nutritional nursing interventions. In 2012, a multicenter point prevalence study was conducted among 878 randomly selected clients from 100 randomly selected home care services across Germany. Following a standardized study protocol, demographics, nutritional assessments (Body Mass Index, Malnutrition Universal Screening Tool (MUST), Mini nutritional Assessment - short form (MNA-sf), nurses' clinical judgment on nutritional status) and interventions were assessed. Common nutritional risk factors for underweight and malnutrition were analyzed in a logistic regression model. Malnutrition figures varied between 4.8% (MNA-sf) and 6.8% (MUST), underweight between 8.7% (BMI malnutrition assessments (MNA-sf 48.8%, MUST 39.1%) due to a lack of information on many clients' loss of weight within the past 3-6 months. Regular weighing was performed in 33.6-57.3% of all clients, depending on weight and nutritional status. Mental overload (OR 8.1/4.4), needs help with feeding (OR 5.0/2.8) and loss of appetite (OR 3.6/3.9) were highly associated with malnutrition/underweight. Malnutrition and underweight are important issues in home care clients. Regular weighing should be performed in all home care clients so that a potential weight loss can be detected in time. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  17. Wood chips procurement and research project at the Mikkeli region; Puuhakkeen hankinta- ja tutkimusprojekti Mikkelin seudulla

    Energy Technology Data Exchange (ETDEWEB)

    Saksa, T. [Finnish Forest Research Inst., Suonenjoki (Finland). Suonenjoki Research Station; Auvinen, P. [Mikkeli city (Finland). Dept. of Agriculture and Forestry

    1996-12-31

    In 1993-94, a large-scale energywood production chain started as a co-operation project by the Mikkeli city forest office and local forestry societies. In 1995 over 115 000 m{sup 3} (about 85 000 MWh of energy) of wood chips were delivered to Pursiala heat and power plant in Mikkeli. About 75 % of these chips was forest processed chips. About 70 % of the forest processed chips was whole tree chips from improvement cuttings of young forest stands and the rest was logging waste chips from regeneration cutting areas. The average total delivery costs of forest processed chips after reduction of energywood and other subsidies were approximately 45 FIM/m{sup 3} (60 FIM/MWh) for the whole tree chips and 38 FIM/m{sup 3} (50 FIM/MWh) for logging waste chips. The delivery costs of forest processed chips could meet the target of Bioenergy Research Programme (45 FIM/MWh) only in the most favourable cases. In an average the delivery costs were about 9 FIM/MWh more than the price obtained when sold to the heat and power plant. However the wood chip production created 27 new jobs and the increase of income to the local economy was about 2.2 milj. FIM /year. The local communities got new tax revenue about 3 FIM/MWh. The gain for the forestry was approximated to be 5 - 6 FIM/MWh. The resources of forest processed chips were studied on the basis of stand measurements. According to the study the most remarkable energywood resources were in young thinning stands on Oxalis-Myrtillus and Myrtillus forest site types. On Oxalis-Myrtillus type almost every and on Myrtillus type every second stand included energywood more than 40 m{sup 3}/ha

  18. Wood chips procurement and research project at the Mikkeli region; Puuhakkeen hankinta- ja tutkimusprojekti Mikkelin seudulla

    Energy Technology Data Exchange (ETDEWEB)

    Saksa, T [Finnish Forest Research Inst., Suonenjoki (Finland). Suonenjoki Research Station; Auvinen, P [Mikkeli city (Finland). Dept. of Agriculture and Forestry

    1997-12-31

    In 1993-94, a large-scale energywood production chain started as a co-operation project by the Mikkeli city forest office and local forestry societies. In 1995 over 115 000 m{sup 3} (about 85 000 MWh of energy) of wood chips were delivered to Pursiala heat and power plant in Mikkeli. About 75 % of these chips was forest processed chips. About 70 % of the forest processed chips was whole tree chips from improvement cuttings of young forest stands and the rest was logging waste chips from regeneration cutting areas. The average total delivery costs of forest processed chips after reduction of energywood and other subsidies were approximately 45 FIM/m{sup 3} (60 FIM/MWh) for the whole tree chips and 38 FIM/m{sup 3} (50 FIM/MWh) for logging waste chips. The delivery costs of forest processed chips could meet the target of Bioenergy Research Programme (45 FIM/MWh) only in the most favourable cases. In an average the delivery costs were about 9 FIM/MWh more than the price obtained when sold to the heat and power plant. However the wood chip production created 27 new jobs and the increase of income to the local economy was about 2.2 milj. FIM /year. The local communities got new tax revenue about 3 FIM/MWh. The gain for the forestry was approximated to be 5 - 6 FIM/MWh. The resources of forest processed chips were studied on the basis of stand measurements. According to the study the most remarkable energywood resources were in young thinning stands on Oxalis-Myrtillus and Myrtillus forest site types. On Oxalis-Myrtillus type almost every and on Myrtillus type every second stand included energywood more than 40 m{sup 3}/ha

  19. [Primary care evaluation of the hypertensive patient management in specialized care after derivation (DERIVA-2 Study)].

    Science.gov (United States)

    Martell-Claros, Nieves; Galgo Nafría, Alberto; Abad-Cardiel, María; Álvarez-Álvarez, Beatriz; García Donaire, José Antonio; Márquez-Contreras, Emilio; Molino-González, Ángel

    2017-10-13

    To know the opinion/evaluation of the primary care physicians (PCPH) of the received information about patients that were attended in specialized care (SC). Cross-sectional study. Performed nationwide in primary care centers. Researchers from the primary care network. We used the SEH-LELHA derivation criteria guidelines, plus an ad hoc survey that included demographic and anthropometric data, blood pressure levels, and the main reason for derivation to SC at the baseline and final (post-derivation) visit. In addition, time deployed for the study of every patient, changes in diagnosis and treatment, type of follow-up, issues throughout the derivation process and assessment of the medical referred to the PCPH were evaluated. With participation of 578 researchers from primary, the study included 1715 patients aged 60.7±13.3years, 62.7% male. Patients were taking 2.3±1.2 (range 0-10) antihypertensive drugs pre-referral and 2.5±1.2 (0-9) after derivation. Blood pressure levels changed from 166±21.6 /97.7±12.6mmHg to 143±14.4 /85.5±10.5mmHg. The number of controlled patients (BP<140 and <90mmHg) increased from 5.8% to 32.2%. Time between pre- and post-derivation visit was 72±64days (median 57days, IQ26-99). The PCPH received a medical report in 80.3% of cases, 76.9% with an explanation of the results of the complementary tests, 75.8% with additional information or a reasoning of treatment and in 71% of cases information about the patient future management. 63% of PCPH were fully agreed with the management of the specialist, 29% agree and 2% strongly disagree. The derivation was evaluated as effective or very effective in 86% of patients and no effective in 9%. Communication between AE and SC in HTA is valued satisfactorily by MAP. However there is still room for improvement in the process. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  20. Validation of CARE-Q in residential aged-care: rating of importance of caring behaviours from an e-cohort sub-study.

    Science.gov (United States)

    Tuckett, Anthony G; Hughes, Karen; Schluter, Philip J; Turner, Cathy

    2009-05-01

    To validate the Caring Assessment Report Evaluation Q-sort questionnaire in the residential aged-care setting. Based on this determination, to conclude with what degree of confidence the questionnaire can be used to determine the ranking of the importance of caring behaviours amongst aged-care nurses and residents in residential aged-care. Perceptions of caring may be context specific. Caring in residential aged-care may stand in contrast to the sense of caring understood and practiced in other settings. Self-administered survey. Residents from three not-for-profit aged-care facilities, across both high-care (nursing-home) and low-care (hostel care) were surveyed relying on the Caring Assessment Report Evaluation Q-sort questionnaire. A sub-sample of registered and enrolled nurses working in residential aged-care and registered with the Nurses & Midwives e-cohort study completed the same survey. Although the Caring Assessment Report Evaluation Q-sort questionnaire showed good internal consistency for the sample of nurses, the results for the residents were more erratic. Both groups displayed large ranges for the inter-item correlations. The results of the Mann-Whitney U-test indicated that the nurses rated the Comforts, Anticipates and Trusting relationship as significantly more important than the residents. Both groups rated the Explains and facilitates subscale as least important. All subscales, however, received median scores greater than, or equal to, six (seven-point, Likert scale) indicating that all were considered important overall. Based on poor Cronbach's alpha coefficients, negative inter-item correlations and qualitative observations, without further development within the residential aged-care facility the free response format version of the Caring Assessment Report Evaluation Q-sort may not be an appropriate measure to use with residential aged-care residents. More research needs to be conducted into how residents and nurses are interpreting the items

  1. Hybridization of Environmental Microbial Community Nucleic Acids by GeoChip.

    Science.gov (United States)

    Van Nostrand, Joy D; Yin, Huaqin; Wu, Liyou; Yuan, Tong; Zhou, Jizhong

    2016-01-01

    Functional gene arrays, like the GeoChip, allow for the study of tens of thousands of genes in a single assay. The GeoChip array (5.0) contains probes for genes involved in geochemical cycling (N, C, S, and P), metal homeostasis, stress response, organic contaminant degradation, antibiotic resistance, secondary metabolism, and virulence factors as well as genes specific for fungi, protists, and viruses. Here, we briefly describe GeoChip design strategies (gene selection and probe design) and discuss minimum quantity and quality requirements for nucleic acids. We then provide detailed protocols for amplification, labeling, and hybridization of samples to the GeoChip.

  2. Genomic prediction of starch content and chipping quality in tetraploid potato using genotyping-by-sequencing

    DEFF Research Database (Denmark)

    Sverrisdóttir, Elsa; Byrne, Stephen; Nielsen, Ea Høegh Riis

    2017-01-01

    continue to fall. In this study, we have generated genomic prediction models for starch content and chipping quality in tetraploid potato to facilitate varietal development. Chipping quality was evaluated as the colour of a potato chip after frying following cold induced sweetening. We used genotyping...... genomic estimated breeding values. Cross-validated prediction correlations of 0.56 and 0.73 were obtained within the training population for starch content and chipping quality, respectively, while correlations were lower when predicting performance in the test panel, at 0.30–0.31 and 0...

  3. Maryland Child Care Choices Study: Changes in Child Care Arrangements of Young Children in Maryland. Publication #2014-57

    Science.gov (United States)

    Krafft, Caroline; Davis, Elizabeth E.; Tout, Kathryn

    2014-01-01

    The purpose of this series is to summarize key findings and implications from the Maryland Child Care Choices study, a longitudinal survey of parents who were applying for Temporary Assistance for Needy Families (TANF) in 2011. Families in the Maryland Child Care Choices study had at least one child age six or younger and lived in one of the…

  4. Biomass energy from wood chips: Diesel fuel dependence?

    International Nuclear Information System (INIS)

    Timmons, Dave; Mejia, Cesar Viteri

    2010-01-01

    Most renewable energy sources depend to some extent on use of other, non-renewable sources. In this study we explore use of diesel fuel in producing and transporting woody biomass in the state of New Hampshire, USA. We use two methods to estimate the diesel fuel used in woody biomass production: 1) a calculation based on case studies of diesel consumption in different parts of the wood chip supply chain, and 2) to support extrapolating those results to a regional system, an econometric study of the variation of wood-chip prices with respect to diesel fuel prices. The econometric study relies on an assumption of fixed demand, then assesses variables impacting supply, with a focus on how the price of diesel fuel affects price of biomass supplied. The two methods yield similar results. The econometric study, representing overall regional practices, suggests that a $1.00 per liter increase in diesel fuel price is associated with a $5.59 per Mg increase in the price of wood chips. On an energy basis, the diesel fuel used directly in wood chip production and transportation appears to account for less than 2% of the potential energy in the wood chips. Thus, the dependence of woody biomass energy production on diesel fuel does not appear to be extreme. (author)

  5. Working together: critical care nurses experiences of temporary staffing within Swedish health care: A qualitative study.

    Science.gov (United States)

    Berg Jansson, Anna; Engström, Åsa

    2017-08-01

    The aim of this study is to describe critical care nurses (CCN's) experiences of working with or as temporary agency staff. This explorative qualitative study is based on interviews with five agency CCNs and five regular CCNs, a total of ten interviews, focusing on the interviewees' experiences of daily work and temporary agency staffing. The interviews were analysed manually and thematically following an inductive approach. Four themes that illustrate both similarities and differences between regular and temporary agency CCNs emerged: "working close to patients versus being responsible for everything", "teamwork versus independence", "both groups needed" and "opportunities and challenges". The study findings illustrate the complexity of the working situation for agency and regular staff in terms of the organisation and management of the temporary agency nurses and the opportunities and challenges faced by both groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. A descriptive quantitative study on multi-ethnic patient satisfaction with nursing care measured by the Revised Humane Caring Scale.

    Science.gov (United States)

    Goh, Mien Li; Ang, Emily N K; Chan, Yiong-Huak; He, Hong-Gu; Vehviläinen-Julkunen, Katri

    2016-08-01

    To determine patients' satisfaction with nursing care during hospitalization. Limited studies reporting patients' satisfaction with quality of nursing care in Singapore. A descriptive study was conducted in a tertiary hospital in Singapore. Data were collected from 270 adult patients using the Revised Humane Caring Scale. Patients were moderately satisfied with the nursing care. There were significant differences of patients' level of satisfaction between/among socio-demographic subgroups including ethnicity, gender, reasons for admission and disciplines. Chinese patients were least satisfied with nursing care. The patients were most satisfied with 'Respecting patient's feeling' (mean=82.29, SD=14.50) and least satisfied with 'Communication and participation' (mean=62.00, SD=16.46). Our results reinforced the need to pay more attention to patient information provision and effective communication, which could improve patient satisfaction. The multi-ethnic patients valued respect as an influential attribute in quality nursing care. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Patient-centered care, nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study.

    Science.gov (United States)

    Bachnick, Stefanie; Ausserhofer, Dietmar; Baernholdt, Marianne; Simon, Michael

    2018-05-01

    Patient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care. The aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care. This is a sub-study of the cross-sectional multi-center "Matching Registered Nurse Services with Changing Care Demands" study. We included 123 units in 23 acute care hospitals from all three of Switzerland's language regions. The sample consisted of 2073 patients, hospitalized for at least 24 h and ≥18 years of age. From the same hospital units, 1810 registered nurses working in direct patient care were also included. Patients' perceptions of patient-centered care were assessed using four items from the Generic Short Patient Experiences Questionnaire. Nurses completed questionnaires assessing perceived staffing and resource adequacy, adjusted staffing, leadership ability and level of implicit rationing of nursing care. We applied a Generalized Linear Mixed Models for analysis including individual-level patient and nurse data aggregated to the unit level. Patients reported high levels of patient-centered care: 90% easily understood nurses, 91% felt the treatment and care were adapted for their situation, 82% received sufficient information, and 70% felt involved in treatment and care decisions. Higher staffing and resource adequacy was associated with higher levels of patient-centered care, e.g., sufficient information (β 0.638 [95%-CI: 0.30-0.98]). Higher leadership ratings were associated with

  8. CMOS foveal image sensor chip

    Science.gov (United States)

    Bandera, Cesar (Inventor); Scott, Peter (Inventor); Sridhar, Ramalingam (Inventor); Xia, Shu (Inventor)

    2002-01-01

    A foveal image sensor integrated circuit comprising a plurality of CMOS active pixel sensors arranged both within and about a central fovea region of the chip. The pixels in the central fovea region have a smaller size than the pixels arranged in peripheral rings about the central region. A new photocharge normalization scheme and associated circuitry normalizes the output signals from the different size pixels in the array. The pixels are assembled into a multi-resolution rectilinear foveal image sensor chip using a novel access scheme to reduce the number of analog RAM cells needed. Localized spatial resolution declines monotonically with offset from the imager's optical axis, analogous to biological foveal vision.

  9. Designing a Care Pathway Model – A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway

    Directory of Open Access Journals (Sweden)

    Robin I. Oosterholt

    2017-03-01

    Full Text Available Introduction: Although the clinical attributes of total hip arthroplasty (THA care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. Theory: The outpatient THA care pathway enables patients to be discharged on the day of surgery, short- ening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. Methods: An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi- structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. Results: The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1 and mobilisation & discharge (4. The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. Conclusion: The design addressed existing problems and is an optimisation of the case hospital’s pathway. The network of actors consists of the patient (1, radiologist (1, anaesthetist (1, nurse specialist (1, pharmacist (1, orthopaedic surgeon (1,4, physiotherapist (1,4, nurse (4, doctor (4 and patient applica- tion (1,4. The critical value exchanges include patient preparation (mental and practical, patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

  10. Space division multiplexing chip-to-chip quantum key distribution

    DEFF Research Database (Denmark)

    Bacco, Davide; Ding, Yunhong; Dalgaard, Kjeld

    2017-01-01

    nodes of the quantum keys to their respective destinations. In this paper we present an experimental demonstration of a photonic integrated silicon chip quantum key distribution protocols based on space division multiplexing (SDM), through multicore fiber technology. Parallel and independent quantum...

