Sample records for care current capabilities

  1. Health Care, Capabilities, and AI Assistive Technologies

    NARCIS (Netherlands)

    Coeckelbergh, Mark


    Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in health care practices raise several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in health care practices as replacements of human care. I analyse them

  2. Bubble Radiation Detection: Current and Future Capability

    Energy Technology Data Exchange (ETDEWEB)

    AJ Peurrung; RA Craig


    Despite a number of noteworthy achievements in other fields, superheated droplet detectors (SDDs) and bubble chambers (BCs) have not been used for nuclear nonproliferation and arms control. This report examines these two radiation-detection technologies in detail and answers the question of how they can be or should be ''adapted'' for use in national security applications. These technologies involve closely related approaches to radiation detection in which an energetic charged particle deposits sufficient energy to initiate the process of bubble nucleation in a superheated fluid. These detectors offer complete gamma-ray insensitivity when used to detect neutrons. They also provide controllable neutron-energy thresholds and excellent position resolution. SDDs are extraordinarily simple and inexpensive. BCs offer the promise of very high efficiency ({approximately}75%). A notable drawback for both technologies is temperature sensitivity. As a result of this problem, the temperature must be controlled whenever high accuracy is required, or harsh environmental conditions are encountered. The primary findings of this work are listed and briefly summarized below: (1) SDDs are ready to function as electronics-free neutron detectors on demand for arms-control applications. The elimination of electronics at the weapon's location greatly eases the negotiability of radiation-detection technologies in general. (2) As a result of their high efficiency and sharp energy threshold, current BCs are almost ready for use in the development of a next-generation active assay system. Development of an instrument based on appropriately safe materials is warranted. (3) Both kinds of bubble detectors are ready for use whenever very high gamma-ray fields must be confronted. Spent fuel MPC and A is a good example where this need presents itself. (4) Both kinds of bubble detectors have the potential to function as low-cost replacements for conventional neutron

  3. Transient Reliability Analysis Capability Developed for CARES/Life (United States)

    Nemeth, Noel N.


    The CARES/Life software developed at the NASA Glenn Research Center provides a general-purpose design tool that predicts the probability of the failure of a ceramic component as a function of its time in service. This award-winning software has been widely used by U.S. industry to establish the reliability and life of a brittle material (e.g., ceramic, intermetallic, and graphite) structures in a wide variety of 21st century applications.Present capabilities of the NASA CARES/Life code include probabilistic life prediction of ceramic components subjected to fast fracture, slow crack growth (stress corrosion), and cyclic fatigue failure modes. Currently, this code can compute the time-dependent reliability of ceramic structures subjected to simple time-dependent loading. For example, in slow crack growth failure conditions CARES/Life can handle sustained and linearly increasing time-dependent loads, whereas in cyclic fatigue applications various types of repetitive constant-amplitude loads can be accounted for. However, in real applications applied loads are rarely that simple but vary with time in more complex ways such as engine startup, shutdown, and dynamic and vibrational loads. In addition, when a given component is subjected to transient environmental and or thermal conditions, the material properties also vary with time. A methodology has now been developed to allow the CARES/Life computer code to perform reliability analysis of ceramic components undergoing transient thermal and mechanical loading. This means that CARES/Life will be able to analyze finite element models of ceramic components that simulate dynamic engine operating conditions. The methodology developed is generalized to account for material property variation (on strength distribution and fatigue) as a function of temperature. This allows CARES/Life to analyze components undergoing rapid temperature change in other words, components undergoing thermal shock. In addition, the capability has

  4. Low Cost Sensors-Current Capabilities and Gaps (United States)

    1. Present the findings from the a recent technology review of gas and particulate phase sensors 2. Focus on the lower-cost sensors 3. Discuss current capabilities, estimated range of measurement, selectivity, deployment platforms, response time, and expected range of acceptabl...

  5. Capability to care and work: when dual roles intersect

    Directory of Open Access Journals (Sweden)

    Barbara Horrell


    Full Text Available Ageing in place is a cost-effective policy solution to eldercare that reflects a dominant positive ageing discourse of choice and independence. It satisfies older people's preference to remain at home and be involved in their community, but depends upon the provision of care and support for frail elders, particularly the oldest-old, who require assistance to achieve these goals. The traditional provision of unpaid eldercare by female relatives is changing as women are increasingly working outside the home, and they have to choose between, or manage, dual roles of caregiving and paid work. Negative effects on health, paid employment, and finances are associated with the intersection of eldercare and employment. Solutions involve reducing or relinquishing paid employment, which would have financial, social, physical, and emotional ramifications in the future. However, being able to successfully accommodate both roles provides a sense of satisfaction and fulfilment. To understand the complexity of managing the tension between work and eldercare requires a detailed analysis of unpaid caregivers’ daily lives. This paper presents findings about eldercare provision and paid work, derived from two qualitative studies that used a participatory methodology for an in-depth exploration of caregivers’ health. The participants’ stories demonstrate that rather than reflecting on access to a range of options, caregivers’ choices are constrained, and involve trading work and other capabilities for the capability to care. Providing care for a loved elder was the first priority, followed by paid work. Having the capability to maintain a healthy and balanced life was the caregivers’ lowest priority. Unpaid informal care has benefits for elders, and it is a valued emotional relationship for caregivers; however, future social policy should address the difficulties that caregiving creates in people's lives along with focusing on the benefits that such care

  6. The ESA River & Lake System: Current Capabilities and Future Potential

    DEFF Research Database (Denmark)

    Smith, Richard G.; Salloway, Mark; Berry, Philippa A. M.;

    Measuring the earth's river and lake resources using satellite radar altimetry offers a unique global monitoring capability, which complements the detailed measurements made by the steadily decreasing number of in-situ gauges. To exploit this unique remote monitoring capability, a global pilot sc...

  7. Trauma care in India: current scenario. (United States)

    Joshipura, M K


    Trauma-care systems in India are at a nascent stage of development. Industrialized cities, rural towns, and villages coexist with a variety of health care facilities and an almost complete lack of organized trauma care. There is gross disparity between trauma services available in various parts of the country. Rural India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. There is no national lead agency to coordinate various components of a trauma system. No mechanism for accreditation of trauma centers and professionals exists. Education in trauma life-support skills has only recently become available. A nationwide survey encompassing various facilities has documented significant deficiencies in current trauma systems. Some initiatives on improving prehospital systems have been seen recently. Although injury is a major public-health problem, the government, medical fraternity, and the society are yet to recognize it as a significant public health challenge.

  8. Reforming health care in Canada: current issues

    Directory of Open Access Journals (Sweden)

    Baris Enis


    Full Text Available This paper examines the current health care reform issues in Canada. The provincial health insurance plans of the 1960s and 1970s had the untoward effects of limiting the federal government's clout for cost control and of promoting a system centered on inpatient and medical care. Recently, several provincial commissions reported that the current governance structures and management processes are outmoded in light of new knowledge, new fiscal realities and the evolution of power among stake-holders. They recommend decentralized governance and restructuring for better management and more citizen participation. Although Canada's health care system remains committed to safeguarding its guiding principles, the balance of power may be shifting from providers to citizens and "technocrats". Also, all provinces are likely to increase their pressure on physicians by means of salary caps, by exploring payment methods such as capitation, limiting access to costly technology, and by demanding practice changes based on evidence of cost-effectiveness.

  9. Current capability of a matured disposable acoustic sensor network (United States)

    Beale, D. A. R.; Geddes, N. J., II; Hume, A.; Gray, A. J.


    In response to the needs of the UK MOD QinetiQ have designed, developed and trialled an ad-hoc, self organising network of acoustic nodes for in-depth deployment that can detect and track military targets in a range of environments and for all types of weapon locating. Research conducted has shown that disposable technologies are sufficiently mature to provide a useful military capability. Work this year has included a 3 month series of trials to exercise the prototype equipment and has provided an indication of in-service capability across a broad range of environments. This paper will discuss the scientific approach that was applied to the development of the equipment, from early laboratory development through to the prototype sensor network deployment in operationally representative environments. Highlights from the trials have been provided. New findings from the fusion of a low cost thermal imager that can be cued by the acoustic network are also discussed.

  10. En Route Critical Care: Evolving, Improving & Advancing Capabilities (United States)


    Conference Civilian Partnerships  ECMO Pediatric/Neonatology Consortium  58 y/o Male unresponsive to care  Needed Adult ECMO – USA ECMO MD – USAF...Neonatologist – Civilian Perfusionist – Civilian ECMO RN  Transported to Iowa 36 2011 MHS Conference International AE En Route Medical Care Conference

  11. Rapid prototyping for biomedical engineering: current capabilities and challenges. (United States)

    Lantada, Andrés Díaz; Morgado, Pilar Lafont


    A new set of manufacturing technologies has emerged in the past decades to address market requirements in a customized way and to provide support for research tasks that require prototypes. These new techniques and technologies are usually referred to as rapid prototyping and manufacturing technologies, and they allow prototypes to be produced in a wide range of materials with remarkable precision in a couple of hours. Although they have been rapidly incorporated into product development methodologies, they are still under development, and their applications in bioengineering are continuously evolving. Rapid prototyping and manufacturing technologies can be of assistance in every stage of the development process of novel biodevices, to address various problems that can arise in the devices' interactions with biological systems and the fact that the design decisions must be tested carefully. This review focuses on the main fields of application for rapid prototyping in biomedical engineering and health sciences, as well as on the most remarkable challenges and research trends.

  12. Single-phase Multilevel Current Source Inverter with Reduced Device Count and Current Balancing Capability

    Directory of Open Access Journals (Sweden)



    Full Text Available Nowadays power converters play an important role in power system and industrial centers. One of the most important and widely used types of conversion is DC to AC conversion that is also called inverters. Generally inverters are divided to voltage source inverter (VSI and current source inverter (CSI. From another view the inverters are divided to two-level and multilevel types. The multilevel inverters are attractive because of their good output waveform quality. However, there has been less attention to multilevel current source inverter (MLCSI when compared with multilevel VSI. In this paper, a new topology for MLCSI is proposed. The proposed topology employs reduced number of switches to generate desired multilevel output current. The proposed MLCSI is capable of balancing the currents of the inductors that are used in the MLCSI structure. A multicarrier PWM based switching strategy is also proposed for the MLCSI. The simulation results using PSCAD/EMTDC as well as the experimental results from a single-phase 5-level CSI laboratory prototype demonstrate its validity.

  13. Building Visual Artists’ Resilience Capabilities: Current Educator Strategies and Methods

    Directory of Open Access Journals (Sweden)

    Eileen Maree Siddins


    Full Text Available Enrolments in higher education programs in the creative and performing arts are increasing in many countries. Yet graduates of these degrees, who enter the broad sector known as the creative industries, face particular challenges in terms of securing long-term and sustainable employment. In addition, creative and performing artists face a range of mental challenges, caused by such factors as: the solitary nature of much creative practice, critical feedback by audiences and gatekeepers, or the general pressures associated with maintaining artistic relevance or integrity. The concepts of resilience and professional wellbeing are therefore highly relevant to those who pursue a career in creative industries, and while there has been an emerging body of work in this area, to date it has focussed on the performing arts area (e.g. music, theatre. Hence, in order to expand knowledge relevant to resilience and artists, this paper sets out to explore the extent to which current educators in the Australian context specifically address these issues within higher visual arts curricula; specifically the areas of illustration, design, film and photography. This was achieved via interviews with seventeen current academics working in these areas. The findings propose that higher education providers of programs in the visual arts consider placing a stronger emphasis on the embedded development of resilience and professional wellbeing capacities.

  14. Current Capabilities and Development Potential in Surgical Robotics

    Directory of Open Access Journals (Sweden)

    Mathias Hoeckelmann


    Full Text Available Commercial surgical robots have been in clinical use since the mid-1990s, supporting surgeons in various tasks. In the past decades, many systems emerged as research platforms, and a few entered the global market. This paper summarizes the currently available surgical systems and research directions in the broader field of surgical robotics. The widely deployed teleoperated manipulators aim to enhance human cognitive and physical skills and provide smart tools for surgeons, while image-guided robotics focus on surpassing human limitations by introducing automated targeting and treatment delivery methods. Both concepts are discussed based on prototypes and commercial systems. Through concrete examples the possible future development paths of surgical robots are illustrated. While research efforts are taking different approaches to improve the capacity of such systems, the aim of this survey is to assess their maturity from the commercialization point of view.

  15. Adaptive optics at the Subaru telescope: current capabilities and development (United States)

    Guyon, Olivier; Hayano, Yutaka; Tamura, Motohide; Kudo, Tomoyuki; Oya, Shin; Minowa, Yosuke; Lai, Olivier; Jovanovic, Nemanja; Takato, Naruhisa; Kasdin, Jeremy; Groff, Tyler; Hayashi, Masahiko; Arimoto, Nobuo; Takami, Hideki; Bradley, Colin; Sugai, Hajime; Perrin, Guy; Tuthill, Peter; Mazin, Ben


    Current AO observations rely heavily on the AO188 instrument, a 188-elements system that can operate in natural or laser guide star (LGS) mode, and delivers diffraction-limited images in near-IR. In its LGS mode, laser light is transported from the solid state laser to the launch telescope by a single mode fiber. AO188 can feed several instruments: the infrared camera and spectrograph (IRCS), a high contrast imaging instrument (HiCIAO) or an optical integral field spectrograph (Kyoto-3DII). Adaptive optics development in support of exoplanet observations has been and continues to be very active. The Subaru Coronagraphic Extreme-AO (SCExAO) system, which combines extreme-AO correction with advanced coronagraphy, is in the commissioning phase, and will greatly increase Subaru Telescope's ability to image and study exoplanets. SCExAO currently feeds light to HiCIAO, and will soon be combined with the CHARIS integral field spectrograph and the fast frame MKIDs exoplanet camera, which have both been specifically designed for high contrast imaging. SCExAO also feeds two visible-light single pupil interferometers: VAMPIRES and FIRST. In parallel to these direct imaging activities, a near-IR high precision spectrograph (IRD) is under development for observing exoplanets with the radial velocity technique. Wide-field adaptive optics techniques are also being pursued. The RAVEN multi-object adaptive optics instrument was installed on Subaru telescope in early 2014. Subaru Telescope is also planning wide field imaging with ground-layer AO with the ULTIMATE-Subaru project.

  16. Dark Current and Multipacting Capabilities in OPAL: Model Benchmarks and Applications

    CERN Document Server

    Wang, C; Yin, Z G; Zhang, T J


    Dark current and multiple electron impacts (multipacting), as for example observed in radio frequency (RF) structures of accelerators, are usually harmful to the equipment and the beam quality. These effects need to be suppressed to guarantee efficient and stable operation. Large scale simulations can be used to understand causes and develop strategies to suppress these phenomenas. We extend \\opal, a parallel framework for charged particle optics in accelerator structures and beam lines, with the necessary physics models to efficiently and precisely simulate multipacting phenomenas. We added a Fowler-Nordheim field emission model, two secondary electron emission models, developed by Furman-Pivi and Vaughan respectively, as well as efficient 3D boundary geometry handling capabilities. The models and their implementation are carefully benchmark against a non-stationary multipacting theory for the classic parallel plate geometry. A dedicated, parallel plate experiment is sketched.

  17. Organizational Context and Capabilities for Integrating Care: A Framework for Improvement

    Directory of Open Access Journals (Sweden)

    Jenna M. Evans


    Full Text Available Background: Interventions aimed at integrating care have become widespread in healthcare; however, there is significant variability in their success. Differences in organizational contexts and associated capabilities may be responsible for some of this variability. Purpose: This study develops and validates a conceptual framework of organizational capabilities for integrating care, identifies which of these capabilities may be most important, and explores the mechanisms by which they influence integrated care efforts.  Methods: The Context and Capabilities for Integrating Care (CCIC Framework was developed through a literature review, and revised and validated through interviews with leaders and care providers engaged in integrated care networks in Ontario, Canada. Interviews involved open-ended questions and graphic elicitation. Quantitative content analysis was used to summarize the data.  Results: The CCIC Framework consists of eighteen organizational factors in three categories: Basic Structures, People and Values, and Key Processes. The three most important capabilities shaping the capacity of organizations to implement integrated care interventions include Leadership Approach, Clinician Engagement and Leadership, and Readiness for Change. The majority of hypothesized relationships among organizational capabilities involved Readiness for Change and Partnering, emphasizing the complexity, interrelatedness and importance of these two factors to integrated care efforts.  Conclusions: Organizational leaders can use the framework to determine readiness to integrate care, develop targeted change management strategies, and select appropriate partners with overlapping or complementary profiles on key capabilities. Researchers may use the results to test and refine the proposed framework, with a focus on the hypothesized relationships among organizational capabilities and between organizational capabilities and performance outcomes.

  18. Telemedicine deployments within NATO military forces: a data analysis of current and projected capabilities. (United States)

    Lam, David M; Poropatich, Ronald K


    Since the creation of the NATO Telemedicine Expert Panel (now renamed the TMED Expert Team) in 2000, when few nations had deployed telemedicine systems to support military field operations, this group has been encouraging the nations to deploy telemedicine (TMED) in support of their forces, and to write the use of TMED into NATO doctrine. This has been a relatively successful effort, and TMED is increasingly being used within the military medical structures of some NATO and Partnership for Peace nations to provide medical care to deployed military personnel. We report the results of a multinational survey of current and projected availability of various telemedicine modalities within the NATO medical services that are participating in the work of the TMED expert team (ET). Though only a "snapshot in time," and not representing all NATO nations, this is the first attempt to identify both current and planned TMED utilization within the multinational military medical community. Participating nations report that communication systems now in place at the lowest levels of medical support increasingly enable the routine use of Web-based teleconsultation modalities. Teleradiology is now being seen as the de facto standard for imaging support. While a number of nations report they have deployed capabilities for obtaining clinical consultations at a distance, most responding nations do not have a formal organizational structure to control and manage remote consultation and rely on informal clinical relationships (e.g., requesting consults from the deployed clinician's home hospital or from friends). Military electronic health records are in use by only a minority of nations and fewer still are capable of civilian interface. Less common TMED capabilities (e.g., tele-microbiology, tele-pathology, tele-medical maintenance) are being increasingly used, but are still rarely deployed. As a result of the findings of this survey, specific recommendations for expanding the use of

  19. The health capability paradigm and the right to health care in the United States. (United States)

    Ruger, Jennifer Prah


    Against a backdrop of non-ideal political and legal conditions, this article examines the health capability paradigm and how its principles can help determine what aspects of health care might legitimately constitute positive health care rights-and if indeed human rights are even the best approach to equitable health care provision. This article addresses the long American preoccupation with negative rights rather than positive rights in health care. Positive health care rights are an exception to the overall moral range and general thrust of U.S. legal doctrine. Some positive rights to health care have arisen from U.S. Constitutional Eighth Amendment cases and federal and state laws like Medicare, Medicaid, the State Children's Health Insurance Program, the Emergency Medical Treatment and Active Labor Act, and the Patient Protection and Affordable Care Act. Finally, this article discusses some of the difficulties inherent in implementing a positive right to health care in the U.S.

  20. Sharing the Caring: Rethinking Current Policies. (United States)

    Edgar, Don


    This article presents an argument for reforming Australian public policy in favor of social care, rather than family, residential, or community care, for the elderly, sick, and disabled. After noting policy assumptions that families are the focus of caring and women are the natural caregivers, the paper describes changes in Australian family…

  1. Estimating Heat and Mass Transfer Processes in Green Roof Systems: Current Modeling Capabilities and Limitations (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Tabares Velasco, P. C.


    This presentation discusses estimating heat and mass transfer processes in green roof systems: current modeling capabilities and limitations. Green roofs are 'specialized roofing systems that support vegetation growth on rooftops.'

  2. Five-Level Current-Source Inverters With Buck–Boost and Inductive-Current Balancing Capabilities

    DEFF Research Database (Denmark)

    Gao, Feng; Loh, Poh Chiang; Blaabjerg, Frede


    This paper presents new five-level current-source inverters (CSIs) with voltage/current buck–boost capability, unlike existing five-level CSIs where only voltage–boost operation is supported. The proposed inverters attain self-inductive-currentbalancing per switching cycle at their dc front ends...... verified in simulation and experimentally using a scaled-down laboratory platform....

  3. Care pathways for dementia: current perspectives

    Directory of Open Access Journals (Sweden)

    Samsi K


    Full Text Available Kritika Samsi, Jill ManthorpeSocial Care Workforce Research Unit, King’s College London, London, UKAbstract: Uncertainty appears to typify the experience of living with dementia. With an uncertain illness trajectory and unpredictable levels of deterioration and stability in symptoms, people with a diagnosis of dementia may live with uncertainty and anxiety and find it hard to make plans or decisions for their future. People with memory problems and caregivers seeking a diagnosis of dementia may also potentially find themselves navigating a labyrinth-like maze of services, practitioners, assessments, and memory tests, with limited understanding of test scores and little information about what support is available. In this context of uncertainty, the apparent clarity and certainty of a “dementia care pathway” may be attractive. However, the term “dementia care pathway” has multiple and overlapping meanings, which can potentially give rise to further confusion if these are ill-defined or a false consensus is presumed. This review distinguishes four meanings: 1 a mechanism for the management and containment of uncertainty and confusion, useful for the professional as well as the person with dementia; 2 a manual for sequencing care activities; 3 a guide to consumers, indicating eligibility for care activities, or a guide to self-management for dementia dyads, indicating the appropriateness of care activities; and 4 a manual for “walking with” the person. Examples of these approaches are presented from UK dementia services with illustrations of existing care pathways and associated time points, specifically focusing on: 1 early symptom identification and first service encounters, 2 assessment process, 3 diagnostic disclosure, 4 postdiagnostic support, and 5 appropriate interventions. We review the evidence around these themes, as well as discuss service pathways and referral routes used by some services in England and internationally. We

  4. Large-Eddy Simulation: Current Capabilities, Recommended Practices, and Future Research (United States)

    Georgiadis, Nicholas J.; Rizzetta, Donald P.; Fureby, Christer


    This paper presents the results of an activity by the Large Eddy Simulation (LES) Working Group of the AIAA Fluid Dynamics Technical Committee to (1) address the current capabilities of LES, (2) outline recommended practices and key considerations for using LES, and (3) identify future research needs to advance the capabilities and reliability of LES for analysis of turbulent flows. To address the current capabilities and future needs, a survey comprised of eleven questions was posed to LES Working Group members to assemble a broad range of perspectives on important topics related to LES. The responses to these survey questions are summarized with the intent not to be a comprehensive dictate on LES, but rather the perspective of one group on some important issues. A list of recommended practices is also provided, which does not treat all aspects of a LES, but provides guidance on some of the key areas that should be considered.

  5. [Update on Current Care Guideline: Sinusitis]. (United States)

    Hytönen, Maija; Nokso-Koivisto, Johanna; Huovinen, Pentti; Ilkko, Eero; Jousimaa, Jukkapekka; Kivistö, Juho; Korppi, Matti; Liira, Helena; Malmivaara, Antti; Numminen, Jura; Pirilä, Tapio


    Patients with common cold have often symptoms similar to sinusitis. These symptoms often resolve in time, but symptomatic treatment (e.g. analgesics, decongestants) may be used. If symptoms continue for over 10 days, or severe symptoms continue for over 3 days, or symptoms turn worse in the course of the disease, bacterial sinusitis should be suspected. Diagnosis is based on clinical findings, and can be confirmed with ultrasound examination. Amoxicillin, penicillin or doxicyclin are recommended for bacterial sinusitis. Patients with chronic or recurrent sinusitis should be referred to specialist care.

  6. The evolution and current state of emergency care in Ghana

    Directory of Open Access Journals (Sweden)

    Maxwell Osei-Ampofo


    Full Text Available Emergency Medicine as a specialty has only recently been introduced to Ghana. This article reviews the overall health and medical care systems as well as the evolution and the current state of emergency care in Ghana and the progress made in establishing Emergency Medicine (EM as a specialty along the Anglo-American model of emergency care. The article also describes the improvements implemented in emergency patient care, and emergency medicine management systems. Although there are challenges to overcome, much optimism remains about the future of this new specialty in Ghana and its ability to transform the face of emergency care.

  7. Pre-hospital care--current concepts. (United States)

    Boyington, T; Williams, D


    After a brief outline of past developments in the training of ambulance personnel, this paper traces the adoption in the UK of Pre-Hospital Trauma Life Support (PHTLS) courses from the US. The 1991 World Student Games in Sheffield, UK led to liaison between training staff from South Yorkshire Metropolitan Ambulance and Paramedic Service (SYMAPS) and from Western New York Medical Training Institute. As a result, the trauma care policy of SYMAPS was altered from aiming to stabilise the patient at the scene of the accident to emphasising rapid and thorough assessment, packaging and transport. This is a resume of the scope of the PHTLS provider course. The course concentrates on the principles of PHTLS for the multisystems trauma victim.

  8. Current approach to burn critical care. (United States)

    Sakallioglu, A E; Haberal, M


    Burn trauma is a frequent cause of morbidity and mortality all over the world. Advancements in resuscitation, surgical tecniques, infection control and nutritional/metaolic support decreased mortality and morbidity. This article intends to review current outlines for initial treatment and resuscitation nutritional/metabolic support and wound management peculiar to burn patients.

  9. Dignity and the capabilities approach in long-term care for older people. (United States)

    Pirhonen, Jari


    The ageing populations of the Western world present a wide range of economic, social, and cultural implications, and given the challenges posed by deteriorating maintenance ratios, the scenario is somewhat worrying. In this paper, I investigate whether Martha C. Nussbaum's capabilities approach could secure dignity for older people in long-term care, despite the per capita decreases in resources. My key research question asks, 'What implications does Nussbaum's list of central human capabilities have for practical social care?' My methodology combines Nussbaum's list with ethnographic data gathered from a Finnish sheltered home for older people. On the basis of this study, it seems that the capabilities approach is a plausible framework for the ethics of care because it highlights differences in the ability to function and thus differences in opportunities to pursue a good life. The ideas presented in this article could assist social policy planners and executives in creating policies and practices that help old people to maintain their dignity until the end of their days.

  10. Current wound healing procedures and potential care. (United States)

    Dreifke, Michael B; Jayasuriya, Amil A; Jayasuriya, Ambalangodage C


    In this review, we describe current and future potential wound healing treatments for acute and chronic wounds. The current wound healing approaches are based on autografts, allografts, and cultured epithelial autografts, and wound dressings based on biocompatible and biodegradable polymers. The Food and Drug Administration approved wound healing dressings based on several polymers including collagen, silicon, chitosan, and hyaluronic acid. The new potential therapeutic intervention for wound healing includes sustained delivery of growth factors, and siRNA delivery, targeting microRNA, and stem cell therapy. In addition, environment sensors can also potentially utilize to monitor and manage microenvironment at wound site. Sensors use optical, odor, pH, and hydration sensors to detect such characteristics as uric acid level, pH, protease level, and infection - all in the hopes of early detection of complications.

  11. Capabilities of the ITER Electron Cyclotron Equatorial Launcher for Heating and Current Drive

    Directory of Open Access Journals (Sweden)

    Ramponi G.


    Full Text Available The ITER Electron Cyclotron Equatorial Launcher is designed to be one of the heating systems to assist and sustain the development of various ITER plasma scenarios starting with the very first plasma operation. Here the capabilities for Heating and Current Drive of this system are reviewed. In particular, the optimum launching conditions are investigated for two scenarios at burn, comparing toroidal and poloidal steering options. Then, the EC capabilities are investigated for different plasma parameters corresponding to various phases of the ITER plasma discharge, from current ramp-up up to burn, and for a wide range of magnetic field, focusing in particular on the EC potential for heating and for L to H-mode assist. It is found that the EC system can contribute to a wide range of heating scenarios during the ramp-up of the magnetic field, significantly increasing the applicable range as a function of magnetic field.

  12. On the Current Drive Capability of Low Dimensional Semiconductors: 1D versus 2D (United States)

    Zhu, Y.; Appenzeller, J.


    Low-dimensional electronic systems are at the heart of many scaling approaches currently pursuit for electronic applications. Here, we present a comparative study between an array of one-dimensional (1D) channels and its two-dimensional (2D) counterpart in terms of current drive capability. Our findings from analytical expressions derived in this article reveal that under certain conditions an array of 1D channels can outperform a 2D field-effect transistor because of the added degree of freedom to adjust the threshold voltage in an array of 1D devices.

  13. On the Current Drive Capability of Low Dimensional Semiconductors: 1D versus 2D. (United States)

    Zhu, Y; Appenzeller, J


    Low-dimensional electronic systems are at the heart of many scaling approaches currently pursuit for electronic applications. Here, we present a comparative study between an array of one-dimensional (1D) channels and its two-dimensional (2D) counterpart in terms of current drive capability. Our findings from analytical expressions derived in this article reveal that under certain conditions an array of 1D channels can outperform a 2D field-effect transistor because of the added degree of freedom to adjust the threshold voltage in an array of 1D devices.

  14. Influence of the helicopter environment on patient care capabilities: flight crew perceptions (United States)

    Myers, K. J.; Rodenberg, H.; Woodard, D.


    INTRODUCTION: Flight crew perceptions of the effect of the rotary-wing environment on patient-care capabilities have not been subject to statistical analysis. We hypothesized that flight crew members perceived significant difficulties in performing patient-care tasks during air medical transport. METHODS: A survey was distributed to a convenience sample of flight crew members from 20 flight programs. Respondents were asked to compare the difficulty of performing patient-care tasks in rotary-wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Student's t-test, type III sum of squares, and analysis of variance. Alpha was defined as p responded. All tasks were significantly rated more difficult in the rotary-wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month or aircraft used. CONCLUSIONS: We conclude that the performance of patient-care tasks are perceived by air medical flight crew to be significantly more difficult during rotary-wing air medical transport than in hospital settings.

  15. Extreme Environment Simulation - Current and New Capabilities to Simulate Venus and Other Planetary Bodies (United States)

    Kremic, Tibor; Vento, Dan; Lalli, Nick; Palinski, Timothy


    Science, technology, and planetary mission communities have a growing interest in components and systems that are capable of working in extreme (high) temperature and pressure conditions. Terrestrial applications range from scientific research, aerospace, defense, automotive systems, energy storage and power distribution, deep mining and others. As the target environments get increasingly extreme, capabilities to develop and test the sensors and systems designed to operate in such environments will be required. An application of particular importance to the planetary science community is the ability for a robotic lander to survive on the Venus surface where pressures are nearly 100 times that of Earth and temperatures approach 500C. The scientific importance and relevance of Venus missions are stated in the current Planetary Decadal Survey. Further, several missions to Venus were proposed in the most recent Discovery call. Despite this interest, the ability to accurately simulate Venus conditions at a scale that can test and validate instruments and spacecraft systems and accurately simulate the Venus atmosphere has been lacking. This paper discusses and compares the capabilities that are known to exist within and outside the United States to simulate the extreme environmental conditions found in terrestrial or planetary surfaces including the Venus atmosphere and surface. The paper then focuses on discussing the recent additional capability found in the NASA Glenn Extreme Environment Rig (GEER). The GEER, located at the NASA Glenn Research Center in Cleveland, Ohio, is designed to simulate not only the temperature and pressure extremes described, but can also accurately reproduce the atmospheric compositions of bodies in the solar system including those with acidic and hazardous elements. GEER capabilities and characteristics are described along with operational considerations relevant to potential users. The paper presents initial operating results and concludes

  16. Current status of neonatal intensive care in India. (United States)

    Karthik Nagesh, N; Razak, Abdul


    Globally, newborn health is now considered as high-level national priority. The current neonatal and infant mortality rate in India is 29 per 1000 live births and 42 per 1000 live births, respectively. The last decade has seen a tremendous growth of neonatal intensive care in India. The proliferation of neonatal intensive care units, as also the infusion of newer technologies with availability of well-trained medical and nursing manpower, has led to good survival and intact outcomes. There is good care available for neonates whose parents can afford the high-end healthcare, but unfortunately, there is a deep divide and the poor rural population is still underserved with lack of even basic newborn care in few areas! There is increasing disparity where the 'well to do' and the 'increasingly affordable middle class' is able to get the most advanced care for their sick neonates. The underserved urban poor and those in rural areas still contribute to the overall high neonatal morbidity and mortality in India. The recent government initiative, the India Newborn Action Plan, is the step in the right direction to bridge this gap. A strong public-private partnership and prioritisation is needed to achieve this goal. This review highlights the current situation of neonatal intensive care in India with a suggested plan for the way forward to achieve better neonatal care.

  17. Current and future impact of osteoarthritis on health care

    DEFF Research Database (Denmark)

    Turkiewicz, A; Petersson, I F; Björk, J


    OBJECTIVE: To estimate the current and future (to year 2032) impact of osteoarthritis (OA) health care seeking. METHOD: Population-based study with prospectively ascertained data from the Skåne Healthcare Register (SHR), Sweden, encompassing more than 15 million person-years of primary and specia......OBJECTIVE: To estimate the current and future (to year 2032) impact of osteoarthritis (OA) health care seeking. METHOD: Population-based study with prospectively ascertained data from the Skåne Healthcare Register (SHR), Sweden, encompassing more than 15 million person-years of primary...

  18. The duty of care: an update. Current legal principles. (United States)

    Fullbrook, Suzanne


    The author had a twofold purpose in writing this article: firstly to inform readers of the current legal principles that inform the duty of care, and secondly to discuss these principles with reference to two recent cases. Practitioners giving consideration to these issues will be assisted in their professional decision-making processes.

  19. UPQC Controlled Capable Of Mitigating Unbalance In Source Voltage And Load Current

    Directory of Open Access Journals (Sweden)

    B. Santhosh Kumar


    Full Text Available This paper reports the development of a laboratory prototype of a fully digital DSP-controlled 12-kVA unified power quality conditioner (UPQC, capable of compensating for both the supply voltage and the load current imperfections. A fully digital controller based on the TMS320F2812 DSP platform is implemented for the reference generation as well as control purposes. The delay problem in the digital controller is overcome by application of a fast DSP, a compact control technique and proper flow of control steps in the DSP software. A phase-locked loop- less software grid synchronization method has been implemented for the effective operation of the UPQC under conditions of grid frequency variation. A sequence-based compensation strategy has been developed to compensate for balanced and unbalanced sags while accommodating the fact that the voltage injection capability of the UPQC is limited. The prototype UPQC power circuit, control features, and control algorithm along with experimental results are presented in this paper.

  20. Space Weather - Current Capabilities, Future Requirements, and the Path to Improved Forecasting (United States)

    Mann, Ian


    We present an overview of Space Weather activities and future opportunities including assessments of current status and capabilities, knowledge gaps, and future directions in relation to both observations and modeling. The review includes input from the scientific community including from SCOSTEP scientific discipline representatives (SDRs), COSPAR Main Scientific Organizers (MSOs), and SCOSTEP/VarSITI leaders. The presentation also draws on results from the recent activities related to the production of the COSPAR-ILWS Space Weather Roadmap "Understanding Space Weather to Shield Society" [Schrijver et al., Advances in Space Research 55, 2745 (2015)], from the activities related to the United Nations (UN) Committee on the Peaceful Uses of Outer Space (COPUOS) actions in relation to the Long-term Sustainability of Outer Space (LTS), and most recently from the newly formed and ongoing efforts of the UN COPUOS Expert Group on Space Weather.

  1. Liquid nitrogen cooled integrated power electronics module with high current carrying capability and lower on resistance (United States)

    Ye, Hua; Lee, Changwoo; Simon, Randy W.; Haldar, Pradeep; Hennessy, Michael J.; Mueller, Eduard K.


    This letter presents the development of high-performance integrated cryogenic power modules, where both driver components and power metal-oxide semiconductor field-effect transistors are integrated in a single package, to be used in a 50kW prototype cryogenic inverter operating at liquid nitrogen temperature. The authors have demonstrated a compact high-voltage, cryogenic integrated power module that exhibited more than 14 times improvement in on-resistance and continuous current carrying capability exceeding 40A. The modules are designed to operate at liquid nitrogen temperature with extreme thermal cycling. The power electronic modules are necessary components that provide control and switching for second generation, yttrium barium copper oxide-based high temperature superconductor devices including cables, motors, and generators.

  2. Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals

    Directory of Open Access Journals (Sweden)

    Amy J. Thurston


    Full Text Available A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8% and urbanite (79.5%, and cancer was the most common diagnosis (36.2%. Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3% had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital.

  3. [Physiotherapeutic care marketing research: current state-of-the art]. (United States)

    Babaskin, D V


    Successful introduction of modern technologies into the national health care systems strongly depends on the current pharmaceutical market situation. The present article is focused on the peculiarities of marketing research with special reference to physiotherapeutic services and commodities. Analysis of the structure and sequence of marketing research processes is described along with the methods applied for the purpose including their support by the use of Internet resources and technologies.

  4. Overview of current capabilities and research and technology developments for planetary protection (United States)

    Frick, Andreas; Mogul, Rakesh; Stabekis, Pericles; Conley, Catharine A.; Ehrenfreund, Pascale


    The pace of scientific exploration of our solar system provides ever-increasing insights into potentially habitable environments, and associated concerns for their contamination by Earth organisms. Biological and organic-chemical contamination has been extensively considered by the COSPAR Panel on Planetary Protection (PPP) and has resulted in the internationally recognized regulations to which spacefaring nations adhere, and which have been in place for 40 years. The only successful Mars lander missions with system-level “sterilization” were the Viking landers in the 1970s. Since then different cleanliness requirements have been applied to spacecraft based on their destination, mission type, and scientific objectives. The Planetary Protection Subcommittee of the NASA Advisory Council has noted that a strategic Research & Technology Development (R&TD) roadmap would be very beneficial to encourage the timely availability of effective tools and methodologies to implement planetary protection requirements. New research avenues in planetary protection for ambitious future exploration missions can best be served by developing an over-arching program that integrates capability-driven developments with mission-driven implementation efforts. This paper analyzes the current status concerning microbial reduction and cleaning methods, recontamination control and bio-barriers, operational analysis methods, and addresses concepts for human exploration. Crosscutting research and support activities are discussed and a rationale for a Strategic Planetary Protection R&TD Roadmap is outlined. Such a roadmap for planetary protection provides a forum for strategic planning and will help to enable the next phases of solar system exploration.

  5. Arctic Observing Network Data Management: Current Capabilities and Their Promise for the Future (United States)

    Collins, J.; Fetterer, F.; Moore, J. A.


    CADIS (the Cooperative Arctic Data and Information Service) serves as the data management, discovery and delivery component of the Arctic Observing Network (AON). As an International Polar Year (IPY) initiative, AON comprises 34 land, atmosphere and ocean observation sites, and will acquire much of the data coming from the interagency Study of Environmental Arctic Change (SEARCH). CADIS is tasked with ensuring that these observational data are managed for long term use by members of the entire Earth System Science community. Portions of CADIS are either in use by the community or available for testing. We now have an opportunity to evaluate the feedback received from our users, to identify any design shortcomings, and to identify those elements which serve their purpose well and will support future development. This presentation will focus on the nuts-and-bolts of the CADIS development to date, with an eye towards presenting lessons learned and best practices based on our experiences so far. The topics include: - How did we assess our users' needs, and how are those contributions reflected in the end product and its capabilities? - Why did we develop a CADIS metadata profile, and how does it allow CADIS to support preservation and scientific interoperability? - How can we shield the user from metadata complexities (especially those associated with various standards) while still obtaining the metadata needed to support an effective data management system? - How can we bridge the gap between the data storage formats considered convenient by researchers in the field, and those which are necessary to provide data interoperability? - What challenges have been encountered in our efforts to provide access to federated data (data stored outside of the CADIS system)? - What are the data browsing and visualization needs of the AON community, and which tools and technologies are most promising in terms of supporting those needs? A live demonstration of the current


    Energy Technology Data Exchange (ETDEWEB)

    Seitz, R.


    The U.S. Department of Energy (USDOE) Office of Environmental Management (EM), Office of Soil and Groundwater, is supporting development of the Advanced Simulation Capability for Environmental Management (ASCEM). ASCEM is a state-of-the-art scientific tool and approach for understanding and predicting contaminant fate and transport in natural and engineered systems. The modular and open source high-performance computing tool facilitates integrated approaches to modeling and site characterization that enable robust and standardized assessments of performance and risk for EM cleanup and closure activities. The ASCEM project continues to make significant progress in development of computer software capabilities with an emphasis on integration of capabilities in FY12. Capability development is occurring for both the Platform and Integrated Toolsets and High-Performance Computing (HPC) Multiprocess Simulator. The Platform capabilities provide the user interface and tools for end-to-end model development, starting with definition of the conceptual model, management of data for model input, model calibration and uncertainty analysis, and processing of model output, including visualization. The HPC capabilities target increased functionality of process model representations, toolsets for interaction with Platform, and verification and model confidence testing. The Platform and HPC capabilities are being tested and evaluated for EM applications in a set of demonstrations as part of Site Applications Thrust Area activities. The Phase I demonstration focusing on individual capabilities of the initial toolsets was completed in 2010. The Phase II demonstration completed in 2012 focused on showcasing integrated ASCEM capabilities. For Phase II, the Hanford Site deep vadose zone (BC Cribs) served as an application site for an end-to-end demonstration of capabilities, with emphasis on integration and linkages between the Platform and HPC components. Other demonstrations

  7. Targeted temperature management: Current evidence and practices in critical care

    Directory of Open Access Journals (Sweden)

    Saurabh Saigal


    Full Text Available Targeted temperature management (TTM in today′s modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21 st century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI, meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios.

  8. The SCEC Community Modeling Environment (SCEC/CME) - An Overview of its Architecture and Current Capabilities (United States)

    Maechling, P. J.; Jordan, T. H.; Minster, B.; Moore, R.; Kesselman, C.; SCEC ITR Collaboration


    these models. In some cases, the CME system also provides alternatives to the SCEC community models. The CME system hosts a collection of community geophysical software codes. These codes include seismic hazard analysis (SHA) programs developed by the SCEC/USGS OpenSHA group. Also, the CME system hosts anelastic wave propagation codes including Kim Olsen's Finite Difference code and Carnegie Mellon's Hercules Finite Element tool chain. The CME system can execute a workflow, that is, a series of geophysical computations using the output of one processing step as the input to a subsequent step. Our workflow capability utilizes grid-based computing software that can submit calculations to a pool of computing resources as well as data management tools that help us maintain an association between data files and metadata descriptions of those files. The CME system maintains, and provides access to, a collection of valuable geophysical data sets. The current CME Digital Library holdings include a collection of 60 ground motion simulation results calculated by a SCEC/PEER working group and a collection of Greens Functions calculated for 33 TriNet broadband receiver sites in the Los Angeles area.

  9. Melt textured YBaCuO transport current capability. Application to current limitation; Capacite de transport et de limitation du courant des materiaux YBaCuO textures

    Energy Technology Data Exchange (ETDEWEB)

    Porcar, L.; Belmont, O.; Noudem, J.G.; Barbut, J.M.; Barrault, M. [Schneider Electric S.A., Grenoble (France); Bourgault, D.; Chaud, X.; Tournier, R. [CNRS-EPM/Matformag, Grenoble (France); Tixador, P. [CNRS-CRTBT/LEG, Grenoble (France)


    Pulsed and permanent sinusoidal transport current have been applied to melt textured Y{sub 1}Ba{sub 2}Cu{sub 3}O{sub 7-{delta}} in order to estimate its current limitation capability. High pulsed transport currents reaching 9000A (23000 A/cm{sup 2}) crossed a 4 cm long sample. In permanent sinusoidal current, 3000 A (7800 A/cm{sup 2}) crossed the sample without showing any resistive losses. Above the critical current, the transition from the superconducting to the normal state is strongly abrupt. (orig.). 8 refs.

  10. Speed Control of Brushless Dc Motor Using Current Fed Quasi Z-source Inverter with Regeneration Capability

    Directory of Open Access Journals (Sweden)

    A. Santhi Mary Antony


    Full Text Available Current fed Quasi Z-Source Inverters (qZSI have the advantages of voltage buck-boost capability, improved reliability, reduced passive component ratings, continuous input current, a common dc rail between source and inverter and unique regeneration capability. This current-fed qZSIs are bidirectional with an additional diode, unlike the voltage-fed ZSI that needs a switch to achieve bidirectional power flow. Since current fed quasi Z Source Inverter has many advantages it can be employed for motor drive applications such as Brushless DC motor (BLDC drive. Therefore this study proposes the use of qZSI for BLDC motor. The simulation results for the same are presented in this study.

  11. Correlational and Differential Influence of Historical Cost and Current Cost Profits on the Operating Capabilities of the Firm


    S. A. Effiong; J. O. Udoayang; A. I. Asuquo


    The study investigated the correlation and differential influence of historical cost and current cost profits on the operating capabilities of the firm. The financial statements of thirty-one Nigerian Companies were surveyed and adjusted for effects of price changes using the Consumers¡¯ Price Index (CPI). Correlation influence between the historical cost profits on the operating ability of the firm was measured and established on one hand and that of current cost profit on the other hand. Di...

  12. Music therapy in cardiac health care: current issues in research. (United States)

    Hanser, Suzanne B


    Music therapy is a service that has become more prevalent as an adjunct to medical practice-as its evidence base expands and music therapists begin to join the cardiology team in every phase of care, from the most serious cases to those maintaining good heart health. Although applications of music medicine, primarily listening to short segments of music, are capable of stabilizing vital signs and managing symptoms in the short-term, music therapy interventions by a qualified practitioner are showing promise in establishing deeper and more lasting impact. On the basis of mind-body approaches, stress/coping models, the neuromatrix theory of pain, and entrainment, music therapy capitalizes on the ability of music to affect the autonomic nervous system. Although only a limited number of randomized controlled trials pinpoint the efficacy of specific music therapy interventions, qualitative research reveals some profound outcomes in certain individuals. A depth of understanding related to the experience of living with a cardiovascular disease can be gained through music therapy approaches such as nonverbal music psychotherapy and guided imagery and music. The multifaceted nature of musical responsiveness contributes to strong individual variability and must be taken into account in the development of research protocols for future music therapy and music medicine interventions. The extant research provides a foundation for exploring the many potential psychosocial, physiological, and spiritual outcomes of a music therapy service for cardiology patients.

  13. Current status and potential of care farms in the Netherlands

    NARCIS (Netherlands)

    Hassink, J.; Zwartbol, Ch.; Agricola, H.J.; Elings, M.; Thissen, J.T.N.M.


    Surveys among care farmers and data from the National Agricultural Census were analysed to describe the care-farming sector in the Netherlands. The number of care farms increased from 75 in 1998 to 591 in 2005. Care farming is the fastest growing sector of multifunctional agriculture. In 2005, nearl

  14. Current state of knowledge about nutritional care of pregnant women

    Directory of Open Access Journals (Sweden)

    Luciana Barretto


    Full Text Available Pregnancy involves a significant anabolic activity that leads to increased nutritional needs relative to the preconception period. This paper aims to review the current understanding of the energy needs of macro and micronutrients during pregnancy as well as guidelines to address common gastrointestinal disorders during pregnancy, the issue of pica and anthropometric assessment to ensure an optimum weight gain. With the exception of iron, most of the nutrients needed by the pregnancy can be provided by a complete and balanced diet. Currently the scientific evidence shows that routine supplementation with iron and folic acid during pregnancy is a practice that prevents iron deficiency anemia, neural tube disorders and preterm births. Intermittent iron supplementation can also be an appropriated intervention. If the diet does not guarantee and adequate support, iodine, vitamin B12 and vitamin D supplements should also be necessaries. The anthropometric assessment by the pattern of weight gain should be present at each prenatal care visit to prevent maternal and fetal complications. In situations where the mother’s weight cannot be assessed, arm muscle circumference is possible to make an overall assessment as it correlates with maternal weight gain alternative. Measurements of biceps, triceps and subscapular skinfolds are another alternative that is useful to evaluate the fatty deposits and their location, in a complementary way to gain weight.

  15. A compact 45 kV curve tracer with picoampere current measurement capability (United States)

    Sullivan, W. W.; Mauch, D.; Bullick, A.; Hettler, C.; Neuber, A.; Dickens, J.


    This paper discusses a compact high voltage curve tracer for high voltage semiconductor device characterization. The system sources up to 3 mA at up to 45 kV in dc conditions. It measures from 328 V to 60 kV with 15 V resolution and from 9.4 pA to 4 mA with 100 fA minimum resolution. Control software for the system is written in Microsoft Visual C# and features real-time measurement control and IV plotting, arc-protection and detection, an electrically isolated universal serial bus interface, and easy data exporting capabilities. The system has survived numerous catastrophic high voltage device-under-test arcing failures with no loss of measurement capability or system damage. Overall sweep times are typically under 2 min, and the curve tracer system was used to characterize the blocking performance of high voltage ceramic capacitors, high voltage silicon carbide photoconductive semiconductor switches, and high voltage coaxial cable.

  16. An investigation of the health value and self-care capabilities of the elderly in urban-rural fringe area nursing homes and the related influencing factors

    Institute of Scientific and Technical Information of China (English)

    Ju-Ying Luo; Ling-Lin Kong; Zhi-Xia Zhang; Yan-Sheng Ye; Cui-Yu Bao; Li-Juan Tu; Ya-Zhen Yang


    Objective: To investigate the health value and self-care capabilities of the elderly living in urban-rural fringe area nursing homes and the factors that influence these variables. Methods: A cluster sampling method was used to select 280 elderly individuals from seven urban-rural fringe communities in Xianning to complete a survey regarding their health value and self-care capabilities. Results: The total health value and self-care capability scores of the elderly were 7.45 ± 1.45 and 100.25 ± 22.56, respectively. Both of these scores significantly differed by age, education level, marital status, and income (P Conclusions: Elderly people living in the urban-rural fringe area with higher health values also had higher self-care capabilities. The self-care capabilities of the elderly can be enhanced by improving their health value using the“knowing-trusting-acting”model.

  17. The culture of care within psychiatric services: tackling inequalities and improving clinical and organisational capabilities

    Directory of Open Access Journals (Sweden)

    Ascoli Micol


    Full Text Available Abstract Introduction Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. Results These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes. Conclusion Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery.

  18. Integrated Computational Materials Engineering of Titanium: Current Capabilities Being Developed Under the Metals Affordability Initiative (United States)

    Glavicic, M. G.; Venkatesh, V.


    A technical review of the titanium model development programs currently funded under the Metals Affordability Initiative is presented. Progress of the "Advanced Titanium Alloy Microstructure and Mechanical Property Modeling" and "ICME of Microtexture Evolution and its Effect on Cold Dwell/High/Low Cycle Fatigue Behavior of Dual Phase Titanium Alloys" will be reviewed followed by a discussion of the future modeling needs of the aerospace industry.

  19. The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study

    Directory of Open Access Journals (Sweden)

    Monique Venter


    Full Text Available Background. Critical care transfers (CCT refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft of patients who are of high acuity. In South Africa (SA, advanced life support (ALS paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7, consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81 of procedures and medications. Many of these items are not currently within the scope of paramedics’ training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners.

  20. Ultra-fast dynamic imaging: an overview of current techniques, their capabilities and future prospects (United States)

    Altucci, C.; Velotta, R.; Marangos, J. P.


    In this review we attempt to sketch an overview of the various methods currently being used or under development to enable ultra-fast dynamic imaging of matter. We concentrate on those techniques which combine atomic scale spatial resolution and femtosecond or even sub-femtosecond temporal resolution. In part this review was inspired and informed by the material presented at the 'Ultrafast Dynamic Imaging II' workshop held in Ischia, Italy in April 2009, but we also have drawn on a wider background of material especially when discussing the emerging laser-based methods.

  1. Palliative care in India: current progress and future needs. (United States)

    Khosla, Divya; Patel, Firuza D; Sharma, Suresh C


    Despite its limited coverage, palliative care has been present in India for about 20 years. Obstacles in the growth of palliative care in India are too many and not only include factors like population density, poverty, geographical diversity, restrictive policies regarding opioid prescription, workforce development at base level, but also limited national palliative care policy and lack of institutional interest in palliative care. Nonetheless we have reasons to be proud in that we have overcome several hurdles and last two decades have seen palpable changes in the mindset of health care providers and policy makers with respect to need of palliative care in India. Systematic and continuous education for medical staff is mandatory, and a major break-through for achieving this purpose would be to increase the number of courses and faculties in palliative medicine at most universities.

  2. Palliative care in India: Current progress and future needs

    Directory of Open Access Journals (Sweden)

    Divya Khosla


    Full Text Available Despite its limited coverage, palliative care has been present in India for about 20 years. Obstacles in the growth of palliative care in India are too many and not only include factors like population density, poverty, geographical diversity, restrictive policies regarding opioid prescription, workforce development at base level, but also limited national palliative care policy and lack of institutional interest in palliative care. Nonetheless we have reasons to be proud in that we have overcome several hurdles and last two decades have seen palpable changes in the mindset of health care providers and policy makers with respect to need of palliative care in India. Systematic and continuous education for medical staff is mandatory, and a major break-through for achieving this purpose would be to increase the number of courses and faculties in palliative medicine at most universities.

  3. Improving care transitions: current practice and future opportunities for pharmacists. (United States)

    Hume, Anne L; Kirwin, Jennifer; Bieber, Heather L; Couchenour, Rachel L; Hall, Deanne L; Kennedy, Amy K; LaPointe, Nancy M Allen; Burkhardt, Crystal D O; Schilli, Kathleen; Seaton, Terry; Trujillo, Jennifer; Wiggins, Barbara


    During the past decade, patient safety issues during care transitions have gained greater attention at both the local and national level. Readmission rates to U.S. hospitals are high, often because of poor care transitions. Serious adverse drug events (ADEs) caused by an incomplete understanding of changes in complex drug regimens can be an important factor contributing to readmission rates. This paper describes the roles and responsibilities of pharmacists in ensuring optimal outcomes from drug therapy during care transitions. Barriers to effective care transitions, including inadequate communication, poor care coordination, and the lack of one clinician ultimately responsible for these transitions, are discussed. This paper also identifies specific patient populations at high risk of ADEs during care transitions. Several national initiatives and newer care transition models are discussed, including multi- and interdisciplinary programs with pharmacists as key members. Among their potential roles, pharmacists should participate on medical rounds where available, perform medication reconciliation and admission drug histories, apply their knowledge of drug therapy to anticipate and resolve problems during transitions, communicate changes in drug regimens between providers and care settings, assess the appropriateness and patient understanding of drug regimens, promote adherence, and assess health literacy. In addition, this paper identifies barriers and ongoing challenges limiting greater involvement of pharmacists from different practice settings during care transitions. Professional degree programs and residency training programs should increase their emphasis on pharmacists' roles, especially as part of interdisciplinary teams, in improving patient safety during care transitions in diverse practice settings. This paper also recommends that Accreditation Council for Pharmacy Education (ACPE) standards include specific language regarding the exposure of students to


    Directory of Open Access Journals (Sweden)

    I. P. Рonomareva


    Full Text Available The purpose of the study is to identify the main problems and prospects of development of palliative care in geriatrics at the present stage. Method of research was to analyze the printed and electronic databases that meet the stated issues. The results of the study highlight the problems of the development of palliative care in geriatric practice: the lack of a developed procedure of rendering palliative care and adequate elderly patient selection criteria, the lack of trained professional staff. The main prospects-association of palliative practices and concepts of modern geriatrics required specialized geriatric assessment and the provision of clinical, medical, social and socio-psychological geriatric syndromes. While promising option for the development of palliative care geriatrics is the integration into the existing health care system, acceptance of the fact that it is a part of the specialized geriatric care. This requires the involvement and training of not only specialists with medical education, but also persons without medical training from among social workers and volunteers working in palliative care. Therefore, the obtained data allowed to conclude that topical is the development of palliative care in geriatrics, taking into account not only clinical but medico-social, socio-psychological features.

  5. Thorium-230 dating of carbonates: current technical capabilities and major applications (United States)

    Edwards, R. L.; Cheng, H.; Pythoud, M.; Lu, Y.; Zhang, P.; Nissen, J.; Berry, A.; Cross, M.


    Uranium-thorium or Th-230 dating has proven to be an important tool in determining the timing of events in the late Quaternary. Among the major applications are: the timing of sea level change, the timing of continental climate change as preserved in cave archives, the timing of climate change in marine and ice core archives through correlation to Th-230 - dated cave records, and calibration of the radiocarbon timescale. The success of these applications has been driven by continuing technical advances in the measurement of the rare actinide isotopes, U-234 and Th-230. The advances have improved the precision, sensitivity, and accuracy of the measurements. The main factor in measurement improvement has been an increase of about 5 orders of magnitude (over the past 30 years) in the fraction of the sample that can be detected, dramatically improving counting statistics, as well as measurement sensitivity. The 5-order of magnitude improvement, comes largely from the shift to mass spectrometric measurement techniques, but also has resulted from subsequent improvement in ionization plus transmission efficiency. While additional improvement above the 5-order of magnitude figure may be possible, current efforts are focused on improving the accuracy of the measurements, standardizing gravimetric standards among laboratories, and shortening measurement times. These efforts will be discussed along with summary results of some of the major applications.

  6. "Generally the young mom suffers much:" Socio-cultural influences of maternal capabilities and nutrition care in Uganda. (United States)

    Ickes, Scott B; Heymsfield, Grace A; Wright, Timothy W; Baguma, Charles


    We conducted 40 in-depth interviews and eight focus groups among mothers and fathers (n = 91) of diverse ages in western Uganda to define the relevant domains of maternal capabilities and their relationship to infant and young child feeding practices. This study was directed by a developing theory of maternal capabilities that posits that the impact of health-directed interventions may be limited by unmeasured and poorly understood maternal characteristics. Ugandan caregivers defined three major life events that constrain women's capabilities for childcare: early pregnancy, close child spacing, and polygamous marriage. Women describe major constraints in their decision-making capabilities generally and specifically to procuring food for young children. Future nutrition programs may improve their impact through activities that model household decision-making scenarios, and that strengthen women's social support networks. Findings suggest that efforts to transform gender norms may be one additional way to improve nutrition outcomes in communities with a generally low status of women relative to men. The willingness of younger fathers to challenge traditional gender norms suggests an opportunity in this context for continued work to strengthen resources for children's nutritional care.

  7. [Current status of palliative care in medical oncology]. (United States)

    Sasaki, Tsubasa; Ohta, Syuji; Seki, Nobuhiko; Eguchi, Kenji


    A team approach is efficient in palliative care for cancer patients. People suffered from cancer have a right to receive high-quality palliative care earlier in cancer treatment. In Japan the National Act for Strategy against Cancer was enacted in 2007. Systematic educational programs supported by the Ministry of Health Labor and Welfare has been conducted for medical staffs, home care staffs, local pharmacists, care managers etc. at core institutes in each district. Pain control is still major target for cancer palliative medicine. Recently various types of opioids can be used routinely in daily clinical setting for Japanese cancer patients. Complementary and alternative medicine (CAM) may also effective in some patients but further study for proving scientific evidence in CAM should be warranted. Tailor-maid pain control will be established in the near future with molecular based pharmacogenomics.

  8. Palliative care for patients with motor neurone disease: current challenges

    Directory of Open Access Journals (Sweden)

    Oliver DJ


    Full Text Available David J Oliver 1Wisdom Hospice, Rochester, 2University of Kent, Canterbury, UK Abstract: Motor neurone disease is a progressive disease, and the patient and his/her family face many challenges during the disease progression, with increasing weakness and multiple losses of function. The provision of care for these patients and their families is equally challenging, anticipating and responding to the person's needs. There are increasing challenges as more is understood about the disease and its management, including the genetic basis, cognitive change, the use of interventions such as ventilatory support, and gastrostomy. There is also an increasing need to ensure that the later stages are recognized so that all can be more prepared for the end of life, including recognition of deterioration and end of life, advance care planning, symptom management and psychosocial care at the end of life, and coping with requests for assisted dying. Careful assessment and good multidisciplinary team (MDT work can enable patients and their families to have as good a quality of life as possible, and allow a peaceful death of the patient. Keywords: Amyotrophic lateral sclerosis, end of life care, cognitive change, noninvasive ventilation, gastrostomy, advance care planning

  9. Current and future capabilities of the neutron reflectometer MIRROR at Oak Ridge National Laboratory's High Flux Isotope Reactor (United States)

    Hamilton, W. A.; Smith, G. S.; Taylor, G. B.; Larkins, B. M.; Porcar, L.


    The peripatetic ORNL HFIR Center for Neutron Scattering reflectometer instrument MIRROR has recently been re-installed in an interim beam line position in the reactor beam room. In 2006 an upgraded version of the instrument will move to a high intensity guide hall position fed by the new HFIR cold source. In this short note, we present some aspects of current instrument operation-particularly with respect to data reduction from the instrument's linear reflection plane detector-with examples of ongoing research and analysis, and a brief outline of the expected capabilities of the fully upgraded guide hall instrument.

  10. Deliberative democracy in health care: current challenges and future prospects

    Directory of Open Access Journals (Sweden)

    Safaei J


    Full Text Available Jalil Safaei Department of Economics, University of Northern British Columbia, Prince George, BC, CanadaBackground: There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM, patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care.Objective: This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries.Method: Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care.Results: Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature.Conclusion: Seeking deliberative democracy in health care is both challenging and rewarding. The


    EPA remote sensing capabilities include applied research for priority applications and technology support for operational assistance to clients across the Agency. The idea is to use MODIS in conjunction with the current limited Landsat capability, commercial satellites, and Unma...

  12. Drought Predictability and Prediction in a Changing Climate: Assessing Current Predictive Knowledge and Capabilities, User Requirements and Research Priorities (United States)

    Schubert, Siegfried


    Drought is fundamentally the result of an extended period of reduced precipitation lasting anywhere from a few weeks to decades and even longer. As such, addressing drought predictability and prediction in a changing climate requires foremost that we make progress on the ability to predict precipitation anomalies on subseasonal and longer time scales. From the perspective of the users of drought forecasts and information, drought is however most directly viewed through its impacts (e.g., on soil moisture, streamflow, crop yields). As such, the question of the predictability of drought must extend to those quantities as well. In order to make progress on these issues, the WCRP drought information group (DIG), with the support of WCRP, the Catalan Institute of Climate Sciences, the La Caixa Foundation, the National Aeronautics and Space Administration, the National Oceanic and Atmospheric Administration, and the National Science Foundation, has organized a workshop to focus on: 1. User requirements for drought prediction information on sub-seasonal to centennial time scales 2. Current understanding of the mechanisms and predictability of drought on sub-seasonal to centennial time scales 3. Current drought prediction/projection capabilities on sub-seasonal to centennial time scales 4. Advancing regional drought prediction capabilities for variables and scales most relevant to user needs on sub-seasonal to centennial time scales. This introductory talk provides an overview of these goals, and outlines the occurrence and mechanisms of drought world-wide.

  13. The 2004 Fitts Lecture: Current Perspective on Combat Casualty Care (United States)


    Hemorrhage 39 47 56 CNS 42 36 36 Multiple 12 13 8 MOF 7 4 Unknown CNS, central nervous system; MOF, multiple organ failure aMAJ Jimie Owsley, 31 CSH...34) aMAJ Jimie Owsley, 31 CSH, unpublished material, Iraq 2004. Fig. 8. Two pictures illustrating the difference between mobile temporary FST...Data courtesy of MAJ Jimie Owsley, MD. The Journal of TRAUMA Injury, Infection, and Critical Care 1000 October 2005 proving body armor, training, and

  14. Studies of challenge in lower hybrid current drive capability at high density regime in experimental advanced superconducting tokamak (United States)

    Ding, B. J.; Li, M. H.; Li, Y. C.; Wang, M.; Liu, F. K.; Shan, J. F.; Li, J. G.; Wan, B. N.; Wan


    Aiming at a fusion reactor, two issues must be solved for the lower hybrid current drive (LHCD), namely good lower hybrid wave (LHW)-plasma coupling and effective current drive at high density. For this goal, efforts have been made to improve LHW-plasma coupling and current drive capability at high density in experimental advanced superconducting tokamak (EAST). LHW-plasma coupling is improved by means of local gas puffing and gas puffing from the electron side is taken as a routine way for EAST to operate with LHCD. Studies of high density experiments suggest that low recycling and high lower hybrid (LH) frequency are preferred for LHCD experiments at high density, consistent with previous results in other machines. With the combination of 2.45 GHz and 4.6 GHz LH waves, a repeatable high confinement mode plasma with maximum density up to 19~\\text{m}-3$ was obtained by LHCD in EAST. In addition, in the first stage of LHCD cyclic operation, an alternative candidate for more economical fusion reactors has been demonstrated in EAST and further work will be continued.

  15. Community mental health care worldwide: current status and further developments. (United States)

    Thornicroft, Graham; Deb, Tanya; Henderson, Claire


    This paper aims to give an overview of the key issues facing those who are in a position to influence the planning and provision of mental health systems, and who need to address questions of which staff, services and sectors to invest in, and for which patients. The paper considers in turn: a) definitions of community mental health care; b) a conceptual framework to use when evaluating the need for hospital and community mental health care; c) the potential for wider platforms, outside the health service, for mental health improvement, including schools and the workplace; d) data on how far community mental health services have been developed across different regions of the world; e) the need to develop in more detail models of community mental health services for low- and middle-income countries which are directly based upon evidence for those countries; f) how to incorporate mental health practice within integrated models to identify and treat people with comorbid long-term conditions; g) possible adverse effects of deinstitutionalization. We then present a series of ten recommendations for the future strengthening of health systems to support and treat people with mental illness.

  16. Current management of diabetes mellitus and future directions in care. (United States)

    Chatterjee, Sudesna; Davies, Melanie J


    The last 90 years have seen considerable advances in the management of type 1 and type 2 diabetes. Prof MacLean of Guy's Hospital wrote in the Postgraduate Medical Journal in 1926 about the numerous challenges that faced patients and their healthcare professionals in delivering safe and effective diabetes care at that time. The discovery of insulin in 1922 heralded a new age in enabling long-term glycaemic control, which reduced morbidity and mortality. Thirty years later, the first oral agents for diabetes, the biguanides and sulfonylureas, appeared and freed type 2 patients from having to inject insulin following diagnosis. Improvements in insulin formulations over the decades, including rapid-acting and long-acting insulin analogues that more closely mimic physiological insulin secretion, have increased the flexibility and efficacy of type 1 diabetes management. The last two decades have seen major advances in technology, which has manifested in more accurate glucose monitoring systems and insulin delivery devices ('insulin pump'). Increased understanding of the pathophysiological deficits underlying type 2 diabetes has led to the development of targeted therapeutic approaches such as on the small intestine (glucagon-like peptide-1 receptor analogues and dipeptidyl-peptidase IV inhibitors) and kidneys (sodium-glucose cotransporter-2 inhibitors). A patient-centred approach delivered by a multidisciplinary team is now advocated. Glycaemic targets are set according to individual circumstances, taking into account factors such as weight, hypoglycaemia risk and patient preference. Stepwise treatment guidelines devised by international diabetes organisations standardise and rationalise management. Structured education programmes and psychological support are now well-established as essential for improving patient motivation and self-empowerment. Large multicentre randomised trials have confirmed the effectiveness of intensive glycaemic control on microvascular

  17. Human factors and ergonomics in home care: Current concerns and future considerations for health information technology. (United States)

    Or, Calvin K L; Valdez, Rupa S; Casper, Gail R; Carayon, Pascale; Burke, Laura J; Brennan, Patricia Flatley; Karsh, Ben-Tzion


    Sicker patients with greater care needs are being discharged to their homes to assume responsibility for their own care with fewer nurses available to aid them. This situation brings with it a host of human factors and ergonomic (HFE) concerns, both for the home care nurse and the home dwelling patient, that can affect quality of care and patient safety. Many of these concerns are related to the critical home care tasks of information access, communication, and patient self-monitoring and self-management. Currently, a variety of health information technologies (HITs) are being promoted as possible solutions to those problems, but those same technologies bring with them a new set of HFE concerns. This paper reviews the HFE considerations for information access, communication, and patients self-monitoring and self-management, discusses how HIT can potentially mitigate current problems, and explains how the design and implementation of HIT itself requires careful HFE attention.

  18. Current and Emerging Detoxification Therapies for Critical Care

    Directory of Open Access Journals (Sweden)

    Brett A. Howell


    Full Text Available Toxicity resulting from prescription drugs such as tricyclic antidepressants and cardioactive steroids, as well as drugs of abuse and exposure to environmental chemicals, represents a major need for detoxification treatments. Particles and colloids, antibody fragments (Fab, and indirect treatment methods such as macroemulsions, are currently being developed or employed as detoxification therapies. Colloids, particles, and protein fragments typically mitigate toxicity by binding to the toxin and reducing its concentration in vital organs. Indirect methods such as macroemulsions and sodium bicarbonate act directly on the affected organs, rather than the toxin. In this review, key design parameters (i.e. binding affinity, biocompatibility, pharmacokinetics are discussed for each type of detoxification treatment. In addition, some of the latest research in each area is reviewed.

  19. Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization. (United States)

    Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K


    The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

  20. Treatment of Hip Dislocations and Associated Injuries: Current State of Care. (United States)

    Beebe, Michael J; Bauer, Jennifer M; Mir, Hassan R


    Hip dislocations, most often caused by motor vehicle accidents or similar high-energy trauma, traverse a large subset of distinct injury patterns. Understanding these patterns and their associated injuries allows surgeons to provide optimal care for these patients both in the early and late postinjury periods. Nonoperative care requires surgeons to understand the indications. Surgical care requires the surgeon to understand the benefits and limitations of several surgical approaches. This article presents the current understanding of hip dislocation treatment, focusing on anatomy, injury classifications, nonoperative and operative management, and postinjury care.

  1. Focus group reflections on the current and future state of cognitive assessment tools in geriatric health care

    Directory of Open Access Journals (Sweden)

    Whitehead JC


    Full Text Available Jocelyne C Whitehead,1 Sara A Gambino,1 Jeffrey D Richter,2 Jennifer D Ryan1,3,41Rotman Research Institute, Baycrest, 2Independent Human Factors Consultant, Toronto, ON, Canada; 3Department of Psychology, 4Department of Psychiatry, University of Toronto, Toronto, ON, CanadaObjective: This study provides insight into the thoughts and opinions of geriatric health-care professionals toward cognitive assessments and the use of emerging technologies, such as eye-tracking, to supplement current tools.Methods: Two focus group sessions were conducted with nurses and physicians who routinely administer neurocognitive assessments to geriatric populations. Video recordings of the focus group sessions were transcribed and a thematic analysis was performed.Results: Participants reported the need for assessment and diagnostic tools that are accessible and efficient, and that are capable of accommodating the rapid growth in the aging population. The prevalence of more complex ailments experienced by older adults has had repercussions in the quality of care that the clients receive, and has contributed to lengthy wait times and resource shortages. Health-care professionals stated that they are hampered by the disjointed structure of the health-care system and that they would benefit from a more efficient allocation of responsibilities made possible through tools that did not require extensive training or certification. Eyetracking-based cognitive assessments were thought to strongly complement this system, yet it was thought that difficulty would be faced in gaining the support and increased uptake by health-care professionals due to the nonintuitive relationship between eyetracking and cognition.Conclusion: The findings suggest that health-care professionals are receptive to the use of eyetracking technology to assess for cognitive health as it would conserve resources by allowing frontline staff to administer assessments with minimal training

  2. What are the current barriers to effective cancer care coordination? A qualitative study

    Directory of Open Access Journals (Sweden)

    Solomon Michael J


    Full Text Available Abstract Background National cancer policies identify the improvement of care coordination as a priority to improve the delivery of health services for people with cancer. Identification of the current barriers to effective cancer care coordination is needed to drive service improvement. Methods A qualitative study was undertaken in which semi-structured individual interviews and focus groups were conducted with those best placed to identify issues; patients who had been treated for a range of cancers and their carers as well as health professionals involved in providing cancer care. Data collection continued until saturation of concepts was reached. A grounded theory influenced approach was used to explore the participants' experiences and views of cancer care coordination. Results Overall, 20 patients, four carers and 29 health professionals participated. Barriers to cancer care coordination related to six aspects of care namely, recognising health professional roles and responsibilities, implementing comprehensive multidisciplinary team meetings, transitioning of care: falling through the cracks, inadequate communication between specialist and primary care, inequitable access to health services and managing scarce resources. Conclusions This study has identified a number of barriers to coordination of cancer care. Development and evaluation of interventions based on these findings is now required.

  3. Coordination between Fault-Ride-Through Capability and Over-current Protection of DFIG Generators for Wind Farms

    DEFF Research Database (Denmark)

    Bak-Jensen, Birgitte; Kawady, T.A.; Abdel-Rahman, Mansour Hassan


    is investigated. Simulation test cases using MATLAB-Simulink are implemented on a 365-MW wind farm in AL-Zaafarana, Egypt. The simulation results show the influence of the FRT capability on the protective relaying coordination in wind farms, showing that the FRT may work in situations where is were expected...

  4. Proficiency testing for bacterial whole genome sequencing: an end-user survey of current capabilities, requirements and priorities

    DEFF Research Database (Denmark)

    Moran-Gilad, Jacob; Sintchenko, Vitali; Karlsmose Pedersen, Susanne


    Group 4 among GMI members in order to ascertain NGS end-use requirements and attitudes towards NGS PT. The survey identified the high professional diversity of laboratories engaged in NGS-based public health projects and the wide range of capabilities within institutions, at a notable range of costs...

  5. Fault Ride Though Control of Photovoltaic Grid-connected Inverter with Current-limited Capability under Offshore Unbalanced Voltage Conditions

    DEFF Research Database (Denmark)

    Liu, Wenzhao; Guo, Xiaoqiang; Savaghebi, Mehdi;


    of the excessive current phenomenon with the conventional fault ride through control is discussed. The quantitative analysis of the current peak value is conducted and a new current-limiting control strategy is proposed to achieve the flexible power control and successful fault ride through in a safe current......The photovoltaic (PV) inverter installed on board experiences the excessive current stress in case of the offshore unbalanced voltage fault ride through (FRT), which significantly affects the operation reliability of the power supply system. In order to solve the problem, the inherent mechanism...

  6. Transformer-based asymmetrical embedded Z-source neutral point clamped inverters with continuous input current and enhanced voltage boost capability

    DEFF Research Database (Denmark)

    Mo, W.; Loh, Poh Chiang; Blaabjerg, Frede


    Z-source Neutral Point Clamped (NPC) inverters were introduced to integrate both the advantages of Z-source inverters and NPC inverters. However, traditional Z-source inverters suffer from high voltage stress and chopping input current. This paper proposes six types transformer-based impedance-source...... NPC inverters which have enhanced voltage boost capability and continuous input current by utilizing of transformer and embedded dc source configuration. Experimental results are presented to verify the theory validation....

  7. In-vitro diagnostic devices introduction to current point-of-care diagnostic devices

    CERN Document Server

    Cheng, Chao-Min; Chen, Chien-Fu


    Addressing the origin, current status, and future development of point-of-care diagnostics, and serving to integrate knowledge and tools from Analytical Chemistry, Bioengineering, Biomaterials, and Nanotechnology, this book focusses on addressing the collective and combined needs of industry and academia (including medical schools) to effectively conduct interdisciplinary research. In addition to summarizing and detailing developed diagnostic devices, this book will attempt to point out the possible future trends of development for point-of-care diagnostics using both scientifically based research and practical engineering needs with the aim to help novices comprehensively understand the development of point-of-care diagnostics. This includes demonstrating several common but critical principles and mechanisms used in point-of-care diagnostics that address practical needs (e.g., disease or healthcare monitoring) using two well-developed examples so far: 1) blood glucose meters (via electrochemistry); and, 2) p...

  8. [Service robots in elderly care. Possible application areas and current state of developments]. (United States)

    Graf, B; Heyer, T; Klein, B; Wallhoff, F


    The term "Service robotics" describes semi- or fully autonomous technical systems able to perform services useful to the well-being of humans. Service robots have the potential to support and disburden both persons in need of care as well as nursing care staff. In addition, they can be used in prevention and rehabilitation in order to reduce or avoid the need for help. Products currently available to support people in domestic environments are mainly cleaning or remote-controlled communication robots. Examples of current research activities are the (further) development of mobile robots as advanced communication assistants or the development of (semi) autonomous manipulation aids and multifunctional household assistants. Transport robots are commonly used in many hospitals. In nursing care facilities, the first evaluations have already been made. So-called emotional robots are now sold as products and can be used for therapeutic, occupational, or entertainment activities.

  9. Improving regional health care in West Africa using current space systems and technology (United States)

    Jemison, Mae C.; Thomas, J. S.


    This paper discusses the issues involved with establishing an integrated satellite health network in West Africa based on currently available technology. The system proposed makes use of a central national facility capable of transmitting and receiving voice/data and video signals from the entire country. Regional, field and local facilities provides timely epidemiologic information, sharing of medical expertise through telemedical consultations, enhances optimized resource distribution and builds a framework for telecommunications for the entire country.

  10. Accessibility and use of essential medicines in health care: Current progress and challenges in India. (United States)

    Bansal, Dipika; Purohit, Vilok K


    Essential Medicine Concept, a major breakthrough in health care, started in 1977 when World Health Organization (WHO) published its first list. Appropriate use of essential medicines is one of the most cost-effective components of modern health care. The selection process has evolved from expert evaluation to evidence-based selection. The first Indian list was published in 1996 and the recent revision with 348 medicines was published in 2011 after 8 years. Health expenditure is less in India as compared to developed countries. India faces a major challenge in providing access to medicines for its 1.2 billion people by focusing on providing essential medicines. In the future, countries will face challenges in selecting high-cost medicines for oncology, orphan diseases and other conditions. There is a need to develop strategies to improve affordable access to essential medicines under the current health care reform.

  11. Educating Medical Laboratory Technologists: Revisiting Our Assumptions in the Current Economic and Health-Care Environment

    Directory of Open Access Journals (Sweden)

    Regina Linder


    Full Text Available Health care occupies a distinct niche in an economy struggling to recover from recession. Professions related to the care of patients are thought to be relatively resistant to downturns, and thus become attractive to students typically drawn to more lucrative pursuits. Currently, a higher profile for clinical laboratory technology among college students and those considering career change results in larger and better prepared applicant pools. However, after decades of contraction marked by closing of programs, prospective students encounter an educational system without the capacity or vigor to meet their needs. Here discussed are some principles and proposals to allow universities, partnering with health-care providers, government agencies, and other stakeholders to develop new programs, or reenergize existing ones to serve our students and patients. Principles include academic rigor in biomedical and clinical science, multiple points of entry for students, flexibility in format, cost effectiveness, career ladders and robust partnerships.

  12. Multimodality Neuromonitoring in Pediatric Neurocritical Care: Review of the Current Resources (United States)

    Tovar-Spinoza, Zulma


    Brain insults in children represent a daily challenge in neurocritical care. Having a constant grasp on various parameters in the pediatric injured brain may affect the patient’s outcome. Currently, new advances provide clinicians with the ability to utilize several modalities to monitor brain function. This multi-modal approach allows real-time information, leading to faster responses in management and furthermore avoiding secondary insults in the injured brain.  PMID:26719828

  13. Current and future care of patients with the cancer anorexia-cachexia syndrome. (United States)

    Del Fabbro, Egidio


    Many important advances have occurred in the field of cancer cachexia over the past decade, including progress in understanding the mechanisms of the cancer anorexia-cachexia syndrome (CACS) and the development of promising pharmacologic and supportive care interventions. However, no approved agents for cancer cachexia currently exist, emphasizing the unmet need for an effective pharmacologic therapy. This article reviews the key elements of CACS assessment in daily practice, the contribution of nutritional impact symptoms (NIS), the evidence for current pharmacologic options, and promising anticachexia agents in perclinical and clinical trials. It also proposes a model for multimodality therapy and highlights issues pertinent to CACS in patients with pancreatic, gastric, and esophageal cancer.

  14. Leakage Current Optimization Techniques During Test Based on Don't Care Bits Assignment

    Institute of Scientific and Technical Information of China (English)

    Wei Wang; Yu Hu; Yin-He Han; Xiao-Wei Li; You-Sheng Zhang


    It is a well-known fact that test power consumption may exceed that during functional operation. Leakage power dissipation caused by leakage current in Complementary Metal-Oxide-Semiconductor (CMOS) circuits during test has become a significant part of the total power dissipation. Hence, it is important to reduce leakage power to prolong battery life in portable systems which employ periodic self-test, to increase test reliability and to reduce test cost. This paper analyzes leakage current and presents a kind of leakage current simulator based on the transistor stacking effect.Using it, we propose techniques based on don't care bits (denoted by Xs) in test vectors to optimize leakage current in integrated circuit (IC) test by genetic algorithm. The techniques identify a set of don't care inputs in given test vectors and reassign specified logic values to the X inputs by the genetic algorithm to get minimum leakage vector (MLV).Experimental results indicate that the techniques can effectually optimize leakage current of combinational circuits and sequential circuits during test while maintaining high fault coverage.

  15. Growth monitoring: a survey of current practices of primary care paediatricians in Europe.

    Directory of Open Access Journals (Sweden)

    Pauline Scherdel

    Full Text Available OBJECTIVE: We aimed to study current practices in growth monitoring by European primary care paediatricians and to explore their perceived needs in this field. METHODS: We developed a cross-sectional, anonymous on-line survey and contacted primary care paediatricians listed in national directories in the 18 European countries with a confederation of primary care paediatricians. Paediatricians participated in the survey between April and September 2011. RESULTS: Of the 1,198 paediatricians from 11 European countries (response rate 13% who participated, 29% used the 2006 World Health Organization Multicentre Growth Reference Study growth charts, 69% used national growth charts; 61% used software to draw growth charts and 79% did not use a formal algorithm to detect abnormal growth on growth charts. Among the 21% of paediatricians who used algorithms, many used non-algorithmic simple thresholds for height and weight and none used the algorithms published in the international literature. In all, 69% of paediatricians declared that a validated algorithm to monitor growth would be useful in daily practice. We found important between-country variations. CONCLUSION: The varied growth-monitoring practices declared by primary care paediatricians reveals the need for standardization and evidence-based algorithms to define abnormal growth and the development of software that would use such algorithms.

  16. Current and future use of point-of-care tests in primary care : an international survey in Australia, Belgium, The Netherlands, the UK and the USA

    NARCIS (Netherlands)

    Howick, Jeremy; Cals, Jochen W L; Jones, Caroline; Price, Christopher P; Plüddemann, Annette; Heneghan, Carl; Berger, Marjolein Y.; Buntinx, Frank; Hickner, John; Pace, Wilson; Badrick, Tony; Van den Bruel, Ann; Laurence, Caroline; van Weert, Henk C; van Severen, Evie; Parrella, Adriana; Thompson, Matthew


    OBJECTIVE: Despite the growing number of point-of-care (POC) tests available, little research has assessed primary care clinician need for such tests. We therefore aimed to determine which POC tests they actually use or would like to use (if not currently available in their practice). DESIGN: Cross-

  17. The LLNL High Accuracy Volume Renderer for Unstructured Data: Capabilities, Current Limits, and Potential for ASCI/VIEWS Deployment

    Energy Technology Data Exchange (ETDEWEB)

    Williams, P L; Max, N L


    This report describes a volume rendering system for unstructured data, especially finite element data, that creates images with very high accuracy. The system will currently handle meshes whose cells are either linear or quadratic tetrahedra, or meshes with mixed cell types: tetrahedra, bricks, prisms, and pyramids. The cells may have nonplanar facets. Whenever possible, exact mathematical solutions for the radiance integrals and for interpolation are used. Accurate semitransparent shaded isosurfaces may be embedded in the volume rendering. For very small cells, subpixel accumulation by splatting is used to avoid sampling error. A new exact and efficient visibility ordering algorithm is described. The most accurate images are generated in software, however, more efficient algorithms utilizing graphics hardware may also be selected. The report describes the parallelization of the system for a distributed-shared memory multiprocessor machine, and concludes by discussing the system's limits, desirable future work, and ways to extend the system so as to be compatible with projected ASCI/VIEWS architectures.

  18. Aircraft modifications: Assessing the current state of Air Force aircraft modifications and the implications for future military capability (United States)

    Hill, Owen Jacob

    How prepared is the U.S. Air Force to modify its aircraft fleet in upcoming years? Aircraft modernization is a complex interaction of new and legacy aircraft, organizational structure, and planning policy. This research will take one component of modernization: aircraft modification, and apply a new method of analysis in order to help formulate policy to promote modernization. Departing from previous small-sample studies dependent upon weight as a chief explanatory variable, this dissertation incorporates a comprehensive dataset that was constructed for this research of all aircraft modifications from 1996 through 2005. With over 700 modification programs, this dataset is used to examine changes to the current modification policy using policy-response regression models. These changes include separating a codependent procurement and installation schedule, reducing the documentation requirements for safety modifications, and budgeting for aging aircraft modifications. The research then concludes with predictive models for the F-15 and F-16 along with their replacements: the F-22 and F-35 Joint Strike Fighter.

  19. The direct relationship between output power and current carrying capability of rotor bars in HTS induction/synchronous motor with the use of DI-BSCCO tapes

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, T; Nagao, K; Nishimura, T; Ogama, Y; Kawamoto, M [Department of Electrical Engineering, Graduate School of Engineering, Kyoto University, 1 Kyoto-Daigaku Katsura, Nishikyo-Ku, Kyoto 615-8510 (Japan); Okazaki, T; Ayai, N; Oyama, H [Electric Power and Energy Research Laboratories, Sumitomo Electric Industries, Ltd, 1-1-3, Shimaya, Konohaya-Ku, Osaka 554-0024 (Japan)], E-mail:


    We report on the direct relationship between output power and the current carrying capability of a squirrel-cage HTS induction/synchronous motor based on experiment. The secondary windings are fabricated by use of so-called DI-BSCCO tapes, and the conventional (normal conducting) stator, three-phase and four-pole, is utilized. The tests are carried out in liquid nitrogen for two kinds of HTS windings, in which the number of HTS rotor bars is varied. It is directly shown that the output power is proportional to the rotor bars' critical current at 77 K. In other words, the torque can be enlarged by increasing the critical current of the HTS rotor bars.

  20. The health care system for female workers and its current status in Japan. (United States)

    Nohara, M; Kagawa, J


    In this paper we describe female workers' health care, the women's and maternal protection system within the Japanese legal system, the current status of female workers in Japan, and problems regarding methods of advancing health care and the women's or maternal protection system. Motherhood is respected in the workplace in Japan, and in order to provide an environment in which women can work and still bear and rear children with a sense of security, laws concerning maternal protection of female workers, and revisions in terms of the system have been made, and a new system has been in effect since the fiscal year of 1998. Nevertheless, gender discrimination against women and the disparagement of women, rooted in gender role stereotypes concerning the division of labor, remain firmly planted in the social environment and in long-established custom.

  1. Assessing the test–retest reliability of career path appreciation as a measure of current and potential work decision-making capability

    Directory of Open Access Journals (Sweden)

    Rudolf M. Oosthuizen


    Full Text Available Orientation: Assessing and developing managerial decision-making capability in a complex and volatile marketplace is imperative for most South African businesses.Purpose: The objective of this study was to assess the test–retest reliability of the career path appreciation (CPA procedure in assessing current and potential levels of work decision-making capability. The study also explored whether different gender and race groups differed significantly in terms of these levels at two CPA assessments.Motivation for the study: Limited recent test–retest research has been done regarding the reliability of the CPA technique as a tool for measuring the work decision-making capability of professional and managerial talent in the South African context. Scholars and practitioners in the field of industrial psychology could therefore benefit from follow-up research into the reliability of CPA.Research approach, design and method: The research followed an ex post facto correlational design using longitudinal data of a non-probability purposive sample (N = 527 within the Bioss SA database.Main findings: The results showed that the participants’ first CPA assessment scores correlated significantly and positively with their second CPA assessment scores. Gender and race groups differed significantly in their levels of current work decision-making capability at both assessments.Practical/managerial implications: The CPA procedure can be used with confidence as an assessment tool in the selection, mentoring and development of high-potential managerial and professional talent for diverse gender and race groups.Contribution/value-add: These findings contribute valuable information regarding the reliability of CPA and the differences between race and gender groups in the South African context.

  2. Learning to Care during Storytime in the Current Context: Moral Education from the Perspective of Care Ethics (United States)

    Rabin, Colette


    Through an examination of storytelling in the present context, this study addresses the teaching of moral education from the standpoint of care ethics. Through observations, interviews, and surveys in one school committed to care ethics, this study aims to show how the philosophical perspective of care ethics can inform practice. Teachers engaged…

  3. Director of Nursing Current Job Tenure and Past Experience and Quality of Care in Nursing Homes (United States)

    Krause, Melanie R.