  11. Care dependency and nursing care problems in nursing home residents with and without dementia: a cross-sectional study.

    Science.gov (United States)

    Schüssler, Sandra; Dassen, Theo; Lohrmann, Christa

    2016-10-01

    Chronic diseases, like dementia, can lead to care dependency and nursing care problems. This study aims to compare the degree of care dependency and the prevalence of nursing care problems (pressure ulcer, incontinence, malnutrition, falls, restraints) between residents with and without dementia and between the stages of dementia. A cross-sectional design was chosen and a total of 277 residents with and 249 residents without dementia from nine Austrian nursing homes were assessed by staff using standardized instruments. Significantly more residents with than without dementia are completely or to a great extent care dependent (54.5 vs. 16.9 %). The comparison of care dependency between the stages of dementia indicates a large difference between moderate and severe dementia (completely care dependent: 9.3 vs. 44.3 %). The comparison of the assessed nursing care problems between residents with and without dementia reveals a significant difference only with regard to incontinence (urinary: 84.2 vs. 53.2 %, fecal: 50.9 vs. 17.7 %, double: 49.1 vs. 14.9 %). Urinary incontinence is high even in early dementia at 64 %, reaching 94 % in severe dementia. Fecal- and double incontinence are comparatively much lower in early dementia (both types 12 %) and rise to more than 80 % (both types) in severe dementia. These results highlight areas in which dementia care needs further improvements. The authors suggest maximizing residents' independence to stabilize care dependency and improve incontinence care. Furthermore, longitudinal studies are recommended to deepen insight into the development of care dependency and nursing care problems in dementia residents.

  12. My Daddy Takes Care of Me! Fathers as Care Providers. Current Population Reports. Household Economic Studies.

    Science.gov (United States)

    Casper, Lynne M.

    1997-01-01

    This report examines statistical data on fathers caring for their children during mothers' working hours and which types of fathers are the most likely to take care of their children. Data are taken from the Survey of Income and Program Participation, a longitudinal survey conducted at four-month intervals by the Census Bureau. Care by fathers is…

  13. Integration home care in the care chain: results from the EURHOMAP study.

    NARCIS (Netherlands)

    Genet, N.; Boerma, W.

    2010-01-01

    Background: Demand for home care is expected to rise sharply across Europe as a result of trends of reduced institutional care and the ageing of populations. The increased volume and complexity in home care will challenge the coordination of services delivered in the home situation and the

  14. Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study.

    Science.gov (United States)

    Divatia, Jigeeshu V; Amin, Pravin R; Ramakrishnan, Nagarajan; Kapadia, Farhad N; Todi, Subhash; Sahu, Samir; Govil, Deepak; Chawla, Rajesh; Kulkarni, Atul P; Samavedam, Srinivas; Jani, Charu K; Rungta, Narendra; Samaddar, Devi Prasad; Mehta, Sujata; Venkataraman, Ramesh; Hegde, Ashit; Bande, B D; Dhanuka, Sanjay; Singh, Virendra; Tewari, Reshma; Zirpe, Kapil; Sathe, Prachee

    2016-04-01

    To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.

  15. Comparative study of main dosimetric characteristics between the GR-200A and MCP-N LiF (Mg, Cu, P) TLD chips

    International Nuclear Information System (INIS)

    Shen Wenxiu; Tang Kaiyong; Wang Shoushan; Cai Gangang; Zhu Hongying; Lu Min

    1999-01-01

    GR-200A and MCP-N are the same kind of LiF(Mg, Cu, P) chip detectors. The main dosimetric characteristics of two LiF (Mg, Cu, P) chip TLDs (GR-200A made in Solid Dosimetric Detector and Method Laboratory, Beijing, and MCP-N made in Poland) are compared, including glow curve structure, TL sensitivity, anti-moisture, reproducibility, background, detection threshold and photosensitivity. Sensitivity of GR-200a is 1.6 times as much as that of MCP-N. The sensitivity of GR-200A is stable after being used for six times, but the sensitivity of MCP-N dropped 2.8%, and its colour turned from white into light brown. The sensitivity and colour of GR-200A did not vary after being stored for 25 days at 98% RH, by comparison the sensitivity of MCP-N dropped 14%, and its colour turned into light brown. It was found that the GR-200A TLD is superior to the MCP-N TLD in above-mentioned characteristics

  16. Meanings and expressions of care and caring for elders in urban Namibian families: a transcultural nursing study.

    Science.gov (United States)

    Leuning, C J; Small, L F; van Dyk, A

    2000-09-01

    Since Namibia's Independence in 1990, the population of elders--persons 65 years old and older--in urban communities is growing steadily. As such, requests for home health care, health counselling, respite care and residential care for aging members of society are overwhelming nurses and the health care system. This study expands transcultural nursing knowledge by increasing understanding of generic (home-based) patterns of elder care that are practised and lived by urban Namibian families. Guided by Madeleine Leininger's theory of culture care diversity and universality and the ethnonursing research method, emic (insider) meanings and expressions of care and caring for elders in selected urban households have been transposed into five substantive themes. The themes, which depict what carring for elders means to urban families, include: 1 nurturing the health of the family, 2 trusting in the benevolence of life as lived, 3 honouring one's elders, 4 sustaining security and purpose for life amid uncertainty, and 5 living with rapidly changing cultural and social structures. These findings add a voice from the developing world to the evolving body of transcultural nursing knowledge. Synthesis of findings with professional care practices facilitates the creation of community-focussed models for provisioning culturally congruent nursing care to elders and their families in urban Namibia.

  17. The positioning of palliative care in acute care: A multiperspective qualitative study in the context of metastatic melanoma.

    Science.gov (United States)

    Fox, Jennifer; Windsor, Carol; Connell, Shirley; Yates, Patsy

    2016-06-01

    The positioning and meaning of palliative care within the healthcare system lacks clarity which adds a level of complexity to the process of transition to palliative care. This study explores the transition to the palliative care process in the acute care context of metastatic melanoma. A theoretical framework drawing on interpretive and critical traditions informs this research. The pragmatism of symbolic interactionism and the critical theory of Habermas brought a broad orientation to the research. Integration of the theoretical framework and grounded-theory methods facilitated data generation and analysis of 29 interviews with patients, family carers, and healthcare professionals. The key analytical findings depict a scope of palliative care that was uncertain for users of the system and for those working within the system. Becoming "palliative" is not a defined event; nor is there unanimity around referral to a palliative care service. As such, ambiguity and tension contribute to the difficulties involved in negotiating the transition to palliative care. Our findings point to uncertainty around the scopes of practice in the transition to palliative care. The challenge in the transition process lies in achieving greater coherency of care within an increasingly specialized healthcare system. The findings may not only inform those within a metastatic melanoma context but may contribute more broadly to palliative practices within the acute care setting.

  18. Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities.

    Science.gov (United States)

    Lin, Jwu-Rong; Chen, Ching-Yu; Peng, Tso-Kwei

    2017-09-11

    The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities.

  19. Changes in the Chemical Composition of Plum Distillate During Maturation with Oak Chips under Different Conditions.

    Science.gov (United States)

    Balcerek, Maria; Pielech-Przybylska, Katarzyna; Dziekońska-Kubczak, Urszula; Patelski, Piotr; Strąk, Ewelina

    2017-09-01

    This study investigates the effect of ageing on the qualitative and quantitative composition of plum distillate in contact with oak wood chips. Maturation was performed with lightly toasted French oak ( Quercus sessiflora and Quercus robur ) chips or oak chips made from fragments of empty barrels that had been used for ageing cognac. The effects of oak chip dose, process temperature, ageing system (static or circulatory) and ultrasound treatment were assessed. Maturation of plum distillate samples with oak chips resulted in higher levels of extractable organics (including tannins) and colour changes, which were correlated with the type and dose of oak chips, and the conditions of maturation. The content of sugars such as glucose, xylose and arabinose also increased, depending on the conditions and type of oak chips. Degradation of lignin resulted in liberation of sinapaldehyde, syringaldehyde, coniferaldehyde and vanillin, with intensities depending on the applied parameters. In terms of volatiles, decreases in the concentration of higher alcohols and aliphatic aldehydes were observed in the majority of maturation experiments, while concentrations of furanic aldehydes increased depending on the type and dose of oak chips, as well as on the conditions of maturation. The quantities of esters such as ethyl acetate decreased in the majority of experimental variants, whereas concentrations of ethyl caproate, ethyl caprylate and ethyl caprate increased gradually. Some phenols and lactones were detected in all matured samples, with the lowest levels found in the samples aged with oak chips made from cognac barrels.

  20. Changes in the Chemical Composition of Plum Distillate During Maturation with Oak Chips under Different Conditions

    Directory of Open Access Journals (Sweden)

    Maria Balcerek

    2017-01-01

    Full Text Available This study investigates the eff ect of ageing on the qualitative and quantitative composition of plum distillate in contact with oak wood chips. Maturation was performed with lightly toasted French oak (Quercus sessifl ora and Quercus robur chips or oak chips made from fragments of empty barrels that had been used for ageing cognac. The eff ects of oak chip dose, process temperature, ageing system (static or circulatory and ultrasound treatment were assessed. Maturation of plum distillate samples with oak chips resulted in higher levels of extractable organics (including tannins and colour changes, which were correlated with the type and dose of oak chips, and the conditions of maturation. The content of sugars such as glucose, xylose and arabinose also increased, depending on the conditions and type of oak chips. Degradation of lignin resulted in liberation of sinapaldehyde, syringaldehyde, coniferaldehyde and vanillin, with intensities depending on the applied parameters. In terms of volatiles, decreases in the concentration of higher alcohols and aliphatic aldehydes were observed in the majority of maturation experiments, while concentrations of furanic aldehydes increased depending on the type and dose of oak chips, as well as on the conditions of maturation. The quantities of esters such as ethyl acetate decreased in the majority of experimental variants, whereas concentrations of ethyl caproate, ethyl caprylate and ethyl caprate increased gradually. Some phenols and lactones were detected in all matured samples, with the lowest levels found in the samples aged with oak chips made from cognac barrels.

  1. Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes.

    Science.gov (United States)

    Bonvicini, Laura; Candela, Silvia; Evangelista, Andrea; Bertani, Daniela; Casoli, Morena; Lusvardi, Annarella; Messori, Antonella; Giorgi Rossi, Paolo

    2014-02-17

    In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Observational population-based study. Reggio Emilia Province. 5957 women resident in the province who delivered between October 2010 and November 2011. CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson's Group. Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93-1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30-6.08). CS frequency was higher in private care for all Robson's classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.

  2. Geographical analyses of wood chips potentials, cost and supply for sustainable energy production in Denmark

    DEFF Research Database (Denmark)

    Möller, Bernd

    2004-01-01

    The paper presents a study which uses a practical application of rasterbased geographical information system to perform cost-supply analysis of wood chips resources for energy production.......The paper presents a study which uses a practical application of rasterbased geographical information system to perform cost-supply analysis of wood chips resources for energy production....

  3. Exploring the usefulness of comprehensive care plans for children with medical complexity (CMC: a qualitative study

    Directory of Open Access Journals (Sweden)

    Adams Sherri

    2013-01-01

    Full Text Available Abstract Background The Medical Home model recommends that Children with Special Health Care Needs (CSHCN receive a medical care plan, outlining the child’s major medical issues and care needs to assist with care coordination. While care plans are a primary component of effective care coordination, the creation and maintenance of care plans is time, labor, and cost intensive, and the desired content of the care plan has not been studied. The purpose of this qualitative study was to understand the usefulness and desired content of comprehensive care plans by exploring the perceptions of parents and health care providers (HCPs of children with medical complexity (CMC. Methods This qualitative study utilized in-depth semi-structured interviews and focus groups. HCPs (n = 15 and parents (n = 15 of CMC who had all used a comprehensive care plan were recruited from a tertiary pediatric academic health sciences center. Themes were identified through grounded theory analysis of interview and focus group data. Results A multi-dimensional model of perceived care plan usefulness emerged. The model highlights three integral aspects of the care plan: care plan characteristics, activating factors and perceived outcomes of using a care plan. Care plans were perceived as a useful tool that centralized and focused the care of the child. Care plans were reported to flatten the hierarchical relationship between HCPs and parents, resulting in enhanced reciprocal information exchange and strengthened relationships. Participants expressed that a standardized template that is family-centered and includes content relevant to both the medical and social needs of the child is beneficial when integrated into overall care planning and delivery for CMC. Conclusions Care plans are perceived to be a useful tool to both health care providers and parents of CMC. These findings inform the utility and development of a comprehensive care plan template as well as a model of how

  4. Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.

    Science.gov (United States)

    Garrouste-Orgeas, Maité; Montuclard, Luc; Timsit, Jean-François; Reignier, Jean; Desmettre, Thibault; Karoubi, Philippe; Moreau, Delphine; Montesino, Laurent; Duguet, Alexandre; Boussat, Sandrine; Ede, Christophe; Monseau, Yannick; Paule, Thierry; Misset, Benoit; Carlet, Jean

    2005-04-01

    To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. Observational, prospective, multiple-center study. Four university hospitals and seven primary-care hospitals in France. None. Age, underlying diseases (McCabe score and Knaus class), dependency, hospital mortality, and ICU characteristics were recorded. The crude ICU refusal rate was 23.8% (137/574), with variations from 7.1% to 63.1%. The reasons for refusal were too well to benefit (76/137, 55.4%), too sick to benefit (51/137, 37.2%), unit too busy (9/137, 6.5%), and refusal by the family (1/137). In logistic regression analyses, two patient-related factors were associated with ICU refusal: dependency (odds ratio [OR], 14.20; 95% confidence interval [CI], 5.27-38.25; p refused patients, and 1.03 (95% CI, 0.28-1.75) for later-admitted patients. ICU refusal rates varied greatly across ICUs and were dependent on both patient and organizational factors. Efforts to define ethically optimal ICU admission policies might lead to greater homogeneity in refusal rates, although case-mix variations would be expected to leave an irreducible amount of variation across ICUs.

  5. Improving delirium care in the intensive care unit: The design of a pragmatic study

    Directory of Open Access Journals (Sweden)

    Hui Siu L

    2011-06-01

    Full Text Available Abstract Background Delirium prevalence in the intensive care unit (ICU is high. Numerous psychotropic agents are used to manage delirium in the ICU with limited data regarding their efficacy or harms. Methods/Design This is a randomized controlled trial of 428 patients aged 18 and older suffering from delirium and admitted to the ICU of Wishard Memorial Hospital in Indianapolis. Subjects assigned to the intervention group will receive a multicomponent pharmacological management protocol for delirium (PMD and those assigned to the control group will receive no change in their usual ICU care. The primary outcomes of the trial are (1 delirium severity as measured by the Delirium Rating Scale revised-98 (DRS-R-98 and (2 delirium duration as determined by the Confusion Assessment Method for the ICU (CAM-ICU. The PMD protocol targets the three neurotransmitter systems thought to be compromised in delirious patients: dopamine, acetylcholine, and gamma-aminobutyric acid. The PMD protocol will target the reduction of anticholinergic medications and benzodiazepines, and introduce a low-dose of haloperidol at 0.5-1 mg for 7 days. The protocol will be delivered by a combination of computer (artificial intelligence and pharmacist (human intelligence decision support system to increase adherence to the PMD protocol. Discussion The proposed study will evaluate the content and the delivery process of a multicomponent pharmacological management program for delirium in the ICU. Trial Registration ClinicalTrials.gov: NCT00842608

  6. Characterization of Ni/SnPb-TiW/Pt Flip Chip Interconnections in Silicon Pixel Detector Modules

    CERN Document Server

    Karadzhinova, Aneliya; Härkönen, Jaakko; Luukka, Panja-riina; Mäenpää, Teppo; Tuominen, Eija; Haeggstrom, Edward; Kalliopuska, Juha; Vahanen, Sami; Kassamakov, Ivan

    2014-01-01

    In contemporary high energy physics experiments, silicon detectors are essential for recording the trajectory of new particles generated by multiple simultaneous collisions. Modern particle tracking systems may feature 100 million channels, or pixels, which need to be individually connected to read-out chains. Silicon pixel detectors are typically connected to readout chips by flip-chip bonding using solder bumps. High-quality electro-mechanical flip-chip interconnects minimizes the number of dead read-out channels in the particle tracking system. Furthermore, the detector modules must endure handling during installation and withstand heat generation and cooling during operation. Silicon pixel detector modules were constructed by flip-chip bonding 16 readout chips to a single sensor. Eutectic SnPb solder bumps were deposited on the readout chips and the sensor chips were coated with TiW/Pt thin film UBM (under bump metallization). The modules were assembled at Advacam Ltd, Finland. We studied the uniformity o...