    Background Directors of nursing (DON) are central to quality of care in nursing homes (NH) because of their role in coordinating and overseeing nursing care. Research is needed to test the association between DON characteristics and quality using large, representative samples of NHs and global measures of quality. One such measure is the quality measure (QM) rating from the Centers for Medicare & Medicaid Services’ Five-Star Quality Rating, which aggregates 10 individual QMs into a single rating. Purpose This study examined whether DON current job tenure or past experience (1) differed across levels of the QM rating, (2) was associated with QM ratings, and (3) was associated with any of the individual 10 QM scores that comprise QM ratings. Methodology Data for a nationally representative sample of 1,174 NHs were obtained from the 2004 National Nursing Home Survey, publicly-reported QMs, and an Area Resource File. Wald tests were used to test differences in mean DON current job tenure and past experience across levels of the QM rating. Multinomial logistic and Poisson regression analyses were used to examine the association between DON current job tenure and past experience and QM ratings and QM scores, respectively, controlling for selected market and organizational characteristics. Findings NHs with longer DON current job tenure tended to have higher QM ratings. Longer DON current job tenure was associated with higher QM ratings and lower QM scores for several individual QMs, suggesting higher quality. DON past experience did not differ across levels of the QM rating and was neither associated with QM ratings or QM scores. Practice Implications This study highlights the need for owners and administrators to support DONs as they either transition into the role of the DON for the first time or learn to effectively fulfill their role in a new NH. PMID:21712721

  4. Patient and citizen participation in German health care--current state and future perspectives. (United States)

    Loh, Andreas; Simon, Daniela; Bieber, Christiane; Eich, Wolfgang; Härter, Martin


    Patient participation within the German healthcare system is described at three different levels: the macro level as active patient influence on the regulation of medical care, the meso level in terms of institutions enhancing patient information and counselling, and the micro level focusing on the actual treatment decision-making process in the medical encounter. The main focus of the present publication is on the health care system-specific influences on patient participation in medical decision-making and on the current state of research and implementation of shared decision-making in Germany. We describe institutions promoting patient involvement, their aims and initiatives as well as recent changes in German legislation. Against the background of German health politics' endorsement of patient participation the German Ministry of Health funded a research consortium with shared decision-making intervention projects in various disease areas. The present state of the intervention projects' results is outlined as well as subsequently funded transfer projects and future perspectives of research grants. Supported by health politics and the utilisation of scientific evidence shared decision-making's transfer into practice is considered to be relevant to the German health care system.

  5. Current state of chronic wound care in Kazakhstan: focus on topical treatments

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    Alma Akhmetova


    Full Text Available Background — The presence of chronic hard-to-heal wounds significantly affects patients’ quality of life causing pain, discomfort, decrease of mobility and consequently leads to social isolation and depression. This type of wound is more prevalent among older population. It has been estimated that up to 1-2% of the world population have this condition. The treatment of hard-to-heal wounds is expensive and long-term process, and, stresses healthcare systems of every country. Unfortunately, limited information is available about the situation with chronic wounds in Kazakhstan as the statistical data on such patients is not monitored and not registered in this country. Methods — The search was conducted by using available electronic sources, including Google Scholar, PubMed, Web of Sciences, Medline, Wiley Online Library, and Cochrane Library databases as well as hard copy versions of peer-reviewed publications in Russian, Kazakh, and English languages. Results — We have identified and analyzed current situation with wound care in the Republic of Kazakhstan. Research has demonstrated a variety of types of treatments utilized in the country, particularly the treatment of the diabetic foot.It also indicates the lack of statistics on wound care. Conclusions — The review highlights the mechanisms of wound healing process, methods for wound care, and encompasses the information available on wound healing in Republic of Kazakhstan. The article emphasizes the necessity of establishing the systemic monitoring of wound care and formation of electronic database. Apart from that, the importance of developing and manufacturing of domestic novel wound treatments have been also stressed out.

  6. Effects of Comprehensive Stroke Care Capabilities on In-Hospital Mortality of Patients with Ischemic and Hemorrhagic Stroke: J-ASPECT Study (United States)

    Iihara, Koji; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Miyamoto, Yoshihiro; Suzuki, Akifumi; Ishikawa, Koichi B.; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru


    Background The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. Methods and Results Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. Conclusions CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type. PMID:24828409

  7. Effects of comprehensive stroke care capabilities on in-hospital mortality of patients with ischemic and hemorrhagic stroke: J-ASPECT study.

    Directory of Open Access Journals (Sweden)

    Koji Iihara

    Full Text Available BACKGROUND: The effectiveness of comprehensive stroke center (CSC capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. METHODS AND RESULTS: Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH, and 28.1% for patients with subarachnoid hemorrhage (SAH. Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. CONCLUSIONS: CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type.

  8. Human resources for mental health care: current situation and strategies for action. (United States)

    Kakuma, Ritsuko; Minas, Harry; van Ginneken, Nadja; Dal Poz, Mario R; Desiraju, Keshav; Morris, Jodi E; Saxena, Shekhar; Scheffler, Richard M


    A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries.

  9. Emergency obstetric care availability: a critical assessment of the current indicator. (United States)

    Gabrysch, Sabine; Zanger, Philipp; Campbell, Oona M R


    Monitoring progress in reducing maternal and perinatal mortality requires suitable indicators. The density of emergency obstetric care (EmOC) facilities has been proposed as a potentially useful indicator, but different UN documents make inconsistent recommendations, and its current formulation is not associated with maternal mortality. We compiled recently published indicator benchmarks and distinguished three sources of inconsistency: (i) use of different denominator metrics (per birth and per population), (ii) different assumptions on need for EmOC and for EmOC facilities and (iii) failure to specify facility capacity (birth load). The UN guidelines and handbook require fewer EmOC facilities than the World Health Report 2005 and do not specify capacity for deliveries or staffing levels. We recommend (i) always using births as the denominator for EmOC facility density, (ii) clearly stating assumptions on the proportion of deliveries needing basic and comprehensive emergency obstetric care and the desired proportion of deliveries in EmOC facilities and (iii) specifying facility capacity and staffing and adapting benchmarks for settings with different population density to ensure geographical accessibility.

  10. Chronic disease management: a review of current performance across quality of care domains and opportunities for improving osteoarthritis care. (United States)

    Brand, Caroline A; Ackerman, Ilana N; Bohensky, Megan A; Bennell, Kim L


    Osteoarthritis is the most prevalent chronic joint disease worldwide. The incidence and prevalence are increasing as the population ages and lifestyle risk factors such as obesity increase. There are several evidence-based clinical practice guidelines available to guide clinician decision making, but there is evidence that care provided is suboptimal across all domains of quality: effectiveness, safety, timeliness and appropriateness, patient-centered care, and efficiency. System, clinician, and patient barriers to optimizing care need to be addressed. Innovative models designed to meet patient needs and those that harness social networks must be developed, especially to support those with mild to moderate disease.

  11. End-of-Life Care and Psychiatry: Current Trends and Future Directions in India. (United States)

    Deodhar, Jayita K


    Although 80% of the deaths worldwide occur in middle- and low-income countries such as India, there is less awareness of end-of-life care (EOLC) for people with chronic, serious, progressive, or advanced life-limiting illnesses, including dementia. EOLC involves good communication, clinical decision-making, liaison with medical teams and families, comprehensive assessment of and specialized interventions for physical, psychological, spiritual, and social needs of patients and their caregivers. The psychiatrist can play a significant role in each of the above domains in EOLC. The current trends in India are examined, including ambiguities between EOLC and euthanasia. Future directions include formulating a national EOLC policy, providing appropriate services and training. The psychiatrist should get involved in this process, with major responsibilities in providing good quality EOLC for patients with both life-limiting physical illnesses and severe mental disorders, supporting their caregivers, and ensuring dignity in death.

  12. End-of-Life Care and Psychiatry: Current Trends and Future Directions in India

    Directory of Open Access Journals (Sweden)

    Jayita K Deodhar


    Full Text Available Although 80% of the deaths worldwide occur in middle- and low-income countries such as India, there is less awareness of end-of-life care (EOLC for people with chronic, serious, progressive, or advanced life-limiting illnesses, including dementia. EOLC involves good communication, clinical decision-making, liaison with medical teams and families, comprehensive assessment of and specialized interventions for physical, psychological, spiritual, and social needs of patients and their caregivers. The psychiatrist can play a significant role in each of the above domains in EOLC. The current trends in India are examined, including ambiguities between EOLC and euthanasia. Future directions include formulating a national EOLC policy, providing appropriate services and training. The psychiatrist should get involved in this process, with major responsibilities in providing good quality EOLC for patients with both life-limiting physical illnesses and severe mental disorders, supporting their caregivers, and ensuring dignity in death.

  13. Current perceptions of respite care: experiences of family and informal carers of people with a learning disability. (United States)

    Mansell, Ian; Wilson, Christine


    Access to regular, high-quality respite care has a beneficial impact on a carer's ability to fulfil their caring role, but provision varies widely. The current study aims to report family and informal carers' perceptions of respite care services offered to them by their local authority. A mixed method, triangulated design, yielded both quantitative and qualitative data. Members of a parent/carer federation were sent a questionnaire which included a section on 'respite care'; 151 of 647 responded. Two focus groups were held with 15 carers who had previously completed the questionnaire. The majority of carers reported that their respite needs were not being met. Unmet needs were hampered by the lack of information regarding criteria for access to respite. Discrepancies were evident between professionals and carers on a shared definition of respite care. Carers were unsure of exactly which activities constituted respite care and for whom the service was being provided.

  14. Capability Paternalism

    NARCIS (Netherlands)

    Claassen, R.J.G.


    A capability approach prescribes paternalist government actions to the extent that it requires the promotion of specific functionings, instead of the corresponding capabilities. Capability theorists have argued that their theories do not have much of these paternalist implications, since promoting c

  15. Self-reported interoceptive awareness in primary care patients with past or current low back pain

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    Mehling WE


    Full Text Available Wolf E Mehling,1,2 Jennifer Daubenmier,1,3 Cynthia J Price,5 Mike Acree,1 Elizabeth Bartmess,1 Anita L Stewart41Osher Center for Integrative Medicine, 2Department of Family and Community Medicine, 3Department of Medicine, 4School of Nursing, Institute for Health and Aging, University of California, San Francisco, CA, 5School of Nursing, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USABackground: Mind–body interactions play a major role in the prognosis of chronic pain, and mind–body therapies such as meditation, yoga, Tai Chi, and Feldenkrais presumably provide benefits for pain patients. The Multidimensional Assessment of Interoceptive Awareness (MAIA scales, designed to measure key aspects of mind–body interaction, were developed and validated with individuals practicing mind–body therapies, but have never been used in pain patients.Methods: We administered the MAIA to primary care patients with past or current low back pain and explored differences in the performance of the MAIA scales between this and the original validation sample. We compared scale means, exploratory item cluster and confirmatory factor analyses, scale–scale correlations, and internal-consistency reliability between the two samples and explored correlations with validity measures.Results: Responses were analyzed from 435 patients, of whom 40% reported current pain. Cross-sectional comparison between the two groups showed marked differences in eight aspects of interoceptive awareness. Factor and cluster analyses generally confirmed the conceptual model with its eight dimensions in a pain population. Correlations with validity measures were in the expected direction. Internal-consistency reliability was good for six of eight MAIA scales. We provided specific suggestions for their further development.Conclusion: Self-reported aspects of interoceptive awareness differ between primary care patients with past or current

  16. Chest Pain of Suspected Cardiac Origin: Current Evidence-based Recommendations for Prehospital Care

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    P. Brian Savino


    Full Text Available Introduction: In the United States, emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG, ST segment elevation myocardial infarction (STEMI regionalization systems, prehospital fibrinolysis and β-blockers. Results: The protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325mg, 24% recommending 162mg and 15% recommending either, as well as nitroglycerin and opiates (58% choosing morphine. Prehospital 12- Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or β-blocker use. Conclusion: Protocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

  17. Paediatric cardiac intensive care unit: current setting and organization in 2010. (United States)

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan


    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.

  18. The Challenge to Prepare Teachers to Care in the Current Context: Perspectives of Teachers of Color (United States)

    Rabin, Colette


    Teacher educators have a civic responsibility to prepare novice teachers to foster relationships across cultural, racial, and socioeconomic divides. Care ethics acknowledges this imperative and context's role in determining varied meanings of care. The voices of teachers of color can help us to understand the demands of care across differences.…

  19. Capability ethics

    NARCIS (Netherlands)

    I.A.M. Robeyns (Ingrid)


    textabstractThe capability approach is one of the most recent additions to the landscape of normative theories in ethics and political philosophy. Yet in its present stage of development, the capability approach is not a full-blown normative theory, in contrast to utilitarianism, deontological theor

  20. Pediatric cardiovascular care in Uganda: Current status, challenges, and opportunities for the future

    Directory of Open Access Journals (Sweden)

    Twalib Olega Aliku


    Full Text Available In many developing countries, concerted action against common childhood infectious diseases has resulted in remarkable reduction in infant and under-five mortality. As a result, pediatric cardiovascular diseases are emerging as a major contributor to childhood morbidity and mortality. Pediatric cardiac surgery and cardiac catheterization interventions are available in only a few of Sub-Saharan African countries. In Uganda, open heart surgeries (OHSs and interventional procedures for pediatric cardiovascular disease are only possible at the Uganda Heart Institute (UHI, having been started with the help of expatriate teams from the years 2007 and 2012, respectively. Thereafter, independent OHS and cardiac catheterization have been possible by the local team at the UHI since the year 2009 and 2013, respectively. The number of OHSs independently performed by the UHI team has progressively increased from 10 in 2010 to 35 in 2015, with mortality rates ranging from 0% to 4.1% over the years. The UHI pediatric catheterization team has independently performed an increasing number of procedures each year from 3 in 2013 to 55 in 2015. We herein describe the evolution and current status of pediatric cardiovascular care in Uganda, highlighting the unique aspects of its establishment, existing constraints, and future plans.

  1. Substrate decoration for improvement of current-carrying capabilities of YBa2Cu3Ox thin films

    DEFF Research Database (Denmark)

    Khoryushin, Alexey; Mozhaev, Peter; Mozhaeva, Julia;


    The effects of substrate decoration with yttria and Y:ZrO2 on the structural and electrical properties of the YBa2Cu3Ox (YBCO) thin films are studied. The films were deposited on (LaAlO3)3–(Sr2AlTaO8)7 substrates by pulsed laser deposition. Two different structures of decoration layer were applied......, a template layer of nanoparticles and an uniform ultra-thin layer. Significant improvement of current-carrying capabilities was observed, especially at high external magnetic fields. Structural studies of these films reveal the presence of extended linear defects in the YBCO matrix. The formation...... of these structures is attributed to seeding of randomly oriented YBCO grains due to suppression of epitaxy in the very beginning of the deposition. The films of both kinds of decoration layers show nearly the same improvement of jC over the reference film at 77 and 50K: jC (5T and 50K) reaches 0.92 and 0.97MA/cm2...

  2. Medication management policy, practice and research in Australian residential aged care: Current and future directions. (United States)

    Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon


    Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting.

  3. Managed care and economic dynamics. (United States)

    Riggs, J E


    Over the past several decades, health care delivery in the United States evolved in an environment lacking marketplace constraints. The unforeseen result was the current health care crisis--uncontrolled costs, shrinking access, and redundant technological capabilities. Managed care is a strategy to impose fiscal constraints on health care delivery. A diagrammatic analysis of the economic dynamics between consumers and producers in an open marketplace is compared with that of patients, providers, and payers under the health care scheme that produced the health care crisis and under managed care. Patient demands, expectations, and needs for health care are not subject to fiscal constraint under managed care since the dislinkage between consumer and payer still exits. Managed care does not impose true open marketplace fiscal constraints on health care delivery. Furthermore, any solution to the US health care crisis that used true marketplace fiscal constraints would necessitate fundamental changes in societal values concerning individual rights to health care.

  4. A national survey of how acupuncture is currently used in midwifery care at Swedish maternity units


    Martensson, Lena; Kvist, LInda; Hermansson, Evelyn


    Objective: it is not known how acupuncture is used in midwifery care in Sweden and what kind of requirements health-care providers have for midwives and acupuncture training programmes. The aims of this study were to survey indications for the use of acupuncture in midwifery care in Sweden, and to examine the criteria and requirements used for purchase of acupuncture education programmes. Design: a postal survey using a structured questionnaire. Setting: 45 maternity units in Sweden. Particip...

  5. Dynamic capabilities

    DEFF Research Database (Denmark)

    Grünbaum, Niels Nolsøe; Stenger, Marianne


    it was dominated by a lack of systematism, assessment, monitoring, marketing speculations and feasibility calculation. Furthermore, the sphere was dictated by asymmetric supplier-customer relationships and negotiation power leading, among other possible factors, to meager profitability.......The consequences of dynamic capabilities (i.e. innovation performance and profitability) is an under researched area in the growing body of literature on dynamic capabilities and innovation management. This study aims to examine the relationship between dynamic capabilities, innovation performance...... and profitability of small and medium sized manufacturing enterprises operating in volatile environments. A multi-case study design was adopted as research strategy. The findings reveal a positive relationship between dynamic capabilities and innovation performance in the case companies, as we would expect. It was...

  6. Mental Health Care in Nepal : Current Situation and Challenges for Development of a District Mental Health Care Plan

    NARCIS (Netherlands)

    Luitel, N.P., Jordans, M.J.D., Adhikari, Al, Upadhaya, N.P., Hanlon, C., Lund, C. & Komproe, I.H.


    Background Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of

  7. [Trends and current questions of cardiovascular prevention in primary health care]. (United States)

    Ilyés, István; Jancsó, Zoltán; Simay, Attila


    Although an impressive progress has been achieved in the treatment of cardiovascular diseases, they are at the top of the mortality statistics in Hungary. Prevention of these diseases is an essential task of the primary health care. Cardiovascular prevention is carried out at primary, secondary and tertiary levels using risk group and population preventive strategies. The two main tasks of primary cardiovascular prevention are health promotion and cardiovascular disease prevention, and its main programs are ensuring healthy nutrition, improving physical training and accomplishing an anti-smoking program. The essential form of secondary prevention is the screening activity of the primary health care. The majority of cardiovascular risk factors can be discovered during the doctor-patient consultation, but laboratory screening is needed for assessing metabolic risks. The official screening rules of the cardiovascular risk factors and diseases are based on diagnostic criteria of the metabolic syndrome; however, nowadays revealing of global cardiometabolic risks is also necessary. In patients without cardiovascular diseases but with risk factors, a cardiovascular risk estimation has to be performed. In primary care, there is a possibility for long term follow-up and continuous care of patients with chronic diseases, which is the main form of the tertiary prevention. In patients with cardiovascular diseases, ranking to cardiovascular risk groups is a very important task since target values of continuous care depend on which risk group they belong to. The methods used during continuous care are lifestyle therapy, specific pharmacotherapy and organ protection with drugs. Combined health education and counselling is the next element of the primary health care prevention; it is a tool that helps primary, secondary and tertiary prevention. Changes needed for improving cardiovascular prevention in primary care are the following: appropriate evaluation of primary prevention

  8. Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

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    Christos Lionis


    Full Text Available Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose: This paper explores the extent to which integrated primary health care (PHC is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.

  9. A qualitative study of the current situation of elderly care in Iran: what can we do for the future?

    Directory of Open Access Journals (Sweden)

    Salime Goharinezhad


    Full Text Available Background: With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran. Objectives: This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare. Design: This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis. Results: The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services. Discussion: According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities’ job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.

  10. A qualitative study of the current situation of elderly care in Iran: what can we do for the future? (United States)

    Goharinezhad, Salime; Maleki, Mohammadreza; Baradaran, Hamid Reza; Ravaghi, Hamid


    Background With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran. Objectives This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare. Design This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis. Results The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services. Discussion According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities’ job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue. PMID:27876456

  11. Current realities and future vision: Developing an interprofessional, integrated health care workforce. (United States)

    Dubus, Nicole; Howard, Heather


    This article shares findings from an interprofessional symposium that took place in Boston in the spring of 2015. Educators and practitioners from various disciplines shared challenges, successes, and ideas on best interprofessional collaboration (IPC) and curricula development. The findings include the importance of patient-and-family-centered care, which includes the patient and his/her family in the decision-making process; increased education regarding IPC in universities and major hospitals; and educational opportunities within health care systems.

  12. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives


    Lim CJ; Kong DCM; Stuart RL


    Ching Jou Lim,1 David CM Kong,1 Rhonda L Stuart2,31Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia; 2Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia; 3Department of Medicine, Monash University, Clayton, VIC, AustraliaAbstract: Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of parti...

  13. Toward a Public Toxicogenomics Capability for Supporting Predictive Toxicology: Survey of Current Resources and Chemical Indexing of Experiments in GEO and ArrayExpress (United States)

    A publicly available toxicogenomics capability for supporting predictive toxicology and meta-analysis depends on availability of gene expression data for chemical treatment scenarios, the ability to locate and aggregate such information by chemical, and broad data coverage within...

  14. [The current state, the possibilities and difficulties of palliative and hospice care in Hungary]. (United States)

    Hegedűs, Katalin; Lukács, Miklós; Schaffer, Judit; Csikós, Agnes


    Hospice-palliative care has existed in Hungary for more than 20 years but physicians know very little about it. The objective of the study is to give detailed practical information about the possibilities and the reasonability of hospice care and the process of how to have access to it. The authors review and analyze the database of the national Hospice-Palliative Association database to provide most recent national data on hospice-palliative care. In addition, legal, financial and educational issues are also discussed. At present there are 90 active hospice providers in Hungary, which provide service for more than 8000 terminally ill cancer patients. According to WHO recommendations there would be a need for much more service providers, institutional supply and more beds. There are also problems concerning the attitude and, therefore, patients are admitted into hospice care too late. Hospice care is often confused with chronic or nursing care due to lack of information. The situation may be improved with proper forms of education such as palliative licence and compulsory, 40-hour palliative training for residents. The authors conclude that a broad dissemination of data may help to overcome misbeliefs concerning hospice and raise awareness concerning death and dying.

  15. Achieving universal health care coverage: Current debates in Ghana on covering those outside the formal sector

    Directory of Open Access Journals (Sweden)

    Abiiro Gilbert


    Full Text Available Abstract Background Globally, extending financial protection and equitable access to health services to those outside the formal sector employment is a major challenge for achieving universal coverage. While some favour contributory schemes, others have embraced tax-funded health service cover for those outside the formal sector. This paper critically examines the issue of how to cover those outside the formal sector through the lens of stakeholder views on the proposed one-time premium payment (OTPP policy in Ghana. Discussion Ghana in 2004 implemented a National Health Insurance Scheme, based on a contributory model where service benefits are restricted to those who contribute (with some groups exempted from contributing, as the policy direction for moving towards universal coverage. In 2008, the OTPP system was proposed as an alternative way of ensuring coverage for those outside formal sector employment. There are divergent stakeholder views with regard to the meaning of the one-time premium and how it will be financed and sustained. Our stakeholder interviews indicate that the underlying issue being debated is whether the current contributory NHIS model for those outside the formal employment sector should be maintained or whether services for this group should be tax funded. However, the advantages and disadvantages of these alternatives are not being explored in an explicit or systematic way and are obscured by the considerable confusion about the likely design of the OTPP policy. We attempt to contribute to the broader debate about how best to fund coverage for those outside the formal sector by unpacking some of these issues and pointing to the empirical evidence needed to shed even further light on appropriate funding mechanisms for universal health systems. Summary The Ghanaian debate on OTPP is related to one of the most important challenges facing low- and middle-income countries seeking to achieve a universal health care system. It

  16. Capability approach

    DEFF Research Database (Denmark)

    Jensen, Niels Rosendal; Kjeldsen, Christian Christrup

    Lærebogen er den første samlede danske præsentation af den af Amartya Sen og Martha Nussbaum udviklede Capability Approach. Bogen indeholder en præsentation og diskussion af Sen og Nussbaums teoretiske platform. I bogen indgår eksempler fra såvel uddannelse/uddannelsespolitik, pædagogik og omsorg....


    DEFF Research Database (Denmark)

    Rasmussen, Lauge Baungaard; Nielsen, Thorkild


    The aim of this article is to analyse entrepreneurship from an action research perspective. What is entrepreneurship about? Which are the fundamental capabilities and processes of entrepreneurship? To answer these questions the article includes a case study of a Danish entrepreneur and his networks...

  18. Effects of the Program Caring for the Caregiver in improving caring capability Efectos del Programa Cuidando al Cuidador, en la mejora de la habilidad de cuidado Efeitos do Programa Cuidando o cuidador, na melhora da capacidade de cuidado

    Directory of Open Access Journals (Sweden)



    Full Text Available Objective of the Study: to evaluate the effectiveness of the Program Caring for the Caregiver to strengthen capabilities with similar groups cared for in Hospital Nacional de Ortopedia y Rehabilitación Dr. Jorge von Ahn,in León,Guatemala. Methodology: quantitative, quasi-experimental method, with the participation of one sample and one control group. Results: both, experimental and control groups had a high general care capability in the pre-test, except for value. In the post-test, both groups enhanced knowledge and patience, the latter to a lesser extend. Discussion: Women continue assuming the care for their relatives, with a high degree of knowledge and patience which may be associated to social and demographic characteristics and low value, because, probably, the instrument has assessment problems. Although in the post-test the group in general reached a maximum score in the two dimensions previously described and low strengthening of value, which supports the need to continue developing the Program Caring for the Caregiver and to promote the creation of a new tool, taking into consideration the product obtained. Conclusions: the experimental Group and the control Group obtained a good initial care capability. When executing the program, an increase in knowledge and patience is observed and to a lesser extend in dimension of value, deducing from this that the latter is not really an area sensitive for the treatment carried out.Objetivo del estudio: evaluar la efectividad del Programa Cuidando al Cuidador, para el fortalecimiento de habilidades con grupos similares atendidos en el Hospital Nacional de Ortopedia y Rehabilitación Dr. Jorge von Ahn, de León, Guatemala. Metodología: cuantitativa de tipo cuasi experimental, con participación de un grupo muestra y otro de control. Resultados: tanto el grupo experimental como el de control tuvieron en la preprueba una alta habilidad de cuidado general, exceptuando el

  19. Efectos del Programa Cuidando al Cuidador, en la mejora de la habilidad de cuidado Efeitos do Programa Cuidando o cuidador, na melhora da capacidade de cuidado Effects of the Program Caring for the Caregiver in improving caring capability

    Directory of Open Access Journals (Sweden)



    valor. Na pós-prova ambos os grupos aumentaram o conhecimento e paciência; o último em menor escala. Discussão: o gênero feminino continua assumindo o cuidado de seus familiares, com alto conhecimento e paciência que poderiam estar vinculadas com características sóciodemográficas, e baixo valor porque o instrumento, talvez, a presenta problemas na hora de ser avaliado. Embora na pós-prova o grupo em geral atingiu a pontuação máxima nas duas dimensões descritas com antecedência e pouco fortalecimento do valor, o que argumenta a necessidade de continuar desenvolvendo o Programa Cuidando ao Cuidador e promover a criação de uma nova ferramenta, considerando o produto obtido. Conclusões: o grupo experimental e o de controle conseguiram um bom nível de capacidade de cuidado inicial. Com a execução do programa se observa o incremento em conhecimento e paciência e, em menor grau, na dimensão de valor, é por isso que concluímos que essa é uma área não tão sensível ao tratamento efetuado.Objective of the Study: to evaluate the effectiveness of the Program Caring for the Caregiver to strengthen capabilities with similar groups cared for in Hospital Nacional de Ortopedia y Rehabilitación Dr. Jorge von Ahn,in León,Gua-temala. Methodology: quantitative, quasi-experimental method, with the participation of one sample and one control group. Results: both, experimental and control groups had a high general care capability in the pre-test, except for value. In the post-test, both groups enhanced knowledge and patience, the latter to a lesser extend. Discussion: Women continue assuming the care for their relatives, with a high degree of knowledge and patience which may be associated to social and demographic characteristics and low value, because, probably, the instrument has assessment problems. Although in the post-test the group in general reached a maximum score in the two dimensions previously described and low strengthening of value, which supports

  20. Current models of care for disorders of sex development - results from an International survey of specialist centres

    DEFF Research Database (Denmark)

    Kyriakou, Andreas; Dessens, Arianne; Bryce, Jillian


    BACKGROUND: To explore the current models of practice in centres delivering specialist care for children with disorders of sex development (DSD), an international survey of 124 clinicians, identified through DSDnet and the I-DSD Registry, was performed in the last quarter of 2014. RESULTS: A total...... a local DSD registry and 40 (53 %) shared their data in a multicentre DSD registry. Attendance in local, national and international DSD-related educational programs was reported by 69, 78 and 84 % clinicians, respectively. Participation in audits/quality improvement exercises in DSD care was reported...... hydroxysteroid dehydrogenase 3 deficiency by 50 and 55 % clinicians, respectively. CONCLUSION: DSD centres report a high level of interaction at an international level, have access to specialist staff and are increasingly relying on molecular genetics for routine diagnostics. The quality of care provided...

  1. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives

    Directory of Open Access Journals (Sweden)

    Lim CJ


    Full Text Available Ching Jou Lim,1 David CM Kong,1 Rhonda L Stuart2,31Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia; 2Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia; 3Department of Medicine, Monash University, Clayton, VIC, AustraliaAbstract: Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of particular concern is the recent emergence of multidrug-resistant organisms among this vulnerable population. Accordingly, antimicrobial stewardship (AMS programs have started to be introduced into the residential aged care facilities setting to promote judicious antimicrobial use. However, to successfully implement AMS programs, there are unique challenges pertaining to this resource-limited setting that need to be addressed. In this review, we summarize the epidemiology of infections in this population and review studies that explore antibiotic use and prescribing patterns. Specific attention is paid to issues relating to inappropriate or suboptimal antibiotic prescribing to guide future AMS interventions.Keywords: residential aged care, health care-associated infection, surveillance, multidrug-resistant, antibiotic prescribing, antimicrobial stewardship

  2. Current views of health care design and construction: practical implications for safer, cleaner environments. (United States)

    Bartley, Judene M; Olmsted, Russell N; Haas, Janet


    Infection preventionists (IP) play an increasingly important role in preventing health care-associated infection in the physical environment associated with new construction or renovation of health care facilities. The Guidelines for Design and Construction of Hospital and Healthcare Facilities, 2010, formerly known as "AIA Guidelines" was the origin of the "infection control risk assessment" now required by multiple agencies. These Guidelines represent minimum US health care standards and provide guidance on best practices. They recognize that the built environment has a profound affect on health and the natural environment and require that health care facilities be designed to "first, do no harm." This review uses the Guidelines as a blueprint for IPs' role in design and construction, updating familiar concepts to the 2010 edition with special emphasis on IP input into design given its longer range impact on health care-associated infection prevention while linking to safety and sustainability. Section I provides an overview of disease transmission risks from the built environment and related costs, section II presents a broad view of design and master planning, and section III addresses the detailed design strategies for infection prevention specifically addressed in the 2010 Facility Guidelines Institute edition.

  3. Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities

    Directory of Open Access Journals (Sweden)

    Scherer Samuel


    Full Text Available Abstract Background Residential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF staff and General Practitioners (GPs relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education. Methods A mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey and 202 GPs (19% of metropolitan GPs. Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically. Results Among RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern

  4. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives. (United States)

    Lim, Ching Jou; Kong, David C M; Stuart, Rhonda L


    Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of particular concern is the recent emergence of multidrug-resistant organisms among this vulnerable population. Accordingly, antimicrobial stewardship (AMS) programs have started to be introduced into the residential aged care facilities setting to promote judicious antimicrobial use. However, to successfully implement AMS programs, there are unique challenges pertaining to this resource-limited setting that need to be addressed. In this review, we summarize the epidemiology of infections in this population and review studies that explore antibiotic use and prescribing patterns. Specific attention is paid to issues relating to inappropriate or suboptimal antibiotic prescribing to guide future AMS interventions.

  5. Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions.

    NARCIS (Netherlands)

    Calder, P.C.; Jensen, G.L.; Koletzko, B.V.; Singer, P.; Wanten, G.J.A.


    BACKGROUND: Energy deficit is a common and serious problem in intensive care units and is associated with increased rates of complications, length of stay, and mortality. Parenteral nutrition (PN), either alone or in combination with enteral nutrition, can improve nutrient delivery to critically ill

  6. [Current state of medical care of polytrauma and mass casualty incidents in Germany. Are we well-prepared?]. (United States)

    Brodauf, L; Heßing, K; Hoffmann, R; Friemert, B


    The white paper on the medical care of the severely injured published in 2006 is a collection of proposals and recommendations concerning structure, organization and equipment for the medical care of severely injured patients. Since its publication 50 networks ( ) have been established as part of the trauma network. This and the trauma register have helped to continuously improve the medical care of severely injured patients since 1993 [26]. Numerous studies have documented the progress made in measures required by the trauma network [4, 6]. For example, the mortality rate of severely injured patients has dropped from 25 % to approximately 10 % in the past 15 years. From the register and network data it is difficult to tell how each of these measures is implemented in the participating hospitals, who provides medical treatment to patients when, and how medical care is organized in detail. This is why a survey on medical care for polytrauma and in mass casualty situations was conducted among medical directors in German surgical hospitals who are members of the German Society for Trauma Surgery (DGU). Thanks to the 211 participants (most of whom specialize in orthopedic and trauma surgery) a detailed description of how medical treatment is currently organized and performed could be acquired. The survey showed that care of patients with polytrauma (i.e. medical treatment and management) is important irrespective of the level of training of physicians and of the level of patient treatment in hospitals. The central role of traumatologists was emphasized not only in terms of actual treatment but also as an administrator for organizational and management matters. Almost all hospitals have plans for a mass casualty situation; however, the levels of preparedness show considerable variation. A highly critical view is taken of the new surgical specialists with respect to interdisciplinary and comprehensive emergency medical treatment

  7. Exploration Medical Capability - Technology Watch (United States)

    Krihak, Michael; Watkins, Sharmila; Barr, Yael; Barsten, Kristina; Fung, Paul; Baumann, David


    The objectives of the Technology Watch process are to identify emerging, high-impact technologies that augment current ExMC development efforts, and to work with academia, industry, and other government agencies to accelerate the development of medical care and research capabilities for the mitigation of potential health issues that could occur during space exploration missions. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion. Such collaborations also further NASA s goal to provide a safe and healthy environment for human exploration. The Tech Watch project addresses requirements and capabilities identified by knowledge and technology gaps that are derived from a discrete set of medical conditions that are most likely to occur on exploration missions. These gaps are addressed through technology readiness level assessments, market surveys, collaborations and distributed innovation opportunities. Ultimately, these gaps need to be closed with respect to exploration missions, and may be achieved through technology development projects. Information management is a key aspect to this process where Tech Watch related meetings, research articles, collaborations and partnerships are tracked by the HRP s Exploration Medical Capabilities (ExMC) Element. In 2011, ExMC will be introducing the Tech Watch external website and evidence wiki that will provide access to ExMC technology and knowledge gaps, technology needs and requirements documents.


    Directory of Open Access Journals (Sweden)

    Dragoi Mihaela Cristina


    Full Text Available The issue of health has always been, both in social reality and in academia and research, a sensitive topic considering the relationship each individual has with his own health and the health care system as a public policy. At public opinion levels and not only, health care is the most important sector demanding the outmost attention, considering that individual health is the fundamental prerequisite for well-being, happiness and a satisfying life. The ever present research and practical question is on the optimal financing of the health care system. Any answer to this question is also a political decision, reflecting the social-economic value of health for a particular country. The size of the resource pool and the criteria and methods for resource allocation are the central economic problems for any health system. This paper takes into consideration the limited resources of the national health care system (the rationalization of health services, the common methods of health financing, the specificity of health services market (the health market being highly asymmetric, with health professionals knowing most if not all of the relevant information, such as diagnosis, treatment options and costs and consumers fully dependent on the information provided in each case and the performance of all hospitals in Romania, in order to assess the latest strategic decisions (introduction of co-payment and merging and reconversion of hospitals taken within the Romanian health care system and their social and economic implications. The main finding show that, even though the intention of reforming and transforming the Romanian health care system into a more efficient one is obvious, the lack of economic and demographic analysis may results into greater discrepancies nationwide. This paper is aimed to renew the necessity of joint collaboration between the economic and medical field, since the relationship between health and economic development runs both ways

  9. Current and (Potential) Future Effects of the Affordable Care Act on HIV Prevention. (United States)

    Viall, Abigail H; McCray, Eugene; Mermin, Jonathan; Wortley, Pascale


    Recent advances in science, program, and policy could better position the nation to achieve its vision of the USA as a place where new HIV infections are rare. Among these developments, passage of the Patient Protection and Affordable Care Act (ACA) in 2010 may prove particularly important, as the health system transformations it has launched offer a supportive foundation for realizing the potential of other advances, both within and beyond the clinical arena. This article summarizes opportunities to expand access to high-impact HIV prevention interventions under the ACA, examines whether available evidence indicates that these opportunities are being realized, and considers potential challenges to further gains for HIV prevention in an era of health reform. This article also highlights the new roles that HIV prevention programs and providers may assume in a health system no longer defined by fragmentation among public health, medical care, and community service providers.

  10. Evidence-Based Point-of-Care Diagnostics: Current Status and Emerging Technologies (United States)

    Chan, Cangel Pui Yee; Mak, Wing Cheung; Cheung, Kwan Yee; Sin, King Keung; Yu, Cheuk Man; Rainer, Timothy H.; Renneberg, Reinhard


    Point-of-care (POC) diagnostics brings tests nearer to the site of patient care. The turnaround time is short, and minimal manual interference enables quick clinical management decisions. Growth in POC diagnostics is being continuously fueled by the global burden of cardiovascular and infectious diseases. Early diagnosis and rapid initiation of treatment are crucial in the management of such patients. This review provides the rationale for the use of POC tests in acute coronary syndrome, heart failure, human immunodeficiency virus, and tuberculosis. We also consider emerging technologies that are based on advanced nanomaterials and microfluidics, improved assay sensitivity, miniaturization in device design, reduced costs, and high-throughput multiplex detection, all of which may shape the future development of POC diagnostics.

  11. Transitional care in clinical networks for young people with juvenile idiopathic arthritis: current situation and challenges. (United States)

    Cruikshank, Mary; Foster, Helen E; Stewart, Jane; Davidson, Joyce E; Rapley, Tim


    Clinical networks for paediatric and adolescent rheumatology are evolving, and their effect and role in the transition process between paediatric and adult services are unknown. We therefore explored the experiences of those involved to try and understand this further. Health professionals, young people with juvenile idiopathic arthritis and their families were recruited via five national health service paediatric and adolescent rheumatology specialist centres and networks across the UK. Seventy participants took part in focus groups and one-to-one interviews. Data was analysed using coding, memoing and mapping techniques to identify features of transitional services across the sector. Variation and inequities in transitional care exist. Although transition services in networks are evolving, development has lagged behind other areas with network establishment focusing more on access to paediatric rheumatology multidisciplinary teams. Challenges include workforce shortfalls, differences in service priorities, standards and healthcare infrastructures, and managing the legacy of historic encounters. Providing equitable high-quality clinically effective services for transition across the UK has a long way to go. There is a call from within the sector for more protected time, staff and resources to develop transition roles and services, as well as streamlining of local referral pathways between paediatric and adult healthcare services. In addition, there is a need to support professionals in developing their understanding of transitional care in clinical networks, particularly around service design, organisational change and the interpersonal skills required for collaborative working. Key messages • Transitional care in clinical networks requires collaborative working and an effective interface with paediatric and adult rheumatology.• Professional centrism and historic encounters may affect collaborative relationships within clinical networks.• Education

  12. Drug-nutrient interactions in the intensive care unit: literature review and current recommendations (United States)

    Heldt, Tatiane; Loss, Sergio Henrique


    Objective To describe the interactions between drugs and nutrients and their frequency in the intensive care unit and to assess the professional team's awareness regarding this subject. Methods The keywords "drug interactions" and "nutrition therapy" were searched in the PubMed (specifically MeSH) electronic database. The studies were systematically reviewed for descriptions of the types of interactions between drugs and nutrients, including their frequency and consequences. Results Sixty-seven articles were found. Among these, 20 articles were appropriate for the methodology adopted and accomplished the objectives of the study. Of these 20 articles, 14 articles described interactions between drugs and enteral nutrition, three described interactions between drugs and parenteral nutrition, and three described the importance and care required to avoid such interactions. Conclusions The literature about drug and nutrient interactions is limited and suggests the inability of health care teams to recognize the potential for these interactions. Possibly, the elaboration of a protocol to evaluate drug-nutrient interactions will increase the safety and efficacy of therapeutics. PMID:23917982

  13. Subsurface flow and transport of organic chemicals: an assessment of current modeling capability and priority directions for future research (1987-1995)

    Energy Technology Data Exchange (ETDEWEB)

    Streile, G.P.; Simmons, C.S.


    Theoretical and computer modeling capability for assessing the subsurface movement and fate of organic contaminants in groundwater was examined. Hence, this study is particularly concerned with energy-related, organic compounds that could enter a subsurface environment and move as components of a liquid phase separate from groundwater. The migration of organic chemicals that exist in an aqueous dissolved state is certainly a part of this more general scenario. However, modeling of the transport of chemicals in aqueous solution has already been the subject of several reviews. Hence, this study emphasizes the multiphase scenario. This study was initiated to focus on the important physicochemical processes that control the behavior of organic substances in groundwater systems, to evaluate the theory describing these processes, and to search for and evaluate computer codes that implement models that correctly conceptualize the problem situation. This study is not a code inventory, and no effort was made to identify every available code capable of representing a particular process.

  14. Current issues in the respiratory care of patients with amyotrophic lateral sclerosis

    Directory of Open Access Journals (Sweden)

    Marco Orsini


    Full Text Available Amyotrophic lateral sclerosis is a progressive neuromuscular disease, resulting in respiratory muscle weakness, reduced pulmonary volumes, ineffective cough, secretion retention, and respiratory failure. Measures as vital capacity, maximal inspiratory and expiratory pressures, sniff nasal inspiratory pressure, cough peak flow and pulse oximetry are recommended to monitor the respiratory function. The patients should be followed up by a multidisciplinary team, focused in improving the quality of life and deal with the respiratory symptoms. The respiratory care approach includes airway clearance techniques, mechanically assisted cough and noninvasive mechanical ventilation. Vaccination and respiratory pharmacological support are also recommended. To date, there is no enough evidence supporting the inspiratory muscle training and diaphragmatic pacing.

  15. [Update on current care guidelines. The tendon disorders of the shoulder]. (United States)

    Lepola, Vesa; Paloneva, Juha; Huuskonen, Marja-Liisa; Kallinen, Mauri; Karppinen, Jaro; Mattila, Kimmo; Mattila, Ville; Raittinen, Jukka; Rautiainen, Jari; Aärimaa, Ville


    Degenerative rotator cuff tendon disease (tendinopathy) is the most common disorder of the shoulder. A full-thickness tear of the rotator cuff may be caused by degeneration, or it may develop due to an acute trauma. The typical symptoms include pain and functional deficiencies. Diagnostics is based on clinical findings. The primary radiologic imaging is x-ray. Degenerative tendon diseases are primarily treated conservatively in primary health care, the most important treatment modality is physiotherapy-guided therapeutic rehabilitation. Surgical treatment is considered in full-thickness rotator cuff tears, especially after traumatic onset.

  16. Intra-household allocation of food and health care: current findings and understandings--introduction. (United States)

    Messer, E


    This work offers an anthropological analysis of intra-household processes underlying gender- and age-specific differences in individual nutritional and health care allocations and outcomes in particular cultures. Based on recent ethnographic studies in India, Nepal, Madagascar, Mexico, and Peru, correspondences are analyzed between local cultural ("emic") and scientist-policy maker practitioner ("etic") understandings of nutrition, health, and human development, and the relative "values" of females, males, and children of different ages. The data and analyses clarify specific epidemiological and demographic findings on age and gender bias in nutrition and health and highlight the multiple cultural, economic, and biological factors that contribute to gender- or age-based discrimination or neglect. Recent advances in nutrition policy have argued for a broader concept of nutritional security, one that incorporates both food quantity and quality, and of nutrition as "food, health and care" (International Conference on Nutrition, World Declaration and Plan of Action for Nutrition, FAO/WHO, Rome, 1992). These ethnographic findings; lend strong support for such broader nutrition concepts and associated nutrition policies. The studies also suggest ways in which anthropological questions, methods, and data and community-based research can help predict or identify the nutritionally vulnerable within households and help other social and medical scientists design more effective interventions.

  17. Current status of multidrug resistant tuberculosis in a tertiary care hospital of East Delhi

    Directory of Open Access Journals (Sweden)

    T Sagar


    Full Text Available Background and Objective: Multidrug resistant tuberculosis (MDR-TB is caused by infection due to Mycobacterium tuberculosis which is resistant to both isoniazid (INH and rifampicin (RIF. It is caused by selection of resistant mutant strains due to inadequate treatment and poor compliance. MDR-TB is a major public health problem as the treatment is complicated, cure rates are well below those for drug susceptible tuberculosis and patient remains infectious for months despite receiving the best available therapy. The drug susceptibility pattern of M. tuberculosis is essential for proper control of MDR-TB in every health care setting, hence the study was initiated with the aim of studying the prevalence of MDR-TB in patients attending a tertiary care hospital in east Delhi. Materials and Methods: Five hundred and forty-three pulmonary and extrapulmonary samples from suspected cases of tuberculosis received in the mycobacteriology laboratory from November 2009 through October 2010 were investigated for M. tuberculosis. All the samples were subjected to direct microscopic examination for demonstration of acid fast bacilli followed by culture on Lowenstein-Jensen (LJ medium to isolate M. tuberculosis. Identification was done by conventional biochemical methods. Drug susceptibility of isolated M. tuberculosis strains was done by conventional 1% proportion method followed by sequencing of RIF resistant isolates to detect mutations to confirm resistance. Results and Conclusions: M. tuberculosis was isolated from 75 out of 543 suspected cases of pulmonary/extrapulmonary TB. Three of the total 75 M. tuberculosis isolates (4% showed resistance to any one of the first line drugs. Prevalence of MDR-TB was 1.3%. The sequencing of single MDR strain showed mutations at codons 516, 517, and 518. Amplification of rpoB and sequential analysis of the amplicon is a better way of detection of mutation and the evidence of new mutation in this study indicate that

  18. Characterization of Electrical Current-Generation Capabilities from Thermophilic Bacterium Thermoanaerobacter pseudethanolicus Using Xylose, Glucose, Cellobiose, or Acetate with Fixed Anode Potentials. (United States)

    Lusk, Bradley G; Khan, Qaiser Farid; Parameswaran, Prathap; Hameed, Abdul; Ali, Naeem; Rittmann, Bruce E; Torres, Cesar I


    Thermoanaerobacter pseudethanolicus 39E (ATCC 33223), a thermophilic, Fe(III)-reducing, and fermentative bacterium, was evaluated for its ability to produce current from four electron donors-xylose, glucose, cellobiose, and acetate-with a fixed anode potential (+ 0.042 V vs SHE) in a microbial electrochemical cell (MXC). Under thermophilic conditions (60 °C), T. pseudethanolicus produced high current densities from xylose (5.8 ± 2.4 A m(-2)), glucose (4.3 ± 1.9 A m(-2)), and cellobiose (5.2 ± 1.6 A m(-2)). It produced insignificant current when grown with acetate, but consumed the acetate produced from sugar fermentation to produce electrical current. Low-scan cyclic voltammetry (LSCV) revealed a sigmoidal response with a midpoint potential of -0.17 V vs SHE. Coulombic efficiency (CE) varied by electron donor, with xylose at 34.8% ± 0.7%, glucose at 65.3% ± 1.0%, and cellobiose at 27.7% ± 1.5%. Anode respiration was sustained over a pH range of 5.4-8.3, with higher current densities observed at higher pH values. Scanning electron microscopy showed a well-developed biofilm of T. pseudethanolicus on the anode, and confocal laser scanning microscopy demonstrated a maximum biofilm thickness (Lf) greater than ~150 μm for the glucose-fed biofilm.

  19. Care of the patient with interstitial cystitis: current theories and management. (United States)

    Burrell, M; Hurm, R


    Interstitial cystitis is a disease process that has only come into focus over recent years. Researchers are looking for a cause of this painful and frustrating disorder of the bladder, but currently, only theories exist. Nurses must understand the pathophysiology of the disease and the dysfunction of the bladder to educate and assist the patient in the management of this chronic process. This report provides the nurse with information and education on the symptoms, pathophysiology, nursing diagnoses, and potential treatment modalities.

  20. Current situation of sexual and reproductive health of men deprived of liberty in the Institutional Care Center of San Jose

    Directory of Open Access Journals (Sweden)

    Dorita Rivas Fonseca


    Full Text Available The objective of this research was to determine the current status of the issue of sexual and reproductive health ofthe prisoners Institutional Care Center (CAI of San Jose. It is a descriptive study. Through a strategic samplingdetermined the participation of 102 men. The information was obtained by applying a self-administeredquestionnaire with closed and open questions. As a result relevant to your socio-demographic profile, it appearsthat deprived of their liberty is a very heterogeneous group. As regards sexual and reproductive health, the firstconcept they relate to the prevention of disease and the second reproductive aspects, this shows limitations inknowledge on the topics, something that affects the daily life activities and self-care. It is concluded that researchby nurses Gyneco-obstetric in the deprived of liberty is almost null not only in the country but in the world,especially if it comes with the male population. In the case of CAI Prison, health care is not enough for thenumber of inmates who inhabit (overpopulation of almost 50%, this implies a deterioration in health and physicalcondition of these people, as well as sexual and reproductive health

  1. Optimal delivery of follow-up care after surgery for Crohn’s disease: current perspectives

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    Campbell JP


    Full Text Available James P Campbell, Byron P Vaughn Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA Abstract: Despite improvements in medical therapies for Crohn’s disease (CD, up to 70% of patients require surgery within 10 years of diagnosis. Surgery is not curative, and almost all patients will experience endoscopic recurrence, and many will go on to clinical recurrence. Identifying patients at high-risk of endoscopic recurrence and standardizing postoperative assessments are essential in preventing clinical recurrence of CD. In this review, we discuss the assessment, monitoring, and treatment of postoperative CD patients. We address the various individual risk factors as well as composite risk factors. Medications used for primary CD treatment can be used in the postoperative setting to prevent endoscopic or clinical recurrence with varying efficacy, although the cost-effectiveness of these approaches are not fully understood. Future directions for postoperative CD management include evaluation of newer biologic agents such as anti-integrin therapy and fecal microbiota transplant for prevention of recurrence. Development of a standard preoperative risk assessment tool to clearly stratify those at high-risk of recurrence is necessary to guide empiric therapy. Lastly, the incorporation of noninvasive testing into disease monitoring will likely lead to early detection of endoscopic recurrence that will allow for tailored treatment to prevent clinical recurrence. Keywords: Crohn’s disease, postoperative care, postoperative recurrence

  2. A Current View of Functional Biomaterials for Wound Care, Molecular and Cellular Therapies

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    Francesco Piraino


    Full Text Available The intricate process of wound healing involves activation of biological pathways that work in concert to regenerate a tissue microenvironment consisting of cells and external cellular matrix (ECM with enzymes, cytokines, and growth factors. Distinct stages characterize the mammalian response to tissue injury: hemostasis, inflammation, new tissue formation, and tissue remodeling. Hemostasis and inflammation start right after the injury, while the formation of new tissue, along with migration and proliferation of cells within the wound site, occurs during the first week to ten days after the injury. In this review paper, we discuss approaches in tissue engineering and regenerative medicine to address each of these processes through the application of biomaterials, either as support to the native microenvironment or as delivery vehicles for functional hemostatic, antibacterial, or anti-inflammatory agents. Molecular therapies are also discussed with particular attention to drug delivery methods and gene therapies. Finally, cellular treatments are reviewed, and an outlook on the future of drug delivery and wound care biomaterials is provided.

  3. Disinfection and Sterilization in Health Care Facilities: An Overview and Current Issues. (United States)

    Rutala, William A; Weber, David J


    When properly used, disinfection and sterilization can ensure the safe use of invasive and noninvasive medical devices. The method of disinfection and sterilization depends on the intended use of the medical device: critical items (contact sterile tissue) must be sterilized before use; semicritical items (contact mucous membranes or nonintact skin) must be high-level disinfected; and noncritical items (contact intact skin) should receive low-level disinfection. Cleaning should always precede high-level disinfection and sterilization. Current disinfection and sterilization guidelines must be strictly followed.

  4. Adoption of standard ERP solution in health care sector: is SAP ERP all-in-one capable to meet specific requirements?


    Kraljic, Adnan; Kraljic, Tarik; Delismajlović, Denis


    Objective of this experience report is to address specific issues regarding standard SAP ERP implementation in a medical institution. Target Company is a state owned health care institution from Bosnia and Herzegovina. Report will treat selected issues which could trouble standard SAP ERP implementation trough predefined ERP implementation methodology for SAP ERP. This report presents observations/ remarks based on experience of authors in particular SAP ERP implementation project in health c...

  5. The Uncertainty Reducing Capabilities of Primary Care Physicians' Video Biographies for Choosing a New Doctor: Is a Video Worth More Than Two Hundred Words? (United States)

    Perrault, Evan K; Silk, Kami J


    Choosing a primary care physician for the first time is an important decision, one that health care systems do not make particularly easy for prospective patients to make solely through the limited information provided on their websites. Without knowledge from others, a new patient is likely to have uncertainty about the physician he or she chooses. Three hundred and twenty participants completed an online experiment and were exposed to two biographies of different doctors with different media and either professional or personal information. Predictions generated by media richness theory revealed greater reductions in uncertainty for video biographies than traditional text biographies. Video biographies, and those containing personal information about the physician, were also related to higher levels of anticipated patient satisfaction and care quality. When asked to choose the physicians they would want to visit, participants overwhelmingly chose the physician with whom they perceived the greatest similarity to themselves, as well as the doctor who provided a video biography. Both theoretical and practical implications of this research are discussed.

  6. Building a clinical leadership community to drive improvement: a multi-case educational study to inform 21st century clinical commissioning, professional capability and patient care. (United States)

    Lynch, Marion; Verner, Elizabeth


    The new NHS requires transformational leadership; people with the knowledge and motivation to make effective change combined with an understanding of the system they work in. The aim of the Practice Leaders' Programme (PLP) is to generate the conditions needed to focus the energy and collaborative creativity required for innovation to enhance leadership skills across the health economy improving patient care. The PLP engaged 60 local leaders from central England in a new approach enabling them to influence others. It has informed educational policy and practice and helped change professional behaviours. Each participant implemented improvements in care and participated in six action learning sets (ALS) and up to six coaching sessions. Evidence of progress, learning and impact was identified in project reports, reflective diaries and evaluations. The ALS brought together key individuals from clinical and management disciplines across a diverse organisation to redesign a system by developing a shared vision for improving the quality of patient care. The links forged, the projects initiated, and the skills cultivated through the PLP produced ongoing benefits and outcomes beyond the course itself. Coaching sessions helped participants focus their efforts to achieve maximum impact and to become resilient in managing service change effectively. The programme has evolved over four years, building on recommendations from external evaluation which identified statistically significant increases in leadership competences. Further enhancement of this programme secured an International Health Improvement Award. Three key findings of positive impact have emerged; personal growth, service improvement, and legacy and sustainability.

  7. Herbal extracts in oral health care - A review of the current scenario and its future needs

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    Byalakere Rudraiah Chandra Shekar


    Full Text Available Background: Oral diseases are among the major public health problems and the commonest of chronic diseases that affect mankind. The application of natural products for the control of oral diseases is considered as an interesting alternative to synthetic antimicrobials due to their lower negative impact, and for the effort to overcome primary or secondary resistance to the drug during therapy. Objective: To review the current evidence on the antimicrobial efficacy of 10 plant extracts on dental caries and plaque microorganisms. Materials and Methods: A comprehensive literature search was made by one of the authors for 2 months in PubMed, PubMed Central, MEDLINE, LILACS/BBO, Cochrane database of systematic reviews, SCIENCE DIRECT, and Google scholar databases. The results from the relevant published literatures are discussed. Summary and Conclusion: The extracts of Azadirachta Indica, Ocimum sanctum, Murraya koenigii L., Acacia nilotica, Eucalyptus camaldulensis, Hibiscus sabdariffa, Mangifera indica, Psidium guajava, Rosa indica, and Aloe barbadensis Miller have all been found to inhibit certain dental caries and periodontal pathogens. The current evidence is on individual plant extracts against bacteria involved in either caries or periodontitis. "Herbal shotgun" or "synergistic multitarget effects" are the terms used for the strategy of combining different extracts. The research assessing the antimicrobial efficacy of a combination of these plant extracts against dental caries and periodontal pathogens is the need of the hour, and such research will aid in the development of a novel, innovative method that can simultaneously inhibit two of the most common dental diseases of mankind, besides slowing the development of drug resistance.

  8. Currents issues in cardiorespiratory care of patients with post-polio syndrome

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    Marco Orsini


    Full Text Available ABSTRACT Post-polio syndrome (PPS is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

  9. Current and Projected Capabilities of the Solar Tower Atmospheric Cherenkov Effect Experiment (STACEE) for gamma -ray Astronomy below 100 GeV (United States)

    Chantell, M. C.; Covault, C. E.; Dragovan, M.; Ong, R. A.; Oser, S.; Bhattacharya, D.; Tumer, O. T.; Gregorich, D. T.; Hanna, D. S.; Williams, D. A.


    There are currently no experiments, either satellite or ground-based, that are sensitive to astrophysical gamma -rays in the energy range between 20 and 250 GeV. We are developing the Solar Tower Atmospheric Cherenkov Effect Experiment (STACEE) to explore this energy range. STACEE will use heliostat mirrors at the National Solar Thermal Test Facility, located at Sandia National Laboratorys near Albuquerque NM., to collect Cherenkov light produced by extensive air showers initiated by high energy gamma -rays. The STACEE collaboration has recently completed a series of tests at this site that demonstrate the ability of this experiment to operate with a gamma -ray energy threshold well below 100 GeV. We present the results of these tests and use them to predict the scientific potential of a 32 heliostat experiment operating for a full winter-spring observing season.

  10. Current problems in national hospitals of Phnom Penh: finance and health care. (United States)

    Uy, Sophoat; Akashi, Hidechika; Taki, Kazumi; Ito, Katsuki


    The current problems in Cambodia's national hospitals subsist in a geographic imbalance in the location of staff and health facilities, and low staff motivation largely due to inadequate payment. This paper aims to investigate the associations among hospital performance, hospital finances, and other related issues in five national hospitals in Phnom Penh, using annual reports of the five hospitals and annual statistics of the Ministry of Health, from 2000 to 2004. The bed occupancy rates (BOR), average lengths of stay (ALS), hospital mortality rates (HMR), maternal and neonatal mortality rates, numbers of patients, main health problems of inpatients, numbers of health personnel, staff incentives, and annual hospital income were used in this study as indicators of five hospitals in Phnom Penh city. The ALS varied from 3.8 to 9 days. The numbers of health personnel (physician, medical assistant, secondary nurses, primary nurses, secondary midwives, and primary midwives) per 100 beds were from 114 to 282. Supplemental salary per staff also differed greatly among these hospitals; the salaries were the highest at Calmette hospital (US$ 212.8) and the lowest at Preah Kossamak (US$ 12.4). In the five hospitals, the average BOR was 58.8%, and the mean of total annual income was US$ 1,427,852 per year. Although not significant, there was a tendency for higher supplemental salaries to be associated with higher BOR (Spearman rank correlation coefficient 0.70, p = 0.188). This study showed the differences in the hospital indicators among five national hospitals in Phnom Penh city, and the tendency of higher BOR in the hospitals paying higher supplemental salaries to the staff. Higher supplemental salary to the staff seemed to contribute the better hospital performance.

  11. Investigating the current methods of assessing behavioral and psychological symptoms in residential aged care facilities in a metropolitan city. (United States)

    Loi, Samantha M; Lautenschlager, Nicola T


    Up to 90% of people with dementia living in residential aged care facilities (RACFs) display behavioral and psychological symptoms of dementia (BPSD), and these are associated with poorer quality of life and increased morbidity and mortality. In order to implement appropriate interventions, it is important to understand the symptoms in more detail. Despite the availability of BPSD assessment tools, it is unknown what the current practice of monitoring of BPSD in RACFs. We sought to investigate the current BPSD assessment tools being used in RACFs and explore different stakeholders' views on current practices. A cross-sectional convenience sample of 21 clinicians were identified and administered a questionnaire. Old age psychiatrists, aged psychiatry clinicians, behavior management teams and RACF staff completed the questionnaires. Clinicians reported that objective consistent information about BPSD were important for recommending and implementing pharmacological and non-pharmacological strategies for BPSD; however, the use of validated BPSD assessments in RACFs was not a usual part of clinical practice. RACF staff stated the major barrier to assessment of BPSD was lack of time. Alternate methods of assessing BPSD which consider preferences from clinicians and RACF staff should be further investigated. Modern technology which can allow "real time" assessment may be a solution.

  12. The Relationship Between the Educational Background and Managerial Experience of Senior Navy Medical Service Corps Executives (Health Care Administrators) and their Perceived Current and Required Management Capabilities. (United States)


    all f8 1.1 ldg 16a__ _ _ 16I 73i APPENDIX F. EDUCATION AND TRAINING GOALS laik Pkin (0.1/0-3) b~ doaf.iio Scoo Mwo Rhode wwad Basnic binry Shut lau am...joint docme, and "WAblh Mir Fumes. Degned 040-5 officers. Beed Dak Feowship Lammin: or Reed Army Medical Camer. Whion. DC Bowling Green Universnty...WI. 30 X operastg ftme -~qIn I VAL max smew. (GRAS) OFp ROaM Nwin od.w" 6 wke. " kee x POWi SeIdise Adonama. 4 vA. 30 x Pkm 0p - nu Med - a1 2 ub. 60 x

  13. 医院临床药学服务能力的制约因素及对策探讨%Restricted factors of hospital clinical pharmaceutical care capability and discussion of improved countermeasures

    Institute of Scientific and Technical Information of China (English)

    孙艳; 黄翠丽; 张明华; 李德东; 王沭


    Objective:To explore effective measures for improving pharmaceutical care capability of the hospital .Methods:A questionnaire survey was made on the clinical physicians ,nurses ,dispensary pharmacists and clinical pharmacists in the 65 tertiary hospitals across the country .The contents of the survey included the scope of hospital pharmaceutical care ,the mode of clinical pharmaceutical care ,the comprehensive capability of pharmacist pharmaceutical care ,as well as the rate of recognition by medical personnel of the hospital .Then ,all the obtained data were summarized and analyzed .Results and Conclusion:Sur‐vey results indicated that the main contents of clinical pharmaceutical care by pharmacists included the review of medical orders , medication consultation of outpatients ,medication education ,drug dispensing and so on .The main factors affecting further de‐velopment of clinical pharmacists were 4 external and 6 internal factors .In view of higher demands on pharmaceutical care by clinical medical personnel ,pharmacists should improve their professional quality to satisfy increasing clinical needs .With this in view ,the pharmacy department should further improve the professional quality of clinical pharmacists and establish the phar‐maceutical care platform suitable to the situation in China ,so as to establish the new pharmaceutical care mode with the patient as the center and rational medication as the core ,and ultimately enhance the pharmaceutical care capability of pharmacists .%目的:探索提高医院药师药学服务能力的有效举措。方法:在全国范围内对65家三级甲等医院医师、护士、药房药师和临床药师进行问卷调研,调研内容主要包括医院药学工作内容、临床药学服务工作方式、药师药学服务综合能力及医护人员对药师认知度等方面,并对采集的数据进行汇总和分析。结果和结论:调研结果表明,药师在医院从事的药学服务工作

  14. Which nurseries currently care for ventilated neonates in Illinois and Wisconsin? Implications for the next generation of perinatal regionalization. (United States)

    Meadow, William; Kim, Mijung; Mendez, David; Bell, Anthony; Gray, Cathy; Corpuz, Maria; Lantos, John


    We were interested in the extent to which advances in the availability of neonatalogy expertise have provided a centrifugal impetus to perinatal care. Specifically, we wondered where infants who were sick enough to require mechanical ventilation were currently being managed. We surveyed 116 of 140 hospitals in Illinois and Wisconsin that offered obstetric/newborn services in 1998-1999. The 23 Level I nurseries were consistently small, and offered virtually no "advanced" neonatal intensive care unit (NICU) technology. The 16 Level III NICUs were consistently large, offered advanced technology and personnel, and received sick infants from many hospitals in their regional network. The 77 Level II nurseries (two thirds of all hospitals with newborn services) were less consistently characterized. In general, Level II nurseries were a "spoke" (not a hub), and did not offer extracorporeal-membrane oxygenation (ECMO), nitric oxide (NO), or cardiovascular (CV) surgery. However, 19 (25%) of 77 Level II centers self-designated as "Level II+". These were significantly more likely to offer ventilators, percutaneous central venous catheters (PCVCs), total parenteral nutrition (TPN), and surgery. Fifty-three percent (18/34) of all nurseries offering mechanical ventilation self-designated as a Level II or II+, as opposed to Level III. Facile inferences about the appropriate role of Level II centers derived from decades-old data are probably unsupportable. It is time to acknowledge the distinction between the Level II nursery of the past and the newly evolving Level II+ NICUs.

  15. Currently used dosage regimens of vancomycin fail to achieve therapeutic levels in approximately 40% of intensive care unit patients (United States)

    Obara, Vitor Yuzo; Zacas, Carolina Petrus; Carrilho, Claudia Maria Dantas de Maio; Delfino, Vinicius Daher Alvares


    Objective This study aimed to assess whether currently used dosages of vancomycin for treatment of serious gram-positive bacterial infections in intensive care unit patients provided initial therapeutic vancomycin trough levels and to examine possible factors associated with the presence of adequate initial vancomycin trough levels in these patients. Methods A prospective descriptive study with convenience sampling was performed. Nursing note and medical record data were collected from September 2013 to July 2014 for patients who met inclusion criteria. Eighty-three patients were included. Initial vancomycin trough levels were obtained immediately before vancomycin fourth dose. Acute kidney injury was defined as an increase of at least 0.3mg/dL in serum creatinine within 48 hours. Results Considering vancomycin trough levels recommended for serious gram-positive infection treatment (15 - 20µg/mL), patients were categorized as presenting with low, adequate, and high vancomycin trough levels (35 [42.2%], 18 [21.7%], and 30 [36.1%] patients, respectively). Acute kidney injury patients had significantly greater vancomycin trough levels (p = 0.0055, with significance for a trend, p = 0.0023). Conclusion Surprisingly, more than 40% of the patients did not reach an effective initial vancomycin trough level. Studies on pharmacokinetic and dosage regimens of vancomycin in intensive care unit patients are necessary to circumvent this high proportion of failures to obtain adequate initial vancomycin trough levels. Vancomycin use without trough serum level monitoring in critically ill patients should be discouraged. PMID:28099635

  16. Effect of transcranial direct current stimulation on visual perception function and performance capability of activities of daily living in stroke patients (United States)

    Kim, Ko-Un; Kim, Su-Han; An, Tae-Gyu


    [Purpose] The purpose of this study was to examine the effects of transcranial direct current stimulation (tDCS) on visual perception and performance of activities of daily living in patients with stroke. [Subjects and Methods] Thirty subjects were assigned equally to a tDCS plus traditional occupational therapy group (experimental group) and a traditional occupational therapy group (control group). The intervention was implemented five times per week, 30 minutes each, for six weeks. In order to assess visual perception function before and after the intervention, the motor-free visual perception test (MVPT) was conducted, and in order to compare the performance of activities of daily living, the Functional Independence Measure scale was employed. [Results] According to the results, both groups improved in visual perception function and in performance of activities of daily living. Although there was no significant difference between the two groups, the experimental group exhibited higher scores. [Conclusion] In conclusion, the application of tDCS for the rehabilitation of patients with stroke may positively affect their visual perception and ability to perform activities of daily living.

  17. Effect of transcranial direct current stimulation on visual perception function and performance capability of activities of daily living in stroke patients. (United States)

    Kim, Ko-Un; Kim, Su-Han; An, Tae-Gyu


    [Purpose] The purpose of this study was to examine the effects of transcranial direct current stimulation (tDCS) on visual perception and performance of activities of daily living in patients with stroke. [Subjects and Methods] Thirty subjects were assigned equally to a tDCS plus traditional occupational therapy group (experimental group) and a traditional occupational therapy group (control group). The intervention was implemented five times per week, 30 minutes each, for six weeks. In order to assess visual perception function before and after the intervention, the motor-free visual perception test (MVPT) was conducted, and in order to compare the performance of activities of daily living, the Functional Independence Measure scale was employed. [Results] According to the results, both groups improved in visual perception function and in performance of activities of daily living. Although there was no significant difference between the two groups, the experimental group exhibited higher scores. [Conclusion] In conclusion, the application of tDCS for the rehabilitation of patients with stroke may positively affect their visual perception and ability to perform activities of daily living.

  18. Current situation of health care in India and corporation in emerging economies--what is the way forward? (United States)

    Surendra, Kumar; Amit, Sengupta; Kumar, Agarwal Vishnu


    In this study, we examine the management and operational problems faced by different categories of health care delivery platforms such as corporate hospitals, medium level private hospitals and public hospitals in Mumbai. Some suggestions are made and we believe many of the short falls or limitations that exist in the current set up can be removed and a way forward can be made in alleviating the suffering of vast majority of humankind living in our mega cities. Three major issues emerged as far as a public health system is concerned--that is shifting of trained health manpower from the public system to private or corporate hospitals, severe strain on the public health system's infrastructure and support services compounded by lack of accountability as far as management and governance are concerned.

  19. Efficacy of misoprostol for the treatment of postpartum hemorrhage: current knowledge and implications for health care planning

    Directory of Open Access Journals (Sweden)

    Prata N


    Full Text Available Ndola Prata, Karen Weidert Bixby Center for Population, Health and Sustainability, School of Public Health, University of California at Berkeley, Berkeley, CA, USA Background: A myriad of interventions exist to treat postpartum hemorrhage (PPH, ranging from uterotonics and hemostatics to surgical and aortic compression devices. Nonetheless, PPH remains the leading cause of maternal mortality worldwide. The purpose of this article is to review the available evidence on the efficacy of misoprostol for the treatment of primary PPH and discuss implications for health care planning. Data and methods: Using PubMed, Web of Science, and GoogleScholar, we reviewed the literature on randomized controlled trials of interventions to treat PPH with misoprostol and non-randomized field trials with controls. We discuss the current knowledge and implications for health care planning, especially in resource-poor settings. Results: The treatment of PPH with 800 µg of misoprostol is equivalent to 40 IU of intravenous oxytocin in women who have received oxytocin for the prevention of PPH. The same dose might be an option for the treatment of PPH in women who did not receive oxytocin for the prevention of PPH and do not have access to oxytocin for treatment. Adding misoprostol to standard uterotonics has no additional benefits to women being treated for PPH, but the beneficial adjunctive role of misoprostol to conventional uterotonics is important in reducing intra- and postoperative hemorrhage during cesarean section. Conclusion: Misoprostol is an effective uterotonic agent in the treatment of PPH. Clinical guidelines and treatment protocols should be updated to reflect the current knowledge on the efficacy of misoprostol for the treatment of PPH with 800 µg sublingually. Keywords: PPH treatment, uterotonics, low-resource settings, cesarean section, retained placenta

  20. Age-friendly primary health care: an assessment of current service provision for older adults in Hong Kong. (United States)

    Woo, Jean; Mak, Benise; Yeung, Fannie


    There has been no study evaluating whether primary care services are sufficiently oriented towards the older population in Hong Kong, particularly those with increasing frailty. Since primary care is a key first interface in promotion and maintenance of health in older people, an assessment of the age-friendliness of service provisions is of critical importance in optimizing the health of aging populations. The age-friendliness of primary care services for older people was assessed using focus groups of elderly people and also of service providers who care for them. Discussion content was based on the WHO guidelines for age-friendly primary care in the following areas: Information, education and training, community-based health care management systems, and the physical environment. Desirable improvements were identified in all domains. The findings underscore the need for wider dissemination of health care needs of older people in the primary care setting.

  1. Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians

    Institute of Scientific and Technical Information of China (English)

    Jian-cang ZHOU; Hong-chen ZHAO; Kong-han PAN; Qiu-ping XU


    This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension (IAH)/abdominal compartment syndrome (ACS) among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units (ICUs). A total of 108 (76.6%) questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission,ICU length of stay, acute physiology and chronic health evaluation (APACHE) Ⅱ score, and mortality were 18.2 beds,764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure (IAP). Although the vast majority of the ICUs adopted the exclusively transvesicular method, the over-whelming majority (88.0%) only measured IAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for IAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended ab-domen (92%), worsening oliguria (80%), and increased ventilatory support requirement (68%). Common causes for IAH/ACS were "third-spacing from massive volume resuscitation in different settings" (88%), "intra-abdominal bleed-ing", and "liver failure with ascites" (52% for both). Though 60% respondents would recommend surgical decompres-sion when the IAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of re-spondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physi

  2. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. (United States)

    Chien, Wai Tong; Leung, Sau Fong; Yeung, Frederick Kk; Wong, Wai Kit


    exception of patient relapse, the longer-term (eg, >2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients' perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services.

  3. Capability enhancement and amputee care in Operation Iraqi Freedom: The role of a rehabilitation and prosthetics assistance team in reconstruction operations. (United States)

    Scherer, Matthew


    Defining the role of the U.S. Army Rehabilitation and Prosthetic Assistance Team in reconstruction operations was a key component of this first of its kind Army Medical Department (AMEDD) mission in a combat theater of operations. In the tradition of civil-military operations, a five-man team trained 11 Iraqi rehabilitation and prosthetic providers on best clinical, technical, and business practices to manage the nation's growing amputee population. The team instructed, assisted, and supervised Iraqi clinicians in the delivery of prosthetic and rehabilitation services to 124 patients over 350 patient clinical visits. After a successful transition from Multi-National Force-Iraq oversight to the Iraqi Ministry of Defense (MoD), the premier prosthetics and rehabilitation clinic in Iraq now provides services to patients from current and past conflicts, including civilians and pediatric patients.

  4. Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda

    Directory of Open Access Journals (Sweden)

    Elizabeth Ekirapa-Kiracho


    Full Text Available Abstract Background Community capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda. Methods A participatory action research project was supported from 2012 to 2015 in three eastern districts. This project involved working with households, saving groups, sub county and district leaders, transporters and village health teams in diagnosing causes of maternal and neonatal mortality and morbidity, developing action plans to address these issues, taking action and learning from action in a cyclical manner. This paper draws from project experience and documentation, as well as thematic analysis of 20 interviews with community and district stakeholders and 12 focus group discussions with women who had recently delivered and men whose wives had recently delivered. Results Women and men reported increased awareness about birth preparedness, improved newborn care practices and more male involvement in maternal and newborn health. However, additional direct communication strategies were required to reach more men beyond the minority who attended community dialogues and home visits. Saving groups and other saving modalities were strengthened, with money saved used to meet transport costs, purchase other items needed for birth and other routine household needs. However saving groups required significant support to improve income generation, management and trust among members. Linkages between savings groups and transport providers improved women’s access to health facilities at reduced cost. Although village health teams were a key resource for providing information, their efforts were constrained by low levels of education, inadequate financial compensation and transportation challenges. Ensuring that the village health

  5. Improving the Current DHS Capabilities Framework (United States)


    Laboratories ( PNL ) to establish the standards for the NIMS initiative. This entire situation creates another set of inconsistencies in criteria, (accessed June 12, 2007), 8. 24 setting agencies: NFPA, PNL , American National Standards Institute (ANSI), and...with Pacific Northwest Laboratory ( PNL ) to develop the NIC standards. The Incident Management Standards Working Group (IMSWG) was established

  6. Physical capability scale: psychometric testing. (United States)

    Resnick, Barbara; Boltz, Marie; Galik, Elizabeth; Wells, Chris


    The purpose of this study was to describe the psychometric testing of the Basic Physical Capability Scale. The study was a secondary data analysis of combined data sets from three studies. Study participants included 93 older adults, recruited from 2 acute-care settings and 110 older adults living in long-term care facilities. Rasch analysis was used for the testing of the measurement model. There was some support for construct validity based on the fit of the items to the scale across both samples. In addition, there was support for hypothesis testing as physical function was significantly associated with physical capability. There was evidence for internal consistency (Alpha coefficients of .77-.83) and interrater reliability based on an intraclass correlation of .81. This study provided preliminary support for the reliability and validity of the Basic Physical Capability Scale, and guidance for scale revisions and continued use.

  7. Medical Data Architecture Project Capabilities and Design (United States)

    Middour, C.; Krihak, M.; Lindsey, A.; Marker, N.; Wolfe, S.; Winther, S.; Ronzano, K.; Bolles, D.; Toscano, W.; Shaw, T.


    Mission constraints will challenge the delivery of medical care on a long-term, deep space exploration mission. This type of mission will be restricted in the availability of medical knowledge, skills, procedures and resources to prevent, diagnose, and treat in-flight medical events. Challenges to providing medical care are anticipated, including resource and resupply constraints, delayed communications and no ability for medical evacuation. The Medical Data Architecture (MDA) project will enable medical care capability in this constrained environment. The first version of the system, called "Test Bed 1," includes capabilities for automated data collection, data storage and data retrieval to provide information to the Crew Medical Officer (CMO). Test Bed 1 seeks to establish a data architecture foundation and develop a scalable data management system through modular design and standardized interfaces. In addition, it will demonstrate to stakeholders the potential for an improved, automated, flow of data to and from the medical system over the current methods employed on the International Space Station (ISS). It integrates a set of external devices, software and processes, and a Subjective, Objective, Assessment, and Plan (SOAP) note commonly used by clinicians. Medical data like electrocardiogram plots, heart rate, skin temperature, respiration rate, medications taken, and more are collected from devices and stored in the Electronic Medical Records (EMR) system, and reported to crew and clinician. Devices integrated include the Astroskin biosensor vest and IMED CARDIAX electrocardiogram (ECG) device with INEED MD ECG Glove, and the NASA-developed Medical Dose Tracker application. The system is designed to be operated as a standalone system, and can be deployed in a variety of environments, from a laptop to a data center. The system is primarily composed of open-source software tools, and is designed to be modular, so new capabilities can be added. The software

  8. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care

    Directory of Open Access Journals (Sweden)

    Chien WT


    functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the exception of patient relapse, the longer-term (eg, >2 years effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients' perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services. Keywords: schizophrenia, psychosocial intervention, patient-focused perspectives

  9. MEDEVAC: critical care transport from the battlefield. (United States)

    Higgins, R A


    In current military operations, the survival rates of critically injured casualties are unprecedented. An often hidden aspect of casualty care is safe transport from the point of injury to a field hospital and subsequently on to higher levels of care. This en route critical care, which is provided by flight medics under the most austere and rigorous conditions, is a crucial link in the care continuum. This article introduces the role and capabilities of US Army MEDEVAC and reflects the author's recent experience in Afghanistan as a flight medic. This article provides an assessment of the operational issues, medical capabilities, and transport experiences to provide a real-world view of critical care transport from the battlefield. The MEDEVAC helicopter environment is one of the most difficult, if not the most demanding, critical care environments. This overview brings to light a small but important piece of the care continuum.

  10. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M.; Vaal, de E.T.; Rood, Pleunie P.M.; Hoogerwerf, N.; Doggen, C.J.M.; Schoonhoven, L.


    Introduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was devel

  11. Pain management in trauma patients in (pre)hospital based emergency care: Current practice versus new guideline

    NARCIS (Netherlands)

    A.C. Scholten (Annemieke); S.A.A. Berben (Sivera); A.H. Westmaas (Alvin H); P.M. van Grunsven (Pierre); E.T. de Vaal; P.P.M. Rood (Pleunie); N. Hoogerwerf (N.); C.J.M. Doggen (Carine); R. van Schoonhoven (Renee)


    textabstractIntroduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideli

  12. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M. van; Vaal, E.T. de; Hoogerwerf, N.; Doggen, C.J.; Schoonhoven, L.


    INTRODUCTION: Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was deve

  13. TeleWound care – providing remote wound assessment and treatment in the home care setting: current status and future directions

    Directory of Open Access Journals (Sweden)

    Santamaria N


    Full Text Available Nick Santamaria,1 Suzanne Kapp2 1University of Melbourne and Melbourne Health, Royal Melbourne Hospital, Melbourne, VIC, Australia; 2Royal District Nursing Service Institute, Melbourne, VIC, Australia Abstract: The use of wound telemedicine systems in the home care environment has been expanding for the last decade. These systems can generally be grouped into two main types: store and forward systems and video conference type systems; additionally, there are also hybrid systems available that include elements of both. Evidence to date suggests that these systems provide significant benefits to patients, clinicians, and to the health care system generally. Reductions in resource use, visit substitution, costs, and high patient and clinician satisfaction have been reported; however, there is a lack of integration with existing health care technology and no clearly defined technical or clinical standards as yet. Similarly, the legalities associated with wound telemedicine and remote consultation remain unclear. As wound telemedicine systems continue to evolve and be deployed in different locations, there remains significant potential to harness their power to benefit patients being treated at home. Keywords: telemedicine, home care, e-health

  14. [Current Status of Preoperative Professional Oral Care by Dentists for Elderly Patients Undergoing Lung Resection and Occurrence of Postoperative Pneumonia]. (United States)

    Hoshikawa, Yasushi; Tanda, Naoko; Matsuda, Yasushi; Katsumata, Hiroshi; Notsuda, Hirotsugu; Watanabe, Tatsuaki; Niikawa, Hiromichi; Noda, Masafumi; Sakurada, Akira; Kondo, Takashi; Okada, Yoshinori


    Pneumonia in elderly people is mainly caused by silent aspiration due to an age-related impairment of cough and swallowing reflexes. Because most of the patients with lung cancer are elderly people, we hypothesized that the age-related impairment of these protective reflexes might exist or occur in patients undergoing lung surgery, and cause postoperative pneumonia. We revealed that many elderly patients showed depressed swallowing reflex even before surgery and transient attenuation of cough reflex after surgery, and that postoperative pneumonia occurred only in the patients whose cough and/or swallowing reflex was abnormal postoperatively. Then, we prospectively showed that 30 elderly patients who received perioperative intensive oral care, including professional assessment of oral status, dental cleaning, and patient education for self-oral care by dentists, followed by intensive oral care by intensive care unit nurses, and encouragement of self-oral care by floor nurses, did not develop pneumonia after lung resection. In this study, we retrospectively reviewed the execution status of professional oral care by dentists and the occurrence of postoperative pneumonia in 159 consecutive patients aged 65 or older undergoing lung resection from 2013 to 2014. Thoracic surgeons in our institute asked dentists to provide professional oral care before lung resection only in 30.3% of the subjects in 2013, and 45.8% in 2014. Postoperative pneumonia occurred in 3 out of 76 subjects(3.9%)in 2013, and 1 out of 83(1.2%) in 2014. In 2013, 1 patient who did not receive preoperative professional oral care developed aspiration pneumonia postoperatively followed by acute exacerbation of idiopathic pulmonary fibrosis and in-hospital death. We need to make an effective system to provide preoperative professional oral care by dentists especially for elderly patients and high-risk patients before lung resection.

  15. Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly. (United States)

    Nakanishi, Miharu; Imai, Hisato


    The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses. The Job Role Quality (JRQ) scale was translated into Japanese language to assess job role quality. Hierarchical multiple regression analysis showed that intention to leave current facility was primarily associated with job role quality: poor skill discretion, high job demand, and poor relationship with supervisor. Intention to leave profession was primarily associated with poor skill discretion. The results of the present study imply the strategies to direct care worker retention for each facility and policy efforts. Each facility can implement specific strategies such as enhanced variety of work and opportunity for use of skills, adequate job allocation, and improvement of supervisor-employee relationship in work place. Policy efforts should enhance broader career opportunities in care working such as advanced specialization and authorized medical practice.

  16. Mobile Test Capabilities (United States)

    Federal Laboratory Consortium — The Electrical Power Mobile Test capabilities are utilized to conduct electrical power quality testing on aircraft and helicopters. This capability allows that the...

  17. A qualitative study of the current situation of elderly care in Iran: what can we do for the future?



    Background: With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran.Objectives: This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps...

  18. Investigation of awareness rate and current situation in hormone replacement therapy in medical care personnel in Shanghai

    Institute of Scientific and Technical Information of China (English)

    Shao Hong-fang; Tao Min-fang; Sun Xun-yan; Jiang Li-zhen


    Objective: To survey the cognition and requirement of perimenopause health care in Shanghai women,and provide updated situation about hormone replacement therapy (HRT) for further improving the quality of perimenopause health care.Methods: A large survey among 480 medical care personnel at age of 40-60 years in 12 hospitals in Shanghai was launched.The designed questionnaires included the awareness rate,basic knowledge of HRT and request for the information of HRT etc.The data were analyzed.Results: Among the respondents,35.81% (169/472) believed that it is necessary to start HRT in perimenopause women; 16.10 % (76/472) knew about H RT at some extent; 43.22 % (204/472) requested for the training of HRT; and 14.19%(67/472)would like to recommend patients using the hormone to treat perimenopause syndrome.In addition,52.41% (76/145)of the medical care personnel who refused to use HRT were worried about the side effects.Conclusion: In Shanghai,the awareness rate of HRT among medical care personnel was relatively low.Only a few medical care personnel prefer to use HRT in perimenopause patients.The main reasons for that were lack of understanding in the treatment of HRT and concerned side effects.


    Frisch, H. P.


    Integration via Mesh Interpolation Coefficients), which transforms field values from one model to another; LINK, which simplifies incorporation of user specific modules into IAC modules; and DATAPAC, the National Bureau of Standards statistical analysis package. The IAC database contains structured files which provide a common basis for communication between modules and the executive system, and can contain unstructured files such as NASTRAN checkpoint files, DISCOS plot files, object code, etc. The user can define groups of data and relations between them. A full data manipulation and query system operates with the database. The current interface modules comprise five groups: 1) Structural analysis - IAC contains a NASTRAN interface for standalone analysis or certain structural/control/thermal combinations. IAC provides enhanced structural capabilities for normal modes and static deformation analysis via special DMAP sequences. IAC 2.5 contains several specialized interfaces from NASTRAN in support of multidisciplinary analysis. 2) Thermal analysis - IAC supports finite element and finite difference techniques for steady state or transient analysis. There are interfaces for the NASTRAN thermal analyzer, SINDA/SINFLO, and TRASYS II. FEMNET, which converts finite element structural analysis models to finite difference thermal analysis models, is also interfaced with the IAC database. 3) System dynamics - The DISCOS simulation program which allows for either nonlinear time domain analysis or linear frequency domain analysis, is fully interfaced to the IAC database management capability. 4) Control analysis - Interfaces for the ORACLS, SAMSAN, NBOD2, and INCA programs allow a wide range of control system analyses and synthesis techniques. Level 2.5 includes EIGEN, which provides tools for large order system eigenanalysis, and BOPACE, which allows for geometric capabilities and finite element analysis with nonlinear material. Also included in IAC level 2.5 is SAMSAN 3.1, an

  20. Determining your organization's 'risk capability'. (United States)

    Hannah, Bill; Hancock, Melinda


    An assessment of a provider's level of risk capability should focus on three key elements: Business intelligence, including sophisticated analytical models that can offer insight into the expected cost and quality of care for a given population. Clinical enterprise maturity, marked by the ability to improve health outcomes and to manage utilization and costs to drive change. Revenue transformation, emphasizing the need for a revenue cycle platform that allows for risk acceptance and management and that provides incentives for performance against defined objectives.