  7. Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study.

    Science.gov (United States)

    Lea, Emma J; Goldberg, Lynette R; Price, Andrea D; Tierney, Laura T; McInerney, Fran

    2017-12-01

    To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia. Older people in residential care frequently are malnourished, and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved. Qualitative, interview-based study. Eleven staff in a range of positions at one care home were interviewed regarding their perceptions of current and potential food/fluid care practices. Transcripts were coded and analysed thematically. Key food and fluid issues reported by these staff members were weight loss and malnutrition, chewing and swallowing difficulties (dysphagia), and inadequate hydration. Staff identified a number of current care practices that they felt to be effective in facilitating older people's food and fluid intake, including responsiveness to their needs. Staff suggestions to facilitate food and fluid intake centred on improved composition and timing of meals, enhanced physical and social eating environment, and increased hydration opportunities. Staff commented on factors that may prevent changes to care practices, particularly the part-time workforce, and proposed changes to overcome such barriers. Staff were aware of key food and fluid issues experienced by the older people in their care and of a range of beneficial care practices, but lacked knowledge of many promising care practices and/or how to implement such practices. Staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking to work and learn together to implement evidence-based change. © 2017 John Wiley & Sons Ltd.

  8. The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients

    Directory of Open Access Journals (Sweden)

    Sina Waibel

    2015-07-01

    Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas

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

    Science.gov (United States)

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

    2016-07-01

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

  10. Ultracold atoms on atom chips

    DEFF Research Database (Denmark)

    Krüger, Peter; Hofferberth, S.; Haller, E.

    2005-01-01

    Miniaturized potentials near the surface of atom chips can be used as flexible and versatile tools for the manipulation of ultracold atoms on a microscale. The full scope of possibilities is only accessible if atom-surface distances can be reduced to microns. We discuss experiments in this regime...

  11. FERMI multi-chip module

    CERN Multimedia

    This FERMI multi-chip module contains five million transistors. 25 000 of these modules will handle the flood of information through parts of the ATLAS and CMS detectors at the LHC. To select interesting events for recording, crucial decisions are taken before the data leaves the detector. FERMI modules are being developed at CERN in partnership with European industry.

  12. Tunable on chip optofluidic laser

    DEFF Research Database (Denmark)

    Bakal, Avraham; Vannahme, Christoph; Kristensen, Anders

    2015-01-01

    A chip scale tunable laser in the visible spectral band is realized by generating a periodic droplet array inside a microfluidic channel. Combined with a gain medium within the droplets, the periodic structure provides the optical feedback of the laser. By controlling the pressure applied to two...

  13. Chip & Cut Tests an Elastomeren

    OpenAIRE

    Euchler, Eric; Heinrich, Gert; Michael, Hannes; Gehde, Michael; Stocek, Radek; Kratina, Ondrej; Kipscholl, Reinhold

    2016-01-01

    Dieser Vortrag stellt einen neuartigen Prüfstand vor, mit welchem das Chip & Cut Verhalten von Elastomeren charakterisiert werden kann. Sowohl theoretischer Hintergrund als auch praktische Erkenntnisse werden diskutiert. Die Vorstellung der Praxisrelevanz dieser Untersuchungen steht im Fokus des Vortrags.

  14. Production of conjugated linoleic acid-rich potato chips.

    Science.gov (United States)

    Jain, Vishal P; Proctor, Andrew

    2007-01-01

    Conjugated linoleic acid (CLA) is found primarily in diary and beef products, but the health benefits of CLA can only be realized if they are consumed at much greater levels than a normal healthy dietary intake. We have recently shown that a CLA-rich soy oil can be produced by simple isomerization of linoleic acid in soy oil by photoirradiation. This oil may allow greatly increased dietary CLA without significantly elevating fat intake. The objective of this study was to prepare CLA-rich potato chips by frying in CLA-rich soy oil. Soy oil was photoisomerized in the presence of iodine catalyst with UV/visible light. The irradiated oil was clay processed to remove the residual iodine and this oil was then used to fry potato chips. Oil was extracted from fried chips and analyzed for its CLA content with gas chromatography. A 1-oz serving of CLA-rich potato chips contained approximately 2.4 g CLA as compared to 0.1 g CLA in 3-oz serving of steak fillet and 0.06 g CLA in 8-oz serving of whole milk. The peroxide value of the oil extracted from potato chips was found to be 1 meq/1000 g sample, which was within the acceptable commercial standards. This study may lead to the commercialization of CLA-rich food products.

  15. Optical lattice on an atom chip

    DEFF Research Database (Denmark)

    Gallego, D.; Hofferberth, S.; Schumm, Thorsten

    2009-01-01

    Optical dipole traps and atom chips are two very powerful tools for the quantum manipulation of neutral atoms. We demonstrate that both methods can be combined by creating an optical lattice potential on an atom chip. A red-detuned laser beam is retroreflected using the atom chip surface as a high......-quality mirror, generating a vertical array of purely optical oblate traps. We transfer thermal atoms from the chip into the lattice and observe cooling into the two-dimensional regime. Using a chip-generated Bose-Einstein condensate, we demonstrate coherent Bloch oscillations in the lattice....

  16. Emerging Methodologies in Pediatric Palliative Care Research: Six Case Studies

    Directory of Open Access Journals (Sweden)

    Katherine E. Nelson

    2018-02-01

    Full Text Available Given the broad focus of pediatric palliative care (PPC on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery.

  17. Emerging Methodologies in Pediatric Palliative Care Research: Six Case Studies

    Science.gov (United States)

    Nelson, Katherine E.; Gerhardt, Cynthia A.; Rosenberg, Abby R.; Widger, Kimberley; Faerber, Jennifer A.; Feudtner, Chris

    2018-01-01

    Given the broad focus of pediatric palliative care (PPC) on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery. PMID:29495384

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

    Directory of Open Access Journals (Sweden)

    Bailey Kerry A

    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.

  19. THE CARE OF NURSING TO THE FAMILY: A BIBLIOGRAPHICAL STUDY

    Directory of Open Access Journals (Sweden)

    Claci Fátima Weirich

    2006-12-01

    Full Text Available SUMMARY: The objective of this study was to identify the scientific article about the care of nursing to the family, published in periodic of Brazilian nursing, index-linked article survey to the LILACS, in the period of 1993 the 2003, and to analyze them how much to the concept and composition of the families, systematization and proposals of action of nursing and formation and qualification of the authors. In the results we find in 10 years (1993-2003, 9 publications concerning nursing in family. Where we can find the predominance of works that focus the systematization and proposals of action, evidencing of a general form, a lack of studies in the area of nursing in family, where the Program of Health of the Family appears as principal source of promotion of care of nursing to the family and motivation for studies that approach this thematic one. All research had had as authorship nurses doctors, masters and specialists, which acted as professors. KEY WORDS: Assistance to the Family; Health of the Family and Nursing and Family.

  20. Diffusion of a collaborative care model in primary care: a longitudinal qualitative study

    Directory of Open Access Journals (Sweden)

    Vedel Isabelle

    2013-01-01

    Full Text Available Background Although collaborative team models (CTM improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs. The objectives of this study are to understand: (1 how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2 the model's diffusion process. Methods We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 PCPs and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics. Results Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM's diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the critical mass of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM's compatibility with norms, values and practices and its relative advantage (impact on patient management and work practices. Opinion leaders played a key role in the diffusion of the CTM among PCPs. Conclusion CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a critical mass of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians.

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

    Science.gov (United States)

    Gesse, Theresa; Golembeski, Susan; Potter, Jonell

    1999-01-01

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

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

    Science.gov (United States)

    Gesse, T; Golembeski, S; Potter, J

    1999-01-01

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

  3. Private sector accountable care organization development: a qualitative study.

    Science.gov (United States)

    Scheck McAlearney, Ann; Hilligoss, Brian; Song, Paula H

    2017-03-01

    To explore accountable care organizations (ACOs) as they develop in the private sector, including their motivation for development, perspectives from consumers regarding these emerging ACOs, and the critical success factors associated with ACO development. Comprehensive organizational case studies of 4 full-risk private sector ACOs that included in-person interviews with providers and administrators and focus groups with local consumers. Sixty-eight key informant interviews conducted during site visits, supplemented by document collection and telephone interviews, and 5 focus groups were held with 52 consumers associated with the study ACOs. We found 3 main motivators for private sector ACO development: 1) opportunity to improve quality and efficiency, 2) potential to improve population health, and 3) belief that payment reform is inevitable. With respect to consumer perspectives, consumers were unaware they received care from an ACO. From the perspectives of ACO stakeholders, these ACOs noted that they prefer to focus on patients' relationships with providers and typically do not emphasize the ACO name or entity. Critical success factors for private sector ACO development included provider engagement, strategic buy-in, prior experience managing risk, IT infrastructure, and leadership, all meant to shift the culture to a focus on value instead of volume. These organizations perceived that pursuing an accountable care strategy allowed them to respond to policy changes anticipated to impact the way healthcare is delivered and reimbursed. Increased understanding of factors that have been important for more mature private sector ACOs may help other healthcare organizations as they strive to enhance value and advance in their ACO journeys.

  4. How do patients with a Turkish background evaluate their medical care in Germany? An observational study in primary care

    Directory of Open Access Journals (Sweden)

    Goetz K

    2015-11-01

    Full Text Available Katja Goetz,1 Jessica Bungartz,2 Joachim Szecsenyi,1 Jost Steinhaeuser3 1Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany; 2Praxis Medizin im Zentrum, München, Germany; 3Institute of Family Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany Background: Patients’ evaluation of medical care is an essential dimension of quality of care and an important aspect of the feedback cycle for health care providers. The aim of this study was to document how patients with a Turkish background evaluate primary care in Germany and determine which aspects of care are associated with language abilities.Methods: The study was based on an observational design. Patients with a Turkish background from German primary care practices completed the EUROPEP (European Project on Patient Evaluation of General Practice Care questionnaire consisting of 23 items. Seventeen primary care practices were involved with either German (n=8 or Turkish (n=9 general practitioners (GPs.Results: A convenience sample of 472 patients with a Turkish background from 17 practices participated in the study (response rate 39.9%. Practices with a German GP had a lower response rate (19.6% than those with a Turkish GP (57.5%. Items evaluated the highest were “keeping data confidential” (73.4% and “quick services for urgent health problems” (69.9%. Subgroup analysis showed lower evaluation scores from patients with good or excellent German language abilities. Patients who consulted a Turkish GP had higher evaluation scores.Conclusion: The evaluation from patients with a Turkish background living in Germany with either Turkish or German GPs showed lower scores than patients in other studies in Europe using EUROPEP. However, our results had higher evaluation scores than those of Turkish patients evaluating GPs in Turkey. Therefore, different explanation models for these findings should be explored in future studies

  5. Palliative care for patients with cancer: do patients receive the care they consider important? A survey study.

    Science.gov (United States)

    Heins, Marianne; Hofstede, Jolien; Rijken, Mieke; Korevaar, Joke; Donker, Gé; Francke, Anneke

    2018-04-17

    In many countries, GPs and home care nurses are involved in care for patients with advanced cancer. Given the varied and complex needs of these patients, providing satisfactory care is a major challenge for them. We therefore aimed to study which aspects of care patients, GPs and home care nurses consider important and whether patients receive these aspects. Seventy-two Dutch patients with advanced cancer, 87 GPs and 26 home care nurses rated the importance of support when experiencing symptoms, respect for patients' autonomy and information provision. Patients also rated whether they received these aspects. Questionnaires were based on the CQ index palliative care. Almost all patients rated information provision and respect for their autonomy as important. The majority also rated support when suffering from specific symptoms as important, especially support when in pain. In general, patients received the care they considered important. However, 49% of those who considered it important to receive support when suffering from fatigue and 23% of those who wanted to receive information on the expected course of their illness did not receive this or only did so sometimes. For most patients with advanced cancer, the palliative care that they receive matches what they consider important. Support for patients experiencing fatigue may need more attention. When symptoms are difficult to control, GPs and nurses may still provide emotional support and practical advice. Furthermore, we recommend that GPs discuss patients' need for information about the expected course of their illness.

  6. Potential for substitution of mental health care towards family practices: an observational study.

    NARCIS (Netherlands)

    Magnée, T.; Beurs, D.P. de; Boxem, R.; Bakker, D.H. de; Verhaak, P.F.

    2017-01-01

    Background: Substitution is the shift of care from specialized health care to less expensive and more accessible primary health care. It seems promising for restraining rising mental health care costs. The goal of this study was to investigate a potential for substitution of patients with

  7. Proactive cancer care in primary care: a mixed-methods study.

    Science.gov (United States)

    Kendall, Marilyn; Mason, Bruce; Momen, Natalie; Barclay, Stephen; Munday, Dan; Lovick, Roberta; Macpherson, Stella; Paterson, Euan; Baughan, Paul; Cormie, Paul; Kiehlmann, Peter; Free, Amanda; Murray, Scott A

    2013-06-01

    Current models of post-treatment cancer care are based on traditional practices and clinician preference rather than evidence of benefit. To assess the feasibility of using a structured template to provide holistic follow-up of patients in primary care from cancer diagnosis onwards. A two-phase mixed methods action research project. An electronic cancer ongoing review document (CORD) was first developed with patients and general practitioners, and used with patients with a new diagnosis of cancer. This was evaluated through documentary analysis of the CORDs, qualitative interviews with patients, family carers and health professionals and record reviews. The records of 107 patients from 13 primary care teams were examined and 45 interviews conducted. The document was started in 54% of people with newly diagnosed cancer, and prompted clear documentation of multidimension needs and understanding. General practitioners found using the document helped to structure consultations and cover psychosocial areas, but they reported it needed to be better integrated in their medical records with computerized prompts in place. Few clinicians discussed the review openly with patients, and the template was often completed afterwards. Anticipatory cancer care from diagnosis to cure or death, 'in primary care', is feasible in the U.K. and acceptable to patients, although there are barriers. The process promoted continuity of care and holism. A reliable system for proactive cancer care in general practice supported by hospital specialists may allow more survivorship care to be delivered in primary care, as in other long-term conditions.

  8. Towards culturally competent paediatric oncology care. A qualitative study from the perspective of care providers.

    Science.gov (United States)

    Suurmond, J; Lieveld, A; van de Wetering, M; Schouten-van Meeteren, A Y N

    2017-11-01

    In order to gain more insight on the influence of ethnic diversity in paediatric cancer care, the perspectives of care providers were explored. Semi-structured interviews were conducted among 12 paediatric oncologists and 13 nurses of two different paediatric oncology wards and were analysed using a framework method. We found that care providers described the contact with Turkish and Moroccan parents as more difficult. They offered two reasons for this: (1) language barriers between care provider and parents hindered the exchange of information; (2) cultural barriers between care provider and parents about sharing the diagnosis and palliative perspective hindered communication. Care providers reported different solutions to deal with these barriers, such as using an interpreter and improving their cultural knowledge about their patients. They, however, were not using interpreters sufficiently and were unaware of the importance of eliciting parents' perspectives. Communication techniques to overcome dilemmas between parents and care providers were not used and care providers were unaware of stereotypes and prejudice. Care providers should be offered insight in cultural barriers they are unaware of. Training in cultural competence might be a possibility to overcome manifest barriers. © 2017 John Wiley & Sons Ltd.

  9. Real-time electrical impedimetric monitoring of blood coagulation process under temperature and hematocrit variations conducted in a microfluidic chip.

    Directory of Open Access Journals (Sweden)

    Kin Fong Lei

    Full Text Available Blood coagulation is an extremely complicated and dynamic physiological process. Monitoring of blood coagulation is essential to predict the risk of hemorrhage and thrombosis during cardiac surgical procedures. In this study, a high throughput microfluidic chip has been developed for the investigation of the blood coagulation process under temperature and hematocrit variations. Electrical impedance of the whole blood was continuously recorded by on-chip electrodes in contact with the blood sample during coagulation. Analysis of the impedance change of the blood was conducted to investigate the characteristics of blood coagulation process and the starting time of blood coagulation was defined. The study of blood coagulation time under temperature and hematocrit variations was shown a good agreement with results in the previous clinical reports. The electrical impedance measurement for the definition of blood coagulation process provides a fast and easy measurement technique. The microfluidic chip was shown to be a sensitive and promising device for monitoring blood coagulation process even in a variety of conditions. It is found valuable for the development of point-of-care coagulation testing devices that utilizes whole blood sample in microliter quantity.