  1. [Emergency care for traffic accidents in Bavaria: current process analysis depending on hospital and emergency service structures]. (United States)

    Lackner, C K; Bielmeier, S; Burghofer, K


    A change is emerging in the hospital landscape due to health political measures, which in consequence also influences the prehospital medical care in emergencies. The main focus of this study was to gather information about emergency medical care after traffic accidents on the basis of data from Bavarian emergency medical services. In 2006 there were 14,261 traffic accidents in Bavaria where an emergency doctor attended the scene. The patients were primarily cared for by land-based rescue services and air rescue services were only used in 19.1% of the cases. Of the patients involved in a traffic accident 47.6% were transported to a primary health care hospital. A prehospital interval of more than 60 min occurred in 20% of the missions. Of the patients 96.2% were transported to tertiary or maximum care hospital by air rescue services but emergency facilities were, however restricted to daylight hours. There was a further limitation due to the routine duty hours in hospitals as only 36.7% of accidents occurred during this time intervall. An increase of admission post trauma in maximum care clinics occurred from 2002 until 2006 while simultaneously the prehospital period was extended. In order to assure sufficient trauma care for seriously injured persons a continuous 24 h availability of emergency trauma facilities is necessary. For this purpose it is necessary to establish regional trauma networks between receiving hospitals as well as air rescue services at night time. Furthermore, a cost-efficient compensation of the structural, personnel and logistic expenses for the treatment of the severely injured has to be assured.

  2. Current rehabilitation practices in intensive care units: a preliminary survey by the Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical Trial Group. (United States)

    Taito, Shunsuke; Sanui, Masamitsu; Yasuda, Hideto; Shime, Nobuaki; Lefor, Alan Kawarai


    We conducted an internet survey targeting healthcare providers in intensive care units (ICUs) in Japan and received 318 responses. Eighteen percent of respondents replied that full-time physical therapists (PTs) exist in their ICUs. Practicing sitting upright or sitting in a chair is frequently performed, while standing and walking are occasionally performed for patients undergoing mechanical ventilation. However, only 16 % of respondents use staged rehabilitation protocols. This preliminary survey suggests that full-time involvement of PTs in the ICU and introduction of rehabilitation protocols may not be common in Japanese ICUs.

  3. Current perceptions of the term Clinical Pharmacy and its relationship to Pharmaceutical Care: a survey of members of the European Society of Clinical Pharmacy. (United States)

    Dreischulte, Tobias; Fernandez-Llimos, Fernando


    Background The definitions that are being used for the terms 'clinical pharmacy' and 'pharmaceutical care' seem to have a certain overlap. Responsibility for therapy outcomes seems to be especially linked to the latter term. Both terms need clarification before a proper definition of clinical pharmacy can be drafted. Objective To identify current disagreements regarding the term 'Clinical Pharmacy' and its relationship to 'Pharmaceutical Care' and to assess to which extent pharmacists with an interest in Clinical Pharmacy are willing to accept responsibility for drug therapy outcomes. Setting The membership of the European Society of Clinical Pharmacy. Methods A total of 1,285 individuals affiliated with the European Society of Clinical Pharmacy were invited by email to participate in an online survey asking participants to state whether certain professional activities, providers, settings, aims and general descriptors constituted (a) 'Clinical Pharmacy only', (b) 'Pharmaceutical Care only', (c) 'both' or (d) 'neither'. Further questions examined pharmacists' willingness to accept ethical or legal responsibility for drug therapy outcomes, under current and ideal working conditions. Main outcome measures Level of agreement with a number of statements. Results There was disagreement (Pharmaceutical care also encompassed certain professional activities, constituted a scientific discipline and targeted cost effectiveness. The proportions of participants willing to accept legal responsibility under current/ideal working conditions were: safety (32.7%/64.3%), effectiveness (17.9%/49.2%), patient-centeredness (17.1%/46.2%), cost-effectiveness (20.3%/44.0%). Conclusions The survey identified key disagreements around the term 'Clinical Pharmacy' and its relationship to 'Pharmaceutical Care', which future discussions around a harmonised definition of 'Clinical Pharmacy' should aim to resolve. Further research is required to understand barriers and facilitators to pharmacists

  4. Comparison of satisfaction with current prosthetic care in veterans and servicemembers from Vietnam and OIF/OEF conflicts with major traumatic limb loss. (United States)

    Berke, Gary M; Fergason, John; Milani, John R; Hattingh, John; McDowell, Martin; Nguyen, Viet; Reiber, Gayle E


    Prosthetic care is a vital aspect of healthcare and rehabilitation for veterans and servicemembers with major traumatic limb loss. Our survey queried 581 veterans and servicemembers with limb loss from the Vietnam and Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) conflicts. Among survey participants, 78.2% from the Vietnam conflict and 90.5% from the OIF/OEF conflict currently use prosthetic devices. In Vietnam respondents, 78% received prosthetic care from private sources, 16% from Department of Veterans Affairs (VA) prosthetic laboratories, 0.9% from Department of Defense (DOD), and 5% from multiple sources. In OIF/OEF respondents, 42% received prosthetic care from private sources, 9% percent from VA, 39% from DOD, and 10% from multiple sources. Participants identified their satisfaction with current prosthetic devices and prosthetic services. Reports of pain, sweating, skin irritation, and problems with socket fit continue to be significant issues for participants from both conflicts regardless of level of amputation or site of service. In those with upper-limb loss who used myoelectric prostheses, minimal effect on prosthesis use and satisfaction was noted. Among lower-limb loss participants from both conflicts, notable differences existed in prosthesis satisfaction by source of care.

  5. Comparison of satisfaction with current prosthetic care in veterans and servicemembers from Vietnam and OIF/OEF conflicts with major traumatic limb loss

    Directory of Open Access Journals (Sweden)

    Gary M. Berke, MS, CP, FAAOP


    Full Text Available Prosthetic care is a vital aspect of healthcare and rehabilitation for veterans and servicemembers with major traumaticlimb loss. Our survey queried 581 veterans and servicememberswith limb loss from the Vietnam and Operation Iraqi Freedom (OIF/Operation Enduring Freedom (OEF conflicts. Among survey participants, 78.2% from the Vietnam conflict and 90.5% from the OIF/OEF conflict currently use prosthetic devices. In Vietnam respondents, 78% received prosthetic care from private sources, 16% from Department of Veterans Affairs (VA prosthetic laboratories, 0.9% from Department of Defense (DOD, and 5% from multiple sources. In OIF/OEF respondents,42% received prosthetic care from private sources, 9% percent from VA, 39% from DOD, and 10% from multiple sources. Participants identified their satisfaction with current prosthetic devices and prosthetic services. Reports of pain, sweating, skin irritation, and problems with socket fit continue to be significant issues for participants from both conflicts regardless of level of amputation or site of service. In those with upper-limb loss who used myoelectric prostheses, minimal effect on prosthesis use and satisfaction was noted. Among lower-limb loss participants from both conflicts, notable differencesexisted in prosthesis satisfaction by source of care.

  6. The Fourth Annual Meeting of the International Network for Pediatric Hemophilia: Current Challenges and Recommendations in the Clinical Care of Children with Hemophilia


    Ljung, Rolf; van den Berg, Marijke; Valentino, Leonard A.; Manco-Johnson, Michael


    The International Network for Pediatric Hemophilia (INPH) comprises a group of physicians committed to the unique care of and challenges facing pediatric hemophilia patients. By collaborating on an international level, extensive experience can be shared on current practice, new trends can be discussed and scientifically valid studies can be developed and performed. The three overall objectives of the group (scientific progress, education and networking) are achieved at each annual meeting sta...

  7. Health Economics Studies Information Exchange; Reports of Current Research in Health Economics, and Medical Care Administration. Publication No. 1719. (United States)

    Public Health Service (DHEW), Arlington, VA. Home Economics Branch.

    The first volume of a continuing series reporting research in progress in health economics and medical care organization and administration was compiled by contacting (1) graduate schools offering degrees in the health professions, sociology, economics, public administration, and public health, (2) charitable foundations indicating an interest in…

  8. Evaluation of current literature to determine the potential effects of radio frequency identification on technology used in diabetes care. (United States)

    Christe, Barbara


    This article examines recently published studies exploring the impact of radio frequency identification (RFID) systems on the technology involved in patient care. The conclusions will be extrapolated to include insulin delivery devices. Background material will also be presented to support examination of the variables involved in electromagnetic fields and potential interference from these RFID systems.

  9. Nondisclosure of Smoking Status to Health Care Providers among Current and Former Smokers in the United States (United States)

    Curry, Laurel Erin; Richardson, Amanda; Xiao, Haijun; Niaura, Raymond S.


    An unintended consequence of tobacco control's success in marginalizing smoking is that smokers may conceal their smoking from those who are best positioned to help them quit: health care providers (HCPs). The purpose of this study was to identify the prevalence of, and factors related to, nondisclosure of smoking to HCPs. Data were obtained from…

  10. Current Practices for Training Staff to Accommodate Youth with Special Health Care Needs in the 4-H Camp Setting (United States)

    Mouton, Lauren; Bruce, Jacklyn


    The theory of inclusion is the foundation for the study reported here; inclusion is a focus not only of formal education, but also of nonformal educational settings such as 4-H. Ideally, 4-H camps are designed to serve youth of all backgrounds and abilities. By accommodating youth with special health care needs, 4-H camps are effectively meeting…

  11. The relevance of the early history of probability theory to current risk assessment practices in mental health care. (United States)

    Large, Matthew


    Probability theory is at the base of modern concepts of risk assessment in mental health. The aim of the current paper is to review the key developments in the early history of probability theory in order to enrich our understanding of current risk assessment practices.

  12. The current research of care services on women after induced abortion%人工流产后关爱服务的研究现状

    Institute of Scientific and Technical Information of China (English)

    陈美芳(综述); 赵仁峰(审校)


    人工流产后关爱服务是流产后服务的综合措施,主要是利用现代避孕相关技术对人工流产后女性及家属实施健康宣教,使其掌握有效的避孕方法,避免意外妊娠,降低重复流产率。国内已有部分医院开展门诊人工流产后关爱服务,受多种因素影响,关爱服务的质量并不乐观。 PDCA循环理论是质量管理的有效工具,研究其在人工流产后关爱服务质量监控中的作用有重要意义。该文对人工流产后关爱服务的研究现状作一综述。%Care service is a comprehensive measure for post-abortion care, which uses modern contraception to educate abortion women and their families, and makes them master effective contraceptive knowledge to avoid acci-dental pregnancy and reduces repeating abortion rate.In China, some hospitals provide post-abortion care for the out-patients.Due to the influence of many factors, so far the quality of post-abortion care is not satisfactory and thus plays a key role in the quality control of the post-abortion care services.We summarise the current research of post-abortion care services in this paper.

  13. Action on AMD. Optimising patient management: act now to ensure current and continual delivery of best possible patient care. (United States)

    Amoaku, W; Blakeney, S; Freeman, M; Gale, R; Johnston, R; Kelly, S P; McLaughlan, B; Sahu, D; Varma, D


    In recent years, there have been significant advances in the clinical management of patients with wet age-related macular degeneration (wet AMD)--a rapidly progressing and potentially blinding degenerative eye disease. Wet AMD is responsible for more than half of registered severe sight impairment (blindness) in the United Kingdom, and patients who are being treated for wet AMD require frequent and long-term follow-up for treatment to be most effective. The clinical workload associated with the frequent follow-up required is substantial. Furthermore, as more new patients are diagnosed and the population continues to age, the patient population will continue to increase. It is thus vital that clinical services continue to adapt so that they can provide a fast and efficient service for patients with wet AMD. This Action on AMD document has been developed by eye health-care professionals and patient representatives, the Action on AMD group. It is intended to highlight the urgent and continuing need for change within wet AMD services. This document also serves as a guide for eye health-care professionals, NHS commissioners, and providers to present possible solutions for improving NHS retinal and macular services. Examples of good practice and service development are considered and can be drawn upon to help services meet the recommended quality of care and achieve best possible outcomes.

  14. Understanding of the Current Long-term Care Policy in China%理解我国现阶段的长期照护政策

    Institute of Scientific and Technical Information of China (English)



    以全面了解目前中国的长期照护政策,从制度发展的角度理解其处境、问题及未来趋势为研究目的,回顾了主要相关文献、政府政策文件,并对全国统计数据进行了对比。研究表明:我国进入21世纪以来,长期照护产生和发展背景是需求迅速增加,且原有服务能力不足,因此我国长期照护政策是从服务机构“能力建设”起步。发展至今,一方面服务数量增加、内容丰富、形成多元提供的格局;另一方面,很多服务需求仍没有得到释放,公平性差,服务机构的持续发展也存在隐患。问题的根源在于空有能力建设,而制度建设不足,尤其是筹资制度。%With the purpose of understanding the current long-term care policy and understanding its position, problems and developing trend with an institutional from the perspective of the transition. This paper reviews the main related papers, the government policy document and compares the national statistical data. Since the entrance of the 21st century, the supply of long-term care needs the rapid development and now it is far from adequate. The construction of the long-term new care system has been started with capacity building ten years ago. Understanding the long-term care policy in current China, on one hand, the institutional care and the community care has both developed fast;but on the other hand, the absence of a stable policy scheme has more and more obstructed the sustainable development of the long-term care.

  15. Care of critically ill surgical patients using the 80-hour Accreditation Council of Graduate Medical Education work-week guidelines: a survey of current strategies. (United States)

    Gordon, Chad R; Axelrad, Alex; Alexander, James B; Dellinger, R Phillip; Ross, Steven E


    As a result of the recently mandated work-hour restrictions, it has become more difficult to provide 24-hour intensive care unit (ICU) in-house coverage by the general surgical residents. To assess the current state of providing appropriate continuous care to surgical critical care patients during the era of resident work-hour constraints, a national survey was conducted by the Association of Program Directors of Surgery. The results revealed that 37 per cent of programs surveyed have residents other than general surgery housestaff providing cross-coverage and writing orders for surgical ICU patients. Residents in emergency medicine, anesthesia, family medicine, otorhinolaryngology, obstetrics/gynecology, internal medicine, urology, and orthopedic surgery have provided this cross-coverage. Some found it necessary to use physician extenders (i.e., nurse practitioners or physician assistants), thereby decreasing the burden of surgical housestaff coverage. The results indicated that 30 per cent use physician extenders to help cover the ICU during daytime hours and 11 per cent used them during nighttime hours. In addition, 24 per cent used a "night-float" system in an attempt to maintain continuous care, yet still adhere to the mandated guidelines. In conclusion, our survey found multiple strategies, including the use of physician extenders, a "night-float" system, and the use of nongeneral surgical residents in an attempt to provide continuous coverage for surgical ICU patients. The overall outcome of these new strategies still needs to be assessed before any beneficial results can be demonstrated.

  16. Systems Engineering for Space Exploration Medical Capabilities (United States)

    Mindock, Jennifer; Reilly, Jeffrey; Urbina, Michelle; Hailey, Melinda; Rubin, David; Reyes, David; Hanson, Andrea; Burba, Tyler; McGuire, Kerry; Cerro, Jeffrey; Middour, Chris


    Human exploration missions to beyond low Earth orbit destinations such as Mars will present significant new challenges to crew health management during a mission compared to current low Earth orbit operations. For the medical system, lack of consumable resupply, evacuation opportunities, and real-time ground support are key drivers toward greater autonomy. Recognition of the limited mission and vehicle resources available to carry out exploration missions motivates the Exploration Medical Capability (ExMC) Element's approach to enabling the necessary autonomy. The Element's work must integrate with the overall exploration mission and vehicle design efforts to successfully provide exploration medical capabilities. ExMC is applying systems engineering principles and practices to accomplish its integrative goals. This paper discusses the structured and integrative approach that is guiding the medical system technical development. Assumptions for the required levels of care on exploration missions, medical system guiding principles, and a Concept of Operations are early products that capture and clarify stakeholder expectations. Mobel-Based Systems Engineering techniques are then applied to define medical system behavior and architecture. Interfaces to other flight and ground systems, and within the medical system are identified and defined. Initial requirements and traceability are established, which sets the stage for identification of future technology development needs. An early approach for verification and validation, taking advantage of terrestrial and near-Earth exploration system analogs, is also defined to further guide system planning and development.

  17. Current Challenges to the United States’ AIDS Drug Assistance Program and Possible Implications of the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Kathleen A. McManus


    Full Text Available AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are the “payer of last resort” for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS. ADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased their contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living longer; the antiretroviral therapy (ART guidelines have been changed to recommend initiation of treatment for all; the United States is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding, ADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not sustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation of the Affordable Care Act (ACA. Lessons learned from the challenges associated with providing sustainable access to ART for vulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after the implementation of the ACA.

  18. Analyzing on the Motivation and Factors for Building Long-term Care Insurance System-Based on Current Situation and Data Analysis of Chengdu%CHINA HEALTH INSURANCE

    Institute of Scientific and Technical Information of China (English)

    谢俊萍; 胡兆舜


    With the accelerating of population aging, besides basic medical insurance, the demands for long-term care are also increasing, especially the needs for reducing the fi nancial and caring burden of families having disabled older people are more urgent. Through analyzing current situation and the data of Chengdu, as well as considering the advanced experience of other countries in long-term care insurance system, we propose that long-term care insurance should be an independent insurance system, which is led and coordinated by government, initiated at low level while mainly protecting target population, and has system elements of fi ne rating and service industry for the elderly care. We hope these suggestions can provide reference for the system design.%随着人口老龄化进程的加快,老年人群在享受基本医疗保险制度的同时,对长期照护的需求进一步加大,特别是失能老人对减轻家庭照护经济和精力负担的诉求尤为迫切。本文通过对成都市现状和数据的分析,在借鉴其他国家经验的基础上,提出我国要建立的长期照护保险制度应是一个独立的险种、应由政府主导协调推进、建制初期应低水平起步并以保障重点人群为主、建立完善的等级评定体系、发展养老服务业等制度建设要素,为制度设计提供参考。

  19. Developing Alliance Capabilities

    DEFF Research Database (Denmark)

    Heimeriks, Koen H.; Duysters, Geert; Vanhaverbeke, Wim

    capability. However, empirical testing in this field is scarce and little is known as to what extent different learning mechanisms are indeed useful in advancing a firm's alliance capability. This paper analyzes to what extent intra-firm learning mechanisms help firms develop their alliance capability......This paper assesses the differential performance effects of learning mechanisms on the development of alliance capabilities. Prior research has suggested that different capability levels could be identified in which specific intra-firm learning mechanisms are used to enhance a firm's alliance....... Differential learning may explain in what way firms yield superior returns from their alliances in comparison to competitors. The empirical results show that different learning mechanisms have different performance effects at different stages of the alliance capability development process. The main lesson from...

  20. Building Service Provider Capabilities

    DEFF Research Database (Denmark)

    Brandl, Kristin; Jaura, Manya; Ørberg Jensen, Peter D.

    In this paper we study whether and how the interaction between clients and the service providers contributes to the development of capabilities in service provider firms. In situations where such a contribution occurs, we analyze how different types of activities in the production process...... of the services, such as sequential or reciprocal task activities, influence the development of different types of capabilities. We study five cases of offshore-outsourced knowledge-intensive business services that are distinguished according to their reciprocal or sequential task activities in their production...... process. We find that clients influence the development of human capital capabilities and management capabilities in reciprocally produced services. While in sequential produced services clients influence the development of organizational capital capabilities and management capital capabilities....

  1. Detainee Health Care: Essential Element of Stability Operations (United States)


    food , by mutilation, death, or any other barbarity. 31 Missing from the 1864 and 1906 Geneva Conventions were guidelines for the treatment of able...government.74 Accordingly the host nation Ministry of Health ( MoH ) must eventually assume the health care of detainees. This requires a functioning system and alignment of current detainee medical operations with the MoH capability without reducing the standard of care. This process begins

  2. Integrated Process Capability Analysis

    Institute of Scientific and Technical Information of China (English)

    Chen; H; T; Huang; M; L; Hung; Y; H; Chen; K; S


    Process Capability Analysis (PCA) is a powerful too l to assess the ability of a process for manufacturing product that meets specific ations. The larger process capability index implies the higher process yield, a nd the larger process capability index also indicates the lower process expected loss. Chen et al. (2001) has applied indices C pu, C pl, and C pk for evaluating the process capability for a multi-process product wi th smaller-the-better, larger-the-better, and nominal-the-best spec...

  3. Career plans of primary care midwives in the Netherlands and their intentions to leave the current job.

    NARCIS (Netherlands)

    Warmelink, J.C.; Wiegers, T.A.; Cock, T.P. de; Spelten, E.R.; Hutton, E.K.


    Background: In labour market policy and planning, it is important to understand the motivations of people to continue in their current job or to seek other employment. Over the last decade, besides the increasingly medical approach to pregnancy and childbirth and decreasing home births, there were a

  4. Accelerator and electrodynamics capability review

    Energy Technology Data Exchange (ETDEWEB)

    Jones, Kevin W [Los Alamos National Laboratory


    Los Alamos National Laboratory (LANL) uses capability reviews to assess the science, technology and engineering (STE) quality and institutional integration and to advise Laboratory Management on the current and future health of the STE. Capability reviews address the STE integration that LANL uses to meet mission requirements. The Capability Review Committees serve a dual role of providing assessment of the Laboratory's technical contributions and integration towards its missions and providing advice to Laboratory Management. The assessments and advice are documented in reports prepared by the Capability Review Committees that are delivered to the Director and to the Principal Associate Director for Science, Technology and Engineering (PADSTE). Laboratory Management will use this report for STE assessment and planning. LANL has defined fifteen STE capabilities. Electrodynamics and Accelerators is one of the seven STE capabilities that LANL Management (Director, PADSTE, technical Associate Directors) has identified for review in Fiscal Year (FY) 2010. Accelerators and electrodynamics at LANL comprise a blend of large-scale facilities and innovative small-scale research with a growing focus on national security applications. This review is organized into five topical areas: (1) Free Electron Lasers; (2) Linear Accelerator Science and Technology; (3) Advanced Electromagnetics; (4) Next Generation Accelerator Concepts; and (5) National Security Accelerator Applications. The focus is on innovative technology with an emphasis on applications relevant to Laboratory mission. The role of Laboratory Directed Research and Development (LDRD) in support of accelerators/electrodynamics will be discussed. The review provides an opportunity for interaction with early career staff. Program sponsors and customers will provide their input on the value of the accelerator and electrodynamics capability to the Laboratory mission.

  5. Dynamic Capabilities and Performance

    DEFF Research Database (Denmark)

    Wilden, Ralf; Gudergan, Siegfried P.; Nielsen, Bo Bernhard


    Dynamic capabilities are widely considered to incorporate those processes that enable organizations to sustain superior performance over time. In this paper, we argue theoretically and demonstrate empirically that these effects are contingent on organizational structure and the competitive...... intensity in the market. Results from partial least square structural equation modeling (PLS-SEM) analyses indicate that organic organizational structures facilitate the impact of dynamic capabilities on organizational performance. Furthermore, we find that the performance effects of dynamic capabilities...... are contingent on the competitive intensity faced by firms. Our findings demonstrate the performance effects of internal alignment between organizational structure and dynamic capabilities, as well as the external fit of dynamic capabilities with competitive intensity. We outline the advantages of PLS...

  6. Are managed care organizations in the United States impeding the delivery of primary care by nurse practitioners? A 2012 update on managed care organization credentialing and reimbursement practices. (United States)

    Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick


    In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.

  7. Capabilities for Strategic Adaptation

    DEFF Research Database (Denmark)

    Distel, Andreas Philipp

    organizational conditions, such as organizational design, support the emergence and performance of such capabilities. In detail, the dissertation consists of three self-contained research papers. The first paper is a systematic, multilevel review of the innovation literature; it reinterprets evidence from prior...... firms’ ability to absorb and leverage new knowledge. The third paper is an empirical study which conceptualizes top managers’ resource cognition as a managerial capability underlying firms’ resource adaptation; it empirically examines the performance implications of this capability and organizational...... empirical studies through the dynamic capabilities lens and develops propositions for future research. The second paper is an empirical study on the origins of firm-level absorptive capacity; it explores how organization-level antecedents, through their impact on individual-level antecedents, influence...

  8. Structural Capability of an Organization toward Innovation Capability

    DEFF Research Database (Denmark)

    Nielsen, Susanne Balslev; Momeni, Mostafa


    competitive advantage in the organizations is the innovation capability. The innovation capability is associated with other organizational capabilities, and many organizations have focused on the need to identify innovation capabilities.This research focuses on recognition of the structural aspect...... of innovation capability and proposes a conceptual framework based on a Qualitative Meta Synthesis of academic literature on organizations innovation capability. This is proposed for the development of the concept of innovation capability in the organizations and this paper includes an expert based validation...... Capability and Structural Capability. Also, it offers the most important components and indices which directly influence and are related to the structural capability of innovation capability....

  9. Social work, general practice and evidence-based policy in the collaborative care of older people: current problems and future possibilities. (United States)

    Kharicha, Kalpa; Levin, Enid; Iliffe, Steve; Davey, Barbara


    While collaborative (or joint) working between social services and primary healthcare continues to rise up the policy agenda, current policy is not based on sound evidence of benefit to either patients or the wider community. Both sets of practitioners report benefits for their own work from adopting new arrangements for collaboration. The underlying assumption behind much of this activity is that a greater degree of integration provides benefits to both users and their carers, a perspective that at times obscures the issue of resource availability, especially in the form of practical community services such as district nursing and home help. At the present time there is insufficient evidence to demonstrate that formal arrangements for collaborative working (CW) are better than those forged informally between committed individuals or teams. Furthermore, arrangements for CW have not hitherto been widely evaluated in systematic studies with a comparative design and focus on outcomes for users and carers rather than on processes. In this paper we propose a number of process measures for future evaluation of CW: (1) study populations must be comparable; (2) details of how services are actually delivered must be obtained and colocation should not be assumed to mean collaboration; (3) care packages in areas of comparable resources should be examined; (4) both destinational outcomes and user-defined evaluations of benefit should be considered; (5) possible disadvantages of integrated care also need to be actively considered; (6) evaluations should include an economic analysis. Those implementing new policies in Primary Care Trusts have, at present, little sound evidence to guide them in their innovative work. However, they should take the opportunity to rigorously test the advantages and disadvantages of collaboration.

  10. A comprehensive estimation method for enterprise capability

    Directory of Open Access Journals (Sweden)

    Tetiana Kuzhda


    Full Text Available In today’s highly competitive business world, the need for efficient enterprise capability management is greater than ever. As more enterprises begin to compete on a global scale, the effective use of enterprise capability will become imperative for them to improve their business activities. The definition of socio-economic capability of the enterprise has been given and the main components of enterprise capability have been pointed out. The comprehensive method to estimate enterprise capability that takes into account both social and economic components has been offered. The methodical approach concerning integrated estimation of the enterprise capability has been developed. Novelty deals with the inclusion of summary measure of the social component of enterprise capability to define the integrated index of enterprise capability. The practical significance of methodological approach is that the method allows assessing the enterprise capability comprehensively through combining two kinds of estimates – social and economic and converts them into a single integrated indicator. It provides a comprehensive approach to socio-economic estimation of enterprise capability, sets a formal basis for making decisions and helps allocate enterprise resources reasonably. Practical implementation of this method will affect the current condition and trends of the enterprise, help to make forecasts and plans for its development and capability efficient use.

  11. Current trends in use of intracanal medications in dental care facilities: questionnaire-based survey on training dental hygienists at educational institutions. (United States)

    Furusawa, Masahiro; Yoshida, Takashi; Hosokawa, Souhei; Ariizumi, Yuugo


    The success of root canal therapy is dependent not only on removal of infected pulp (pulpectomy) followed by root canal enlargement, but also on the pharmacological effects of intracanal medications. Various intracanal medications are used. Formaldehyde preparations such as formocresol were common in the past, but these are no longer used in Europe or the US due to the biological toxicity of formaldehyde. In this study, a questionnaire was used to determine current trends in the use of intracanal medications at dental care facilities where dental hygiene students undergo practical training. The questionnaire comprised questions regarding the types of frequently used intracanal medications and their methods of application at dental care facilities in Saitama and Shizuoka prefectures. The results indicated that calcium hydroxide preparations were more commonly used in Europe or the US. However, these results also revealed that formaldehyde preparations were frequently used, which slightly differs from the scenario in Europe and the US. This study revealed that multiple intracanal medications were used for root canal therapy. Furthermore, it was also observed that cotton plugs were generally used as applicator tips for intracanal medications, whereas the use of absorbent paper points was relatively uncommon. The results suggest that the cost of absorbent paper points needs to be reduced.

  12. Evaluation of Critical Care Monitor Technology During the US Navy Strong Angel Exercise (United States)

    Johannesen, John; Rasbury, Jack


    The NASA critical path road map identifies "trauma and acute medical problems" as a clinical capability risk category ( Specific risks include major trauma, organ laceration or contusion, hemoperitoneum, pulmonary failure, pneumo- and hemothorax, burn, open bone fracture, blunt head trauma, and penetrating injury. Mitigation of these risks includes the capability for critical care monitoring. Currently, the International Space Station (ISS) Crew Health Care System (CHeCS) does not provide such a capability. The Clinical Space Medicine Strategic Planning Forum (4/8/97), sponsored by NASA Medical Operations, identified the development of trauma care capabilities as one of the top priorities for space medicine. The Clinical Care Capability Development Project (CCCDP) subsequently undertook the task to address this need.


    Directory of Open Access Journals (Sweden)



    Full Text Available Strategic airlift remains a critical supporting capability that should be achieved, maintained and improved. This capability ensures the ability to deploy and sustain military forces across possible distant battlefields. The paper analyses the growing strategic airlift capabilities gap between operational needs and current realities, and underlines the need for an enhanced strategic airlift capability to meet current and future NATO alliance needs. By analyzing requirements against the existing/potential solutions, this paper further ponders over options like the organic national capability, partnerships such as the Strategic Airlift Consortium (SAC or leasing aircraft through a venture such as the Strategic Airlift Interim Solution (SALIS. The paper also evaluates the feasibility of applying these solutions to European Union airlift needs.

  14. Management Innovation Capabilities

    DEFF Research Database (Denmark)

    Harder, Mie

    Management innovation is the implementation of a new management practice, process, technique or structure that significantly alters the way the work of management is performed. This paper presents a typology categorizing management innovation along two dimensions; radicalness and complexity. Then......, the paper introduces the concept of management innovation capabilities which refers to the ability of a firm to purposefully create, extend and modify its managerial resource base to address rapidly changing environments. Drawing upon behavioral theory of the firm and the dynamic capabilities framework......, the paper proposes a model of the foundations of management innovation. Propositions and implications for future research are discussed....

  15. Capability Handbook- offline metrology

    DEFF Research Database (Denmark)

    Islam, Aminul; Marhöfer, David Maximilian; Tosello, Guido;

    This offline metrological capability handbook has been made in relation to HiMicro Task 3.3. The purpose of this document is to assess the metrological capability of the HiMicro partners and to gather the information of all available metrological instruments in the one single document. It provides...... a quick overview of what is possible today by the state of the art, what the HiMicro consortium can do and what metrological requirements we have concerning the HiMicro industrial demonstrators....

  16. Reforming health care in Canada: current issues La reforma del sistema de atención a la salud en Canadá: situación actual

    Directory of Open Access Journals (Sweden)

    Enis Baris


    Full Text Available This paper examines the current health care reform issues in Canada. The provincial health insurance plans of the 1960s and 1970s had the untoward effects of limiting the federal government’s clout for cost control and of promoting a system centered on inpatient and medical care. Recently, several provincial commissions reported that the current governance structures and management processes are outmoded in light of new knowledge, new fiscal realities and the evolution of power among stake-holders. They recommend decentralized governance and restructuring for better management and more citizen participation. Although Canada’s health care system remains committed to safeguarding its guiding principles, the balance of power may be shifting from providers to citizens and "technocrats". Also, all provinces are likely to increase their pressure on physicians by means of salary caps, by exploring payment methods such as capitation, limiting access to costly technology, and by demanding practice changes based on evidence of cost-effectiveness.Este artículo examina los temas más recientes en las reformas del sistema de atención a la salud en Canadá. Los planes de seguridad en el sector salud durante los años sesenta y setenta tuvieron efectos inapropiados en cuanto a que limitaron el poder del gobierno federal para controlar costos y promover un sistema centrado en la atención médico-hospitalaria. Recientemente, varias comisiones provinciales reportaron que las actuales estructuras de gobierno y gestión de los procesos no están actualizadas en términos del nuevo conocimiento, las nuevas realidades fiscales y la evolución en las formas de poder entre los grupos de interés. Sus recomendaciones incluyen formas descentralizadas de gobierno y mayor participación ciudadana. A pesar de que el sistema de atención a la salud en Canadá permanece comprometido a garantizar sus principios centrales, el balance de poder estaría cambiando de los

  17. Testing an intervention to improve functional capability in advanced cardiopulmonary illness. (United States)

    Dougherty, Cynthia M; Steele, Bonnie G; Hunziker, Jim


    The development of a conceptually driven exercise and self-management intervention for improving functional capability and reducing health care costs using social cognitive theory is described. The intervention has 2 components: a 1-month outpatient exercise intervention followed by a home component, lasting 5 months. The intervention is expected to have significant impact on daily function, quality of life, gait/balance, self-efficacy, and health care utilization in persons with advanced heart failure or chronic obstructive pulmonary disease. We report preliminary results related to process-related variables, including feasibility, safety, and intervention adherence. Intervention outcomes are currently under study and will be reported when available.

  18. Capabilities Report 2012 (United States)


    74 Biosurveillance - Rapid Identification of Unknown Microorganisms...RSI is dedicated to the effort and capabilities of enabling biosurveillance through coordinated and integrated national and international systems...natural, accidental, or deliberate in nature. These initiatives include: biosurveillance , outbreak recognition and avoidance, pathogen characterization

  19. Metrology Measurement Capabilities

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Glen E. Gronniger


    This document contains descriptions of Federal Manufacturing & Technologies (FM&T) Metrology capabilities, traceability flow charts, and the measurement uncertainty of each measurement capability. Metrology provides NIST traceable precision measurements or equipment calibration for a wide variety of parameters, ranges, and state-of-the-art uncertainties. Metrology laboratories conform to the requirements of the Department of Energy Development and Production Manual Chapter 13.2, ANSI/ISO/IEC ANSI/ISO/IEC 17025:2005, and ANSI/NCSL Z540-1. FM&T Metrology laboratories are accredited by NVLAP for the parameters, ranges, and uncertainties listed in the specific scope of accreditation under NVLAP Lab code 200108-0. See the Internet at These parameters are summarized. The Honeywell Federal Manufacturing & Technologies (FM&T) Metrology Department has developed measurement technology and calibration capability in four major fields of measurement: (1) Mechanical; (2) Environmental, Gas, Liquid; (3) Electrical (DC, AC, RF/Microwave); and (4) Optical and Radiation. Metrology Engineering provides the expertise to develop measurement capabilities for virtually any type of measurement in the fields listed above. A strong audit function has been developed to provide a means to evaluate the calibration programs of our suppliers and internal calibration organizations. Evaluation includes measurement audits and technical surveys.

  20. Capabilities for Intercultural Dialogue (United States)

    Crosbie, Veronica


    The capabilities approach offers a valuable analytical lens for exploring the challenge and complexity of intercultural dialogue in contemporary settings. The central tenets of the approach, developed by Amartya Sen and Martha Nussbaum, involve a set of humanistic goals including the recognition that development is a process whereby people's…

  1. Building server capabilities

    DEFF Research Database (Denmark)

    Adeyemi, Oluseyi

    -only”, exporting parts and components back to headquarter for sales in the home country. In the course of time, the role of offshore subsidiaries in a company’s operations network tends to change and, with that, the capabilities, of the subsidiaries. Focusing on Danish subsidiaries in China, the objective...

  2. Building Server Capabilities

    DEFF Research Database (Denmark)

    Adeyemi, Oluseyi


    -only”, exporting parts and components back to headquarter for sales in the home country. In the course of time, the role of offshore subsidiaries in a company’s operations network tends to change and, with that, the capabilities, of the subsidiaries. Focusing on Danish subsidiaries in China, the objective...

  3. The Capability Approach

    NARCIS (Netherlands)

    I.A.M. Robeyns (Ingrid)


    textabstract In its most general description, the capability approach is a flexible and multi-purpose normative framework, rather than a precise theory of well-being, freedom or justice. At its core are two normative claims: first, the claim that the freedom to achieve well-being is of primary mora

  4. Capabilities for Intercultural Dialogue (United States)

    Crosbie, Veronica


    The capabilities approach offers a valuable analytical lens for exploring the challenge and complexity of intercultural dialogue in contemporary settings. The central tenets of the approach, developed by Amartya Sen and Martha Nussbaum, involve a set of humanistic goals including the recognition that development is a process whereby people's…

  5. Brandishing Cyberattack Capabilities (United States)


    the two are reversed, no attack, however carefully calibrated, will change the target’s policy in the desired direction. The attack will be either too...its freelance and “patriotic” hackers). Ironically, moves to legitimize such weapons may make it easier for other countries to take ownership, hence

  6. Analytical Chemistry Core Capability Assessment - Preliminary Report

    Energy Technology Data Exchange (ETDEWEB)

    Barr, Mary E. [Los Alamos National Laboratory; Farish, Thomas J. [Los Alamos National Laboratory


    The concept of 'core capability' can be nebulous one. Even at a fairly specific level, where core capability equals maintaining essential services, it is highly dependent upon the perspective of the requestor. Samples are submitted to analytical services because the requesters do not have the capability to conduct adequate analyses themselves. Some requests are for general chemical information in support of R and D, process control, or process improvement. Many analyses, however, are part of a product certification package and must comply with higher-level customer quality assurance requirements. So which services are essential to that customer - just those for product certification? Does the customer also (indirectly) need services that support process control and improvement? And what is the timeframe? Capability is often expressed in terms of the currently utilized procedures, and most programmatic customers can only plan a few years out, at best. But should core capability consider the long term where new technologies, aging facilities, and personnel replacements must be considered? These questions, and a multitude of others, explain why attempts to gain long-term consensus on the definition of core capability have consistently failed. This preliminary report will not try to define core capability for any specific program or set of programs. Instead, it will try to address the underlying concerns that drive the desire to determine core capability. Essentially, programmatic customers want to be able to call upon analytical chemistry services to provide all the assays they need, and they don't want to pay for analytical chemistry services they don't currently use (or use infrequently). This report will focus on explaining how the current analytical capabilities and methods evolved to serve a variety of needs with a focus on why some analytes have multiple analytical techniques, and what determines the infrastructure for these analyses. This

  7. Metrology Measurement Capabilities

    Energy Technology Data Exchange (ETDEWEB)

    Barnes, L.M.


    This document contains descriptions of Federal Manufacturing and Technologies (FM and T) Metrology capabilities, traceability flow charts, and the measurement uncertainty of each measurement capability. Metrology provides NIST traceable precision measurements or equipment calibration for a wide variety of parameters, ranges, and state-of-the-art uncertainties in laboratories that conform to the requirements of the Department of Energy Development and Production Manual Chapter 8.4, and ANSI/NCSL Z540-1 (equivalent to ISO Guide 25). FM and T Metrology laboratories are accredited by NVLAP for the parameters, ranges, and uncertainties listed in the specific scope of accreditation under NVLAP Lab code 200108-0. These parameters are summarized.

  8. Metrology Measurement Capabilities

    Energy Technology Data Exchange (ETDEWEB)

    Barnes, L.M.


    This document contains descriptions of Federal Manufacturing & Technologies (FM&T) Metrology capabilities, traceability flow charts, and the measurement uncertainty of each measurement capability. Metrology provides NIST traceable precision measurements or equipment calibration for a wide variety of parameters, ranges, and state-of-the-art uncertainties. Metrology laboratories conform to the requirements of the Department of Energy Development and Production Manual Chapter 8.4, ANSI/ISO/IEC ANSI/ISO/IEC 17025:2000, and ANSI/NCSL Z540-1 (equivalent to ISO Guide 25). FM&T Metrology laboratories are accredited by NVLAP for the parameters, ranges, and uncertainties listed in the specific scope of accreditation under NVLAP Lab code 200108-0. See the Internet at These parameters are summarized in the table at the bottom of this introduction.

  9. Capabilities and Special Needs

    DEFF Research Database (Denmark)

    Kjeldsen, Christian Christrup

    thesis deals with a new Danish innovative policy (Act. no. 564 of 2007), a social work and educational intervention for mentally challenged Young people and other young people with special needs, the so-called individually arranged youth education (STU). The investigated area has lately been taken......The author, Christian Christrup Kjeldsen, presents a comprehensive capability-oriented study of high excellence. For this work he has recieved the doctor titel Dr.phil (Doktor der Philosophie) from Bielefeld University, Germany 2013 with the highest possible grade "ausgezeichnet". The doctoral...... into international consideration in relation to the implementation of the UN convention on the rights of persons with disabilities. As for the theoretical basis, the research makes use of the sociological open-ended and relational concepts of Pierre Bourdieu and the normative yardstick of the Capability Approach...

  10. Current practices of mobilization, analgesia, relaxants and sedation in Indian ICUs: A survey conducted by the Indian Society of Critical Care Medicine

    Directory of Open Access Journals (Sweden)

    Rajesh Chawla


    Full Text Available Background and Aim: Use of sedation, analgesia and neuromuscular blocking agents is widely practiced in Intensive Care Units (ICUs. Our aim is to study the current practice patterns related to mobilization, analgesia, relaxants and sedation (MARS to help in standardizing best practices in these areas in the ICU. Materials and Methods: A web-based nationwide survey involving physicians of the Indian Society of Critical Care Medicine (ISCCM and the Indian Society of Anesthesiologists (ISA was carried out. A questionnaire included questions on demographics, assessment scales for delirium, sedation and pain, as also the pharmacological agents and the practice methods. Results: Most ICUs function in a semi-closed model. Midazolam (94.99% and Fentanyl (47.04% were the most common sedative and analgesic agents used, respectively. Vecuronium was the preferred neuromuscular agent. Monitoring of sedation, analgesia and delirium in the ICU. Ramsay′s Sedation Scale (56.1% and Visual Analogue Scale (48.07% were the preferred sedation and pain scales, respectively. CAM (Confusion Assessment Method-ICU was the most preferred method of delirium assessment. Haloperidol was the most commonly used agent for delirium. Majority of the respondents were aware of the benefit of early mobilization, but lack of support staff and safety concerns were the main obstacles to its implementation. Conclusion: The results of the survey suggest that compliance with existing guidelines is low. Benzodiazepines still remain the predominant ICU sedative. The recommended practice of giving analgesia before sedation is almost non-existent. Delirium remains an underrecognized entity. Monitoring of sedation levels, analgesia and delirium is low and validated and recommended scales for the same are rarely used. Although awareness of the benefits of early mobilization are high, the implementation is low.

  11. Joint Forces Capabilities (United States)


    for countering the proliferation of weapons of mass destruction (WMD) in space. The Space Operations Center ( SPOC ), USSPACECOM is the single point...of contact for assessing space capabilities. Combatant commanders, subordinate JFCs, and Services can access this information from the SPOC via the...special operations forces SPOC Space Operations Center SSBN fleet ballistic missile submarine SST space support team UJTL Universal Joint Task List UN

  12. Capabilities for innovation

    DEFF Research Database (Denmark)

    Nielsen, Peter; Nielsen, René Nesgaard; Bamberger, Simon Grandjean


    is a survey that collected information from 601 firms belonging to the private urban sector in Denmark. The survey was carried out in late 2010. Keywords: dynamic capabilities/innovation/globalization/employee/employer cooperation/Nordic model Acknowledgment: The GOPA study was financed by grant 20080053113....../12-2008-09 from the Foundation for Research of Work Environment, Denmark. The funders played no part in the conduct or reporting of the research....

  13. The UPBEAT nurse-delivered personalized care intervention for people with coronary heart disease who report current chest pain and depression: a randomised controlled pilot study.

    Directory of Open Access Journals (Sweden)

    Elizabeth A Barley

    Full Text Available BACKGROUND: Depression is common in people with coronary heart disease (CHD and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression. METHODS: Multi-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC or treatment as usual (TAU for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables. RESULT: 1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years were randomized. PC participants (n = 41 identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%, high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up. Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03. Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9 and illness perceptions (mean scale increase of 7.8 vs 2.5 had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000. CONCLUSIONS: Trial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU

  14. Exploration Medical Capability (ExMC) Projects (United States)

    Wu, Jimmy; Watkins, Sharmila; Baumann, David


    During missions to the Moon or Mars, the crew will need medical capabilities to diagnose and treat disease as well as for maintaining their health. The Exploration Medical Capability Element develops medical technologies, medical informatics, and clinical capabilities for different levels of care during space missions. The work done by team members in this Element is leading edge technology, procedure, and pharmacological development. They develop data systems that protect patient's private medical information, aid in the diagnosis of medical conditions, and act as a repository of relevant NASA life sciences experimental studies. To minimize the medical risks to crew health the physicians and scientists in this Element develop models to quantify the probability of medical events occurring during a mission. They define procedures to treat an ill or injured crew member who does not have access to an emergency room and who must be cared for in a microgravity environment where both liquids and solids behave differently than on Earth. To support the development of these medical capabilities, the Element manages the development of medical technologies that prevent, monitor, diagnose, and treat an ill or injured crewmember. The Exploration Medical Capability Element collaborates with the National Space Biomedical Research Institute (NSBRI), the Department of Defense, other Government-funded agencies, academic institutions, and industry.