  10. Chip-Level Electromigration Reliability for Cu Interconnects

    International Nuclear Information System (INIS)

    Gall, M.; Oh, C.; Grinshpon, A.; Zolotov, V.; Panda, R.; Demircan, E.; Mueller, J.; Justison, P.; Ramakrishna, K.; Thrasher, S.; Hernandez, R.; Herrick, M.; Fox, R.; Boeck, B.; Kawasaki, H.; Haznedar, H.; Ku, P.

    2004-01-01

    Even after the successful introduction of Cu-based metallization, the electromigration (EM) failure risk has remained one of the most important reliability concerns for most advanced process technologies. Ever increasing operating current densities and the introduction of low-k materials in the backend process scheme are some of the issues that threaten reliable, long-term operation at elevated temperatures. The traditional method of verifying EM reliability only through current density limit checks is proving to be inadequate in general, or quite expensive at the best. A Statistical EM Budgeting (SEB) methodology has been proposed to assess more realistic chip-level EM reliability from the complex statistical distribution of currents in a chip. To be valuable, this approach requires accurate estimation of currents for all interconnect segments in a chip. However, no efficient technique to manage the complexity of such a task for very large chip designs is known. We present an efficient method to estimate currents exhaustively for all interconnects in a chip. The proposed method uses pre-characterization of cells and macros, and steps to identify and filter out symmetrically bi-directional interconnects. We illustrate the strength of the proposed approach using a high-performance microprocessor design for embedded applications as a case study

  11. On-chip network interfaces supporting automatic burst write creation, posted writes and read prefetch

    NARCIS (Netherlands)

    Stefan, R.; Windt, de J.; Goossens, K.G.W.

    2010-01-01

    Networks-on-Chip are seen as a scalable solution for facilitating the development of Systems-on-Chip with an increasing number of IP cores. Many studies already address the implementation details of such networks and a large effort has been invested in optimizing the routing strategy and the

  12. Materials Characterization of CIGS solar cells on Top of CMOS chips

    NARCIS (Netherlands)

    Lu, J.; Liu, W.; Kovalgin, A.Y.; Sun, Y.; Schmitz, J.; Venkatasubramanian, R.; Radousky, H.; Liang, H.

    2011-01-01

    In the current work, we present a detailed study on the material properties of the CIGS layers, fabricated on top of the CMOS chips, and compare the results with the fabrication on standard glass substrates. Almost identical elemental composition on both glass and CMOS chips (within measurement

  13. Fungal pretreatment of albizia chips for enhanced biogas production by solid-state anaerobic digestion

    Science.gov (United States)

    Albizia biomass is a forestry waste, and holds a great potential in biogas production by solid-state anaerobic digestion (SS-AD). However, low methane yields from albizia chips were observed due to their recalcitrant structure. In this study, albizia chips were pretreated by Ceriporiopsis subvermisp...

  14. Monitoring moisture content, temperature, and humidity in whole-tree pine chip piles

    Science.gov (United States)

    John Klepac; Dana Mitchell; Jason Thompson

    2015-01-01

    Two whole-tree chip piles were monitored for moisture content, temperature, and relative humidity from October 8th, 2010 to March 16th, 2011 at a location in south Alabama. Initial moisture content samples were collected immediately after chips were delivered to the study location on October 8th for Pile 1 and October 22nd for Pile 2. During pile construction, Lascar...

  15. Highly expressed loci are vulnerable to misleading ChIP localization of multiple unrelated proteins

    NARCIS (Netherlands)

    Teytelman, L.; Thurtle, D.M.; Rine, J.; van Oudenaarden, A.

    2013-01-01

    Chromatin immunoprecipitation (ChIP) is the gold-standard technique for localizing nuclear proteins in the genome. We used ChIP, in combination with deep sequencing (Seq), to study the genome-wide distribution of the Silent information regulator (Sir) complex in Saccharomyces cerevisiae. We analyzed

  16. Oxalic acid pretreatment of rice straw particles and loblolly pine chips : release of hemicellulosic carbohydrates

    Science.gov (United States)

    Xianjun Li; Zhiyong Cai; Eric Horn; Jerrold E. Winandy

    2011-01-01

    This study was conducted to evaluate the effect of oxalic acid (OA) pretreatment on carbohydrates released from rice straw particles and wood chips. The results showed that OA treatment accelerated carbohydrates extraction from rice straw particles and wood chips. OA pretreatment dramatically increased the amount of carbohydrates extracted, up to 24 times for wood...

  17. Microfluidic organ-on-chip technology for blood-brain barrier research.

    Science.gov (United States)

    van der Helm, Marinke W; van der Meer, Andries D; Eijkel, Jan C T; van den Berg, Albert; Segerink, Loes I

    2016-01-01

    Organs-on-chips are a new class of microengineered laboratory models that combine several of the advantages of current in vivo and in vitro models. In this review, we summarize the advances that have been made in the development of organ-on-chip models of the blood-brain barrier (BBBs-on-chips) and the challenges that are still ahead. The BBB is formed by specialized endothelial cells and separates blood from brain tissue. It protects the brain from harmful compounds from the blood and provides homeostasis for optimal neuronal function [corrected]. Studying BBB function and dysfunction is important for drug development and biomedical research. Microfluidic BBBs-on-chips enable real-time study of (human) cells in an engineered physiological microenvironment, for example incorporating small geometries and fluid flow as well as sensors. Examples of BBBs-on-chips in literature already show the potential of more realistic microenvironments and the study of organ-level functions. A key challenge in the field of BBB-on-chip development is the current lack of standardized quantification of parameters such as barrier permeability and shear stress. This limits the potential for direct comparison of the performance of different BBB-on-chip models to each other and existing models. We give recommendations for further standardization in model characterization and conclude that the rapidly emerging field of BBB-on-chip models holds great promise for further studies in BBB biology and drug development.

  18. Care coordination in primary health care: an evaluative study in a municipality in the Northeast of Brazil.

    Science.gov (United States)

    Aleluia, Italo Ricardo Santos; Medina, Maria Guadalupe; Almeida, Patty Fidelis de; Vilasbôas, Ana Luiza Queiroz

    2017-06-01

    International and Brazilian studies have highlighted the importance of the coordination of care for the organization of local health systems. This study aimed to analyze the coordination of care by Primary Health Care (PHC) in a municipal health system in the State of Bahia. This study was conducted in the lead municipality of the macro-region and involved two levels of analysis: PHC team and municipal management. Outlining conditions for the study were defined (hypertension and diabetes mellitus) and an objective image corresponding to the coordination of care was developed based on current national and international literature review. Semi-structured interviews with professionals, managers of PHC services were conducted and current documentary sources were also used. It was demonstrated that the coordination of care has not been met by municipal systems, where only 14 of the 22 proposed criteria have been met. The main difficulties and reasons were: a lack of health care protocols and the non-implementation of computer systems and telecommunication technologies. The results and the conceptual framework to assess the coordination of care are relevant contributions to this study, which can be applied to other contexts with similar characteristics.

  19. Competencies of specialised wound care nurses : a European Delphi study

    NARCIS (Netherlands)

    Eskes, Anne M; Maaskant, Jolanda M; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A; Ubbink, Dirk T; Vermeulen, Hester

    2014-01-01

    Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries

  20. Competencies of specialised wound care nurses: a European Delphi study

    NARCIS (Netherlands)

    Eskes, Anne M.; Maaskant, Jolanda M.; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A.; Ubbink, Dirk T.; Vermeulen, Hester

    2014-01-01

    Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries

  1. Hope in palliative care: A longitudinal qualitative study

    NARCIS (Netherlands)

    Olsman, E.

    2015-01-01

    This thesis describes hope in palliative care patients, their family members and their healthcare professionals. An interpretative synthesis of the literature (chapter 2) and a metaphor analysis of semi-structured interviews with palliative care professionals (chapter 3) highlight palliative care

  2. Ethical challenges and solutions regarding delirium studies in palliative care.

    Science.gov (United States)

    Sweet, Lisa; Adamis, Dimitrios; Meagher, David J; Davis, Daniel; Currow, David C; Bush, Shirley H; Barnes, Christopher; Hartwick, Michael; Agar, Meera; Simon, Jessica; Breitbart, William; MacDonald, Neil; Lawlor, Peter G

    2014-08-01

    Delirium occurs commonly in settings of palliative care (PC), in which patient vulnerability in the unique context of end-of-life care and delirium-associated impairment of decision-making capacity may together present many ethical challenges. Based on deliberations at the Studies to Understand Delirium in Palliative Care Settings (SUNDIPS) meeting and an associated literature review, this article discusses ethical issues central to the conduct of research on delirious PC patients. Together with an analysis of the ethical deliberations at the SUNDIPS meeting, we conducted a narrative literature review by key words searching of relevant databases and a subsequent hand search of initially identified articles. We also reviewed statements of relevance to delirium research in major national and international ethics guidelines. Key issues identified include the inclusion of PC patients in delirium research, capacity determination, and the mandate to respect patient autonomy and ensure maintenance of patient dignity. Proposed solutions include designing informed consent statements that are clear, concise, and free of complex phraseology; use of concise, yet accurate, capacity assessment instruments with a minimally burdensome schedule; and use of PC friendly consent models, such as facilitated, deferred, experienced, advance, and proxy models. Delirium research in PC patients must meet the common standards for such research in any setting. Certain features unique to PC establish a need for extra diligence in meeting these standards and the employment of assessments, consent procedures, and patient-family interactions that are clearly grounded on the tenets of PC. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  3. Case studies of patient interactions, care provision and the impact of emotions: a qualitative study.

    Science.gov (United States)

    Banning, Maggi; Gumley, Virginia

    2013-12-01

    Caring is a complex phenomenon. Nurses aim to relieve patient suffering, acknowledge subjective experiences, display empathy but also manage emotions related to care provision. This study explored nurses' perceptions, experiences and emotions related to caring for cancer patients. This qualitative study used semi-structured interviews to explore the emotions management of 32 nurses working in a cancer hospital in Pakistan. Data saturation occurred after 20 interviews. Three themes emerged from the data related to caring, acknowledgement of patients' feelings, professional behaviour, patient involvement and emotional control. Some nurses repressed their emotions and feelings over patients who had difficulties sustaining hope. In such cases nurses require supportive networks to assist their emotions management and intra-personal skills. Educational support is needed to help nurses express their views in relation to emotional contagion, significance of repressed emotions and to identify supportive ways to assist nurses to communicate their experiences.

  4. Who cares? An ethical study of the moral attitude of professionals in palliative care practice.

    NARCIS (Netherlands)

    Olthuis, G.J.

    2007-01-01

    What induces people to devote their active working life to the care of patients who are seriously ill with a life-threatening condition which is usually going to kill them? Why do professional carers want a career in palliative care? What motivates them and what sort of qualities do they need to be

  5. Benchmarking HIV health care: from individual patient care to health care evaluation. An example from the EuroSIDA study

    Directory of Open Access Journals (Sweden)

    Podlekareva Daria N

    2012-09-01

    Full Text Available Abstract Background State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV patients based on four key indicators. Methods Four indicators of health care were assessed: Compliance with current guidelines on initiation of: 1 combination antiretroviral therapy (cART; 2 chemoprophylaxis; 3 frequency of laboratory monitoring; and 4 virological response to cART (proportion of patients with HIV-RNA 90% of time on cART. Results 7097 EuroSIDA patients were included from Northern (n = 923, Southern (n = 1059, West Central (n = 1290 East Central (n = 1366, Eastern (n = 1964 Europe, and Argentina (n = 495. Patients in Eastern Europe with a CD4 3 were less likely to initiate cART and Pneumocystis jiroveci-chemoprophylaxis compared to patients from all other regions, and less frequently had a laboratory assessment of their disease status. The proportion of patients with virological response was highest in Northern, 89% vs. 84%, 78%, 78%, 61%, 55% in West Central, Southern, East Central Europe, Argentina and Eastern Europe, respectively (p Conclusions This assessment of HIV health care utilization revealed pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for the assessment and benchmarking of the clinical management of HIV patients in any setting worldwide.

  6. Health Care Professionals' Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study.

    Science.gov (United States)

    Milberg, Anna; Torres, Sandra; Ågård, Pernilla

    2016-01-01

    The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals' understandings of cross-cultural interaction during end-of-life care. Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis. The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, 'unusual' emotional and pain expressions, the expectation that these patients' families would be 'different' and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting "the unknown". In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients. The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as "the unknown" since they anticipate a variety of challenges

  7. Health Care Professionals’ Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study

    Science.gov (United States)

    Torres, Sandra; Ågård, Pernilla

    2016-01-01

    Objective The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals’ understandings of cross-cultural interaction during end-of-life care. Methods Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis. Results The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, ‘unusual’ emotional and pain expressions, the expectation that these patients’ families would be ‘different’ and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting “the unknown”. In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients. Conclusions The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as

  8. Health Care Professionals' Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study.

    Directory of Open Access Journals (Sweden)

    Anna Milberg

    Full Text Available The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals' understandings of cross-cultural interaction during end-of-life care.Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis.The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, 'unusual' emotional and pain expressions, the expectation that these patients' families would be 'different' and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting "the unknown". In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients.The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as "the unknown" since they anticipate a variety

  9. The impact of personality on person-centred care: a study of care staff in Swedish nursing homes.

    Science.gov (United States)

    Elfstrand Corlin, Tinna; Kajonius, Petri J; Kazemi, Ali

    2017-06-01

    In this study, we explore how personal and situational factors relate to the provision of person-centred care (PCC) in nursing homes. Specifically, we focus on the relationship between the care staff's personality traits and provision of PCC and to what extent perceptions of the working environment influences this relationship. The ultimate goal of elderly care is to meet the older person's needs and individual preferences (PCC). Interpersonal aspects of care and the quality of relationship between the care staff and the older person are therefore central in PCC. A cross-sectional Swedish sample of elderly care staff (N = 322) completed an electronic survey including measures of personality (Mini-IPIP) and person-centred care (Individualized Care Inventory, ICI). A principal component analysis was conducted on the ICI-data to separate the user orientation (process quality) of PCC from the preconditions (structure quality) of PCC. Among the five factors of personality, neuroticism was the strongest predictor of ICI user orientation. ICI preconditions significantly mediated this relationship, indicating the importance of a supportive working environment. In addition, stress was introduced as a potential explanation and was shown to mediate the impact of neuroticism on ICI preconditions. Personality traits have a significant impact on user orientation, and the perception of a supportive and stress free working environment is an important prerequisite for achieving high-quality person-centred elderly care. Understanding how personality is linked to the way care staff interacts with the older person adds a new perspective on provision of person-centred elderly care. © 2016 John Wiley & Sons Ltd.

  10. Decision-making in palliative care: a reflective case study.

    Science.gov (United States)

    Birchall, Melissa

    2005-01-01

    Critical examination of the processes by which we as nurses judge and reach clinical decisions is important. It facilitates the maintenance and refinement of good standards of nursing care and the pinpointing of areas where improvement is needed. In turn this potentially could support broader validation of nurse expertise and contribute to emancipation of the nursing profession. As pure theory, clinical decision-making may appear abstract and alien to nurses struggling in 'the swampy lowlands' (Schon 1983) of the realities of practice. This paper explores some of the key concepts in decision-making theory by introducing, then integrating, them in a reflective case study. The case study, which examines a 'snapshot' of the patient and practitioner's journey, interwoven with theory surrounding clinical decision-making, may aid understanding and utility of concepts and theories in practice.

  11. Obesity predicts primary health care visits: a cohort study.

    Science.gov (United States)

    Twells, Laurie K; Bridger, Tracey; Knight, John C; Alaghehbandan, Reza; Barrett, Brendan

    2012-02-01

    The objective of this study was to explore the relationship between body mass index (BMI), its association with chronic disease, and its impact on health services utilization in the province of Newfoundland and Labrador, Canada, from 1998 to 2002. A data linkage study was conducted involving a provincial health survey linked to 2 health care use administrative databases. The study population comprised 2345 adults between the ages of 20 and 64 years. Self-reported height and weight measures and other covariates, including chronic diseases, were obtained from a provincial survey. BMI categories include: normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese class I (BMI 30-34.9), obese class II (BMI ≥ 35), and obese class III (BMI ≥ 40). Survey responses were linked with objective physician and hospital health services utilization over a 5-year period. Weight classifications in the study sample were as follows: 37% normal, 39% overweight, 17% obese, and 6% morbidly obese. The obese and morbidly obese were more likely to report having serious chronic conditions after adjusting for age and sex. Only the morbidly obese group (BMI ≥ 35 kg/m(2)) had a significantly higher number of visits to a general practitioner (GP) over a 5-year period compared to the normal weight group (median 22.0 vs. 17.0, Pchronic conditions and other relevant covariates, being morbidly obese remained a significant predictor of GP visits (Pobesity is placing a burden at the primary health care level. More resources are needed in order to support GPs in their efforts to manage and treat obese adults who have associated comorbidities.

  12. What components of chronic care organisation relate to better primary care for coronary heart disease patients? An observational study.

    OpenAIRE

    Lieshout, J. van; Frigola Capell, E.; Ludt, S.; Grol, R.P.T.M.; Wensing, M.J.P.

    2012-01-01

    OBJECTIVES: Cardiovascular risk management (CVRM) received by patients shows large variation across countries. In this study we explored the aspects of primary care organisation associated with key components of CVRM in coronary heart disease (CHD) patients. DESIGN: Observational study. SETTING: 273 primary care practices in Austria, Belgium, England, Finland, France, Germany, The Netherlands, Slovenia, Switzerland and Spain. PARTICIPANTS: A random sample of 4563 CHD patients identified by co...

  13. Baccalaureate nursing students' perspectives on learning about caring in China: a qualitative descriptive study.

    Science.gov (United States)

    Ma, Fang; Li, Jiping; Liang, Hongmin; Bai, Yangjuan; Song, Jianhua

    2014-03-04

    The need to provide humanistic care in the contemporary healthcare system is more imperative now and the importance of cultivating caring in nursing education is urgent. Caring as the primary work of nursing has been discussed extensively, such as the meaning of caring, and teaching and learning strategies to improve nursing students' caring ability. Yet attempts to understand students' perspectives on learning about caring and to know their learning needs are seldom presented. The aim of this qualitative descriptive study was to explore the baccalaureate nursing students' perspectives on learning about caring in China. A qualitative descriptive study using focus group interviews were undertaken in two colleges in Yunnan Province, China from February 2010 to April 2010. Purposeful sampling of 20 baccalaureate nursing students were recruited. Content analysis of the transcribed data was adopted to identify the themes. Four categories with some sub-categories related to students' perspectives on learning about caring were identified from the data: 1) Learning caring by role model; 2) conducive learning environment as the incentive to the learning about caring; 3) lack of directive substantive way of learning as the hindrance to the learning about caring; 4) lack of cultural competency as the barrier to the learning about caring. Both caring and uncaring experiences can promote the learning about caring in a way of reflective practice. The formal, informal and hidden curricula play an important role in the learning about caring. Cultural awareness, sensitivity and humility are important in the process of learning to care in a multicultural area.

  14. Chip shape and secondary fragmentation through TBM excavation

    International Nuclear Information System (INIS)

    Tsusaka, Kimikazu; Tanimoto, Chikaosa; Ueno, Takaaki; Koizumi, Yu; Nakane, Tatsuto

    2008-01-01

    The chips through TBM tunneling are well-known for one of useful indices to reflect the geological conditions. The flat and elongated chips whose width are equal to the spacing of cutter trace indicate the cutting face with less joints and good practice of TBM excavation with less secondary fragmentation rate. Through a case history in granitic rock, the authors proposed the new index, which is the ratio of length of major axis to thickness. Also the authors studied the relationship between the index and the excavation efficiencies. In conclusion, it was clarified that chips with the new index over 3.5 were generally observed when a TBM drove with less than 30% the secondary fragmentation rate. (author)

  15. Drilling of metal matrix composites: cutting forces and chip formation

    International Nuclear Information System (INIS)

    Songmene, V.; Balout, B.; Masounave, J.

    2002-01-01

    Particulate metal matrix composites (MMCs) are known for their low weight and their high wear resistance, but also for the difficulties encountered during their machining. New aluminium MMCs containing with both soft lubricating graphite particles and hard particles (silicon carbide or alumina) with improved machinability were developed. This study investigates the drilling of these composites as compared to non-reinforced aluminium. The microstructure of chip, the cutting forces, the shear angles and the friction at tool-chip interface are used to compare the machinability of these composites. It was found that, during drilling of this new family of composites, the feed rate, and the nature of reinforcing particles govern the cutting forces. The mathematical models established by previous researchers for predicting the cutting forces when drilling metals were validated for these composites. The reinforcing particles within the composite help for chip segmentation, making the composite more brittle and easy to shear during the cutting process. (author)

  16. The factors influencing burnout and job satisfaction among critical care nurses: a study of Saudi critical care nurses.

    Science.gov (United States)

    Alharbi, Jalal; Wilson, Rhonda; Woods, Cindy; Usher, Kim

    2016-09-01

    The aim of the study was to explore the prevalence of burnout and job satisfaction among Saudi national critical care nurses. Burnout is caused by a number of factors, including personal, organisational and professional issues. Previous literature reports a strong relationship between burnout and job satisfaction among critical care nurses. Little is known about this phenomenon among Saudi national critical care nurses. A convenience sample of 150 Saudi national critical care nurses from three hospitals in Hail, Saudi Arabia were included in a cross-sectional survey. Saudi national critical care registered nurses reported moderate to high levels of burnout in the areas of emotional exhaustion and depersonalisation. Participants also reported a feeling of ambivalence and dissatisfaction with their jobs but were satisfied with the nature of their work. Saudi national critical care nurses experience moderate to high levels of burnout and low levels of job satisfaction. Burnout is a predictor of job satisfaction for Saudi national critical care nurses. These results provide clear evidence of the need for nurse managers and policy makers to devise strategies to help nurses better cope with a stressful work environment, thereby also improving job satisfaction among Saudi national critical care nurses. © 2016 John Wiley & Sons Ltd.

  17. Interprofessional care in intensive care settings and the factors that impact it: results from a scoping review of ethnographic studies.

    Science.gov (United States)

    Paradis, Elise; Leslie, Myles; Gropper, Michael A; Aboumatar, Hanan J; Kitto, Simon; Reeves, Scott

    2013-12-01

    At the heart of safe cultures are effective interactions within and between interprofessional teams. Critical care clinicians see severely ill patients who require coordinated interprofessional care. In this scoping review, we asked: "What do we know about processes, relationships, organizational and contextual factors that shape the ability of clinicians to deliver interprofessional care in adult ICUs?" Using the 5-stage process established by Levac et al. (2010), we reviewed 981 abstracts to identify ethnographic articles that shed light on interprofessional care in the intensive care unit. The quality of selected articles is assessed using best practices in ethnographic research; their main insights evaluated in light of an interprofessional framework developed by Reeves et al (Interprofessional Teamwork for Health and Social Care. San Francisco, CA: Wiley-Blackwell; 2010). Overall, studies were of mixed quality, with an average (SD) score of 5.8 out of 10 (1.77). Insights into intensive care unit cultures include the importance of paying attention to workflow, the nefarious impact of hierarchical relationships, the mixed responses to protocols imposed from the top down, and a general undertheorization of sex and race. This review highlights several lessons for safe cultures and argues that more needs to be known about the context of critical care if quality and safety interventions are to succeed. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Patient preferences for future care - how can Advance Care Planning become embedded into dementia care: a study protocol

    OpenAIRE

    Robinson, Louise; Bamford, Claire; Beyer, Fiona; Clark, Alexa; Dickinson, Claire; Emmet, Charlotte; Exley, Catherine; Hughes, Julian; Robson, Lesley; Rousseau, Nikki

    2010-01-01

    Abstract Background People living with a long term condition may wish to be able to plan ahead, so that if in future they cannot make decisions, their wishes about their care will be known; this process is termed Advance Care Planning (ACP). In dementia, guidance stipulates that ACP discussions should take place whilst the person still has capacity to make decisions. However there is a lack of evidence on the effectiveness of ACP in influencing patient choice and resource use. The aims of thi...

  19. Primary care COPD patients compared with large pharmaceutically-sponsored COPD studies: an UNLOCK validation study.

    Directory of Open Access Journals (Sweden)

    Annemarije L Kruis

    Full Text Available BACKGROUND: Guideline recommendations for chronic obstructive pulmonary disease (COPD are based on the results of large pharmaceutically-sponsored COPD studies (LPCS. There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care. OBJECTIVE: We aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials. METHODS: Baseline data of seven primary care databases (n=3508 from Europe were compared to baseline data of the LPCS. In addition, we examined the proportion of primary care patients eligible to participate in the LPCS, based on inclusion criteria. RESULTS: Overall, patients included in the LPCS were younger (mean difference (MD-2.4; p=0.03, predominantly male (MD 12.4; p=0.1 with worse lung function (FEV1% MD -16.4; p<0.01 and worse quality of life scores (SGRQ MD 15.8; p=0.01. There were large differences in GOLD stage distribution compared to primary care patients. Mean exacerbation rates were higher in LPCS, with an overrepresentation of patients with ≥ 1 and ≥ 2 exacerbations, although results were not statistically significant. Our findings add to the literature, as we revealed hitherto unknown GOLD I exacerbation characteristics, showing 34% of mild patients had ≥ 1 exacerbations per year and 12% had ≥ 2 exacerbations per year. The proportion of primary care patients eligible for inclusion in LPCS ranged from 17% (TRISTAN to 42% (ECLIPSE, UPLIFT. CONCLUSION: Primary care COPD patients stand out from patients enrolled in LPCS in terms of gender, lung function, quality of life and exacerbations. More research is needed to determine the effect of pharmacological treatment in mild to moderate patients. We encourage future guideline makers to involve primary care

  20. 42 CFR 456.243 - Content of medical care evaluation studies.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.243 Section 456.243 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Ur Plan: Medical Care Evaluation Studies § 456.243 Content of medical care evaluation studies. Each...

  1. The critical components of an electronic care plan tool for primary care: an exploratory qualitative study

    Directory of Open Access Journals (Sweden)

    Lisa Rotenstein

    2016-07-01

    Full Text Available Background A critical need exists for effective electronic tools that facilitate multidisciplinary care for complex patients in patient-centered medical homes. Objective To identify the essential components of a primary care (PC based electronic care plan (ECP tool that facilitates coordination of care for complex patients. Methods Three focus groups and nine semi-structured interviews were conducted at an academic PC practice in order to identify the ideal components of an ECP. Results Critical components of an ECP identified included: 1 patient background information, including patient demographics, care team member designation and key patient contacts, 2 user- and patient-centric task management functionalities, 3 a summary of a patient’s care needs linked to the responsible member of the care team and 4 integration with the electronic medical record. We then designed an ECP mockup incorporating these components. Conclusion Our investigation identified key principles that healthcare software developers can integrate into PC and patient-centered ECP tools.

  2. Acrylamide mitigation in potato chips by using NaCl

    DEFF Research Database (Denmark)

    Pedreschi, Franco; Risum, Jørgen; Granby, Kit

    2009-01-01

    Acrylamide is known to cause cancer in laboratory animals but there is no direct evidence that this substance causes cancer in humans. In April 2002, Swedish researchers shocked the world when they presented preliminary findings on the presence of acrylamide in fried and baked foods, most notably...... potato chips and French fries, at levels of 30-2300 ppb. The objective of this research was to study the effect of immersing potato slices in a NaCI solution in relation to acrylamide formation in the prepared potato chips. Potato slices (Verdi variety, diameter: 40 mm, width: 2.0 mm) were fried at 170...

  3. Scratching experiments on quartz crystals: Orientation effects in chipping

    Science.gov (United States)

    Tellier, C. R.; Benmessaouda, D.

    1994-06-01

    The deformation and microfracture properties of quartz crystals were studied by scratching experiments. The critical load at which microfractures are initiated was found to be orientation dependent, whereas the average width of ductile grooves and chips remained relatively insensitive to crystal orientation. In contrast, a marked anisotropy in the shape of chips was observed. This anisotropy has been interpreted in terms of microfractures propagating preferentially along slip planes. Simple geometrical conditions for the SEM (scanning electron microscopy) observation of active slip planes are proposed.

  4. Electrochemical Migration on Electronic Chip Resistors in Chloride Environments

    DEFF Research Database (Denmark)

    Minzari, Daniel; Jellesen, Morten Stendahl; Møller, Per

    2009-01-01

    Electrochemical migration behavior of end terminals on ceramic chip resistors (CCRs) was studied using a novel experimental setup in varying sodium chloride concentrations from 0 to 1000 ppm. The chip resistor used for the investigation was 10-kΩ CCR size 0805 with end terminals made of 97Sn3Pb...... rate of the Sn and stability of Sn ions in the solution layer play a significant role in the formation of dendrites, which is controlled by chloride concentration and potential bias. Morphology, composition, and resistance of the dendrites were dependent on chloride concentration and potential....

  5. Radiation effects on the Viking-2 preamplifier-readout chip

    International Nuclear Information System (INIS)

    Fallot-Burghardt, W.; Hawblitzel, C.; Hofmann, W.; Knoepfle, K.T.; Seeger, M.; Brenner, R.; Nygaard, E.; Rudge, A.; Toker, O.; Weilhammer, P.; Yoshioka, K.

    1994-01-01

    We have studied the radiation sensitivity of the Viking-2 VLSI circuit which has been designed for the readout of silicon strip detectors and manufactured at Mietec in 1.5 μm CMOS technology. Both biased and unbiased chips have been irradiated with a 137 Cs γ source up to a total dose of 2 kGy (200 krad) after which all tested chips were still fully functional. We report the characteristic changes of device parameters with dose, including equivalent noise charge for different capacitive loads, and determine transistor threshold shifts and change of mobilities. ((orig.))

  6. Negative health care experiences of immigrant patients: a qualitative study

    Directory of Open Access Journals (Sweden)

    Stronks Karien

    2011-01-01

    Full Text Available Abstract Background Negative events are abusive, potentially dangerous or life-threatening health care events, as perceived by the patient. Patients' perceptions of negative events are regarded as a potentially important source of information about the quality of health care. We explored negative events in hospital care as perceived by immigrant patients. Methods Semi-structured individual and group interviews were conducted with respondents about negative experiences of health care. Interviews were transcribed and analyzed using a framework method. A total of 22 respondents representing 7 non-Dutch ethnic origins were interviewed; each respondent reported a negative event in hospital care or treatment. Results Respondents reported negative events in relation to: 1 inadequate information exchange with care providers; 2 different expectations between respondents and care providers about medical procedures; 3 experienced prejudicial behavior on the part of care providers. Conclusions We identified three key situations in which negative events were experienced by immigrant patients. Exploring negative events from the immigrant patient perspective offers important information to help improve health care. Our results indicate that care providers need to be trained in adequately exchanging information with the immigrant patient and finding out specific patient needs and perspectives on illness and treatment.

  7. Defining palliative care in cystic fibrosis: A Delphi study.

    Science.gov (United States)

    Dellon, E P; Goggin, J; Chen, E; Sabadosa, K; Hempstead, S E; Faro, A; Homa, K

    2018-05-01

    The goal of palliative care is to improve quality of life for people with serious illness. We aimed to create a cystic fibrosis (CF)-specific definition of palliative care. A working group of 36 CF care providers, researchers, palliative care providers, quality improvement experts, individuals with CF, and CF caregivers completed a series of questionnaires to rate the value of each of 22 attributes of palliative care, rank top attributes to construct definitions of palliative care, and then rate proposed definitions. An average of 28 participants completed each of four questionnaires, with consistent distribution of stakeholder roles across questionnaires. Many identified overlaps in routine CF care and palliative care and highlighted the importance of a definition that feels relevant across the lifespan. Modified Delphi methodology was used to define palliative care in CF. The definition will be used as the foundation for development of CF-specific palliative care guidelines. Copyright © 2017 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

  8. Dementia care mapping to support staff in the care of people with intellectual disability and dementia: a feasibility study.

    Science.gov (United States)

    Schaap, Feija D; Fokkens, Andrea S; Dijkstra, Geke J; Reijneveld, Sijmen A; Finnema, Evelyn J

    2018-04-24

    The number of people with intellectual disability and dementia increases; this combination causes behavioural changes. Dementia Care Mapping (DCM) supports staff in dementia care in nursing homes and may be useful in intellectual disability-care. This qualitative study examines the feasibility of DCM for older people with intellectual disability and dementia. The present authors obtained data in focus groups and interviews with professional users and analysed using a framework for feasibility studies. With experts in dementia and intellectual disability researches, the present authors determined the overall feasibility. DCM was found to be feasible in intellectual disability-care, regarding five domains of feasibility. Staff reported DCM to be useful and valuable and addresses to their demand for skills and knowledge. All professional users found DCM feasible in intellectual disability-care, which was confirmed by experts. DCM is feasible in intellectual disability-care. When fully tailored to intellectual disability-care, DCM is useful and provides opportunities to assess its effectiveness. © 2018 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd.