  15. Graphical Visualization of Human Exploration Capabilities (United States)

    Rodgers, Erica M.; Williams-Byrd, Julie; Arney, Dale C.; Simon, Matthew A.; Williams, Phillip A.; Barsoum, Christopher; Cowan, Tyler; Larman, Kevin T.; Hay, Jason; Burg, Alex


    of planned future work to modify the computer program to include additional data and of alternate capability roadmap formats currently under consideration.

  16. The care of adults with congenital heart disease across the globe: Current assessment and future perspective: A position statement from the International Society for Adult Congenital Heart Disease (ISACHD). (United States)

    Webb, Gary; Mulder, Barbara J; Aboulhosn, Jamil; Daniels, Curt J; Elizari, Maria Amalia; Hong, Gu; Horlick, Eric; Landzberg, Michael J; Marelli, Ariane J; O'Donnell, Clare P; Oechslin, Erwin N; Pearson, Dorothy D; Pieper, Els P G; Saxena, Anita; Schwerzmann, Markus; Stout, Karen K; Warnes, Carole A; Khairy, Paul


    The number of adults with congenital heart disease (CHD) has increased markedly over the past few decades as a result of astounding successes in pediatric cardiac care. Nevertheless, it is now well understood that CHD is not cured but palliated, such that life-long expert care is required to optimize outcomes. All countries in the world that experience improved survival in CHD must face new challenges inherent to the emergence of a growing and aging CHD population with changing needs and medical and psychosocial issues. Founded in 1992, the International Society for Adult Congenital Heart Disease (ISACHD) is the leading global organization of professionals dedicated to pursuing excellence in the care of adults with CHD worldwide. Recognizing the unique and varied issues involved in caring for adults with CHD, ISACHD established a task force to assess the current status of care for adults with CHD across the globe, highlight major challenges and priorities, and provide future direction. The writing committee consisted of experts from North America, South America, Europe, South Asia, East Asia, and Oceania. The committee was divided into subgroups to review key aspects of adult CHD (ACHD) care. Regional representatives were tasked with investigating and reporting on relevant local issues as accurately as possible, within the constraints of available data. The resulting ISACHD position statement addresses changing patterns of worldwide epidemiology, models of care and organization of care, education and training, and the global research landscape in ACHD.

  17. The Shipbuilding Industries of the U.S. and U.S.S.R. as Bases for National Maritime Policies: Current Capabilities and Surge Demand Potential. Volume I. Main Report (United States)


    Structurals (MIL) 10 10 16 24 12 16 10 12 13 2. Alloy Steel HY80 Plate 12 14 24 26 20 20 16 16 20 Extrusions (MIL) 40 24 24 30 42 26 20 24 24 HY80 However, for some specialized alloy steel plates such as HY80 for submarine hulls, the shipbuilders are almost the only users. The firms in...National Steel and Shipbuilding Company .......... .- 7 3-2 Ingalls Shipbuilding (Division of Litton Systemsinc - 3-3 Current (1980) Lead Times for

  18. Professionals and Public Good Capabilities

    Directory of Open Access Journals (Sweden)

    Melanie Walker


    Full Text Available Martha Nussbaum (2011 reminds us that, all over the world people are struggling for a life that is fully human - a life worthy of human dignity. Purely income-based and preference-based evaluations, as Sen (1999 argues, do not adequately capture what it means for each person to have quality of life. There are other things that make life good for a person, including access to publicly provided professional services. The question then is what version of education inflects more towards the intrinsic and transformational possibilities of professional work and contributions to decent societies? This paper suggests that we need a normative approach to professional education and professionalism; it is not the case that any old version will do. We also need normative criteria to move beyond social critique and to overcome a merely defensive attitude and to give a positive definition to the potential achievements of the professions. Moreover universities are connected to society, most especially through the professionals they educate; it is reasonable in our contemporary world to educate professional graduates to be in a position to alleviate inequalities, and to have the knowledge, skills and values to be able to do so. To make this case, we draw on the human capabilities approach of Sen (1999, 2009 and Nussbaum (2000, 2011 to conceptualise professional education for the public good as an ally of the struggles of people living in poverty and experiencing inequalities, expanding the well-being of people to be and to do in ways they have reason to value – to be mobile, cared for, respected, and so on. In particular we are interested in which human capabilities and functionings are most needed for a professional practice and professionalism that can contribute to transformative social change and how professional development is enabled via pedagogical arrangements.

  19. PHOBOS physics capabilities

    Energy Technology Data Exchange (ETDEWEB)

    Baker, M.D. [Massachusetts Institute of Technology, Cambridge, MA (United States)


    PHOBOS is the name of a detector and of a research program to study systematically the physics of relativistic heavy-ion collisions over a large range of impact parameters and nuclear species. Collisions with a center mass energy of 200 A GeV at RHIC are expected to produce the highest energy densities ever accessible in the laboratory. In this writeup, the authors outline the physics capabilities of the PHOBOS detector and describe the detector design in terms of the general philosophy behind the PHOBOS research program. In order to make the discussion concrete, they then focus on two specific examples of physics measurements that they plan to make at RHIC: dN/d{eta} for charged particles and the mass spectrum from {phi} {yields} K{sup +}K{sup {minus}} decays.

  20. Knowledge Management Capabilities Rubrics

    Directory of Open Access Journals (Sweden)

    Azizah B.A. Rahman


    Full Text Available Problem statement: Recently researchers discerned the vitality and importance of Knowledge Management Capabilities (KMC evaluation in organizations. In fact evaluation of KMC helps to prevent failure in Knowledge Management (KM projects. Approach: One of the most popular methods in the phase of evaluating KMC is Fuzzy method which evaluates seven attributes of KMC. Fuzzy needs KM experts to give their opinion about these attributes as input data. However in some organizations these experts are not available. Results: Therefore in this study a rubric matrix is developed as an assessment tool with ordered rank (very high, medium and very low of descriptive characteristics of criteria (seven attributes that organizations wish to evaluate. Conclusion: This rubric is applicable for members of an organization which are not familiar completely with KMC and also will be maintained by analyzing and surveying many different researches.

  1. [Nondestructive Evaluation (NDE) Capabilities (United States)

    Born, Martin


    These poster boards display the United Space Alliance's (USA) systems and equipment used for Nondestructive Evaluation. These include: (1) the Robotic Inspection Facility, (2) CAT-Scan and Laminography, (3) Laser Surface Profilometry, (4) Remote Eddy Current, (5) Ultrasonic Phased Array, (7) Infrared Flash Thermography, and (8) Backscatter X-Ray (BSX)

  2. Why Health Matters to Justice: A Capability Theory Perspective

    DEFF Research Database (Denmark)

    Nielsen, Lasse


    The capability approach, originated by Amartya Sen is among the most comprehensive and influential accounts of justice that applies to issues of health and health care. However, although health is always presumed as an important capability in Sen’s works, he never manages to fully explain why...

  3. The current status of foot self-care knowledge, behaviours, and analysis of influencing factors in patients with type 2 diabetes mellitus in China

    Directory of Open Access Journals (Sweden)

    Rao Li


    Conclusions: The status of foot self-care knowledge and behaviours are not optimistic. According to the patients' own characteristics, the theory of knowledge, attitude and practice applies to encouraging patients to go for periodic inspection and education about diabetic complications so as to enhance the knowledge and promote the self-care behaviours.

  4. Open architecture for rapid deployment of capability (United States)

    Glassman, Jacob


    Modern warfare has drastically changed from conventional to non-conventional and from fixed threats to dynamic ones over the past several decades. This unprecedented fundamental shift has now made our adversaries and their weapons more nebulous and ever changing. Our current acquisition system however is not suited to develop, test and deploy essential capability to counter these dynamic threats in time to combat them. This environment requires a new infrastructure in our system design to rapidly adopt capabilities that we do not currently plan for or even know about. The key to enabling this rapid implementation is Open Architecture in acquisition. The DoD has shown it can rapidly prototype capabilities such as unmanned vehicles but has severely struggled in moving from the prototyping to deployment. A major driver of this disconnect is the lack of established infrastructure to employ said capability such as launch and recovery systems and command and control. If we are to be successful in transitioning our rapid capability to the warfighter we must implement established well defined interfaces and enabling technologies to facilitate the rapid adoption of capability so the warfighter has the tools to effectively counter the threat.

  5. Small rover exploration capabilities (United States)

    Salotti, Jean-Marc; Laithier, Corentin; Machut, Benoit; Marie, Aurélien; Bruneau, Audrey; Grömer, Gernot; Foing, Bernard H.


    For a human mission to the Moon or Mars, an important question is to determine the best strategy for the choice of surface vehicles. Recent studies suggest that the first missions to Mars will be strongly constrained and that only small unpressurized vehicles will be available. We analyze the exploration capabilities and limitations of small surface vehicles from the user perspective. Following the “human centered design” paradigm, the team focused on human systems interactions and conducted the following experiments: - Another member of our team participated in the ILEWG EuroMoonMars 2013 simulation at the Mars Desert Research Station in Utah during the same period of time. Although the possible traverses were restricted, a similar study with analog space suits and quads has been carried out. - Other experiments have been conducted in an old rock quarry close to Bordeaux, France. An expert in the use of quads for all types of terrains performed a demonstration and helped us to characterize the difficulties, the risks and advantages and drawbacks of different vehicles and tools. The vehicles that will be used on the surface of Mars have not been defined yet. Nevertheless, the results of our project already show that using a light and unpressurized vehicle (in the order of 150 kg) for the mobility on the Martian surface can be a true advantage. Part of the study was dedicated to the search for appropriate tools that could be used to make the vehicles easier to handle, safer to use and more efficient in the field to cross an obstacle. The final recommendation is to use winches and ramps, which already are widely used by quad drivers. We report on the extension of the reachable areas if such tools were available. This work has been supported by ILEWG, EuroMoonMars and the Austrian Space Forum (OEWF).

  6. Hanford transuranic analytical capability

    Energy Technology Data Exchange (ETDEWEB)

    McVey, C.B.


    With the current DOE focus on ER/WM programs, an increase in the quantity of waste samples that requires detailed analysis is forecasted. One of the prime areas of growth is the demand for DOE environmental protocol analyses of TRU waste samples. Currently there is no laboratory capacity to support analysis of TRU waste samples in excess of 200 nCi/gm. This study recommends that an interim solution be undertaken to provide these services. By adding two glove boxes in room 11A of 222S the interim waste analytical needs can be met for a period of four to five years or until a front end facility is erected at or near the 222-S facility. The yearly average of samples is projected to be approximately 600 samples. The figure has changed significantly due to budget changes and has been downgraded from 10,000 samples to the 600 level. Until these budget and sample projection changes become firmer, a long term option is not recommended at this time. A revision to this document is recommended by March 1996 to review the long term option and sample projections.

  7. The development of capability indicators

    NARCIS (Netherlands)

    Anand, Paul; Hunter, Graham; Carter, Ian; Dowding, Keith; Guala, Francesco; Van Hees, Martin


    This paper is motivated by sustained interest in the capabilities approach to welfare economics combined with the paucity of economic statistics that measure capabilities at the individual level. Specifically, it takes a much discussed account of the normatively desirable capabilities constitutive o

  8. Capability-based computer systems

    CERN Document Server

    Levy, Henry M


    Capability-Based Computer Systems focuses on computer programs and their capabilities. The text first elaborates capability- and object-based system concepts, including capability-based systems, object-based approach, and summary. The book then describes early descriptor architectures and explains the Burroughs B5000, Rice University Computer, and Basic Language Machine. The text also focuses on early capability architectures. Dennis and Van Horn's Supervisor; CAL-TSS System; MIT PDP-1 Timesharing System; and Chicago Magic Number Machine are discussed. The book then describes Plessey System 25

  9. Defining Medical Levels of Care for Exploration Missions (United States)

    Hailey, M.; Reyes, D.; Urbina, M.; Rubin, D.; Antonsen, E.


    NASA medical care standards establish requirements for providing health and medical programs for crewmembers during all phases of a mission. These requirements are intended to prevent or mitigate negative health consequences of long-duration spaceflight, thereby optimizing crew health and performance over the course of the mission. Current standards are documented in the two volumes of the NASA-STD-3001 Space Flight Human-System Standard document, established by the Office of the Chief Health and Medical Officer. Its purpose is to provide uniform technical standards for the design, selection, and application of medical hardware, software, processes, procedures, practices, and methods for human-rated systems. NASA-STD-3001 Vol. 1 identifies five levels of care for human spaceflight. These levels of care are accompanied by several components that illustrate the type of medical care expected for each. The Exploration Medical Capability (ExMC) of the Human Research Program has expanded the context of these provided levels of care and components. This supplemental information includes definitions for each component of care and example actions that describe the type of capabilities that coincide with the definition. This interpretation is necessary in order to fully and systematically define the capabilities required for each level of care in order to define the medical requirements and plan for infrastructure needed for medical systems of future exploration missions, such as one to Mars.

  10. Renewal of Navy’s Riverine Capability: A Preliminary Examination of Past, Current and Future Capabilities (United States)


    operates under the 2nd Assault Amphibian Battalion in Iraq [41]. In conjunction with this change of policy, the SURC contract was terminated with the...34Bolivia Ecuador "Colombia El Salvador "French Guiana Haiti "Nicaragua Honduras "Peru Panama " Suriname "Venezuela River deltas This section lists major

  11. LANL capabilities towards bioenergy and biofuels programs

    Energy Technology Data Exchange (ETDEWEB)

    Olivares, Jose A [Los Alamos National Laboratory; Park, Min S [Los Alamos National Laboratory; Unkefer, Clifford J [Los Alamos National Laboratory; Bradbury, Andrew M [Los Alamos National Laboratory; Waldo, Geoffrey S [Los Alamos National Laboratory


    LANL invented technology for increasing growth and productivity of photosysnthetic organisms, including algae and higher plants. The technology has been extensively tested at the greenhouse and field scale for crop plants. Initial bioreactor testing of its efficacy on algal growth has shown promising results. It increases algal growth rates even under optimwn nutrient supply and careful pH control with CO{sub 2} continuously available. The technology uses a small organic molecule, applied to the plant surfaces or added to the algal growth medium. CO{sub 2} concentration is necessary to optimize algal production in either ponds or reactors. LANL has successfully designed, built and demonstrated an effective, efficient technology using DOE funding. Such a system would be very valuable for capitalizing on local inexpensive sources of CO{sub 2} for algal production operations. Furthermore, our protein engineering team has a concept to produce highly stable carbonic anhydyrase (CA) enzyme, which could be very useful to assure maximum utilization of the CO{sub 2} supply. Stable CA could be used either imnlobilized on solid supports or engineered into the algal strain. The current technologies for harvesting the algae and obtaining the lipids do not meet the needs for rapid, low cost separations for high volumes of material. LANL has obtained proof of concept for the high volume flowing stream concentration of algae, algal lysis and separation of the lipid, protein and water fractions, using acoustic platforms. This capability is targeted toward developing biosynthetics, chiral syntheses, high throughput protein expression and purification, organic chemistry, recognition ligands, and stable isotopes geared toward Bioenergy applications. Areas of expertise include stable isotope chemistry, biomaterials, polymers, biopolymers, organocatalysis, advanced characterization methods, and chemistry of model compounds. The ultimate realization of the ability to design and

  12. Transforming organizational capabilities in strategizing

    DEFF Research Database (Denmark)

    Jørgensen, Claus; Friis, Ole Uhrskov; Koch, Christian


    -term evolvements within the companies. We develop our framework of understanding organizational capabilities drawing on dynamic capability, relational capability and strategy as practice concepts, appreciating the performative aspects of developing new routines. Our two cases are taken from one author’s Ph......Offshored and networked enterprises are becoming an important if not leading organizational form and this development seriously challenges their organizational capabilities. More specifically, over the last years, SMEs have commenced entering these kinds of arrangements. As the organizational...... capabilities of SMEs are limited at the outset, even more emphasis is needed regarding the issues of developing relevant organizational capabilities. This paper aims at investigating how capabilities evolve during an offshoring process of more than 5 years in two Danish SMEs, i.e. not only short- but long...

  13. The New MCNP6 Depletion Capability

    Energy Technology Data Exchange (ETDEWEB)

    Fensin, Michael Lorne [Los Alamos National Laboratory; James, Michael R. [Los Alamos National Laboratory; Hendricks, John S. [Los Alamos National Laboratory; Goorley, John T. [Los Alamos National Laboratory


    The first MCNP based inline Monte Carlo depletion capability was officially released from the Radiation Safety Information and Computational Center as MCNPX 2.6.0. Both the MCNP5 and MCNPX codes have historically provided a successful combinatorial geometry based, continuous energy, Monte Carlo radiation transport solution for advanced reactor modeling and simulation. However, due to separate development pathways, useful simulation capabilities were dispersed between both codes and not unified in a single technology. MCNP6, the next evolution in the MCNP suite of codes, now combines the capability of both simulation tools, as well as providing new advanced technology, in a single radiation transport code. We describe here the new capabilities of the MCNP6 depletion code dating from the official RSICC release MCNPX 2.6.0, reported previously, to the now current state of MCNP6. NEA/OECD benchmark results are also reported. The MCNP6 depletion capability enhancements beyond MCNPX 2.6.0 reported here include: (1) new performance enhancing parallel architecture that implements both shared and distributed memory constructs; (2) enhanced memory management that maximizes calculation fidelity; and (3) improved burnup physics for better nuclide prediction. MCNP6 depletion enables complete, relatively easy-to-use depletion calculations in a single Monte Carlo code. The enhancements described here help provide a powerful capability as well as dictate a path forward for future development to improve the usefulness of the technology.

  14. Stratospheric balloons from Esrange - current and future capabilities (United States)

    Norberg, O.

    Stratospheric balloon operations have been carried out at the Swedish Space Corporation's rocket, balloon and satellite operations base Esrange since 1974; approximately 550 stratospheric balloons have been launched during this period. The facility, located in northern Sweden at 68 degrees north, is fully equipped with a large launch pad, payload and flight train preparation hangars, telemetry stations, recovery helicopters, and supporting infrastructure. Many of the scientific balloons launched are CNES missions. This paper will present the possibilities for scientific and technical balloon missions at high latitudes and with a vast landing area in northern Sweden, Finland, and Russia. The proximity to the Arctic polar vortex makes Esrange an ideal base for studies of for example the ozone destruction process in the Arctic. A new option proposed by the Swedish Space Corporation and NASA is to perform week-long missions from the south of Sweden to western Canada. A newly developed line-of-sight telemetry system, E-LINK, for high bit-rates (> 2 Mbps both downlink and uplink) and based on the Ethernet communication standard is also described.

  15. [Preventive measures of food poisoning at care facilities for the elderly--current status and problems in food poisoning by noroviruses]. (United States)

    Ezoe, Kumiko; Nagatomi, Hideki; Imaizumi, Iwao


    Food poisoning at care facilities for the elderly has been breaking out approximately ten cases per year nationwide from 2001 to 2010. Especially, it reflected the characteristics of food poisoning caused by noroviruses at a high rate. Usually we have been preventing from food poisoning by noroviruses working on existing measures such as temperature control of food materials, sanitary handlings of cooking tools and table wares, and so on. Additionally, the most effective measures to avoid secondary pollution at care facilities for the elderly is that all members at these facilities have to have a sense of crisis about food poisoning by noroviruses and managers at these facilities must take care of health control for all staff.

  16. Expanding Lookout Capabilities for Architectural Analysis (United States)

    Shick, B.

    SMC/SYSW/ENY's Lookout tool provides a M&S capability for architectural analysis. It models the contributions of ground and space-based assets in several mission threads and scenarios to quantify overall Space Situational Awareness (SSA) capability. Plotting performance results versus costs enables decision makers to identify and evaluate Best Value families of systems and combinations of architectures. Currently, SMC intends to use Lookout to impact the Fiscal Year 2012 budget programming cycle, the National SSA Initial Capabilities Document (ICD) and Architecture definition effort, planning for programs of record, and AFSPC & SMC leadership. Ultimately, Lookout will enable additional space superiority analysis. Previous Lookout work focused on modeling the metric tracking capabilities of the Space Surveillance Network (detecting and tracking) and proposed concepts to close identified collection shortfalls. SMC/SYSW/ENY leveraged some of the lessons learned in developing and implementing the metric tracking models to expand Lookout to develop an initial characterization capability, including non-resolved space object identification (SOI), imaging, and Foreign Instrumentation and Signals (FIS) Intelligence. Characterization collection phenomenologies added in FY08 and FY09 include mechanical tracking and phased array radars, visible telescopes, and signals collection. Lookout enables evaluating the characterization collections for quantity, quality, and timeliness. Capturing the Tasking, Collection, Processing, Exploitation, and Dissemination processes represent one of the biggest challenges in including characterization capabilities in mission thread and scenario-based analysis. The SMC/SYSW/ENY team met with several representatives of the community and held community-wide Technical Interchange Meetings. Based on feedback from these meetings, SMC created an infrastructure for modeling the tasking processes and scales to relate collection quality to intelligence

  17. Capabilities and Incapabilities of the Capabilities Approach to Health Justice. (United States)

    Selgelid, Michael J


    This first part of this article critiques Sridhar Venkatapuram's conception of health as a capability. It argues that Venkatapuram relies on the problematic concept of dignity, implies that those who are unhealthy lack lives worthy of dignity (which seems politically incorrect), sets a low bar for health, appeals to metaphysically problematic thresholds, fails to draw clear connections between appealed-to capabilities and health, and downplays the importance/relevance of health functioning. It concludes by questioning whether justice entitlements should pertain to the capability for health versus health achievements, challenging Venkatapuram's claims about the strength of health entitlements, and demonstrating that the capabilities approach is unnecessary to address social determinants of health.

  18. Impact of Personnel Capabilities on Organizational Innovation Capability

    DEFF Research Database (Denmark)

    Nielsen, Susanne Balslev; Momeni, Mostafa


    in this rapidly changing world. This research focuses on definition of the personnel aspect of innovation capability, and proposes a conceptual model based on the scientific articles of academic literature on organisations innovation capability. This paper includes an expert based validation in three rounds...... of the Delphi method. And for the purpose of a better appreciation of the relationship dominating the factors of the model, it has distributed the questionnaire to Iranian companies in the Food industry. This research proposed a direct relationship between Innovation Capability and the Personnel Capability...

  19. A protocol for an individualised, facilitated and sustainable approach to implementing current evidence in preventing falls in residential aged care facilities

    Directory of Open Access Journals (Sweden)

    Hill Keith


    Full Text Available Abstract Background Falls are common adverse events in residential care facilities. Commonly reported figures indicate that at least 50% of residents fall in a 12 month period, and that this figure is substantially higher for residents with dementia. This paper reports the protocol of a project which aims to implement evidence based falls prevention strategies in nine residential aged care facilities (RACFs in Australia. The facilities in the study include high and low care, small and large facilities, metropolitan and regional, facilities with a specific cultural focus, and target groups recognised as being more challenging to successful implementation of falls prevention practice (e.g. residents with dementia. Methods The project will be conducted from November 2007-November 2009. The project will involve baseline scoping of existing falls rates and falls prevention activities in each facility, an action research process, interactive falls prevention training, individual falls risk assessments, provision of equipment and modifications, organisation based steering committees, and an economic evaluation. In each RACF, staff will be invited to join an action research group that will lead the process of developing and implementing interventions designed to facilitate an evidence based approach to falls management in their facility. In all RACFs a pre/post design will be adopted with a range of standardised measures utilised to determine the impact of the interventions. Discussion The care gap in residential aged care that will be addressed through this project relates to the challenges in implementing best practice falls prevention actions despite the availability of best practice guidelines. There are numerous factors that may limit the uptake of best practice falls prevention guidelines in residential aged care facilities. A multi-factorial individualised (to the specific requirements of each facility approach will be used to develop and

  20. Primary Health Care,a Concept to Be Fully Understood and Implemented in Current China's Health Care Reform%Primary Health Care -基础医疗卫生服务应该在中国新医改中得到正确理解和全面实施

    Institute of Scientific and Technical Information of China (English)

    徐国平; 王家骥


    's vision of health care and development strategy,in areas such as government policy - making, health care financing,infrastructure planning,and health care workforce training. This article elucidates how PHC has been misconstrued and translated into " entry level health Care" in China and why it is a wrong interpretation of the PHC concept from various angles,including the basic English meaning of " primary" and " health care" ,the concept of comprehensive PHC, the global PHC experience,and the harmful consequences of the misconception in China's PHC development and in society at large. China's current new health care reform towards a PHC - centered health system has made significant early achievements,but also faces huge challenges,including the widespread and ingrained misconception of PHC. It is hoped that academic scholars in the health care field,medical professionals,and officials in the government gain clearer insight into the PHC concept and rectify its harmful effects on PHC development in various sectors,and promote advancement of meaningful health care reform applicable to the masses.

  1. 社区儿童保健服务现状探讨%Current status of child health care service in community

    Institute of Scientific and Technical Information of China (English)



    目的 了解社区儿童保健服务状况,探讨社区儿童保健工作重点,更好地为辖区儿童提供优质服务.方法 对10个社区卫生服务中心上报儿童保健工作年报表及儿童保健工作相关台账等资料进行整理分析.结果 社区新生儿访视率、3岁以下儿童保健覆盖率大于95%;视力筛查率、听力保健率偏低;对社区户籍3岁以下儿童保健覆盖率和系统管理率均高于流动儿童,流动儿童死亡率高于户籍儿童.社区卫生服务中心儿童保健人员专职率为85.71%,资质合格率为92.86%,其年龄、职称结构趋于老化.结论 加强对流动儿童的保健管理,拓展社区儿童保健服务内容,完善儿童保健信息系统,提高工作效率;重视儿童保健人才队伍的培养,不断提高社区儿童保健服务水平是今后社区儿童保健的工作重点.%Objective To understand the status of child health care service in community and explore the focus of community child health care, so as to provide high quality services for community children. Methods The annual reports of child health care and child health care ledger data from 10 community health service centers were sorted and analyzed. Results Community pediatric visit rate of neonates and coverage rate of children under 3 years were higher than 95% . The rate of vision screening and that of hearing care were relatively low. The health care coverage rate and system management rate of children under 3 years with household registration were higher than those of migrant children. The mortality rate of migrant children was higher than that of children with household registration. Full-time staff in community health service centers accounted for 85. 71%, and the qualified rate of qualification was 92. 86%. The structure of age and professional titles were aging. Conclusion The management of migrant children' s health care should be strengthened, and the child health care services in community needed to

  2. The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO). (United States)

    Popescu, R A; Schäfer, R; Califano, R; Eckert, R; Coleman, R; Douillard, J-Y; Cervantes, A; Casali, P G; Sessa, C; Van Cutsem, E; de Vries, E; Pavlidis, N; Fumasoli, K; Wörmann, B; Samonigg, H; Cascinu, S; Cruz Hernández, J J; Howard, A J; Ciardiello, F; Stahel, R A; Piccart, M


    The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire 'cancer journey'. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today's and tomorrow's professional cancer care.

  3. Incidence and nature of medication errors in neonatal intensive care with strategies to improve safety - A review of the current literature

    NARCIS (Netherlands)

    Chedoe, Indra; Molendijk, Harry A.; Dittrich, Suzanne T. A. M.; Jansman, Frank G. A.; Harting, Johannes W.; Brouwers, Jacobus R. B. J.; Taxis, Katja


    Neonates are highly vulnerable to medication errors because of their extensive exposure to medications in the neonatal intensive care unit (NICU), the general lack of evidence on pharmacotherapeutic interventions in neonates and the lack of neonate-specific formulations. We searched PubMed and EMBAS

  4. 儿科药学监护现状及发展方向%Current Situation and Development Direction of Pharmaceutical care in Pediatrics

    Institute of Scientific and Technical Information of China (English)



    Objective The review of our pediatric pharmaceutical care status and development direction,combined with domestic and foreign children's drug laws, discuss the importance and necessity of pediatric pharmaceutical care.Methods Through Wanfang database and Pubmed search in recent years pediatricpharmaceutical care and related professional Chinese and English literature,combined with literature analysis,status and development of pediatric pharmacycare and summarized.Results In recent years, the development of pediatric pharmacy care has made great progress, but the system has not been formed, evidence-based medicine, pharmacogenomics is the development direction of pediatric pharmaceutical care.Conclusion Pediatric pharmaceutical care is in its infancy, the development of clinicalpharmacy in China should pay attention to its necessity,focus on basic research, folow the international front,continuous innovation, establish pediatricpharmaceutical care system as soon as possible.%目的:综述我国儿科药学监护现状及发展方向,结合国内外儿童用药法规,探讨儿科药学监护的必要性和重要性。方法通过万方数据库和Pubmed检索近年来儿科药学监护及相关专业中文及英文文献,结合文献对儿科药学监护现状和发展方向进行分析、归纳及总结。结果近年来,儿科药学监护发展取得很大进展,但是目前尚未形成体系,循证药学、药物基因组学等是儿科药学监护的发展方向。结论儿科药学监护正处于起步阶段,我国临床药学发展应重视其必要性,注重基础研究,跟踪国际前沿,不断创新,尽快建立起儿科药学监护体系。

  5. Current limiters

    Energy Technology Data Exchange (ETDEWEB)

    Loescher, D.H. [Sandia National Labs., Albuquerque, NM (United States). Systems Surety Assessment Dept.; Noren, K. [Univ. of Idaho, Moscow, ID (United States). Dept. of Electrical Engineering


    The current that flows between the electrical test equipment and the nuclear explosive must be limited to safe levels during electrical tests conducted on nuclear explosives at the DOE Pantex facility. The safest way to limit the current is to use batteries that can provide only acceptably low current into a short circuit; unfortunately this is not always possible. When it is not possible, current limiters, along with other design features, are used to limit the current. Three types of current limiters, the fuse blower, the resistor limiter, and the MOSFET-pass-transistor limiters, are used extensively in Pantex test equipment. Detailed failure mode and effects analyses were conducted on these limiters. Two other types of limiters were also analyzed. It was found that there is no best type of limiter that should be used in all applications. The fuse blower has advantages when many circuits must be monitored, a low insertion voltage drop is important, and size and weight must be kept low. However, this limiter has many failure modes that can lead to the loss of over current protection. The resistor limiter is simple and inexpensive, but is normally usable only on circuits for which the nominal current is less than a few tens of milliamperes. The MOSFET limiter can be used on high current circuits, but it has a number of single point failure modes that can lead to a loss of protective action. Because bad component placement or poor wire routing can defeat any limiter, placement and routing must be designed carefully and documented thoroughly.

  6. Technological Dynamics and Social Capability

    DEFF Research Database (Denmark)

    Fagerberg, Jan; Feldman, Maryann; Srholec, Martin


    This article analyzes factors shaping technological capabilities in USA and European countries, and shows that the differences between the two continents in this respect are much smaller than commonly assumed. The analysis demonstrates a tendency toward convergence in technological capabilities...... for the sample as a whole between 1998 and 2008. The results indicate that social capabilities, such as well-developed public knowledge infrastructure, an egalitarian distribution of income, a participatory democracy and prevalence of public safety condition the growth of technological capabilities. Possible...

  7. A business analytics capability framework

    Directory of Open Access Journals (Sweden)

    Ranko Cosic


    Full Text Available Business analytics (BA capabilities can potentially provide value and lead to better organisational performance. This paper develops a holistic, theoretically-grounded and practically relevant business analytics capability framework (BACF that specifies, defines and ranks the capabilities that constitute an organisational BA initiative. The BACF was developed in two phases. First, an a priori conceptual framework was developed based on the Resource-Based View theory of the firm and a thematic content analysis of the BA literature. Second, the conceptual framework was further developed and refined using a three round Delphi study involving 16 BA experts. Changes from the Delphi study resulted in a refined and confirmed framework including detailed capability definitions, together with a ranking of the capabilities based on importance. The BACF will help academic researchers and industry practitioners to better understand the capabilities that constitute an organisational BA initiative and their relative importance. In future work, the capabilities in the BACF will be operationalised to measure their as-is status, thus enabling organisations to identify key areas of strength and weakness and prioritise future capability improvement efforts.

  8. Connecting Curriculum, Capabilities and Careers (United States)

    Thomas, Ian; Depasquale, James


    Purpose: The reported research aims to examine the extent to which sustainability capabilities have been delivered by a specific example of Education for Sustainability (EfS) and Education for Sustainable Development (ESD), and how important the capabilities have been in the workplace. Design/methodology/approach Students who participated in an…

  9. Is point of care testing in Irish hospitals ready for the laboratory modernisation process? An audit against the current national Irish guidelines.

    LENUS (Irish Health Repository)

    O'Kelly, R A


    BACKGROUND: The Laboratory modernisation process in Ireland will include point of care testing (POCT) as one of its central tenets. However, a previous baseline survey showed that POCT was under-resourced particularly with respect to information technology (IT) and staffing. AIMS: An audit was undertaken to see if POCT services had improved since the publication of National Guidelines and if such services were ready for the major changes in laboratory medicine as envisaged by the Health Service Executive. METHODS: The 15 recommendations of the 2007 Guidelines were used as a template for a questionnaire, which was distributed by the Irish External Quality Assessment Scheme. RESULTS: Thirty-nine of a possible 45 acute hospitals replied. Only a quarter of respondent hospitals had POCT committees, however, allocation of staff to POCT had doubled since the first baseline survey. Poor IT infrastructure, the use of unapproved devices, and low levels of adverse incident reporting were still major issues. CONCLUSIONS: Point of care testing remains under-resourced, despite the roll out of such devices throughout the health service including primary care. The present high standards of laboratory medicine may not be maintained if the quality and cost-effectiveness of POCT is not controlled. Adherence to national Guidelines and adequate resourcing is essential to ensure patient safety.

  10. A system-wide analysis using a senior-friendly hospital framework identifies current practices and opportunities for improvement in the care of hospitalized older adults. (United States)

    Wong, Ken S; Ryan, David P; Liu, Barbara A


    Older adults are vulnerable to hospital-associated complications such as falls, pressure ulcers, functional decline, and delirium, which can contribute to prolonged hospital stay, readmission, and nursing home placement. These vulnerabilities are exacerbated when the hospital's practices, services, and physical environment are not sufficiently mindful of the complex, multidimensional needs of frail individuals. Several frameworks have emerged to help hospitals examine how organization-wide processes can be customized to avoid these complications. This article describes the application of one such framework-the Senior-Friendly Hospital (SFH) framework adopted in Ontario, Canada-which comprises five interrelated domains: organizational support, processes of care, emotional and behavioral environment, ethics in clinical care and research, and physical environment. This framework provided the blueprint for a self-assessment of all 155 adult hospitals across the province of Ontario. The system-wide analysis identified practice gaps and promising practices within each domain of the SFH framework. Taken together, these results informed 12 recommendations to support hospitals at all stages of development in becoming friendly to older adults. Priorities for system-wide action were identified, encouraging hospitals to implement or further develop their processes to better address hospital-acquired delirium and functional decline. These recommendations led to collaborative action across the province, including the development of an online toolkit and the identification of accountability indicators to support hospitals in quality improvement focusing on senior-friendly care.

  11. Annual Industrial Capabilities Report to Congress (United States)


    currently fielded M291 Skin Decontamination Kit (M291 SDK) or begin full rate production of Reactive Skin Decontaminant Lotion ( RSDL ). The study...concluded that exclusive award of RSDL will shrink the supplier base for the M291 SDK because the Department of Defense is the major buyer of the...product. The sole award of RSDL or M291 SDK will not have any long-term adverse impact on the sector, future capabilities, and manufacturing capacity

  12. Enhanced Army Airborne Forces: A New Joint Operational Capability (United States)


    Operational Capability John Gordon IV, Agnes Gereben Schaefer, David A. Shlapak, Caroline Baxter , Scott Boston, Michael McGee, Todd Nichols, Elizabeth...a public service of the RAND Corporation. CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE quality and objectivity. Enhanced Army Airborne Forces A New Joint Operational Capability John Gordon IV, Agnes Gereben Schaefer, David A

  13. NASA's Space Launch System: An Evolving Capability for Exploration An Evolving Capability for Exploration (United States)

    Creech, Stephen D.; Crumbly, Christopher M.; Robinson, Kimerly F.


    A foundational capability for international human deep-space exploration, NASA's Space Launch System (SLS) vehicle represents a new spaceflight infrastructure asset, creating opportunities for mission profiles and space systems that cannot currently be executed. While the primary purpose of SLS, which is making rapid progress towards initial launch readiness in two years, will be to support NASA's Journey to Mars, discussions are already well underway regarding other potential utilization of the vehicle's unique capabilities. In its initial Block 1 configuration, capable of launching 70 metric tons (t) to low Earth orbit (LEO), SLS is capable of propelling the Orion crew vehicle to cislunar space, while also delivering small CubeSat-class spacecraft to deep-space destinations. With the addition of a more powerful upper stage, the Block 1B configuration of SLS will be able to deliver 105 t to LEO and enable more ambitious human missions into the proving ground of space. This configuration offers opportunities for launching co-manifested payloads with the Orion crew vehicle, and a class of secondary payloads, larger than today's CubeSats. Further upgrades to the vehicle, including advanced boosters, will evolve its performance to 130 t in its Block 2 configuration. Both Block 1B and Block 2 also offer the capability to carry 8.4- or 10-m payload fairings, larger than any contemporary launch vehicle. With unmatched mass-lift capability, payload volume, and C3, SLS not only enables spacecraft or mission designs currently impossible with contemporary EELVs, it also offers enhancing benefits, such as reduced risk, operational costs and/or complexity, shorter transit time to destination or launching large systems either monolithically or in fewer components. This paper will discuss both the performance and capabilities of Space Launch System as it evolves, and the current state of SLS utilization planning.

  14. 当前社区居家养老服务中的关键问题反思及前瞻%Retrospect the Problems about Current Community & Home Care Pattern and Putforward Development Strategy

    Institute of Scientific and Technical Information of China (English)



    Community&home care Pattern is one kind of upper-to-down caring pattern led by local government. In the policy context that the government assume welfare limited responsibility,and thinking about caring practice of Qingdao and Shanghai city, this thesis mainly retrospect main problems of current community&home care Pattern from the four dimensions: service providers, service recipients, service demanding, serving operating mechanism. The main problems are as follows,absence of caring system in local government,caring operation is led by the idea of government management performance, service providers are not clear, power and responsibility is not defined,service content and service demand is not consistent. The au-thor think the future sustainable development of Community & home care Pattern should adhere to six principles:centralizing aging policy,integrating service providers among government,market and society,service demand led,first making caring sys-tem,service socializing and marketing.%社区居家养老服务是典型的自上而下政府主导型养老模式。结合青岛、上海等地的养老实践,在政府承担有限福利责任背景下,围绕服务主体、服务对象、服务需求、运作机制四个关键要素,反思当前我国社区居家养老服务中的问题,表现为:基层制度安排缺位、绩效导向、服务主体不明,服务权责不清、服务内容与服务需求不契合等关键问题,社区居家养老福利政策中心化、服务主体三位一体,需求导向、制度植入,服务的社会化、市场化趋向等,是未来社区居家养老可持续发展的着重考虑因素。

  15. Survey on current caring behaviors in nursing students: the influencing factors%实习护生护理关怀行为及影响因素的调查

    Institute of Scientific and Technical Information of China (English)

    单君; 陈宏林; 朱健华


    目的 了解实习护生护理关怀行为实施现状及相关影响因素.方法 采用方便抽样方法,使用美国学者Wolf关怀行为量表修改版,对在江苏省某三甲医院实习的150名护生进行调查.结果 实习护生护理关怀行为得分为(80.98±8.92)分.护生的护理关怀行为主要体现在对患者信息保密(3.76±0.49)、懂得注射和滴注(3.69±0.54)、倾听主诉(3.71±0.50)、对患者表示关心(3.63±0.52)、按时治疗和给药(3.61±0.64)方面;但帮助患者成长(2.91±0.77)、让患者参与护理计划制定(2.88±0.91)得分最低.影响实习护生实施护理关怀行为的因素为护理关怀课程的学习及学历(P<0.05,P<0.01).结论 实习护生护理关怀行为得分呈中等偏上水平,并主要侧重于治疗性关怀,对患者的人文关怀尚欠缺.护理教育者应探讨合适的教学方法,开设护理关怀课程并付诸实践,不断提高护生护理关怀意识和行动力.%Objective To evaluate the current caring behaviors in nursing students and to explore the influencing factors.Methods Caring behaviors inventory revised by Wolf was used to investigate 150 nursing students by convenient sampling method.Results The mean score of caring behaviors in nursing studentas was(80.98± 8.92).The caring behaviors of nursing students mainly reflects on "treating patient' s information confidentially" (3.76 ± 0.49), "knowing how to give shots, and intravenous infusion" ( 3.69 ±0.54), "attentively listening to the patient"(3.71 ± 0.50), "showing concern for the patient" (3.63 ± 0.52), "giving patient's treatment and medications on time”(3.61±0.64).However, the scores of "helping the patient grow"(2.91±0.77) and "including the patient in planning his or her care" (2.88±0.91)were the lowest.Studying of nursing care curriculum or not and educational background were considered to be the principal influencing factors in students' practice of caring behaviors(P<0.05, P<0

  16. Research in cardiovascular care

    DEFF Research Database (Denmark)

    Jaarsma, Tiny; Deaton, Christi; Fitzsimmons, Donna


    To deliver optimal patient care, evidence-based care is advocated and research is needed to support health care staff of all disciplines in deciding which options to use in their daily practice. Due to the increasing complexity of cardiac care across the life span of patients combined...... of the body of knowledge that is needed to further improve cardiovascular care. In this paper, knowledge gaps in current research related to cardiovascular patient care are identified, upcoming challenges are explored and recommendations for future research are given....

  17. MCNP: Multigroup/adjoint capabilities

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, J.C.; Redmond, E.L. II; Palmtag, S.P.; Hendricks, J.S.


    This report discusses various aspects related to the use and validity of the general purpose Monte Carlo code MCNP for multigroup/adjoint calculations. The increased desire to perform comparisons between Monte Carlo and deterministic codes, along with the ever-present desire to increase the efficiency of large MCNP calculations has produced a greater user demand for the multigroup/adjoint capabilities. To more fully utilize these capabilities, we review the applications of the Monte Carlo multigroup/adjoint method, describe how to generate multigroup cross sections for MCNP with the auxiliary CRSRD code, describe how to use the multigroup/adjoint capability in MCNP, and provide examples and results indicating the effectiveness and validity of the MCNP multigroup/adjoint treatment. This information should assist users in taking advantage of the MCNP multigroup/adjoint capabilities.

  18. Building server capabilities in China

    DEFF Research Database (Denmark)

    Adeyemi, Oluseyi; Slepniov, Dmitrij; Wæhrens, Brian Vejrum;


    The purpose of this paper is to further our understanding of multinational companies building server capabilities in China. The paper is based on the cases of two western companies with operations in China. The findings highlight a number of common patterns in the 1) managerial challenges related...... to the development of server capabilities at offshore sites, and 2) means of how these challenges can be handled....