  9. Posttraumatic stress in intensive care unit survivors - a prospective study

    DEFF Research Database (Denmark)

    Ratzer, Mette; Brink, Ole; Knudsen, Linda

    2014-01-01

    Aims: This study aimed to estimate the prevalence of severe Posttraumatic Stress Disorder (PTSD) symptoms and to identify factors associated with PTSD in survivors of intensive care unit (ICU) treatment following traumatic injury. Methods: Fifty-two patients who were admitted to an ICU through...... the emergency ward following traumatic injury were prospectively followed. Information on injury severity and ICU treatment were obtained through medical records. Demographic information and measures of acute stress symptoms, experienced social support, coping style, sense of coherence (SOC) and locus...... of control were assessed within one-month post-accident (T1). At the six months follow-up (T2), PTSD was assessed with the Harvard Trauma Questionnaire (HTQ). Results: In the six months follow-up, 10 respondents (19.2%) had HTQ total scores reaching a level suggestive of PTSD (N = 52), and 11 respondents (21...

  10. Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

    Directory of Open Access Journals (Sweden)

    Reed Peter

    2012-12-01

    Full Text Available Abstract Background Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance. Methods We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Results Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Conclusions Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets

  11. Fighting over small chips; Kjemper om smaa brikker

    Energy Technology Data Exchange (ETDEWEB)

    Valmot, Odd R

    2004-07-01

    In a few years, radio frequency identification (RFID) will replace bar codes. The major software suppliers are preparing for hard competition over small chips. Oracle, IBM and Microsoft have been working on RFID for many years. Together these companies are providing most of the database technology that takes care of the transactions and information we are dependent on. RFID is now going to be linked with such information storage. RFID also fits very well into the product development of industry and logistics for which the Internet has been a driving force. Firms that have begun using RFID profit considerably by it. Even by a small number of RFID readers around in works and stores many are experiencing a reduction of goods in the logistics chain of up to 30 per cent. The technology offers so many advantages that it is industrially profitable even with the current prices of the RFID chips.

  12. Examining courtesy stigma among foreign health care workers caring for persons with Alzheimer's disease: A focus group study.

    Science.gov (United States)

    Werner, Perla; Hess, Adi

    2016-01-01

    Studies have shown that courtesy stigma is common among informal caregivers of persons with Alzheimer's disease. Guided by attribution theory and using focus group methodology, we examined this topic among 12 foreign health care workers. Findings revealed that stigma is noticeable in the everyday reality of foreign workers caring for persons with dementia and that its management is shaped by beliefs and knowledge about the disease in their original countries, and by knowledge gained as caregivers. Greater understanding of stigma among foreign workers is crucial for advancing knowledge in the area and for improving the care provided to persons with Alzheimer's disease.

  13. Developing a framework of service convenience in health care: An exploratory study for a primary care provider.

    Science.gov (United States)

    Tuzovic, Sven; Kuppelwieser, Volker

    2016-01-01

    From retail health clinics and online appointment scheduling to (mobile) kiosks that enable patient check-in and automate the collection of copays and open balances, convenience has become an important topic in the health care sector over the last few years. While service convenience has also gained much interest in academia, one common limitation is that authors have adopted a "goods-centered" perspective focusing primarily on retail settings. Results of this exploratory study reveal that health care service convenience encompasses seven different dimensions: decision, access, scheduling, registration and check-in, transaction, care delivery, and postconsultation convenience. Implications and future research suggestions are discussed.

  14. Students experienced help from preservative care. A reflective case study of two nursing students caring from a nursing framework on good care for older people

    Directory of Open Access Journals (Sweden)

    Jan S. Jukema

    2015-11-01

    Full Text Available Background: The practice of nursing is shaped partly by nurses’ professional perspective of good care, guided by a nursing framework. An example is the framework of preservative care, which defines good nursing care for vulnerable older people in nursing homes. Currently we lack an understanding of how this framework could help nurses in training; it may be a useful developmental aid for undergraduate nursing students but so far there are no empirical data to support this. Aim: The purpose of this study is to explore how helpful a particular framework can be in the learning journey of two undergraduate nursing students. The study draws on narrative and reflective accounts, guided by the question: ‘How does preservative care as a framework of good care help two undergraduate nursing students develop their caring for older people?’ Methods: This was a reflective case study, in which two students – experienced registered nurses (non-graduates following a part-time education programme – reflected on their practices, using preservative care as a framework for taking care of older people. They kept reflective journals and received constructive feedback from the author of the preservative care framework (the first author. Their data were analysed in three steps. Findings: Both students reported gaining profound help from the framework in their evaluations of daily practices, although they rated the help differently in terms of demanding and rewarding experiences. The framework was particularly helpful in developing qualities in three domains: person-centredness, professional role and specific nursing competencies. Conclusions: The results of our study indicate how using a particular nursing framework made a difference to the practice of two undergraduate nursing students. Exploring the meaning and place of particular nursing frameworks in nursing education is necessary to establish their potential benefits for students. Implications for

  15. Experiment list: SRX122465 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available 6 || chip antibody=Relb || treatment=LPS || time=120 min || chip antibody manufacturer 1=Bethyl || chip anti...body catalog number 1=A302-183A || chip antibody manufacturer 2=Santa Cruz || chip antibody catalog number 2

  16. Experiment list: SRX122555 [Chip-atlas[Archive

    Lifescience Database Archive (English)

    Full Text Available chip antibody=Stat1 || treatment=LPS || time=120 min || chip antibody manufacturer 1=Santa Cruz || chip anti...body catalog number 1=sc-346 || chip antibody manufacturer 2=Bethyl || chip antibody catalog number 2=A302-7

  17. Study of Cloud Computing in HealthCare Industry

    OpenAIRE

    Reddy, G. Nikhita; Reddy, G. J. Ugander

    2014-01-01

    In Todays real world technology has become a domiant crucial component in every industry including healthcare industry. The benefits of storing electronically the records of patients have increased the productivity of patient care and easy accessibility and usage. The recent technological innovations in the health care is the invention of cloud based Technology. But many fears and security measures regarding patient records storing remotely is a concern for many in health care industry. One n...

  18. Airtight storage of wood chips for use as a fuel

    Energy Technology Data Exchange (ETDEWEB)

    Lamond, W.J.; Graham, R.; Boyd, J.E.L.; Harling, R.; Lowe, J.F.

    1993-11-01

    This study was carried out to see if airtight storage was a possible alternative to drying as a procedure for the successful storage of chipped wood for fuel. Twelve insulated bins, with a capacity of approximately 0.1 m{sup 3} each, were filled with freshly cut Sitka Spruce wood chips. Ten of these bins were sealed immediately after filling and the remaining two left unsealed for the duration of the experiment (12 months). The programme of sampling for gas, moisture content, mycology and bacteriology is described. The results showed that sealed storage reduced the overall dry matter loss in the bins to around 1% per month compared to 2% for the unsealed bins. This compares favourably with losses of around 3% per month which have been reported for open stacks of chips with much lower initial moisture contents than that used in these experiments. There was a slight reduction in the colorific value of oven dried chips between the initial and after storage samples. The moisture content of the chips in all the bins increased over the storage period. The average energy loss was 2.9% per month for sealed and 2.0% per month for unsealed treatment. A typical ecological succession was shown by the chips, commencing with field fungi and terminating with a dominant yeast population. Potential costs for suitable stores vary from Pounds 1.27 per m{sup 3} per year for a plastic covered outdoor stack to Pounds 11.72 per m{sup 3} per year for a vitreous enamel silo. (UK)

  19. GaN-based integrated photonics chip with suspended LED and waveguide

    Science.gov (United States)

    Li, Xin; Wang, Yongjin; Hane, Kazuhiro; Shi, Zheng; Yan, Jiang

    2018-05-01

    We propose a GaN-based integrated photonics chip with suspended LED and straight waveguide with different geometric parameters. The integrated photonics chip is prepared by double-side process. Light transmission performance of the integrated chip verse current is quantitatively analyzed by capturing light transmitted to waveguide tip and BPM (beam propagation method) simulation. Reduction of the waveguide width from 8 μm to 4 μm results in an over linear reduction of the light output power while a doubling of the length from 250 μm to 500 μm only results in under linear decrease of the output power. Free-space data transmission with 80 Mbps random binary sequence of the integrated chip is capable of achieving high speed data transmission via visible light. This study provides a potential approach for GaN-based integrated photonics chip as micro light source and passive optical device in VLC (visible light communication).

  20. Rurality and mental health: an Australian primary care study.

    Science.gov (United States)

    Campbell, A; Manoff, T; Caffery, J

    2006-01-01

    Until recently, there has been a significant gap in the literature exploring the issues of the mental health needs for rural communities in Australia. In this study we investigated the prevalence of diagnosable psychological disorders in both a rural and a non-rural primary care sample in far north Queensland, Australia. In a previous study we had screened some 300 GP attendees, on a number of sociodemographic variables and measures of psychological wellbeing, from four rural GP practices and one regional GP practice. Of these, 130 participants agreed to further follow up. In this study, 118 of the participants were selected and contacted by phone to complete the Composite International Diagnostic Interview-Short Form (CIDI-SF). The CIDI-SF diagnosis was then analysed in relation to the sociodemographic indicators that had previously been collected. The prevalence of diagnosable mental health disorders in the rural sample was found to be higher in comparison with the regional urban sample. The sociodemographic factors of rural residence, gender, and length of residence were associated with having a CIDI-SF diagnosis. Although there were a number of methodological limitations to this study, there did appear to be a significant relationship between rural location and the likelihood of receiving a CIDI-SF diagnosis. Why this might be the case is not clear, and we consider a number of explanations, but our finding suggests that further research in mental health should consider the issue of rurality as a key feature to be explored.

  1. CLINICAL STUDY OF APPENDICULAR PERFORATION IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Venkata Anantha Lakshmi Manabala

    2016-06-01

    Full Text Available INTRODUCTION Acute Appendicitis is the commonest abdominal surgical emergency in young adults all over the world. In early 1900s, Ochsner in Chicago and Sherren at the London Hospital were both advocates of conservative treatment in late cases. Appendicular perforation is a serious complication in view of the ensuing peritonitis with the consequent sequelae and morbidity. AIM To study the incidence, morbidity and sequelae of appendicular perforation. MATERIALS & METHODS This is a prospective study done in our hospital where 110 cases of peritonitis due to appendicular perforation were selected for our study. All the cases where peritonitis was due to appendicular perforation at laparotomy were included. The study period was from January 2014 to December 2015. The cases of peritonitis due to other causes like duodenal, gastric, enteric perforation were excluded. Patients with acute abdominal emergency with clinical diagnosis of peritonitis were examined carefully with detailed history and clinical examination. Necessary investigations were done and patients taken up for emergency surgery. CONCLUSIONS Acute Appendicitis is the commonest abdominal surgical emergency in young adults all over the world. Age incidence of appendicular perforation is maximum in the age group of 21–30 years. Next common age group is 31–40 yrs. Incidence is more in males. Male to female ratio is 2.4:1. Pain abdomen, vomiting, fever and anorexia were common symptoms in all the patients. Majority of the patients came late to the hospital accounting for the cause of perforation and subsequent mortality and morbidity.

  2. Prevention of anxiety disorders in primary care: A feasibility study

    Directory of Open Access Journals (Sweden)

    Batelaan Neeltje M

    2012-11-01

    Full Text Available Abstract Background Anxiety disorders are highly prevalent in primary care and cause a substantial burden of disease. Screening on risk status, followed by preventive interventions in those at risk may prevent the onset of anxiety disorders, and thereby reduce the disease burden. The willingness to participate in screening and interventions is crucial for the scope of preventive strategies, but unknown. This feasibility study, therefore, investigated participation rates of screening and preventive services for anxiety disorders in primary care, and explored reasons to refrain from screening. Methods In three general practices, screening was offered to individuals visiting their general practitioner (total n = 2454. To assess risk status, a 10-item questionnaire was followed by a telephone interview (including the CIDI when scoring above a predefined threshold. Preventive services were offered to those at risk. Participation rates for screening and preventive services for anxiety disorders were assessed. Those not willing to be screened were asked for their main reason to refrain from screening. Results Of all individuals, 17.3% participated in initial screening, and of those with a possible risk status, 56.0% continued screening. In 30.1% of those assessed, a risk status to develop an anxiety disorder was verified. Of these, 22.6% already received some form of mental health treatment and 38.7% of them agreed to participate in a preventive intervention and were referred. The most frequently mentioned reasons to refrain from screening were the emotional burden associated with elevated risk status, the assumption not to be at risk, and a lack of motivation to act upon an elevated risk status by using preventive services. Conclusions Screening in general practice, followed by offering services to prevent anxiety disorders in those at risk did not appear to be a feasible strategy due to low participation rates. To enable the development of

  3. Modelling catchment areas for secondary care providers: a case study.

    Science.gov (United States)

    Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

    2011-09-01

    Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

  4. ReseqChip: Automated integration of multiple local context probe data from the MitoChip array in mitochondrial DNA sequence assembly

    Directory of Open Access Journals (Sweden)

    Spang Rainer

    2009-12-01

    Full Text Available Abstract Background The Affymetrix MitoChip v2.0 is an oligonucleotide tiling array for the resequencing of the human mitochondrial (mt genome. For each of 16,569 nucleotide positions of the mt genome it holds two sets of four 25-mer probes each that match the heavy and the light strand of a reference mt genome and vary only at their central position to interrogate all four possible alleles. In addition, the MitoChip v2.0 carries alternative local context probes to account for known mtDNA variants. These probes have been neglected in most studies due to the lack of software for their automated analysis. Results We provide ReseqChip, a free software that automates the process of resequencing mtDNA using multiple local context probes on the MitoChip v2.0. ReseqChip significantly improves base call rate and sequence accuracy. ReseqChip is available at http://code.open-bio.org/svnweb/index.cgi/bioperl/browse/bioperl-live/trunk/Bio/Microarray/Tools/. Conclusions ReseqChip allows for the automated consolidation of base calls from alternative local mt genome context probes. It thereby improves the accuracy of resequencing, while reducing the number of non-called bases.

  5. Certainty and uncertainty about end of life care nursing practices in New Zealand Intensive Care Units: a mixed methods study.

    Science.gov (United States)

    Coombs, Maureen; Fulbrook, Paul; Donovan, Sarah; Tester, Rachel; deVries, Kay

    2015-05-01

    With end-of-life (EOL) central to the nursing role in intensive care, few studies have been undertaken to explore EOL care in the context of New Zealand (NZ) intensive care nursing. To investigate NZ intensive care nurses' experiences of, and attitudes towards EOL care. Sequential mixed methods study using cross sectional survey with follow-on focus groups. NZ intensive care nurses (N=465) across four large tertiary intensive care units (ICUs) were contacted to complete a 43-item web-based survey. A follow-on focus group was conducted in each of the sites to explore specific aspects of the survey findings. 203 fully completed surveys were returned (response rate 44%) from the four ICUs. Over half of nurses surveyed (55%, n=111) disagreed that withholding and withdrawing life support treatment were ethically the same. 78% (n=159) of nurses stated that withholding treatment was ethically more acceptable than withdrawing it. Whilst nurses generally supported reducing inspired oxygen to air for ventilated patients at EOL (71%, n=139) this was also an area that demonstrated one of the highest levels of uncertainty (21%, n=41). Just under a quarter of respondents were also uncertain about the use of continued nutritional support, continued passive limb exercises and use of deep sedation during EOL. The 18 nurses who participated in follow-on focus groups detailed the supportive, culturally sensitive, collaborative environment that EOL was conducted in. However diverse opinions and understandings were held on the use of passive limb and use of fluids at EOL. Whilst results from this NZ study broadly align with European studies, uncertainty about specific areas of EOL practices highlight that further guidance for nurses is required. Copyright © 2015 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  6. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care.