  19. UGV Interoperability Profile (IOP) Capabilities Plan for Version 0 (United States)


    tied to the waypoint plan execution state machine model . This capability is applicable to the BN driving mode. Other Guidance: Current JAUS...the correct range. Limitations and Constraints: This capability will be largely tied to the leader/follower execution state machine model . This

  20. 农民视角下新农合保障能力及影响因素评估——基于宝鸡市421户参合农民的调研%The Evaluation on Medical Care Security Capability of New Rural Cooperative System and Influencing Factors from Perspective of Farmers: Take Baoji Area as an Example

    Institute of Scientific and Technical Information of China (English)

    魏凤; 金华旺


    本文使用对陕西省宝鸡市11个乡镇421户参合农民的调研资料,分析了新农合运行现状及保障能力状况,并运用Ordered Logit模型从农民视角对新农合保障能力及其影响因素进行了分析。研究结果显示,参合农户对新农合保障能力评价为"很强"和"较强"的占62.2%,"较差"及"很差"的占8.84%,评价为"一般"的占29.3%。新农合的贯彻执行力度、政府的资金支持力度、医疗机构的设备保障状况、药品的价格质量、基金管理的合理程度以及定点医疗机构对常见病的医治能力,是显著影响农民对新农合保障能力作出不同评价的因素。%Based on the survey data of 421 households in 11 villages and towns of baoji shi, using ordered logit model, this paper analyzed the medical care security capabilities of new-type rural cooperative medical system (NRCMS) and its influencing factors from the perspective of farmers. The results show that 62.3% participants of NRCMS believed it has a very good effect for medical care, 8.84% participants evaluated as poor level, and 29.3% assessed as general. The implementation level of the new-type rural cooperative system, the government's financial support degree, medical equipment protection status, the quality and the price of medicine, a reasonable degree of fund management, designated medical institutions for treatment of common diseases ability,which affect the evaluation results of farmers on NRCMS medical security capabilities significantly.

  1. 母婴护理信息化应用现状%The Current Situation of Maternal and Child Care Information Application

    Institute of Scientific and Technical Information of China (English)

    韩斌如; 陈慧娟


    目的:分析互联网与传统医疗的融合特点,探索母婴护理的新途径.方法:在"互联网+"和孕产妇数量猛增的背景下,分析医疗信息化实现形式和母婴护理信息化临床应用方向.结果:母婴信息化具有资源丰裕化、行为互动化、渠道平台化和大数据决策辅助等优势,同时也面临着信息准确性、干预有效性、隐私保护性及数据滞后的挑战.结论:孕产妇需要一个灵活、快捷、方便、高效的途径来进行全程、全面、连续的健康管理,"互联网+母婴护理"具有很大的发展前景,但需要多方合作不断进行实践探索.%Objective:To analyze characteristics of the convergence of Internet and traditional healthcare, and explore a new way of maternal and child care. Methods:Under the background of "Internet +" and surge in the number of pregnant and lying-in woman, clinical medical the realization form of healthcare informatization and the clinical application direction of maternal and child care informatization. Results:The maternal and child informatization has abundant resources, behavior interaction, channel platform, big data decision aid and other advantages. It also faces a lot of challenges, such as information accuracy, intervention effectiveness, privacy protection and the lagging of data. Conclusion:Pregnant and lying-in women need a flexible, fast, convenient and efficient way for the all-process, comprehensive and continuous health management. "Internet + maternal and child care" has great prospects for development, but it needs multilateral cooperation and continuous practice and exploration.

  2. The Aging Mind Proves Capable of Lifelong Growth. (United States)

    Goleman, Daniel


    Current research shows that, while fluid intelligence may decline with age, crystallized intelligence continues to rise over the life span. Key factors in maintaining mental capabilities include staying socially involved, being mentally active, and being flexible. (SK)

  3. Advance Health Care Directives and “Public Guardian”: The Italian Supreme Court Requests the Status of Current and Not Future Inability

    Directory of Open Access Journals (Sweden)

    Francesco Paolo Busardò


    Full Text Available Advance health care decisions animate an intense debate in several European countries, which started more than 20 years ago in the USA and led to the adoption of different rules, based on the diverse legal, sociocultural and philosophical traditions of each society. In Italy, the controversial issue of advance directives and end of life’s rights, in the absence of a clear and comprehensive legislation, has been over time a subject of interest of the Supreme Court. Since 2004 a law introduced the “Public Guardian,” aiming to provide an instrument of assistance to the person lacking in autonomy because of an illness or incapacity. Recently, this critical issue has once again been brought to the interest of the Supreme Court, which passed a judgment trying to clarify the legislative application of the appointment of the Guardian in the field of advance directives.

  4. ICU谵妄患者治疗护理的研究进展%Current situation of caring patients with ICU delirium

    Institute of Scientific and Technical Information of China (English)

    王玲; 刘畅; 岳鹏


    This article reviewed the research progress about ICU delirium from the aspects of definition , diagnosis, missed diagnosis,misdiagnosis and outcome,and summarized the influencing factors of nursing management of patients with ICU delirium. Based on these,the article also provided some suggestions in treating and caring patients of ICU delirium.%通过阐述ICU谵妄的概念、诊断、漏诊、误诊及ICU谵妄的后果等几个方面,归纳了ICU谵妄患者护理管理的影响因素,在此基础上,就ICU谵妄患者的治疗与护理提出了建议,并进行了展望.

  5. Pediatric Primary Care as a Component of Systems of Care (United States)

    Brown, Jonathan D.


    Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of…

  6. 社区医护团队的自我和谐现状研究%Current Status of Self Consistency and Congruence of Community Health Care Team

    Institute of Scientific and Technical Information of China (English)

    罗春玲; 黄莲; 叶巧如; 吴翠红; 苏芬; 苏春波


    To study the present situation of self consistency and congruence of the community health care team, to investigate the factors influencing the self consistency and congruence and how to improve its degree. Methods Self consistency and congruence scale ( SCCS ) was taken to investigate 245 members of the staff in the community health services centers under the Longhua People's Hospital of Bao'an District of Shenzhen. Results There was no difference of SCCS score between the community doctor and the community nurse ( P > 0. 05 ). The average total score of SCCS for community health care staff was ( 99. 96 ± 10. 85 ), of which the score of self - experience inconsistence was ( 48. 84 ± 7. 59 ), the self flexibility score was (41. 98 ±5. 53 ), and the self - stereotypes score was ( 21. 22 ± 3. 75 ), with statistically significant differences as compared with the nom of college students ( P < 0. 05 ) . Conclusion The community health care staffs are of lower self consistency and congruence. They need enhanced mental health education given by relevant management departments.%目的 了解社区医护团队的自我和谐现状,探讨影响社区医护团队自我和谐的因素及采取何种应对方式来提高社区医护团队的自我和谐程度.方法 采用自我和谐量表,对在深圳市宝安区龙华人民医院下属的社区卫生服务中心工作的245名医护人员进行调查.结果 社区医生和护士的自我和谐得分间差异无统计学意义(P>0.05).社区医护团队自我和谐量表总分均值为(99.96±10.85)分,其中自我与经验的不和谐得分为(48.84±7.59)分,自我的灵活性得分为(41.98±5.53)分,自我的刻板性得分为(21.22±3.75)分,与大学生常模比较差异均有统计学意义(P<0.05).结论 社区医护团队的自我和谐程度偏低,管理部门应加强对社区医护团队的心理健康教育.

  7. Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population

    Directory of Open Access Journals (Sweden)

    Hetlevik Irene


    Full Text Available Abstract Background Previous studies indicate that clinical guidelines using combined risk evaluation for cardiovascular diseases (CVD may overestimate risk. The aim of this study was to model and discuss implementation of the current (2007 hypertension guidelines in a general Norwegian population. Methods Implementation of the current European Guidelines for the Management of Arterial Hypertension was modelled on data from a cross-sectional, representative Norwegian population study (The Nord-Trøndelag Health Study 1995-97, comprising 65,028 adults, aged 20-89, of whom 51,066 (79% were eligible for modelling. Results Among individuals with blood pressure ≥120/80 mmHg, 93% (74% of the total, adult population would need regular clinical attention and/or drug treatment, based on their total CVD risk profile. This translates into 296,624 follow-up visits/100,000 adults/year. In the Norwegian healthcare environment, 99 general practitioner (GP positions would be required in the study region for this task alone. The number of GPs currently serving the adult population in the study area is 87 per 100,000 adults. Conclusion The potential workload associated with the European hypertension guidelines could destabilise the healthcare system in Norway, one of the world's most long- and healthy-living nations, by international comparison. Large-scale, preventive medical enterprises can hardly be regarded as scientifically sound and ethically justifiable, unless issues of practical feasibility, sustainability and social determinants of health are considered.


    Directory of Open Access Journals (Sweden)



    Full Text Available BSTRACT: INTRODUCTION: Spirituality has been integral part of medicine and h ealth since ancient age. This has been accepted in various devel oped countries as evident by a plethora of published articles. However, the extent of spiritual component in medical practice in India is largely unknown. The present study is a questionnair e based study to assess the extent of knowledge (awareness, attitude and practices among medical professionals at a tertiary care Hospital regarding role of spirituality in management of health and diseases. METHODS: A pre- designed validated list of questionnaire was distri buted among 250 doctors of all specialties at the hospital along with brief introduction on purpos e and scope of the study. The questions were collected back personally after giving sufficie nt time to attempt them. Doctors were evaluated regarding their knowledge, attitude and pr actice about spirituality in medicine using multiple choice question format. RESULTS: The response rate from participants was 80% (200/250. More than 90% participants had a good deal of knowledge of spirituality but unable to distinguish between truly spiritual practices from traditionally followed religious rituals. More than 70% felt that there is relevance of spirit ual practices in health and diseases but pointed out lack of credible scientific data to inco rporate these in health management strategy. There was wide variation among participants regardi ng underlying mechanism/s responsible for spiritual healing. Most of them believed this to be Psychological (90%, Neuroendocrine (70% or Immunology (26% and only (4% attributed it to all these factors. Majority of the participants agreed that spirituality offers maximum h ealth benefits in chronic and incurable diseases. Participants vouched for introduction of spiritual m edicine in medical curriculum to be taught by medical professionals with expertise in spir ituality. They also opined that there is need to involve

  9. A unifying process capability metric

    Directory of Open Access Journals (Sweden)

    John Jay Flaig


    Full Text Available A new economic approach to process capability assessment is presented, which differs from the commonly used engineering metrics. The proposed metric consists of two economic capability measures – the expected profit and the variation in profit of the process. This dual economic metric offers a number of significant advantages over other engineering or economic metrics used in process capability analysis. First, it is easy to understand and communicate. Second, it is based on a measure of total system performance. Third, it unifies the fraction nonconforming approach and the expected loss approach. Fourth, it reflects the underlying interest of management in knowing the expected financial performance of a process and its potential variation.

  10. CLAS Capabilities at Higher Energies

    Energy Technology Data Exchange (ETDEWEB)

    Stepan Stepanyan


    In order to study the capability of the Hall B CLAS detector at high energies, we studied the resolution and the acceptance for various final states in the electroproduction on a proton target at 10 GeV beam energy. We find that, although CLAS can do some of the interesting physics at higher energies in the present configuration, several modifications can significantly improve the overall physics acceptable to CLAS at high energies. In this report, we present some of the results of those studies with suggestions on possible detector improvements to optimize the physics capabilities of CLAS.

  11. Nanofabrication principles, capabilities and limits

    CERN Document Server

    Cui, Zheng


    This second edition of Nanofabrication is one of the most comprehensive introductions on nanofabrication technologies and processes. A practical guide and reference, this book introduces readers to all of the developed technologies that are capable of making structures below 100nm. The principle of each technology is introduced and illustrated with minimum mathematics involved. Also analyzed are the capabilities of each technology in making sub-100nm structures, and the limits of preventing a technology from going further down the dimensional scale. This book provides readers with a toolkit that will help with any of their nanofabrication challenges.

  12. Sistemas atuais de cuidados e manutenção de lentes de contato Current care and maintenance systems for contact lenses

    Directory of Open Access Journals (Sweden)

    César Lipener


    Full Text Available A correta manutenção das lentes de contato é fundamental para se obter sucesso e manter a continuidade de seu uso. É grande o número de pacientes que abandonam o uso de suas lentes por problemas que poderiam ser solucionados com tratamentos relativamente simples ou com uma orientação mais adequada. O mau uso das lentes, associado à má adaptação, contaminação, doenças oculares prévias e fatores ambientais, podem aumentar o número de infecções corneanas através da proliferação de microorganismos. O presente artigo visa apresentar as atualizações em relação aos cuidados e manutenção com as lentes de contato.The proper maintenance of contact lenses is crucial for their success and to maintain the continuity of their use. Many patients abandon the use of their lenses due to problems that could be solved with relatively simple treatments. The misuse of lenses, coupled with poor adjustment, contamination, eye disease and environmental factors may increase the number of corneal infections through the proliferation of microorganisms. This article aims to provide contact lens care and maintenance updates.

  13. NASA Biomedical Informatics Capabilities and Needs (United States)

    Johnson-Throop, Kathy A.


    To improve on-orbit clinical capabilities by developing and providing operational support for intelligent, robust, reliable, and secure, enterprise-wide and comprehensive health care and biomedical informatics systems with increasing levels of autonomy, for use on Earth, low Earth orbit & exploration class missions. Biomedical Informatics is an emerging discipline that has been defined as the study, invention, and implementation of structures and algorithms to improve communication, understanding and management of medical information. The end objective of biomedical informatics is the coalescing of data, knowledge, and the tools necessary to apply that data and knowledge in the decision-making process, at the time and place that a decision needs to be made.

  14. Recent Investments by NASA's National Force Measurement Technology Capability (United States)

    Commo, Sean A.; Ponder, Jonathan D.


    The National Force Measurement Technology Capability (NFMTC) is a nationwide partnership established in 2008 and sponsored by NASA's Aeronautics Evaluation and Test Capabilities (AETC) project to maintain and further develop force measurement capabilities. The NFMTC focuses on force measurement in wind tunnels and provides operational support in addition to conducting balance research. Based on force measurement capability challenges, strategic investments into research tasks are designed to meet the experimental requirements of current and future aerospace research programs and projects. This paper highlights recent and force measurement investments into several areas including recapitalizing the strain-gage balance inventory, developing balance best practices, improving calibration and facility capabilities, and researching potential technologies to advance balance capabilities.

  15. Let the left hand know what the right is doing: a vision for care coordination and electronic health records. (United States)

    Rudin, Robert S; Bates, David W


    Despite the potential for electronic health records to help providers coordinate care, the current marketplace has failed to provide adequate solutions. Using a simple framework, we describe a vision of information technology capabilities that could substantially improve four care coordination activities: identifying collaborators, contacting collaborators, collaborating, and monitoring. Collaborators can include any individual clinician, caregiver, or provider organization involved in care for a given patient. This vision can be used to guide the development of care coordination tools and help policymakers track and promote their adoption.

  16. Communitarian claims and community capabilities: furthering priority setting? (United States)

    Mooney, Gavin


    Priority setting in health care is generally not done well. This paper draws on ideas from Amartya Sen and Martha Nussbaum and adds some communitarian underpinnings to provide a way of improving on current uses of program budgeting and marginal analysis (PBMA) in priority setting. The paper suggests that shifting to a communitarian base for priority setting alters the distribution of property rights over health service decision making and increases the probability that recommendations from PBMA exercises will be implemented. The approach is built on a paradigm which departs from three tenets of welfarism as it is normally conceived: (i) individuals qua individuals seek to maximise their individual utility/well-being; (ii) individuals want to do this; and (iii) it is the values of individuals qua individuals that count. Some of the problems of PBMA, as it has been applied to date, are highlighted. It is argued that these are due largely to a lack of 'credible commitment'. Bringing in the community and communitarian values to PBMA priority setting exercises can help to overcome some of the barriers to getting PBMA recommendations implemented. The approach has the merit of reflecting Sen's concept of capabilities (but extending that to a community level). It avoids the often consequentialist base of a conventional welfarist framework, and it allows community values as opposed to individual values to come to the fore. How to elicit communitarian values is explored.

  17. Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 1: normal and chronic wounds: biology, causes, and approaches to care. (United States)

    Demidova-Rice, Tatiana N; Hamblin, Michael R; Herman, Ira M


    This is the first installment of 2 articles that discuss the biology and pathophysiology of wound healing, review the role that growth factors play in this process, and describe current ways of growth factor delivery into the wound bed. Part 1 discusses the latest advances in clinicians' understanding of the control points that regulate wound healing. Importantly, biological similarities and differences between acute and chronic wounds are considered, including the signaling pathways that initiate cellular and tissue responses after injury, which may be impeded during chronic wound healing.

  18. Does Care Matter?

    DEFF Research Database (Denmark)

    Loft, Lisbeth Trille Gylling; Hogan, Dennis P.


    employment during the first 36 weeks following a birth, and its association with experienced non-parental child care use before labor force entry. Using data from the Early Childhood Longitudinal Survey – Birth Cohort (N = 10,400 mothers), results from discrete-time hazard models show that use of non......The aim of this study is to introduce the concept of care capital and provide an example of its application in the context of child care and maternal employment using the currently most suitable American data. We define care capital as the nexus of available, accessible, and experienced resources...... for care. The American setting is an ideal context to investigate the linkages between child care capital and maternal employment as the patterns of child care use tend to be more diverse compared to other national context. In the presented application of care capital, we examine mothers’ entry to paid...

  19. Developing Collaborative Product Development Capabilities

    DEFF Research Database (Denmark)

    Mahnke, Volker; Tran, Yen


    innovation strategies’. Our analyses suggest that developing such collaboration capabilities benefits from the search for complementary practices, the combination of learning styles, and the development of weak and strong ties. Results also underscore the crucial importance of co-evolution of multi...

  20. Microfoundations of Routines and Capabilities

    DEFF Research Database (Denmark)

    Felin, Teppo; Foss, Nicolai Juul; Heimriks, Koen H.

    We discuss the microfoundations of routines and capabilities, including why a microfoundations view is needed and how it may inform work on organizational and competitive heterogeneity. Building on extant research, we identify three primary categories of micro-level components underlying routines...

  1. Microfoundations of Routines and Capabilities

    DEFF Research Database (Denmark)

    Felin, Tippo; Foss, Nicolai Juul; Heimericks, Koen H.;


    This article introduces the Special Issue and discusses the microfoundations of routines and capabilities, including why a microfoundations view is needed and how it may inform work on organizational and competitive heterogeneity. Building on extant research, we identify three primary categories...


    Directory of Open Access Journals (Sweden)

    Cătălin IANCU


    Full Text Available In the paper are presented the SolidWorks analysis steps to be taken in order to study sustainability of parts or assemblies designed. There are presented the software capabilities and the settings that have to be done for such analysis and the results shown by software.

  3. The Discrepancies Between the IEC Updated versions for Skin and Hair Care Appliances and the Current National Standards%IEC最新版皮肤及毛发护理器具标准与现行国标之间的差异

    Institute of Scientific and Technical Information of China (English)



    The paper introduces the newest IEC standard for the skin & hair care appliance, and then compares them with the standards of the national standard that is carrying at present. The author puts his emphasis on the discrepancies between the IEC updated versions for skin and hair care appliances and the current national standards.

  4. Challenges faced by health-care providers offering infant-feeding counseling to HIV-positive women in sub-Saharan Africa: a review of current research. (United States)

    Tuthill, Emily L; Chan, Jessica; Butler, Lisa M


    Exclusive breastfeeding (EBF) has been identified as the optimal nutrition and critical behavior in attaining human immunodeficiency virus (HIV)-free infant survival in resource-limited settings. Health-care providers (HCPs) in clinic- and community-settings throughout sub-Saharan Africa (sSA) provide infant-feeding counseling. However, rates of EBF at 6 months of age are suboptimal. HCPs are uniquely positioned to educate HIV-positive mothers and provide support by addressing known barriers to EBF. However, limited evidence exists on the experiences faced by HCPs in providing counseling on infant feeding to HIV-positive women. Our objective is to describe experiences faced by HCPs when delivering infant-feeding counseling in the context of HIV in program settings in sSA. We searched a range of electronic databases, including PubMed, CINAHL, and PsycINFO from January 1990 to February 2013, in addition to hand-searching, cross-reference searching, and personal communications. The search was limited to publications in English. Empirical studies of HCP experiences providing infant-feeding counseling in the prevention of mother-to-child transmission (PMTCT) of HIV programs in sSA were selected. We identified 10 peer-reviewed articles reporting HCP challenges in infant-feeding counseling that met inclusion criteria. Articles included qualitative, cross-sectional and mixed-method studies, and cumulatively reported 31 challenges faced by HCPs. Among the challenges identified, the most commonly reported were personal beliefs held by the HCPs toward infant feeding in the context of HIV, contradictory messages, staff workload, directive counseling styles, and a lack of practical strategies to offer mothers, often leading to improvised counseling approaches. Counseling strategies need to be developed that are relevant, meaningful, and responsive to the needs of both HCPs and mothers.

  5. Different Points of a Continuum? Cross Sectional Comparison of the Current and Pre-contact Psychosocial Problems among the Different Categories of Adolescents in Institutional Care in Nigeria

    Directory of Open Access Journals (Sweden)

    Atilola Olayinka


    provision while in custodial care.

  6. Current research funding methods dumb down health care and rehabilitation for disabled people and aging population: a call for a change. (United States)

    Negrini, S; Padua, L; Kiekens, C; Michail, X; Boldrini, P


    Health care systems in Western societies are faced with two major challenges: aging populations and the growing burden of chronic conditions. This translates into more persons with disabilities and the need for more Physical and Rehabilitation Medicine (PRM) services. We raise the point of how these emerging needs are faced by the actual research funding. We briefly present the results of an analysis we made about research funding by the Italian National Health Service as an interesting case study, since it relates to Italy (the financer) and the United States, where National Institutes of Health (NIH) reviewers were identified according to their classification of research topics. The topics of potentially greatest interest for aging Western societies, like chronicity, disability and rehabilitation, were among those least often funded and considered in the traditional method of financing research projects. These results could be based on those PRM peculiarities that make the specialty different from all other classical biomedical specialties, namely the bio-psycho-social approach and its specific research methodologies. Moreover, PRM researchers are spread among the different topics as usually classified, and it is probable that PRM projects are judged by non-PRM reviewers. There are at least two possible ways in which research can be better placed to meet the emerging needs of Western societies (chronicity, disability and consequently also rehabilitation). One is to create specific keywords on these topics so as to improve the match between researchers and reviewers; the second is to allocate specific funds to research in these areas. In fact, the not coherence between emerging needs and research priorities have already been periodically addressed in the past with specific "political" and/or "social" initiatives, when researchers were forced to respond to new emergencies: some historical examples include cancer or HIV and viral diseases or the recent Ebola

  7. Synthetic aperture radar capabilities in development

    Energy Technology Data Exchange (ETDEWEB)

    Miller, M. [Lawrence Livermore National Lab., CA (United States)


    The Imaging and Detection Program (IDP) within the Laser Program is currently developing an X-band Synthetic Aperture Radar (SAR) to support the Joint US/UK Radar Ocean Imaging Program. The radar system will be mounted in the program`s Airborne Experimental Test-Bed (AETB), where the initial mission is to image ocean surfaces and better understand the physics of low grazing angle backscatter. The Synthetic Aperture Radar presentation will discuss its overall functionality and a brief discussion on the AETB`s capabilities. Vital subsystems including radar, computer, navigation, antenna stabilization, and SAR focusing algorithms will be examined in more detail.

  8. Pharmacists belong in accountable care organizations and integrated care teams. (United States)

    Smith, Marie; Bates, David W; Bodenheimer, Thomas S


    Effective health care workforce development requires the adoption of team-based care delivery models, in which participating professionals practice at the full extent of their training in pursuit of care quality and cost goals. The proliferation of such new models as medical homes, accountable care organizations, and community-based care teams is creating new opportunities for pharmacists to assume roles and responsibilities commensurate with their capabilities. Some challenges to including pharmacists in team-based care delivery models, including the lack of payment mechanisms that explicitly provide for pharmacist services, have yet to be fully addressed by policy makers and others. Nevertheless, evolving models and strategies reveal a variety of ways to draw on pharmacists' expertise in such critical areas as medication management for high-risk patients. As Affordable Care Act provisions are implemented, health care workforce projections need to consider the growing number of pharmacists expected to play an increasing role in delivering primary care services.

  9. Critical Care (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications ... a team of specially-trained health care providers. Critical care usually takes place in an intensive care ...

  10. Tracheostomy care (United States)

    Respiratory failure - tracheostomy care; Ventilator - tracheostomy care; Respiratory insufficiency - tracheostomy care ... Before you leave the hospital, health care providers will teach you how ... and suction the tube Keep the air you breathe moist Clean ...

  11. Management of neovascular age-related macular degeneration: current state-of-the-art care for optimizing visual outcomes and therapies in development. (United States)

    Agarwal, Aniruddha; Rhoades, William R; Hanout, Mostafa; Soliman, Mohamed Kamel; Sarwar, Salman; Sadiq, Mohammad Ali; Sepah, Yasir Jamal; Do, Diana V; Nguyen, Quan Dong


    Contemporary management of neovascular age-related macular degeneration (AMD) has evolved significantly over the last few years. The goal of treatment is shifting from merely salvaging vision to maintaining a high quality of life. There have been significant breakthroughs in the identification of viable drug targets and gene therapies. Imaging tools with near-histological precision have enhanced our knowledge about pathophysiological mechanisms that play a role in vision loss due to AMD. Visual, social, and vocational rehabilitation are all important treatment goals. In this review, evidence from landmark clinical trials is summarized to elucidate the optimum modern-day management of neovascular AMD. Therapeutic strategies currently under development, such as gene therapy and personalized medicine, are also described.

  12. Organizational Learning Capability: An Example of University Hospital

    Directory of Open Access Journals (Sweden)



    Full Text Available In health care institutions aiming healthy society by the way protecting and promoting human health, reaching information has a vital importance. This descriptive research purposed an evaluation of organizational learning capability of 396 employees working in Gülhane Military Medical Academy Hospital. A questionnaire including socio-demographic characteristics was used along with Organizational Learning Capability scale designed by Ricardo CHIVA and His Friends. Data acquired was analyzed with SPSS 15.0 program. Participants’ Organizational Learning Capability and its subscales means were assessed in terms of their sociodemographic characteristics. Assessing participants’ answers in terms of 5 subscales which are experimentation, risk taking, interaction with the external environment, dialogue and participatory decision-making; for education level and professional groups, statistical significant differences was found between Organizational Learning Capability and its subscales means.

  13. Current Status of Wound Care in Shanghai Communities:A Qualitative Research%上海市社区创口护理工作开展现状的质性研究

    Institute of Scientific and Technical Information of China (English)

    葛津津; 刘薇群; 杨阳; 奚弘妮; 汤培凤; 陆佳韵


    Objective To investigate the current status of wound care in Shanghai communities , in order to provide references for relevant work management and personnel training.Methods In April 2014, using purposive sampling method , we selected 12 community health service centers in Shanghai and enrolled the nursing leader or an outstanding nurse from each center.Focus group interviewing method was employed to collect data , and keywords analysis was conducted to analyze the data.Results At present, the wound care in Shanghai communities is in unfavorable condition.The primary type of wound is pressure sores , the cases of wound are usually in critical condition , and elderly patients take the majority.Household care givers are inadequate in nursing knowledge , and there is a lack of professional wound care givers and specialists.The relevant training is still at an initial stage.The management system of wound care in communities is imperfect.Conclusion Wound care in Shanghai is in high demand , while the relevant human resource is in shortage , and the management system is imperfect.We suggest the personnel training of community wound care should be strengthened and wound care modes fit for different communities should be established.%目的:了解上海市社区创口护理工作开展现状,以为其工作管理和人才培养提供依据。方法于2014年4月,采用立意抽样法,在上海市抽取12家社区卫生服务中心,在每家社区卫生服务中心抽取护理管理者或骨干护士1名,共纳入12名。采用焦点小组访谈法进行资料收集,采用主题词分析法进行资料分析。结果上海市社区创口护理情况较严峻,创口类型以压疮为主,创口损伤程度较严重,以老年患者居多,且家庭照护者创口护理知识相对缺乏;社区专业创口护理师缺乏,专家型人才缺如,教育尚处于初始阶段;社区创口护理管理体系不完善。结论上

  14. Judgmental Forecasting of Operational Capabilities

    DEFF Research Database (Denmark)

    Hallin, Carina Antonia; Tveterås, Sigbjørn; Andersen, Torben Juul

    This paper explores a new judgmental forecasting indicator, the Employee Sensed Operational Capabilities (ESOC). The purpose of the ESOC is to establish a practical prediction tool that can provide early signals about changes in financial performance by gauging frontline employees’ sensing...... can predict financial performance. Monthly data were collected from frontline employees in three different companies during an 18-month period, and the initial results indicate that the ESOChas predictive power....... of changes in the firm’s operational capabilities. We present the first stage of the development of ESOC by applying a formative measurement approach to test the index in relation to financial performance and against an organizational commitment scale. We use distributed lag models to test whether the ESOC...

  15. LOFT Augmented Operator Capability Program

    Energy Technology Data Exchange (ETDEWEB)

    Hollenbeck, D.A.; Krantz, E.A.; Hunt, G.L.; Meyer, O.R.


    The outline of the LOFT Augmented Operator Capability Program is presented. This program utilizes the LOFT (Loss-of-Fluid Test) reactor facility which is located at the Idaho National Engineering Laboratory and the LOFT operational transient experiment series as a test bed for methods of enhancing the reactor operator's capability for safer operation. The design of an Operational Diagnotics and Display System is presented which was backfit to the existing data acquisition computers. Basic color-graphic displays of the process schematic and trend type are presented. In addition, displays were developed and are presented which represent safety state vector information. A task analysis method was applied to LOFT reactor operating procedures to test its usefulness in defining the operator's information needs and workload.

  16. Improving the RPC rate capability

    CERN Document Server

    Aielli, G; Cardarelli, R; Di Ciaccio, A; Di Stante, L; Iuppa, R; Liberti, B; Paolozzi, L; Pastori, E; Santonico, R; Toppi, M


    This paper has the purpose to study the rate capability of the Resistive Plate Chamber, RPC, starting from the basic physics of this detector. The effect of different working parameters determining the rate capability is analysed in detail, in order to optimize a new family of RPCs for applications to heavy irradiation environments and in particular to the LHC phase 2. A special emphasis is given to the improvement achievable by minimizing the avalanche charge delivered in the gas. The paper shows experimental results of Cosmic Ray tests, performed to study the avalanche features for different gas gap sizes, with particular attention to the overall delivered charge. For this purpose, the paper studies, in parallel to the prompt electronic signal, also the ionic signal which gives the main contribution to the delivered charge. Whenever possible the test results are interpreted on the base of the RPC detector physics and are intended to extend and reinforce our physical understanding of this detector.

  17. Human-Centered Design Capability (United States)

    Fitts, David J.; Howard, Robert


    For NASA, human-centered design (HCD) seeks opportunities to mitigate the challenges of living and working in space in order to enhance human productivity and well-being. Direct design participation during the development stage is difficult, however, during project formulation, a HCD approach can lead to better more cost-effective products. HCD can also help a program enter the development stage with a clear vision for product acquisition. HCD tools for clarifying design intent are listed. To infuse HCD into the spaceflight lifecycle the Space and Life Sciences Directorate developed the Habitability Design Center. The Center has collaborated successfully with program and project design teams and with JSC's Engineering Directorate. This presentation discusses HCD capabilities and depicts the Center's design examples and capabilities.

  18. 深圳市盐田区孕前保健现状分析%Analysis on the current situation of progestational health care in Yantian District, Shenzhen

    Institute of Scientific and Technical Information of China (English)

    王明真; 郁晓慧; 苗云


    目的:通过分析深圳市盐田区妇女孕前保健检查资料,了解该群体健康状况,为今后的保健工作提供科学依据.方法:选择480例在盐田区妇幼保健院进行孕前检查的育龄期妇女为研究对象,按照孕前保健服务流程询问病史、体检及化验,对资料进行整理与统计分析.结果:调查对象年龄范围为23~38岁,检出疾病12种,排列前3位的依次为宫颈炎(29.58%)、阴道炎(26.67%)、支原体感染 (8.75%),患病率为79.58%(191/240).5种微量元素中钙缺乏为首位(95.21%),铁、铜、锌缺乏分别为(29.79%)、(60.00%)、(19.79%),镁未查到缺乏.调查对象中,孕前开始服用叶酸的女性仅31.00%,服用依从性与受调查者文化程度和职业有关.结论:孕前健康检查町以为准备怀孕的夫妇提供健康状况评估、健康指导,从而有效降低出生缺陷的发生,应加强孕前检查宣传力度和范围.%Objective: To understand the population health status by analyzing the data of progestational health examination among the women in Yantian District of Shenzhen, provide a scientific basis for future health care work. Methods: 480 women of childbearing age receiving progestational examination in the hospital were selected as study objects, their medical history, physical examination and laboratory reports were obtained according to the progestational health serving procedure, then the data were collected and analysed statistically. Results: The age range of investigated objects was 23 ~ 38 years old, 12 kinds of diseases were detected, the top three diseases were cervicitis (29. 58% ), vaginitis (26. 67% ) and mycoplasma infection (8.75%), the prevalence was 79. 58% (191/240) . Among five kinds of trace elements, the incidence of calcium deficiency was the highest, accounting for 95. 21%, the incidences of iron deficiency, copper deficiency and zinc deficiency were 29. 79%, 60. 00% and 19. 79%, respectively; magnesium deficiency

  19. Satellite-based Tropical Cyclone Monitoring Capabilities (United States)

    Hawkins, J.; Richardson, K.; Surratt, M.; Yang, S.; Lee, T. F.; Sampson, C. R.; Solbrig, J.; Kuciauskas, A. P.; Miller, S. D.; Kent, J.


    Satellite remote sensing capabilities to monitor tropical cyclone (TC) location, structure, and intensity have evolved by utilizing a combination of operational and research and development (R&D) sensors. The microwave imagers from the operational Defense Meteorological Satellite Program [Special Sensor Microwave/Imager (SSM/I) and the Special Sensor Microwave Imager Sounder (SSMIS)] form the "base" for structure observations due to their ability to view through upper-level clouds, modest size swaths and ability to capture most storm structure features. The NASA TRMM microwave imager and precipitation radar continue their 15+ yearlong missions in serving the TC warning and research communities. The cessation of NASA's QuikSCAT satellite after more than a decade of service is sorely missed, but India's OceanSat-2 scatterometer is now providing crucial ocean surface wind vectors in addition to the Navy's WindSat ocean surface wind vector retrievals. Another Advanced Scatterometer (ASCAT) onboard EUMETSAT's MetOp-2 satellite is slated for launch soon. Passive microwave imagery has received a much needed boost with the launch of the French/Indian Megha Tropiques imager in September 2011, basically greatly supplementing the very successful NASA TRMM pathfinder with a larger swath and more frequent temporal sampling. While initial data issues have delayed data utilization, current news indicates this data will be available in 2013. Future NASA Global Precipitation Mission (GPM) sensors starting in 2014 will provide enhanced capabilities. Also, the inclusion of the new microwave sounder data from the NPP ATMS (Oct 2011) will assist in mapping TC convective structures. The National Polar orbiting Partnership (NPP) program's VIIRS sensor includes a day night band (DNB) with the capability to view TC cloud structure at night when sufficient lunar illumination exits. Examples highlighting this new capability will be discussed in concert with additional data fusion efforts.

  20. Management of neovascular age-related macular degeneration: current state-of-the-art care for optimizing visual outcomes and therapies in development

    Directory of Open Access Journals (Sweden)

    Agarwal A


    Full Text Available Aniruddha Agarwal, William R Rhoades, Mostafa Hanout, Mohamed Kamel Soliman, Salman Sarwar, Mohammad Ali Sadiq, Yasir Jamal Sepah, Diana V Do, Quan Dong Nguyen Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA Abstract: Contemporary management of neovascular age-related macular degeneration (AMD has evolved significantly over the last few years. The goal of treatment is shifting from merely salvaging vision to maintaining a high quality of life. There have been significant breakthroughs in the identification of viable drug targets and gene therapies. Imaging tools with near-histological precision have enhanced our knowledge about pathophysiological mechanisms that play a role in vision loss due to AMD. Visual, social, and vocational rehabilitation are all important treatment goals. In this review, evidence from landmark clinical trials is summarized to elucidate the optimum modern-day management of neovascular AMD. Therapeutic strategies currently under development, such as gene therapy and personalized medicine, are also described. Keywords: AMD, neovascular AMD, choroidal neovascular membrane, pharmacogenomics, VEGF, low-vision rehabilitation, gene therapy

  1. Opening the black box: measuring hospital information technology capability. (United States)

    Burke, Darrell E; Menachemi, Nir


    Recently, health care investment in information technology (IT) has experienced a significant increase. Paralleling this increase has been an increase in IT capabilities. Despite the interest in and promises of IT in the health care setting, there is a paucity of empirical research that has attempted to define an organizational measure of IT capability. The dearth of research has contributed to the traditional belief that IT is perceived as a "black box," whereby organizational resources enter the box as "inputs" and are somehow transformed into positive outcomes for an organization. However, for positive outcomes to be realized, these outcomes must be measurable. This research uses a stakeholder perspective to develop a theoretically specified measure of IT capability. A latent construct, IT munificence, is proposed using tenets from diffusion of innovation theory and strategic contingency theory. The construct is tested using a sample of 1,545 acute care hospitals located in the United States. IT munificence fits the study data well, supporting the hypothesis that IT munificence represents a strategy of hospital IT capability.

  2. Design Mechanism as Territorial Strategic Capability

    Directory of Open Access Journals (Sweden)

    Gianita BLEOJU


    Full Text Available The current exigencies that a territory must faced in order to its’ optimalpositioning in future regional competition requires the ability to design theappropriate mechanism which better valorize the territory capability. Such aconstruct is vital for territorial sustainable development and supposes thecreation of a specific body of knowledge from distinctive local resourceexploitation and unique value creation and allocation. Territorial mechanismdesign is a typical management decision about identification, ownership andcontrol of specific strategic capabilities and their combination in a distinctiveterritorial portfolio. The most difficult responsibility is to allocate the territorialvalue added which is a source of conflict among territorial components. Ourcurrent paper research covers the basics of two complementary territorialpillars-rural and tourism potential and proves the lack of specific designmechanisms which explain the current diminishing value of Galati Brailaregion. The proposed management system, relying upon territorial controlmechanism, will ensure knowledge sharing process via collaborative learning,with the final role of appropriate territorial attractivity signals, reinforcingidentity as key factor of territorial attractability. Our paper is fully documentedon there years of data analyzing from territorial area of interest. This offers usthe necessary empiric contrasting for our proposed solution.

  3. Expanding capabilities of the debris analysis workstation (United States)

    Spencer, David B.; Sorge, Marlon E.; Mains, Deanna L.; Shubert, Ann J.; Gerhart, Charlotte M.; Yates, Ken W.; Leake, Michael


    Determining the hazards from debris-generating events is a design and safety consideration for a number of space systems, both currently operating and planned. To meet these and other requirements, the United States Air Force (USAF) Phillips Laboratory (PL) Space Debris Research Program has developed a simulation software package called the Debris Analysis Workstation (DAW). This software provides an analysis capability for assessing a wide variety of debris hazards. DAW integrates several component debris analysis models and data visualization tools into a single analysis platform that meets the needs for Department of Defense space debris analysis, and is both user friendly and modular. This allows for studies to be performed expeditiously by analysts who are not debris experts. The current version of DAW includes models for spacecraft breakup, debris orbital lifetime, collision hazard risk assessment, and collision dispersion, as well as a satellite catalog database manager, a drag inclusive propagator, a graphical user interface, and data visualization routines. Together they provide capabilities to conduct several types of analyses, ranging from range safety assessments to satellite constellation risk assessment. Work is progressing to add new capabilities with the incorporation of additional models and improved designs. The existing tools are in their initial integrated form, but the 'glue' that will ultimately bring them together into an integrated system is an object oriented language layer scheduled to be added soon. Other candidate component models under consideration for incorporation include additional orbital propagators, error estimation routines, other dispersion models, and other breakup models. At present, DAW resides on a SUNR workstation, although future versions could be tailored for other platforms, depending on the need.

  4. Optimizing Health Care Coalitions: Conceptual Frameworks and a Research Agenda. (United States)

    Hupert, Nathaniel; Biala, Karen; Holland, Tara; Baehr, Avi; Hasan, Aisha; Harvey, Melissa


    The US health care system has maintained an objective of preparedness for natural or manmade catastrophic events as part of its larger charge to deliver health services for the American population. In 2002, support for hospital-based preparedness activities was bolstered by the creation of the National Bioterrorism Hospital Preparedness Program, now called the Hospital Preparedness Program, in the US Department of Health and Human Services. Since 2012, this program has promoted linking health care facilities into health care coalitions that build key preparedness and emergency response capabilities. Recognizing that well-functioning health care coalitions can have a positive impact on the health outcomes of the populations they serve, this article informs efforts to optimize health care coalition activity. We first review the landscape of health care coalitions in the United States. Then, using principles from supply chain management and high-reliability organization theory, we present 2 frameworks extending beyond the Office of the Assistant Secretary for Preparedness and Response's current guidance in a way that may help health care coalition leaders gain conceptual insight into how different enterprises achieve similar ends relevant to emergency response. We conclude with a proposed research agenda to advance understanding of how coalitions can contribute to the day-to-day functioning of health care systems and disaster preparedness.

  5. Technological capability at the Brazilian official pharmaceutical laboratories

    Directory of Open Access Journals (Sweden)

    José Vitor Bomtempo Martins


    Full Text Available This paper studies the technological capability in the Brazilian Official Pharmaceutical Laboratories [OPL]. The technological capability analysis could contribute to organization strategies and governmental actions in order to improve OPL basic tasks as well to incorporate new ones, particularly concerning the innovation management. Inspired in Figueiredo (2000, 2003a, 2003b and Figueiredo and Ariffin (2003, a framework was drawn and adapted to pharmaceutical industry characteristics and current sanitary and health legislation. The framework allows to map different dimensions of the technological capability (installations, processes, products, equipments, organizational capability and knowledge management and the level attained by OPL (ordinary or innovating capability. OPL show a good development of ordinary capabilities, particularly in Product and Processes. Concerning the other dimensions, OPL are quite diverse. In general, innovating capabilities are not much developed. In the short term, it was identified a dispersion in the capacitating efforts. Considering their present level and the absorption efforts, good perspectives can be found in Installations, Processes and Organizational Capability. A lower level of efforts in Products and Knowledge Management could undermine these capabilities in the future.

  6. 汶川地震受灾地区灾后社区、乡镇卫生院工作者精神卫生服务能力评估%Capability of basic mental health services of primary health care providers in Wenchuan earthquake disaster areas

    Institute of Scientific and Technical Information of China (English)

    胡宓; 肖水源


    目的:了解汶川受灾地区社区、乡镇卫生院工作者的精神卫生知识掌握情况及精神卫生服务能力,为精神卫生培训提供依据,为我国精神卫生服务体系建设提供科学参考.方法:选取灾后社区、乡镇卫生工作者心理卫生服务技能培训班学员353名为研究样本,回收有效问卷313份.使用自编精神卫生知识评估问卷和精神卫生服务调查表进行评估.自编精神卫生知识评估问卷包含抑郁症、酒精依赖、精神分裂症(阳性症状为主)、创伤后应激障碍和躯体形式障碍5种精神障碍.结果:受灾地区乡镇、社区卫生院工作者对于社区5种精神障碍准确诊断率最高的案例为抑郁症(77.0%),药物处理中位数得分最高的为酒依赖;非药物处理中位数得分最高的是酒依赖和创伤后应激障碍.培训前1月内报告未接诊过精神障碍患者的社区、乡镇卫生院工作者占53.4%.不知道任何1所精神卫生服务机构的卫生院工作者占35.1%;不知道精神科专科会诊的占37.7%;不能邀请精神科专科会诊的占39.6%.结论:汶川地震后,受灾地区的乡镇、社区卫生院工作者精神卫生知识和技能掌握较少,精神卫生服务能力相对弱.%[Abstract] Objective: To investigate the capability of basic mental health services of primary health care providers in the Wenchuan earthquake disaster areas which will attribute to improving the mental health services of China Methods: The self-made knowledge and inventory of basic mental health services scales were used to measure the skills and abilities of primary health care physicians to identify and treat mental illnesses. A total of 313 primary health care physicians were assessed in the Wenchuan disaster area by a questionnaire including knowledge of 5 mental disorders, I. E., depressive disorders, alcohol dependence, schizophrenia (especially positive symptoms) , post - traumatic stress disorders (PTSD) and

  7. Care, Europeanization and Gender

    DEFF Research Database (Denmark)

    Dyrberg, Torben Bech

    This book adresses the recent underexamined developments concerning care in Europe, including the negotiations about care at the top EU level to that of individual workers. Through a comparative and interdisciplinary approach, this collection examines and further develops current theoretical and ...