    NARCIS (Netherlands)

    Schäfer, W.L.A.; Boerma, W.G.W.; Kringos, D.S.; Maeseneer, J. de; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    Background: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary

  7. Bacteriological study of urinary tract infection in antenatal care patients

    Directory of Open Access Journals (Sweden)

    Srivastava Ritu, Singh Brij N, Begum Rehana, Yadav Ramesh

    2014-04-01

    Full Text Available Aims & Objective: To isolate and diagnose the Uropathogens and its antibiotic sensitivity pattern in anti-natal care patient suffering from Urinary tract Infections. Material and Methods: 150 samples were collected by consent pregnant women between the age group of 18 to 40 years. A midstream clean catch is adequate, provided by all pregnant women’s through given careful instructions. For enumeration of bacteria we perform standard loop techniques method. The number of colonies counted or estimated, and this number used to calculate the number of viable bacteria per ml of urine. The bacterial strains were identified by colonies character stick, gram staining, morphological and biochemical character. The bacterial strains identification was done up to genus and species level. The antibiotics sensitivity test of bacterial strains was done as per CLSI guidelines by Kirby-Baure Disc Diffusion Methods. Results: The significant bactiurea was found in 50 patients among 150 patients used. The most commonly isolated bacteria was Escherichia coli 23(40% Klebsiellaaerogens 11 (22% Staphylococcus aureus 10 (20% Pseudomonas aerugenosa 4(8%.The incidence of bacteriuria among in their first pregnancy was 22.2%.The higher incidence of UTI in 2nd and 3rd trimester was found to have 31.4% & 40%. These studies were showing high level of resistance to first line antibiotics such as Cotrimaxozole. Conclusion: To minimizing the complication of the pregnant women should be educated about the physiology of pregnancy clinical presentation includes asymptomatic bacteria, acute cystitis & pyelonephritis. Pregnant women should be screened for asymptomatic bacteriuria by urine culture and treated with appropriate antibiotics. After the post treatment pregnant women should be examine again to confirm post treatment urine sterility.

  8. ICU telemedicine and critical care mortality: a national effectiveness study

    Science.gov (United States)

    Kahn, Jeremy M; Le, Tri Q.; Barnato, Amber E.; Hravnak, Marilyn; Kuza, Courtney C.; Pike, Francis; Angus, Derek C.

    2015-01-01

    Background Intensive care unit (ICU) telemedicine is an increasingly common strategy for improving the outcome of critical care, but its overall impact is uncertain. Objectives To determine the effectiveness of ICU telemedicine in a national sample of hospitals and quantify variation in effectiveness across hospitals. Research design We performed a multi-center retrospective case-control study using 2001–2010 Medicare claims data linked to a national survey identifying United States hospitals adopting ICU telemedicine. We matched each adopting hospital (cases) to up to 3 non-adopting hospitals (controls) based on size, case-mix and geographic proximity during the year of adoption. Using ICU admissions from 2 years before and after the adoption date, we compared outcomes between case and control hospitals using a difference-in-differences approach. Results 132 adopting case hospitals were matched to 389 similar non-adopting control hospitals. The pre- and post-adoption unadjusted 90-day mortality was similar in both case hospitals (24.0% vs. 24.3%, p=0.07) and control hospitals (23.5% vs. 23.7%, ptelemedicine adoption was associated with a small relative reduction in 90-day mortality (ratio of odds ratios: 0.96, 95% CI = 0.95–0.98, ptelemedicine effect across individual hospitals (median ratio of odds ratios: 1.01; interquartile range 0.85–1.12; range 0.45–2.54). Only 16 case hospitals (12.2%) experienced statistically significant mortality reductions post-adoption. Hospitals with a significant mortality reduction were more likely to have large annual admission volumes (ptelemedicine adoption resulted in a small relative overall mortality reduction, there was heterogeneity in effect across adopting hospitals, with large-volume urban hospitals experiencing the greatest mortality reductions. PMID:26765148

  9. A Conceptual Framework for Studying the Safety of Transitions in Emergency Care

    National Research Council Canada - National Science Library

    Behara, Ravi; Wears, Robert L; Perry, Shawna J; Eisenberg, Eric; Murphy, Lexa; Vanderhoef, Mary; Shapiro, Marc; Beach, Christopher; Croskerry, Pat; Cosby, Karen

    2005-01-01

    .... We observed transitions of care in five hospital emergency departments as part of a larger study on safety in emergency care and found that in addition to many other differences in work patterns...

  10. Flip chip assembly of thinned chips for hybrid pixel detector applications

    International Nuclear Information System (INIS)

    Fritzsch, T; Zoschke, K; Rothermund, M; Oppermann, H; Woehrmann, M; Ehrmann, O; Lang, K D; Huegging, F

    2014-01-01

    There is a steady trend to ultra-thin microelectronic devices. Especially for future particle detector systems a reduced readout chip thickness is required to limit the loss of tracking precision due to scattering. The reduction of silicon thickness is performed at wafer level in a two-step thinning process. To minimize the risk of wafer breakage the thinned wafer needs to be handled by a carrier during the whole process chain of wafer bumping. Another key process is the flip chip assembly of thinned readout chips onto thin sensor tiles. Besides the prevention of silicon breakage the minimization of chip warpage is one additional task for a high yield and reliable flip chip process. A new technology using glass carrier wafer will be described in detail. The main advantage of this technology is the combination of a carrier support during wafer processing and the chip support during flip chip assembly. For that a glass wafer is glue-bonded onto the backside of the thinned readout chip wafer. After the bump deposition process the glass-readout chip stack is diced in one step. Finally the glass carrier chip is released by laser illumination after flip chip assembly of the readout chip onto sensor tile. The results of the flip chip assembly process development for the ATLAS IBL upgrade are described more in detail. The new ATLAS FEI4B chip with a size of 20 × 19 mm 2 is flip chip bonded with a thickness of only 150 μm, but the capability of this technology has been demonstrated on hybrid modules with a reduced readout chip thickness of down to 50 μm which is a major step for ultra-thin electronic systems

  11. The strength of primary care in Europe: an international comparative study.

    Science.gov (United States)

    Kringos, Dionne; Boerma, Wienke; Bourgueil, Yann; Cartier, Thomas; Dedeu, Toni; Hasvold, Toralf; Hutchinson, Allen; Lember, Margus; Oleszczyk, Marek; Rotar Pavlic, Danica; Svab, Igor; Tedeschi, Paolo; Wilm, Stefan; Wilson, Andrew; Windak, Adam; Van der Zee, Jouke; Groenewegen, Peter

    2013-11-01

    A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking. Evaluation of strength of primary care in Europe. International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey. Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations. Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries. Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management.

  12. A retrospective study of end-of-life care decisions in the critically Ill in a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Yi Lin Lee

    2018-01-01

    Full Text Available Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU. The practice of approaching end-of-life (EOL care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU. The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process. Methods: All consecutive patients aged 21 and above admitted to the SICU from July 2011 to March 2012, and who passed away in the ICU or within 7 days of discharge from the ICU (to account for transferred patients out of the ICU after end-of life care decisions were made and subsequently passed away were included in the study. Results: There were 473 SICU admissions during this period, out of which 53 were included with a mean age of 67.2 ± 11.1 years. EOL discussions were held in 81.1% of patients with a median time from admission to first discussion at 1 day (IQR 0–2.75 and a median number of ICU discussion of 1 (IQR 1–2. As most patients lacked decision-making capacity (inability to retain and process information secondary to the underlying disease pathology or sedative use, a surrogate was involved: group decision in 27.9%, child in 25.6% and an unclear family nominated member in 20.9%. 28.3% of patients were managed as for full active with resuscitation, 39.6% nonescalation of care, and 32.1% for withdrawal. The main reasons for conservative management (nonescalation and withdrawal of care were certain death in 52.3%, medical futility with minimal response to maximal care (27.3%, and the presence of underlying malignancy (18.2%. There was no significant difference between race or religion among patients for active or conservative management. Conclusion: 71.7% of patients who passed away in the ICU or

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

    Science.gov (United States)

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

    2016-11-25

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

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

    Directory of Open Access Journals (Sweden)

    Enid WY Kwong

    2016-11-01

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

  15. Optical continuum generation on a silicon chip

    Science.gov (United States)

    Jalali, Bahram; Boyraz, Ozdal; Koonath, Prakash; Raghunathan, Varun; Indukuri, Tejaswi; Dimitropoulos, Dimitri

    2005-08-01

    Although the Raman effect is nearly two orders of magnitude stronger than the electronic Kerr nonlinearity in silicon, under pulsed operation regime where the pulse width is shorter than the phonon response time, Raman effect is suppressed and Kerr nonlinearity dominates. Continuum generation, made possible by the non-resonant Kerr nonlinearity, offers a technologically and economically appealing path to WDM communication at the inter-chip or intra-chip levels. We have studied this phenomenon experimentally and theoretically. Experimentally, a 2 fold spectral broadening is obtained by launching ~4ps optical pulses with 2.2GW/cm2 peak power into a conventional silicon waveguide. Theoretical calculations, that include the effect of two-photon-absorption, free carrier absorption and refractive index change indicate that up to >30 times spectral broadening is achievable in an optimized device. The broadening is due to self phase modulation and saturates due to two photon absorption. Additionally, we find that free carrier dynamics also contributes to the spectral broadening and cause the overall spectrum to be asymmetric with respect to the pump wavelength.

  16. Negative health care experiences of immigrant patients: a qualitative study

    NARCIS (Netherlands)

    Suurmond, J.; Uiters, E.; de Bruijne, M.C.; Stronks, K.; Essink-Bot, M.L.

    2011-01-01

    ABSTRACT: BACKGROUND: Negative events are abusive, potentially dangerous or life-threatening health care events, as perceived by the patient. Patients' perceptions of negative events are regarded as a potentially important source of information about the quality of health care. We explored negative

  17. Flemish palliative care nurses' attitudes toward euthanasia: a quantitative study.

    Science.gov (United States)

    Gielen, Joris; van den Branden, Stef; van Iersel, Trudie; Broeckaert, Bert

    2009-10-01

    To adequately measure the attitudes of Flemish palliative care nurses toward euthanasia, and assess the relationship between these attitudes and demographic factors and the (perceived) influence of experience in palliative care on death anxiety. An anonymous questionnaire was sent to all nurses (n=589) employed in palliative care in Flanders, Belgium: 70.5% of the nurses (n=415) responded. A majority of the nurses supported the Belgian law regulating euthanasia but also believed that most euthanasia requests disappear as soon as a patient experiences the benefits of good palliative care. Three clusters were discovered: staunch advocates of euthanasia (150 nurses, 41.1%); moderate advocates of euthanasia (135 nurses, 37%); and (moderate) opponents of euthanasia (80 nurses, 21.9%). An absolute opposition between advocates and opponents of euthanasia was not observed. A statistically significant relationship was found between the euthanasia clusters and years of experience in palliative care, and (perceived) influence of experience in palliative care on anxiety when a patient dies. Flemish palliative care nurses' attitudes toward euthanasia are nuanced and contextual. By indicating that most euthanasia requests disappear as soon as a patient experiences the benefits of good palliative care, the nurses applied a 'palliative filter' a standard procedure in the case of a euthanasia request.

  18. Logistics of in-wood chipping and trucking of chips; Palstahaketuksen logistinen ketju

    Energy Technology Data Exchange (ETDEWEB)

    Nuuja, J. [Joensuu Univ. (Finland). Faculty of Forestry; Asikainen, A. [Metsaeosaamiskeskus, Joensuu (Finland). Joensuu Science Park

    1996-12-31

    In this study a in wood chipper and truck transport of chips were modelled and studied by discrete-event simulation. The input data, which included stand characteristics and information about transport distances was compiled by GRASS-program. This data based on the inventory done by Forestry Center TAPIO. With the model various transport alternatives were compared and the effect of work condition factors were studied. It was find out, that a long distance transport with interchangeable container truck gives better productivity than a truck with a trailer. This results from shorter loading time for the interchangeable container truck

  19. Logistics of in-wood chipping and trucking of chips; Palstahaketuksen logistinen ketju

    Energy Technology Data Exchange (ETDEWEB)

    Nuuja, J [Joensuu Univ. (Finland). Faculty of Forestry; Asikainen, A [Metsaeosaamiskeskus, Joensuu (Finland). Joensuu Science Park

    1997-12-31

    In this study a in wood chipper and truck transport of chips were modelled and studied by discrete-event simulation. The input data, which included stand characteristics and information about transport distances was compiled by GRASS-program. This data based on the inventory done by Forestry Center TAPIO. With the model various transport alternatives were compared and the effect of work condition factors were studied. It was find out, that a long distance transport with interchangeable container truck gives better productivity than a truck with a trailer. This results from shorter loading time for the interchangeable container truck

  20. [Modifications of vital signs during hygiene care in intensive care patients: an explorative study].

    Science.gov (United States)

    Lucchini, Alberto; Giacovelli, Matteo; Elli, Stefano; Gariboldi, Roberto; Pelucchi, Giulia; Bondi, Herman; Brambilla, Daniela

    2009-01-01

    Hygiene care in critical patients may alter vital signs. Aim of this paper is to measure vital signs and their modifications in critical patients during hygiene care and measure differences with pre and post hygiene values. Vital signs of 6 patients two hours before, during and 90 minutes after hygienic care were measured. During and 2 hours after the end of hygiene a modification of vital signs was observed compared to basic values (mean values during/90 min after, compared to baseline): heart rate +11.20%/ +1.48; systolic blood pressure +22.68%/+1.56; arterial capillary saturimetry -4.31/+0.27, Respiratory frequency +8.10/+2.66, tidal volume +4,04/-7,51, CO2 min/vol +5,34/- 22.33, bladder temperature -0.85/-0.60. Hygiene care in critical care patients may significantly alter vital signs. Therefore a strict haemodinamic and respiratory monitoring is warranted as well as protocols for the management of sedation and of vasoactive support.

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

    Science.gov (United States)

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

    2015-01-01

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

  2. Health care needs and use of health care services among newly arrived Syrian refugees: a cross-sectional study.

    Science.gov (United States)

    Oda, Anna; Tuck, Andrew; Agic, Branka; Hynie, Michaela; Roche, Brenda; McKenzie, Kwame

    2017-05-03

    Canada welcomed 33 723 Syrian refugees between November 2015 and November 2016. This paper reports the results of a rapid assessment of health care needs and use of health care services among newly arrived Syrian refugees in Toronto. A cross-sectional study was conducted in Toronto among Syrian refugees aged 18 years or more who had been in Canada for 12 months or less. Participants were recruited initially through distribution of flyers in hotels and through direct referrals and communication with community and settlement agency partners, and then through snowball sampling. We collected sociodemographic information and data on self-perceived physical health and mental health, unmet health care needs and use of health care services. A total of 400 Syrian refugees (221 women [55.2%] and 179 men [44.8%]) were enrolled. Of the 400, 209 (52.2%) were privately sponsored refugees, 177 (44.2%) were government-assisted refugees, and 12 (3.0%) were refugees under the Blended Visa Office-Referred Program. They reported high levels of self-perceived physical and mental health. Over 90% of the sample saw a doctor in their first year in Canada, and 79.8% had a family doctor they saw regularly. However, almost half (49.0%) of the respondents reported unmet health care needs, with the 3 most common reasons reported being long wait times, costs associated with services and lack of time to seek health care services. Many factors may explain our respondents' high levels of self-perceived physical and mental health during the first year of resettlement, including initial resettlement support and eligibility for health care under the Interim Federal Health Program. However, newly arrived Syrian refugees report unmet health care needs, which necessitates more comprehensive care and management beyond the initial resettlement support. Copyright 2017, Joule Inc. or its licensors.

  3. Photonic network-on-chip design

    CERN Document Server

    Bergman, Keren; Biberman, Aleksandr; Chan, Johnnie; Hendry, Gilbert

    2013-01-01

    This book provides a comprehensive synthesis of the theory and practice of photonic devices for networks-on-chip. It outlines the issues in designing photonic network-on-chip architectures for future many-core high performance chip multiprocessors. The discussion is built from the bottom up: starting with the design and implementation of key photonic devices and building blocks, reviewing networking and network-on-chip theory and existing research, and finishing with describing various architectures, their characteristics, and the impact they will have on a computing system. After acquainting

  4. Why Do We Need to Study the Fundamentals of Care?

    Science.gov (United States)

    Kitson, Alison

    2016-01-01

    This paper makes the case for revisiting our understanding and valuing of basic or fundamental nursing care. Despite the interest in movements such as the person-centred or patient-centred care agenda, there continues to be concern about patient safety, quality of experience and getting the simple things right. Part of this debate is around whether meeting patients' fundamental care needs (such as personal hygiene, elimination and eating and drinking) within acute care settings constitutes legitimate nursing responsibilities or whether these needs ought to become part of "hotel services" executed by care assistants with elementary training or, as in many lower-income health systems, undertaken by relatives. Copyright © 2016 Longwoods Publishing.

  5. Numerical investigation of heat transfer in Plastic Leaded Chip ...

    African Journals Online (AJOL)

    Plastic Leaded Chip Carrier (PLCC) package has been emerged a promising option to tackle the thermal management issue of micro-electronic devices. In the present study, three dimensional numerical analysis of heat and fluid flow through PLCC packages oriented in-line and mounted horizontally on a printed circuit ...

  6. NanoTopoChip : High-throughput nanotopographical cell instruction

    NARCIS (Netherlands)

    Hulshof, Frits F.B.; Zhao, Yiping; Vasilevich, Aliaksei; Beijer, Nick R.M.; de Boer, Meint; Papenburg, Bernke J.; van Blitterswijk, Clemens; Stamatialis, Dimitrios; de Boer, Jan

    2017-01-01

    Surface topography is able to influence cell phenotype in numerous ways and offers opportunities to manipulate cells and tissues. In this work, we develop the Nano-TopoChip and study the cell instructive effects of nanoscale topographies. A combination of deep UV projection lithography and

  7. An innovative container supply chain for forest chips

    Energy Technology Data Exchange (ETDEWEB)

    Karttunen, Kalle; Korpinen, Olli-Jussi; Laettilae, Lauri; Foehr, Jarno; Ranta, Tapio [Lappeenranta Univ. of Technology, Mikkeli (Finland)], e-mail: kalle.karttunen@lut.fi

    2012-11-01

    Most forest chips are transported by trucks with a solid frame. Forest-chip volumes will at least double before 2020, which means longer transport distances from the supply areas to the largest demand sites in Finland. The study concentrates on an innovative container solution based on a channel composite structure, creating a lighter, temperature-isolated, and more durable structure. In addition to the structural benefits, the container includes an innovative supply chain with a beneficial handling operation, interchangeability and maximising of the payload capacity, resulting in an energy- and cost-efficient solution. This innovative-container-based supply chain for forest chips has been studied via cost analysis, GIS analysis, and discrete-event simulation methods. The purpose of the study was to compare a truck of interchangeable containers with solid-frame trucks. The option of interchangeable containers allows combining truck logistics with other modes of transport, such as trains and waterways. The study showed the cost-efficiency potential of container truck logistics, stemming from the cost and payload savings and the supply-chain productivity advantages over solid-frame trucks. The innovative solution for interchangeable-container logistics is an option for large-scale supply of forest chips.

  8. Acrylamide Mitigation in Potato Chips by Using NaCl

    DEFF Research Database (Denmark)

    Pedreschi, Franco; Granby, Kit; Risum, Jørgen

    2010-01-01

    In April 2002, Swedish researchers shocked the world when they presented preliminary findings on the presence of acrylamide in fried and baked foods, most notably potato chips and French fries, at levels of 30–2,300 ppb. The objective of this research was to study the effect of immersing potato...

  9. Microfluidic desalination : capacitive deionization on chip for microfluidic sample preparation

    NARCIS (Netherlands)

    Roelofs, Susan Helena

    2015-01-01

    The main aim of the work described in this thesis is to implement the desalination technique capacitive deionization (CDI) on a microfluidic chip to improve the reproducibility in the analysis of biological samples for drug development. Secondly, microfluidic CDI allows for the in situ study of ion

  10. A scalable single-chip multi-processor architecture with on-chip RTOS kernel

    NARCIS (Netherlands)

    Theelen, B.D.; Verschueren, A.C.; Reyes Suarez, V.V.; Stevens, M.P.J.; Nunez, A.

    2003-01-01

    Now that system-on-chip technology is emerging, single-chip multi-processors are becoming feasible. A key problem of designing such systems is the complexity of their on-chip interconnects and memory architecture. It is furthermore unclear at what level software should be integrated. An example of a

  11. Medication errors in home care: a qualitative focus group study.

    Science.gov (United States)

    Berland, Astrid; Bentsen, Signe Berit

    2017-11-01

    To explore registered nurses' experiences of medication errors and patient safety in home care. The focus of care for older patients has shifted from institutional care towards a model of home care. Medication errors are common in this situation and can result in patient morbidity and mortality. An exploratory qualitative design with focus group interviews was used. Four focus group interviews were conducted with 20 registered nurses in home care. The data were analysed using content analysis. Five categories were identified as follows: lack of information, lack of competence, reporting medication errors, trade name products vs. generic name products, and improving routines. Medication errors occur frequently in home care and can threaten the safety of patients. Insufficient exchange of information and poor communication between the specialist and home-care health services, and between general practitioners and healthcare workers can lead to medication errors. A lack of competence in healthcare workers can also lead to medication errors. To prevent these, it is important that there should be up-to-date information and communication between healthcare workers during the transfer of patients from specialist to home care. Ensuring competence among healthcare workers with regard to medication is also important. In addition, there should be openness and accurate reporting of medication errors, as well as in setting routines for the preparation, alteration and administration of medicines. To prevent medication errors in home care, up-to-date information and communication between healthcare workers is important when patients are transferred from specialist to home care. It is also important to ensure adequate competence with regard to medication, and that there should be openness when medication errors occur, as well as in setting routines for the preparation, alteration and administration of medications. © 2017 John Wiley & Sons Ltd.

  12. Dominance of paternalism in family-centered care in the pediatric intensive care unit (PICU): an ethnographic study.

    Science.gov (United States)

    Vasli, Parvaneh; Dehghan-Nayeri, Nahid; Borim-Nezhad, Leili; Vedadhir, AbouAli

    2015-06-01

    This article examines the culture of family-centered care (FCC) in the pediatric intensive care unit (PICU) using focused ethnography. Data collection strategy was participant observation, fieldwork, and interviews with main actors of the PICU, namely supervisors, nurses, and parents. This study took place in one PICU in a hospital in Tehran, Iran. The results were in the main named as paternalism and were presented as five themes: "non-possessed environment," "separation of the children from their parents," non-interactive communication," "limited participation," and "affection and sympathy combined with superiority." In conclusion, the prevailing atmosphere in care was paternalistic as there was a huge gap between conceptually or theoretically accepted application of FCC in PICU and what is practically administrated. Bridging such a gap between theory and practice can be helpful in improving social, environment, and organizational culture for the children, their parents, and health care providers as well as their performance in the context of PICU.

  13. Supportive care organisation in France: an in depth study by the French speaking association for supportive care in cancer (AFSOS).

    Science.gov (United States)

    Scotté, F; Hervé, C; Oudard, S; Bugat, M E; Bugat, R; Farsi, F; Namer, M; Tourani, J M; Tournigand, C; Yazbek, G; Richard, S; Krakowski, I

    2013-03-01

    Supportive care in cancer (SCC) was further enhanced in the Second National Cancer Act decreed in December 2009. The aim of our study was to assess current SCC efficacy. The French speaking association for supportive care in cancer (AFSOS) conducted an observational study to evaluate practices, organisations and information given to patients. A specific 32 point questionnaire was sent to 1621 French physicians (MDs) caring for cancer patients. Three different organisations were evaluated: the individual MDs, the transversal team and its particular structure specialised in global patient care specifically developed at comprehensive cancer centres - CCC. During their disease, 68% of patients received SCC, which was more available during the palliative period (90%) than at the diagnosis (44%). Our results found that 71% of cancer departments had a specific interdisciplinary cross-team to provide SCC, particularly in CCC (62%; p=0.01) while 37% had specific inpatient units. A specific organisation dedicated to home care was greater in CCC than in public or private centres (69%, 45%, 20% respectively; p=0.01). Adverse event information was performed more by an oncologist than other specialists (p=0.01). Our results suggest that the specific SCC organisation could be a useful management tool to improve supportive care for cancer patients. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. RESOURCE MANAGEMENT AMONG INTENSIVE CARE NURSES: AN ETHNOGRAPHIC STUDY.

    Science.gov (United States)

    Heydari, Abbas; Najar, Ali Vafaee; Bakhshi, Mahmoud

    2015-12-01

    Nurses are the main users of supplies and equipment applied in the Intensive Care Units (ICUs) which are high-priced and costly. Therefore, understanding ICU nurses' experiences about resource management contributes to the better control of the costs. This study aimed to investigate the culture of nurses' working environment regarding the resource management in the ICUs in Iran. In this study, a focused ethnographic method was used. Twenty-eight informants among ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations as a participant observer was used for data gathering. Data analysis was performed using the methods described by Miles and Huberman (1994). Two main themes describing the culture of ICU nurses regarding resource management included (a) consumption monitoring and auditing, and (b) prudent use. The results revealed that the efforts for resource management are conducted in the conditions of scarcity and uncertainty in supply. ICU nurses had a sense of futurism in the supply and use of resources in the unit and do the planning through taking the rules and guidelines as well as the available resources and their values into account. Improper storage of some supplies and equipment was a reaction to this uncertain condition among nurses. To manage the resources effectively, improvement of supply chain management in hospital seems essential. It is also necessary to hold educational classes in order to enhance the nurses' awareness on effective supply chain and storage of the items in the unit stock.

  15. The epidemiology of skin care provided by nurses at home: a multicentre prevalence study.

    Science.gov (United States)

    Kottner, Jan; Boronat, Xavier; Blume-Peytavi, Ulrike; Lahmann, Nils; Suhr, Ralf

    2015-03-01

    The aim of this study was to estimate the frequencies and patterns of skin care and applied skin care products in the home care nursing setting in Germany. Skin care belongs to the core activities of nursing practice. Especially in aged and long-term care settings, clients are vulnerable to various skin conditions. Dry skin is one of the most prevalent problems. Using mild skin cleansers and the regular application of moisturizing leave-on products is recommended. Until today, there are no quantitative empirical data about nursing skin care practice at home in the community. A multicentre cross-sectional study was conducted in July 2012. Home care clients from the German home care nursing setting were randomly selected. Instructed nurse raters performed the data collection using standardized forms. Variables included demographics, skin care needs and skin caring activities. Approximately 60% of home care clients received skin care interventions. The majority were washed and two-thirds received a leave-on product once daily. There was large heterogeneity in cleansing and skin care product use. Most often the product labels were unknown or product types were selected haphazardly. Skin care interventions play a significant role in home care and nurses have a considerable responsibility for skin health. Skin care provided does not meet recent recommendations. The importance of targeted skin cleansing and care might be underestimated. There are a confusing variety of skin care products available and often the labels provide little information regarding the ingredients or guidance about how they affect skin health. © 2014 John Wiley & Sons Ltd.

  16. Patient safety event reporting in critical care: a study of three intensive care units.

    Science.gov (United States)

    Harris, Carolyn B; Krauss, Melissa J; Coopersmith, Craig M; Avidan, Michael; Nast, Patricia A; Kollef, Marin H; Dunagan, W Claiborne; Fraser, Victoria J

    2007-04-01

    To increase patient safety event reporting in three intensive care units (ICUs) using a new voluntary card-based event reporting system and to compare and evaluate observed differences in reporting among healthcare workers across ICUs. Prospective, single-center, interventional study. A medical ICU (19 beds), surgical ICU (24 beds), and cardiothoracic ICU (17 beds) at a 1,371-bed urban teaching hospital. Adult patients admitted to these three study ICUs. Use of a new, internally designed, card-based reporting program to solicit voluntary anonymous reporting of medical errors and patient safety concerns. During a 14-month period, 714 patient safety events were reported using a new card-based reporting system, reflecting a significant increase in reporting compared with pre-intervention Web-based reporting (20.4 reported events/1,000 patient days pre-intervention to 41.7 reported events/1,000 patient days postintervention; rate ratio, 2.05; 95% confidence interval, 1.79-2.34). Nurses submitted the majority of reports (nurses, 67.1%; physicians, 23.1%; other reporters, 9.5%); however, physicians experienced the greatest increase in reporting among their group (physicians, 43-fold; nurses, 1.7-fold; other reporters, 4.3-fold) relative to pre-intervention rates. There were significant differences in the reporting of harm by job description: 31.1% of reports from nurses, 36.2% from other staff, and 17.0% from physicians described events that did not reach/affect the patient (p = .001); and 33.9% of reports from physicians, 27.2% from nurses, and 13.0% from other staff described events that caused harm (p = .005). Overall reported patient safety events per 1,000 patient days differed by ICU (medical ICU = 55.5, cardiothoracic ICU = 25.3, surgical ICU = 40.2; p reporting system increased reporting significantly compared with pre-intervention Web-based reporting and revealed significant differences in reporting by healthcare worker and ICU. These differences may reveal

  17. [Primary care nurses' difficulties in advance care planning processes: A qualitative study].

    Science.gov (United States)

    Granero-Moya, Nani; Frías-Osuna, Antonio; Barrio-Cantalejo, Inés M; Ramos-Morcillo, Antonio Jesús

    2016-12-01

    To know the primary care nurses' difficulties to promote advance care planning process with patients in the end of life. Phenomenological qualitative methodology. Health Management Area North of Jaén. Primary care nurses. Purposive sampling. Fourteen in-depth interviews were conducted until the speeches saturation. Content analysis in four steps: transcription, coding, obtaining results and conclusions verification. Supported whit the software Nvivo 8. Triangulation of results between researchers. Professionals' difficulties: Lack of knowledge about the topic, lack of communication skills, lack of experience and presence of negative emotions. In the health institution lack of time and interference with other professionals is a barrier. Also the patient's attitude and the family are identified as an obstacle because few people speak about the end of life. Finally, our society prevents open discussion about issues related to death. Professional learning about advanced care planning, training in communication skills and emotional education are necessary. Health managers should consider the fact that early interventions for planning health decisions require training, time and continued attention. If a cultural change does not happen, an evasive way to face the end of life will persist. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  18. Perspectives on the delegation of hygienic care in the context of home nursing: a qualitative study.

    Science.gov (United States)

    Dumitrescu, Irina; Vliegher, Kristel De; Cordyn, Sam; Maigre, Audrey; Peters, Edgard; Putzeys, Dominique

    2018-05-02

    In light of current trends and healthcare evolutions, delegation of patient care from home nurses to health care assistants (HCAs) is increasingly important. Hygienic care is an essential component of nursing education and practice, yet it has rarely been the subject of scientific literature. To understand the opinions and experiences of home nurses and policy makers with regard to the meaning of hygienic care and the delegation of these acts in the context of home nursing. A descriptive qualitative study (six focus groups with home nurses and two with policy makers from the Belgian home nursing sector). Content analysis of the data and the use of NVivo 11.0 software. Hygienic care is a cyclical care process of continuously investing in a trusting relationship with a patient, assessing their care needs and ability for self-care and taking action and evaluating care as situations change. All of this must be mutally agreed with the patient and should consider their environment and lifestyle. The decision to delegate hygienic care is based on patient assessments and the patient's specific care needs using nursing diagnoses and indicators. Finally, barriers and facilitating factors for both delegating and providing hygienic care were addressed. Hygienic care is a crucial component of nursing care, that can be delegated to HCAs with the necessary supervision.

  19. Improving "lab-on-a-chip" techniques using biomedical nanotechnology: a review.

    Science.gov (United States)

    Gorjikhah, Fatemeh; Davaran, Soodabeh; Salehi, Roya; Bakhtiari, Mohsen; Hasanzadeh, Arash; Panahi, Yunes; Emamverdy, Masumeh; Akbarzadeh, Abolfazl

    2016-11-01

    Nanotechnology and its applications in biomedical sciences principally in molecular nanodiagnostics are known as nanomolecular diagnostics, which provides new options for clinical nanodiagnostic techniques. Molecular nanodiagnostics are a critical role in the development of personalized medicine, which features point-of care performance of diagnostic procedure. This can to check patients at point-of-care facilities or in remote or resource-poor locations, therefore reducing checking time from days to minutes. In this review, applications of nanotechnology suited to biomedicine are discussed in two main class: biomedical applications for use inside (such as drugs, diagnostic techniques, prostheses, and implants) and outside the body (such as "lab-on-a-chip" techniques). A lab-on-a-chip (LOC) is a tool that incorporates numerous laboratory tasks onto a small device, usually only millimeters or centimeters in size. Finally, are discussed the applications of biomedical nanotechnology in improving "lab-on-a-chip" techniques.

  20. Rapid and label-free bioanalytical method of alpha fetoprotein detection using LSPR chip

    Science.gov (United States)

    Kim, Dongjoo; Kim, Jinwoon; Kwak, Cheol Hwan; Heo, Nam Su; Oh, Seo Yeong; Lee, Hoomin; Lee, Go-Woon; Vilian, A. T. Ezhil; Han, Young-Kyu; Kim, Woo-Sik; Kim, Gi-bum; Kwon, Soonjo; Huh, Yun Suk

    2017-07-01

    Alpha fetoprotein (AFP) is a cancer marker, particularly for hepatocellular carcinoma. Normal levels of AFP are less than 20 ng/mL; however, its levels can reach more than 400 ng/mL in patients with HCC. Enzyme linked immunosorbent assay (ELISA) and radioimmunoassay (RIA) have been employed for clinical diagnosis of AFP; however, these methods are time consuming and labor intensive. In this study, we developed a localized surface plasmon resonance (LSPR) based biosensor for simple and rapid detection of AFP. This biosensor consists of a UV-Vis spectrometer, a cuvette cell, and a biosensor chip nanopatterned with gold nanoparticles (AuNPs). In our LSPR biosensor, binding of AFP to the surface of the sensor chip