  8. Volatile Anesthetics. Is a New Player Emerging in Critical Care Sedation? (United States)

    Jerath, Angela; Parotto, Matteo; Wasowicz, Marcin; Ferguson, Niall D


    Volatile anesthetic agent use in the intensive care unit, aided by technological advances, has become more accessible to critical care physicians. With increasing concern over adverse patient consequences associated with our current sedation practice, there is growing interest to find non-benzodiazepine-based alternative sedatives. Research has demonstrated that volatile-based sedation may provide superior awakening and extubation times in comparison with current intravenous sedation agents (propofol and benzodiazepines). Volatile agents may possess important end-organ protective properties mediated via cytoprotective and antiinflammatory mechanisms. However, like all sedatives, volatile agents are capable of deeply sedating patients, which can have respiratory depressant effects and reduce patient mobility. This review seeks to critically appraise current volatile use in critical care medicine including current research, technical consideration of their use, contraindications, areas of controversy, and proposed future research topics.

  9. Developing a dispersant spraying capability

    Energy Technology Data Exchange (ETDEWEB)

    Gill, S.D.


    In developing a national dispersant spraying capability, the Canadian Coast Guard (CCG) has undertaken a modification program to enable the conventional offshore spraying gear to be mounted on almost any vessel of convenience. Smaller, more versatile inshore spraying vessels and pumps have been designed and built. With the popularization of concentrated dispersants, the inshore pumping equipment can be used aboard hovercraft for special application situations. A program of acquiring mobile dispersant storage tanks has been undertaken with auxiliary equipment that will facilitate the shipment of dispersants in bulk by air freight. Work also has commenced on extending the dispersant application program to include the CCG fleet of helicopters.

  10. The investigation of current situation and requirement of preconception care in Baoan district of Shenzhen%深圳市宝安区孕前保健现状及需求调查

    Institute of Scientific and Technical Information of China (English)

    刘小凤; 刘小雅; 宋秀玲; 王瑛; 翟剑


    Objective To explore current situation and requirement of preconception care in Baoan district of Shenzhen . Methods A total of 1 080 primiparas conducted prenatal examination in the Family Planning Specialist Hospital of Shenzhen Baoan District and Songgang People’ s Hospital from Jan 2013 to Jan 2014 were selected .Interview and questionnaire were used to analyze the current situation and requirement of preconception care among respondents .Results 1 038 valid questionnaires were retrieved , only 37.19%( 386/1038 ) primiparas had participated in preconception care .The preconception care rate of respondents with high education degree was higher than that of respondents with low education degree (P<0.05).76.49%(794/1038) respondents had heard of preconception care , while most of them didn ’ t comprehensive understand the content .34.10%(354/1038) respondents had taken folic acid supplements in progestation , but the correct use rate was only 6.78%(24/354).The priorities of approaches to acquire knowledge were friends and colleagues , network, community outreach and medical institutions .The priorities of expecting approaches to acquire knowledge were online media , community outreach and medical institutions .The priorities of medical institution choice were maternal and child health care or women's and children's hospital , community hospitals and comprehensive hospital . Conclusion The participation rate , cognition degree , compliance of preconception care and folic acid use rate are low in Baoan district of Shenzhen .It is imperative to improve the knowledge training on preconception care as well as the forms and contents of the services.The institution should improve service levels to meet the requirements of preconception care .%目的:了解深圳市宝安区孕前保健现状及需求情况。方法将2013年1月至2014年1月深圳宝安区首次到宝安区计划生育专科医院和松岗人民医院做产前检查的孕妇1080例作为调查

  11. 29 CFR 825.125 - Definition of health care provider. (United States)


    ... 29 Labor 3 2010-07-01 2010-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of medicine... providing health care services. (b) Others “capable of providing health care services” include only:...

  12. Using health information technology to manage a patient population in accountable care organizations. (United States)

    Wu, Frances M; Rundall, Thomas G; Shortell, Stephen M; Bloom, Joan R


    Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications - Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications - ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value - Using new empirical data, this study increases understanding of the extent of ACOs' current and developing HIT capabilities to support ongoing care management.


    Energy Technology Data Exchange (ETDEWEB)

    Swegle, J.; Tincher, D.


    This is the second of three papers (in addition to an introductory summary) aimed at providing a framework for evaluating future reductions or modifications of the U.S. nuclear force, first by considering previous instances in which nuclear-force capabilities were eliminated; second by looking forward into at least the foreseeable future at the features of global and regional deterrence (recognizing that new weapon systems currently projected will have expected lifetimes stretching beyond our ability to predict the future); and third by providing examples of past or possible undesirable outcomes in the shaping of the future nuclear force, as well as some closing thoughts for the future. This paper begins with a discussion of the current nuclear force and the plans and procurement programs for the modernization of that force. Current weapon systems and warheads were conceived and built decades ago, and procurement programs have begun for the modernization or replacement of major elements of the nuclear force: the heavy bomber, the air-launched cruise missile, the ICBMs, and the ballistic-missile submarines. In addition, the Nuclear Weapons Council has approved a new framework for nuclear-warhead life extension � not fully fleshed out yet � that aims to reduce the current number of nuclear explosives from seven to five, the so-called �3+2� vision. This vision includes three interoperable warheads for both ICBMs and SLBMs (thus eliminating one backup weapon) and two warheads for aircraft delivery (one gravity bomb and one cruise-missile, eliminating a second backup gravity bomb). This paper also includes a discussion of the current and near-term nuclear-deterrence mission, both global and regional, and offers some observations on future of the strategic deterrence mission and the challenges of regional and extended nuclear deterrence.


    Energy Technology Data Exchange (ETDEWEB)

    Swegle, J.; Tincher, D.


    This is the second of three papers (in addition to an introductory summary) aimed at providing a framework for evaluating future reductions or modifications of the U.S. nuclear force, first by considering previous instances in which nuclear-force capabilities were eliminated; second by looking forward into at least the foreseeable future at the features of global and regional deterrence (recognizing that new weapon systems currently projected will have expected lifetimes stretching beyond our ability to predict the future); and third by providing examples of past or possible undesirable outcomes in the shaping of the future nuclear force, as well as some closing thoughts for the future. This paper begins with a discussion of the current nuclear force and the plans and procurement programs for the modernization of that force. Current weapon systems and warheads were conceived and built decades ago, and procurement programs have begun for the modernization or replacement of major elements of the nuclear force: the heavy bomber, the air-launched cruise missile, the ICBMs, and the ballistic-missile submarines. In addition, the Nuclear Weapons Council has approved a new framework for nuclear-warhead life extension not fully fleshed out yet that aims to reduce the current number of nuclear explosives from seven to five, the so-called 3+2 vision. This vision includes three interoperable warheads for both ICBMs and SLBMs (thus eliminating one backup weapon) and two warheads for aircraft delivery (one gravity bomb and one cruise-missile, eliminating a second backup gravity bomb). This paper also includes a discussion of the current and near-term nuclear-deterrence mission, both global and regional, and offers some observations on future of the strategic deterrence mission and the challenges of regional and extended nuclear deterrence.

  15. Hospice Care (United States)

    Hospice care is end-of-life care. A team of health care professionals and volunteers provides it. ... can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's ...

  16. Palliative Care (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  17. Rapid Capability Fielding Toolbox Study (United States)


    templates derived from best  practices.  The Object Management Group (OMG) is incorporating emerging standards for W3C, SysML, RDF, OWL,  and  BPMN ...capabilities to the  warfighter. 33  Glossary  Acronyms    BPMN   Business Process Modeling Notation  CAD  Computer‐Aided Design  CAE  Computer‐Aided...deployed  on  standards‐based  run‐time  environments.    The  trend  is  that  the  emerging  standards  for  W3C,  SysML,  RDF,  OWL,  and  BPMN   are

  18. Amartya Sen's Capability Approach and Education (United States)

    Walker, Melanie


    The human capabilities approach developed by the economist Amartya Sen links development, quality of life and freedom. This article explores the key ideas in the capability approach of: capability, functioning, agency, human diversity and public participation in generating valued capabilities. It then considers how these ideas relate specifically…

  19. Tonopah Test Range capabilities: technical manual

    Energy Technology Data Exchange (ETDEWEB)

    Manhart, R.L.


    This manual describes Tonopah Test Range (TTR), defines its testing capabilities, and outlines the steps necessary to schedule tests on the Range. Operated by Sandia National Laboratories, TTR is a major test facility for DOE-funded weapon programs. The Range presents an integrated system for ballistic test vehicle tracking and data acquisition. Multiple radars, optical trackers, telemetry stations, a central computer complex, and combined landline/RF communications systems assure full Range coverage for any type of test. Range operations are conducted by a department within Sandia's Field Engineering Directorate. While the overall Range functions as a complete system, it is operationally divided into the Test Measurements, Instrumentation Development, and Range Operations divisions. The primary function of TTR is to support DOE weapons test activities. Management, however, encourages other Government agencies and their contractors to schedule tests on the Range which can make effective use of its capabilities. Information concerning Range use by organizations outside of DOE is presented. Range instrumentation and support facilities are described in detail. This equipment represents the current state-of-the-art and reflects a continuing commitment by TTR management to field the most effective tracking and data acquisition system available.

  20. SAPHIRE 8 New Features and Capabilities

    Energy Technology Data Exchange (ETDEWEB)

    Curtis Smith


    The Systems Analysis Programs for Hands-on Integrated Reliability Evaluations (SAPHIRE) software performs probabilistic risk assessment (PRA) calculations. SAPHIRE is used in support of NRC’s risk-informed programs such as the Accident Sequence Precursor (ASP) program, Management Directive 8.3, “NRC Incident Investigation Program,” or the Significance Determination Process (SDP). It is also used to develop and run the Standardized Plant Analysis Risk (SPAR) models. SAPHIRE Version 8 is a new version of the software with an improved interface and capabilities to support risk-informed programs. SAPHIRE Version 8 is designed to easily handle larger and more complex models. Applications of previous SAPHIRE versions indicated the need to build and solve models with a large number of sequences. Risk assessments that include endstate evaluations for core damage frequency and large, early release frequency evaluations have greatly increased the number of sequences required. In addition, the complexity of the models has increased since risk assessments evaluate both potential internal and external events, as well as different plant operational states. Special features of SAPHIRE 8 help create and run integrated models which may be composed of different model types. SAPHIRE 8 includes features and capabilities that are new or improved over the current Version 7 to address the new requirements for risk-informed programs and SPAR models. These include: • Improved User Interfaces • Model development • Methods • General Support Features

  1. Health care in Costa Rica: boom and crisis. (United States)

    Mesa-Lago, C


    In 1960-1980 Costa Rica experienced a health boom, achieving significant improvements which moved that country into the number two position in Latin America for indicators such as population coverage, infant mortality, life expectancy and health services. In addition, there was a gradual process of integration of health services. But in the same period, the cost of health care as a percentage of GNP increased almost 5-fold and in 1980 was the fourth highest in the region. The economic crisis of the 1980s aggravated the financial difficulties; to cope with them, the government introduced an austere program to reduce costs and plans to transform the current model of health care into a more efficient one capable of maintaining Costa Rica's high health standards in the future. The paper is divided into five sections: summary of the historical development of health care, and description of its current organization and of its gradual process of integration; estimation of population coverage and its trends, evaluation of inequalities in coverage, and identification of the non-covered group; analysis of health-care financing and its sources, as well of the recent financial desequilibrium, its causes and measures to restore the equilibrium; description of health care benefits and their differences among groups and regions, analysis of the country's advances in health-care facilities and standards, and measurement of the impact of the health care system in income distribution; and description of the rising cost of health care and the current crisis, analysis of the causes of both phenomena, and review of the measures that have been and should be implemented to solve these problems.

  2. Intelsat VII communications capabilities and performance (United States)

    Abdel-Nabi, T.; Koh, E.; Kennedy, D.

    This paper describes the general characteristics of the Intelsat VII communications payload and analyzes the suitability of its design for digital transmission, for efficient incorporation of small earth stations into the Intelsat network, and for a relatively straightforward transition from the current Intelsat VA/VI configuration. An overview is presented of the comunications performance of the Intelsat VII satellite for the more important Intelsat digital and analog services, and earth stations standards. Specifically, the advantages, in terms of performance and capabilities, of the improved transponder linearity characteristics associated with the C-Band SSPA's and the K(u)-Band linearized TWTA's are addressed. The enhanced ability of this spacecraft to provide bandwidth where required from several possible orbital locations is discussed.

  3. Numerical modeling capabilities to predict repository performance

    Energy Technology Data Exchange (ETDEWEB)


    This report presents a summary of current numerical modeling capabilities that are applicable to the design and performance evaluation of underground repositories for the storage of nuclear waste. The report includes codes that are available in-house, within Golder Associates and Lawrence Livermore Laboratories; as well as those that are generally available within the industry and universities. The first listing of programs are in-house codes in the subject areas of hydrology, solute transport, thermal and mechanical stress analysis, and structural geology. The second listing of programs are divided by subject into the following categories: site selection, structural geology, mine structural design, mine ventilation, hydrology, and mine design/construction/operation. These programs are not specifically designed for use in the design and evaluation of an underground repository for nuclear waste; but several or most of them may be so used.

  4. The NICER mission: Status and technical capabilities (United States)

    Chakrabarty, Deepto; Arzoumanian, Zaven; Gendreau, Keith


    NASA's Neutron Star Interior Composition Explorer (NICER), in development for deployment to the International Space Station as an external attached payload, will address decades-old questions about the structure, dynamics, and energetics of neutron stars through high-precision timing of the soft X-ray emissions of rotation- and accretion-powered pulsars. NICER's performance in timing, spectroscopy, and high-throughput sensitivity to 0.2-12 keV X-rays represents a substantial enhancement over existing capabilities, enabling a rich diversity of investigations in both neutron star science as well as broader X-ray astrophysics, the latter through an approved Guest Observer program. This talk briefly summarizes the NICER design and the status of hardware fabrication and testing, currently on pace to deliver the NICER payload for its planned launch in early 2017.

  5. Deburring: technical capabilities and cost-effective approaches. Lessons 7 and 8

    Energy Technology Data Exchange (ETDEWEB)

    Gillespie, L.K.


    This ten-lesson text on deburring is designed to provide engineers and production supervisors with an overall understanding of deburring economics and current capabilities. Chapter 7 discusses deburring techniques. Electropolish and electrochemical deburring (ECD) are not the answer to everyone's deburring problems. They are high technology processes when compared to tumbling processes. They require more care, skill, and knowledge than many of the older processes. They are not mass finishing processes. In contrast, they can deburr areas totally untouchable by other processes, and electropolish can produce brilliant finishes. ECD selectively works only in one area, and neither process exerts cutting forces which would distort thin sections. ECD is applicable to all metals and all sizes of burrs. Once established, both processes can be controlled by unskilled help.

  6. [Update on current care guidelines. Neck pain]. (United States)


    Neck pain is very common. Age, female gender, obesity, and several physical and psychological work related factors increase the risk while physical activity appears to decrease it. Non-specific neck pain is most common but serious or specific illness must be ruled out and neural compression identified. Patients are encouraged to remain active and improve their ergonomics. Acute neck pain often disappears without any special treatment. Paracetamol is the primary pain medication. Multidisciplinary treatment is recommended if disabling pain has lasted for two months, and intensive muscle exercises in chronic neck pain. Progressive muscle weakness and myelopathy indicate a surgical assessment.

  7. [Update on current care guidelines: ovarian cancer]. (United States)

    Leminen, Arto; Auranen, Annika; Bützow, Ralf; Hietanen, Sakari; Komulainen, Marja; Kuoppala, Tapio; Mäenpää, Johanna; Puistola, Ulla; Vuento, Maarit; Vuorela, Piia; Yliskoski, Merja


    Ovarian cancer is the most lethal gynaecological cancer. It appears that seemingly ovarian or primary peritoneal carcinomas, in fact, originate from fimbriae. BRCA1/2 mutation carriers are recommended for the removal of ovaries and fimbriae, to reduce the risk of cancer. Treatment of epithelial ovarian cancer is based on the combination of surgery and chemotherapy. The residual tumour volume at the primary operation is the most important predictive factor of survival. The best response at the primary treatment is observed with combination chemotherapy with taxane and platinum. Adding bevacitzumab to first line chemotherapy may improve survival.

  8. [Update on Current Care Guideline: Insomnia]. (United States)

    Partinen, Markku; Huutoniemi, Anne; Kajaste, Soili; Lagerstedt, Rea; Markkula, Juha; Mäkinen, Erkki; Paakkari, Ilari; Partonen, Timo; Polo, Päivi; Saarenpää-Heikkilä, Outi; Seppälä, Maaria; Kukkonen-Harjula, Katriina; Tuunainen, Arja


    Insomnia symptoms must be differentiated from insomnia disorder. The correct aiagnosis or insomnia aisoraer is important, as insomnia may also be a symptom of many other diseases. Cognitive behavioral methods are recommended as first-line treatment options. Treatment of acute insomnia with hypnotics should not exceed two weeks. In elderly persons adverse effects of hypnotics may exceed their beneficial effects in long-term use. Antidepressive medications acting on the histamine-1 system may be used in very small doses. The new guideline includes e.g. insomnia in pregnant and menopausal women and in cancer patients, and driving issues.

  9. Development of covariance capabilities in EMPIRE code

    Energy Technology Data Exchange (ETDEWEB)

    Herman,M.; Pigni, M.T.; Oblozinsky, P.; Mughabghab, S.F.; Mattoon, C.M.; Capote, R.; Cho, Young-Sik; Trkov, A.


    The nuclear reaction code EMPIRE has been extended to provide evaluation capabilities for neutron cross section covariances in the thermal, resolved resonance, unresolved resonance and fast neutron regions. The Atlas of Neutron Resonances by Mughabghab is used as a primary source of information on uncertainties at low energies. Care is taken to ensure consistency among the resonance parameter uncertainties and those for thermal cross sections. The resulting resonance parameter covariances are formatted in the ENDF-6 File 32. In the fast neutron range our methodology is based on model calculations with the code EMPIRE combined with experimental data through several available approaches. The model-based covariances can be obtained using deterministic (Kalman) or stochastic (Monte Carlo) propagation of model parameter uncertainties. We show that these two procedures yield comparable results. The Kalman filter and/or the generalized least square fitting procedures are employed to incorporate experimental information. We compare the two approaches analyzing results for the major reaction channels on {sup 89}Y. We also discuss a long-standing issue of unreasonably low uncertainties and link it to the rigidity of the model.

  10. 艾滋病病人机会性感染救治保障机制研究%Analysis of the current medical care system to treat and relieve AIDS patients with opportunistic infections

    Institute of Scientific and Technical Information of China (English)

    李佳; 王俊杰; 周郁; 许文青; 陈清峰


    目的 分析中国艾滋病病人机会性感染救治保障机制的现状及存在问题,为进一步完善该机制提供建议.方法 采取定量和定性调查相结合的方法.结果 中国制定了“四免一关怀”等机会性感染医疗费用减免政策,并结合医疗体制改革要求通过医保、救助等进一步减轻费用负担.各地主要采取了医保和新农合报销补偿政策倾斜、定额医疗补助、医疗救助以及直接减免部分治疗费用等4种方式落实减免政策.目前仍存在缺乏对病种、临床路径的明确界定,医疗费用减免措施尚未覆盖所有贫困患者,医疗保障水平仍较低,救治保障资金缺口较大等问题.结论 建议明确纳入医疗保障范围的常见机会性感染病种等机会性感染治疗服务体系中存在的问题;短期可通过城乡医疗救助,长期可通过将机会性感染纳入重大疾病保障;建立分级负担、多渠道的机会性感染医疗保障经费筹措机制;加强艾滋病治疗定点医疗机构的综合诊疗能力建设;进一步开展相关专题研究等.%Objective To analyze the current medical care system to treat and relieve AIDS patients with opportunistic infections (OIs) and existing bottlenecks,and to provide suggestions to improve this system.Methods Combined qualitative and quantitative surveys were undertaken.Results Policies including "Four Free One Care" were adopted to reduce financial burden of AIDS patients with OIs under medical treatment,and commitments were made to further reduce the burden through essential medical insurance and relief system in combination with national health care system reform.Local governments progressively implemented these policies by increasing ratio of reimbursement from essential medical insurance and new rural medical cooperative scheme,providing lump-sum medical subsidies,medical relief and direct deducting medical fee.The existing bottlenecks included:lack of clear definition of

  11. Danish Palliative Care Database

    DEFF Research Database (Denmark)

    Grønvold, Mogens; Adsersen, Mathilde; Hansen, Maiken Bang


    Aims: The aim of the Danish Palliative Care Database (DPD) is to monitor, evaluate, and improve the clinical quality of specialized palliative care (SPC) (ie, the activity of hospital-based palliative care teams/departments and hospices) in Denmark. Study population: The study population is all......, and the patient-reported European Organisation for Research and Treatment of Cancer Quality of Life Questionaire-Core-15-Palliative Care questionnaire, assessing health-related quality of life. The data support the estimation of currently five quality of care indicators, ie, the proportions of 1) referred......-Core-15-Palliative Care at admission to SPC, and 5) patients who were discussed at a multidisciplinary conference. Descriptive data: In 2014, all 43 SPC units in Denmark reported their data to DPD, and all 9,434 cancer patients (100%) referred to SPC were registered in DPD. In total, 41,104 unique cancer...

  12. Computer-assisted sperm analysis (CASA): capabilities and potential developments. (United States)

    Amann, Rupert P; Waberski, Dagmar


    Computer-assisted sperm analysis (CASA) systems have evolved over approximately 40 years, through advances in devices to capture the image from a microscope, huge increases in computational power concurrent with amazing reduction in size of computers, new computer languages, and updated/expanded software algorithms. Remarkably, basic concepts for identifying sperm and their motion patterns are little changed. Older and slower systems remain in use. Most major spermatology laboratories and semen processing facilities have a CASA system, but the extent of reliance thereon ranges widely. This review describes capabilities and limitations of present CASA technology used with boar, bull, and stallion sperm, followed by possible future developments. Each marketed system is different. Modern CASA systems can automatically view multiple fields in a shallow specimen chamber to capture strobe-like images of 500 to >2000 sperm, at 50 or 60 frames per second, in clear or complex extenders, and in CASA cannot accurately predict 'fertility' that will be obtained with a semen sample or subject. However, when carefully validated, current CASA systems provide information important for quality assurance of semen planned for marketing, and for the understanding of the diversity of sperm responses to changes in the microenvironment in research. The four take-home messages from this review are: (1) animal species, extender or medium, specimen chamber, intensity of illumination, imaging hardware and software, instrument settings, technician, etc., all affect accuracy and precision of output values; (2) semen production facilities probably do not need a substantially different CASA system whereas biology laboratories would benefit from systems capable of imaging and tracking sperm in deep chambers for a flexible period of time; (3) software should enable grouping of individual sperm based on one or more attributes so outputs reflect subpopulations or clusters of similar sperm with unique

  13. Investigate on current situation of puerperium health care of women from a village of He'nan province%河南省某村妇女产褥期保健现状调查

    Institute of Scientific and Technical Information of China (English)

    伍东红; 渠利霞; 楚银萍; 高金玲; 潘雪


    Objective: To understand the current situation of puerperium health care of women from a village of He'nan province. Methods: Questionnaire investigation and individual interview were adopted to survey 57 mothers whose infants ≤2 years in a village of He'nan province. Results: Fifty - one puerperium women didn't eat fruits (89. 5% ) , 36 puerperium women didn't eat vegetables (63. 2% ) , 49 puerperium women didn't wash hair (86. 0% ) , 49 puerperium women didn't go out (89. 0% ) , 50 puerperium women stayed in a airproof environment (87. 7% ) . The educational levels of parturient women was one of influencing factors of self - health attitude. Conclusion: Misunderstandings exist in self-health of rural women during puerperium period, such as unreasonable dietary structure, bad health status, and less exercises; rural medical health care service is not widespread, maternal and child health care knowledge should be popularized to rural area according to specific circumstance to improve maternal - infantile health level.%目的:了解河南省某村妇女产褥期保健现状.方法:运用问卷调查和个别访谈法对河南省某村57名≤2岁婴幼儿的母亲进行调查.结果:产褥期妇女不吃水果51人,占89.5%;不吃蔬菜36人,占63.2%;不洗发49人,占86.0%;不外出活动49人,占89.0%;不通风50人,占87.7%.产妇的文化程度是自我保健态度的影响因素.结论:农村妇女产褥期自我保健存在误区,饮食结构欠合理、卫生状况欠佳、运动较少.农村医疗卫生保健服务尚未普及,应视具体情况,向农村普及妇幼保健知识,提高母婴健康水平.

  14. 失能老年人的生活状况和社区照护服务需求研究%Study on Current Life Situation and Community Care Service Demand of Disabled Elders

    Institute of Scientific and Technical Information of China (English)

    姜向群; 刘妮娜; 魏蒙


    This paper uses the datum of survey on the basic situation and service demand for the elderly in Xicheng District in Beijing from Gerontology Institute of Renmin University, and analyzes their current life situation and care service demand. The reality reveals that there has been a low degree of utilization of community service facilities for disabled elders. Besides, community service items have been in shortage and had low supply rate. Accordingly, this study recognized that the advancement of social services for disabled elders can be conducted from two aspects: the short-term goals and long-term planning. On one hand, short-term goals include following items: providing corresponding services subsidies for disabled elders, transferring the core of community servicesfrom "entertainment" to "health maintenance" and properly handling the relationship among home-based care, institution care and family support for disabled elders, etc. On the other hand, the long-term planning covers establishment of system and mechanism of social services for disabled elders, furthermore, promotion of the market development of social services for disabled elders etc.%利用中国人民大学老年学研究所2013年对北京市西城区老年人基本情况和服务需求的调查数据,就失能老年人的生活状况和照护服务需求进行分析。失能老年人对社区养老服务设施的利用率低,社区照护服务项目及有效供给不足。可以从短期目标与长期规划两个方面着手推进失能老年人的社会服务发展。短期目标包括给予失能老年人相应服务补贴,社区服务重心由“娱乐型”向“医养型”转变,妥善处理失能老年人居家养老、机构养老与家庭养老的关系等;长期目标包括建立失能老年人社会服务机制、推进失能老年人社会服务市场化发展等。

  15. UK coal mining engineering capability

    Energy Technology Data Exchange (ETDEWEB)



    The document outlines the current position of underground coal mining in the UK and identifies the key suppliers of equipment and services, in the following sections: longwall face machinery; roadway drivage; seismic exploration; ventilation; methane drainage; underground transport; electrical and control systems; underground safety; research and development; consultancy services; coal associations. A directory of 43 companies organizations and academic institutions is included. 13 figs., 1 tab.

  16. OPSAID improvements and capabilities report.

    Energy Technology Data Exchange (ETDEWEB)

    Halbgewachs, Ronald D.; Chavez, Adrian R.


    Process Control System (PCS) and Industrial Control System (ICS) security is critical to our national security. But there are a number of technological, economic, and educational impediments to PCS owners implementing effective security on their systems. Sandia National Laboratories has performed the research and development of the OPSAID (Open PCS Security Architecture for Interoperable Design), a project sponsored by the US Department of Energy Office of Electricity Delivery and Energy Reliability (DOE/OE), to address this issue. OPSAID is an open-source architecture for PCS/ICS security that provides a design basis for vendors to build add-on security devices for legacy systems, while providing a path forward for the development of inherently-secure PCS elements in the future. Using standardized hardware, a proof-of-concept prototype system was also developed. This report describes the improvements and capabilities that have been added to OPSAID since an initial report was released. Testing and validation of this architecture has been conducted in another project, Lemnos Interoperable Security Project, sponsored by DOE/OE and managed by the National Energy Technology Laboratory (NETL).

  17. Solar mechanics thermal response capabilities.

    Energy Technology Data Exchange (ETDEWEB)

    Dobranich, Dean D.


    In many applications, the thermal response of structures exposed to solar heat loads is of interest. Solar mechanics governing equations were developed and integrated with the Calore thermal response code via user subroutines to provide this computational simulation capability. Solar heat loads are estimated based on the latitude and day of the year. Vector algebra is used to determine the solar loading on each face of a finite element model based on its orientation relative to the sun as the earth rotates. Atmospheric attenuation is accounted for as the optical path length varies from sunrise to sunset. Both direct and diffuse components of solar flux are calculated. In addition, shadowing of structures by other structures can be accounted for. User subroutines were also developed to provide convective and radiative boundary conditions for the diurnal variations in air temperature and effective sky temperature. These temperature boundary conditions are based on available local weather data and depend on latitude and day of the year, consistent with the solar mechanics formulation. These user subroutines, coupled with the Calore three-dimensional thermal response code, provide a complete package for addressing complex thermal problems involving solar heating. The governing equations are documented in sufficient detail to facilitate implementation into other heat transfer codes. Suggestions for improvements to the approach are offered.

  18. Palliative Care (United States)

    ... you are a partner with the palliative care team as you all work toward the same goal — providing the best quality of life for your child for as ... Care for Children With Terminal Illness Managing Home Health Care Taking Care of You: Support ...

  19. Hospice care (United States)

    ... family a break (called respite care). Doctor services. Nursing care. Home health aide and homemaker services. Counseling. Medical ... may be given in other locations, including: A nursing home A ... in charge of care is called the primary care giver. This may ...

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

    Directory of Open Access Journals (Sweden)

    Baldauf Annika


    status and severity (PHQ-9, self-management capabilities and clinical parameters. Data collection will be performed at baseline, 12 and 24 months (12 months post-intervention. Discussion Practice-based care management for high risk individuals involving trained HCAs appears to be a promising approach to face the needs of an aging population with increasing care demands. Trial registration Current Controlled Trials ISRCTN56104508

  1. Science capabilities of the Maunakea Spectroscopic Explorer (United States)

    Devost, Daniel; McConnachie, Alan; Flagey, Nicolas; Cote, Patrick; Balogh, Michael; Driver, Simon P.; Venn, Kim


    The Maunakea Spectroscopic Explorer (MSE) project will transform the CFHT 3.6m optical telescope into a 10m class dedicated multiobject spectroscopic facility, with an ability to simultaneously measure thousands of objects with a spectral resolution range spanning 2,000 to 20,000. The project is currently in design phase, with full science operations nominally starting in 2025. MSE will enable transformational science in areas as diverse as exoplanetary host characterization; stellar monitoring campaigns; tomographic mapping of the interstellar and intergalactic media; the in-situ chemical tagging of the distant Galaxy; connecting galaxies to the large scale structure of the Universe; measuring the mass functions of cold dark matter sub-halos in galaxy and cluster-scale hosts; reverberation mapping of supermassive black holes in quasars. MSE is an essential follow-up facility to current and next generations of multi-wavelength imaging surveys, including LSST, Gaia, Euclid, eROSITA, SKA, and WFIRST, and is an ideal feeder facility for E-ELT, TMT and GMT. I will give an update on the status of the project and review some of the most exciting scientific capabilities of the observatory.

  2. 北京社区失能老年人与照护现状分析%Analysis on disabled elderly and the current status of caring in communities of Beijing

    Institute of Scientific and Technical Information of China (English)

    王建平; 汤哲; 孙菲; 刁丽君; 何士大


    目的了解北京社区失能老年人与照护现状。方法采取分层、随机、整群的抽样方法,入户调查西城区(城区)、大兴区(郊区农村)和怀柔区(山区农村)60岁及以上老年人2776例。采用日常生活活动能力量表评估老年人的失能状况。结果调查的老年人中失能老年人为324例,占11.7%,农村失能老年人构成比(16.8%)高于城区(7.4%);随年龄增长失能率增高。10.8%的失能老年人为独居,无照料人同住,尤其农村及女性失能老年人独居比例高。失能老年人的照护人主要是子女(56.6%),其次是配偶(31.1%)。62.7%的失能老年人月均收入在500元以下,农村低收入比例明显高于城区。失能老年人家庭认为目前医药负担较重的占67.6%,其中28.7%的失能老年人家庭认为承受困难。结论老年人失能比例高,家庭与社会照护现状不能满足需求的增长,应探索和建立失能老年人长期照护的有效模式。%Objective To understand the disabled elderly in Beijing and the current status of caring of them. Methods Stratified, random and cluster sampling methods were used, and household surveys were taken among 2776 cases of elderly aged 60 and above in Xicheng District (city), Daxing District (rural outskirts) and Huairou District (moun-tainous countryside). ADL (Activity of Daily Living Scale) was used to assess the elderly disability status. Results In the investigation, 324 elderly were disabled; accounting for 11.7%, the number of disabled elderly in rural areas was signifi-cantly higher than that in urban area, and the disability ratio increaseed along with the age growth. 10.8% of disabled el-derly live alone, not living with caregivers; the ratio was especially higher in rural area and for elderly women. Children of the elderly were mainly the caregivers for the disabled elderly, followed by the spouse. The average monthly income of 67.7% of the

  3. Sandia Laboratories technical capabilities: computation systems

    Energy Technology Data Exchange (ETDEWEB)


    This report characterizes the computation systems capabilities at Sandia Laboratories. Selected applications of these capabilities are presented to illustrate the extent to which they can be applied in research and development programs. 9 figures.

  4. Organizational Economics of Capability and Heterogeneity

    DEFF Research Database (Denmark)

    Argyres, Nicholas S.; Felin, Teppo; Foss, Nicolai Juul;


    For decades, the literatures on firm capabilities and organizational economics have been at odds with each other, specifically relative to explaining organizational boundaries and heterogeneity. We briefly trace the history of the relationship between the capabilities literature and organizationa...

  5. Membrane filters and membrane-filtration processes for health care. (United States)

    Eudailey, W A


    The development of membrane-filtration processes is reviewed, and current types and uses of membrane filtration in health care is discussed. Development of adequate support structures for filters and of disposable filtration devices has facilitated development of filtration processes for pharmaceutical industry, manufacturing in hospital pharmacies, and direct patient care. Hydrophobic filters have also been developed; aqueous solutions cannot wet the pore structures of these filters and therefore cannot pass. Sterility-testing systems have also been developed. There are two types of filters: depth (constructed of compacted fibers) and membrane (which have a homogeneous internal structure). Depth filters retain only a portion of particles in a particular size range and are generally not acceptable for use in health care. Membrane filters retain all particles of a given size. Types of membrane filters are selected for specific uses based on needed flow rates, particulate load, and retention capability. Membrane filters may be validated using bacterial-passage, bubble-point, and diffusion tests. Most membrane filters used in health care are microporous filters that retain particles in the 0.1-10-micron size range. Applications are currently being developed for ultrafilters, which retain both particles and substances with large molecular structures such as proteins, and reverse-osmosis filter membranes, which allow only water or water-miscible solvents of very low molecular weights to pass. Experience in engineering designs, quality assurance, and test procedures has led to the development of many safe, reliable, and effective membrane products for health care.

  6. Biotechnology: Opportunities to Enhance Army Capabilities (United States)


    capabilities for field repair. Also, bioplastics could replace traditional synthetic materials used in equipment because of I greater strength, lighter...robots will require many of the same novel synthetic raterials as commercial robots. However, bioceramics, biopolymers, and bioplastics more suited...biological capability or performance enhanced by electronic or electrochemical devices I Bioplast - a minute quantity of living protoplasm capable of

  7. Selecting Capabilities for Quality of Life Measurement (United States)

    Robeyns, Ingrid


    The capability approach advocates that interpersonal comparisons be made in the space of functionings and capabilities. However, Amartya Sen has not specified which capabilities should be selected as the relevant ones. This has provoked two types of criticism. The stronger critique is Martha Nussbaum's claim that Sen should endorse one specific…

  8. A Strategic Approach to Medical Care for Exploration Missions (United States)

    Canga, Michael A.; Shah, Ronak V.; Mindock, Jennifer A.; Antonsen, Erik L.


    Exploration missions will present significant new challenges to crew health, including effects of variable gravity environments, limited communication with Earth-based personnel for diagnosis and consultation for medical events, limited resupply, and limited ability for crew return. Providing health care capabilities for exploration class missions will require system trades be performed to identify a minimum set of requirements and crosscutting capabilities, which can be used in design of exploration medical systems. Medical data, information, and knowledge collected during current space missions must be catalogued and put in formats that facilitate querying and analysis. These data are used to inform the medical research and development program through analysis of risk trade studies between medical care capabilities and system constraints such as mass, power, volume, and training. Medical capability as a quantifiable variable is proposed as a surrogate risk metric and explored for trade space analysis that can improve communication between the medical and engineering approaches to mission design. The resulting medical system design approach selected will inform NASA mission architecture, vehicle, and subsystem design for the next generation of spacecraft.

  9. Benchmarking HIV health care

    DEFF Research Database (Denmark)

    Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda


    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 Euro...... to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East and Argentina (adjusted OR 0.16[95%CI 0.11-0.23, p HIV health care utilization...

  10. Power Capability in Low Voltage DC Distribution Systems

    Directory of Open Access Journals (Sweden)

    C.O. Gecan


    Full Text Available Recent developments in power electronics components enable the use of power electronics in Low Voltage (LV networks. This development makes the model of a Low Voltage Direct Current (LVDC distribution system possible. The technical and economical benefits of this technology make possible the alternative hypothesis of using DC instead of AC distribution systems. Some aspects, such as increasing the capability of the existing lines, interconnecting distributed generation units and even supplying in DC some loads are creating additional requirements of using a LVDC distribution system. The paper presents some general considerations regarding cables used in a LVAC distribution system and different line reconfigurations witch enable the use of cobles in a LVDC distribution system. The reconfigurations are presented in respect of the DC network topologies: unipolar and bipolar. The central aim of this paper is to investigate capability of power transmission and to calculate the transmission distance for cables used in Low Voltage AC and DC distribution systems. Capability computation is considered in respect of two constrains imposed in the cables cross section selection: cable thermal limit and the maximum allowable voltage drop. Cable thermal limit is represented in calculations by the maximum rated current. The equations used to calculate the power capability are presented for single-phase and threephase AC networks and unipolar and bipolar DC networks. Based on these equations, comparisons between power capability of cables with different cross sections used in Low Voltage DC and AC distribution systems are realized and presented.

  11. Standards for scalable clinical decision support: need, current and emerging standards, gaps, and proposal for progress. (United States)

    Kawamoto, Kensaku; Del Fiol, Guilherme; Lobach, David F; Jenders, Robert A


    Despite their potential to significantly improve health care, advanced clinical decision support (CDS) capabilities are not widely available in the clinical setting. An important reason for this limited availability of CDS capabilities is the application-specific and institution-specific nature of most current CDS implementations. Thus, a critical need for enabling CDS capabilities on a much larger scale is the development and adoption of standards that enable current and emerging CDS resources to be more effectively leveraged across multiple applications and care settings. Standards required for such effective scaling of CDS include (i) standard terminologies and information models to represent and communicate about health care data; (ii) standard approaches to representing clinical knowledge in both human-readable and machine-executable formats; and (iii) standard approaches for leveraging these knowledge resources to provide CDS capabilities across various applications and care settings. A number of standards do exist or are under development to meet these needs. However, many gaps and challenges remain, including the excessive complexity of many standards; the limited availability of easily accessible knowledge resources implemented using standard approaches; and the lack of tooling and other practical resources to enable the efficient adoption of existing standards. Thus, the future development and widespread adoption of current CDS standards will depend critically on the availability of tooling, knowledge bases, and other resources that make the adoption of CDS standards not only the right approach to take, but the cost-effective path to follow given the alternative of using a traditional, ad hoc approach to implementing CDS.

  12. Capability Development in an Offshoring Context

    DEFF Research Database (Denmark)

    Jaura, Manya

    Capability development can be defined as deliberate firm-level investment involving a search and learning process aimed at modifying or enhancing existing capabilities. Increasingly, firms are relocating advanced services to offshore locations resulting in the challenge of capability development...... in the offshore unit. Guided by the research question – what drives or impedes capability development in an offshoring context – the purpose of this thesis is to investigate how an idiosyncratic offshoring context affects capability development. The thesis consists of three papers using various datasets...... and qualitative methods that investigate capability development in an offshoring context. The first paper investigates how capability development takes place for a service-provider firm at the activity level. The second paper examines the transition made by a captive offshore unit, from performing standardized...

  13. Activity-based resource capability modeling

    Institute of Scientific and Technical Information of China (English)

    CHENG Shao-wu; XU Xiao-fei; WANG Gang; SUN Xue-dong


    To analyse and optimize a enterprise process in a wide scope, an activity-based method of modeling resource capabilities is presented. It models resource capabilities by means of the same structure as an activity, that is, resource capabilities are defined by input objects, actions and output objects. A set of activity-based re-source capability modeling rules and matching rules between an activity and a resource are introduced. This method can not only be used to describe capability of manufacturing tools, but also capability of persons and applications, etc. It unifies methods of modeling capability of all kinds of resources in an enterprise and supports the optimization of the resource allocation of a process.

  14. Exploring JWST's Capability to Constrain Habitability on Simulated Terrestrial TESS Planets (United States)

    Tremblay, Luke; Britt, Amber; Batalha, Natasha; Schwieterman, Edward; Arney, Giada; Domagal-Goldman, Shawn; Mandell, Avi; Planetary Systems Laboratory; Virtual Planetary Laboratory


    In the following, we have worked to develop a flexible "observability" scale of biologically relevant molecules in the atmospheres of newly discovered exoplanets for the instruments aboard NASA's next flagship mission, the James Webb Space Telescope (JWST). We sought to create such a scale in order to provide the community with a tool with which to optimize target selection for JWST observations based on detections of the upcoming Transiting Exoplanet Satellite Survey (TESS). Current literature has laid the groundwork for defining both biologically relevant molecules as well as what characteristics would make a new world "habitable", but it has so far lacked a cohesive analysis of JWST's capabilities to observe these molecules in exoplanet atmospheres and thereby constrain habitability. In developing our Observability Scale, we utilized a range of hypothetical planets (over planetary radii and stellar insolation) and generated three self-consistent atmospheric models (of dierent molecular compositions) for each of our simulated planets. With these planets and their corresponding atmospheres, we utilized the most accurate JWST instrument simulator, created specically to process transiting exoplanet spectra. Through careful analysis of these simulated outputs, we were able to determine the relevant parameters that effected JWST's ability to constrain each individual molecular bands with statistical accuracy and therefore generate a scale based on those key parameters. As a preliminary test of our Observability Scale, we have also applied it to the list of TESS candidate stars in order to determine JWST's observational capabilities for any soon-to-be-detected planet in those solar systems.

  15. NASA's Space Launch System: An Evolving Capability for Exploration (United States)

    Creech, Stephen D.; Robinson, Kimberly F.


    A foundational capability for international human deep-space exploration, NASA's Space Launch System (SLS) vehicle represents a new spaceflight infrastructure asset, creating opportunities for mission profiles and space systems that cannot currently be executed. While the primary purpose of SLS, which is making rapid progress towards initial launch readiness in two years, will be to support NASA's Journey to Mars, discussions are already well underway regarding other potential utilization of the vehicle's unique capabilities. In its initial Block 1 configuration, capable of launching 70 metric tons (t) to low Earth orbit (LEO), SLS will propel the Orion crew vehicle to cislunar space, while also delivering small CubeSat-class spacecraft to deep-space destinations. With the addition of a more powerful upper stage, the Block 1B configuration of SLS will be able to deliver 105 t to LEO and enable more ambitious human missions into the proving ground of space. This configuration offers opportunities for launching co-manifested payloads with the Orion crew vehicle, and a class of secondary payloads, larger than today's CubeSats. Further upgrades to the vehicle, including advanced boosters, will evolve its performance to 130 t in its Block 2 configuration. Both Block 1B and Block 2 also offer the capability to carry 8.4- or 10-m payload fairings, larger than any contemporary launch vehicle. With unmatched mass-lift capability, payload volume, and C3, SLS not only enables spacecraft or mission designs currently impossible with contemporary EELVs, it also offers enhancing benefits, such as reduced risk, operational costs and/or complexity, shorter transit time to destination or launching large systems either monolithically or in fewer components. This paper will discuss both the performance and capabilities of Space Launch System as it evolves, and the current state of SLS utilization planning.

  16. A型血友病患儿家庭治疗护理状况回顾性调查分析%Current status of home care for children with hemophilia A

    Institute of Scientific and Technical Information of China (English)



    目的 调查中国A型血友病4~18岁患儿家庭治疗和护理状况。方法 2006年、2010年两次对血友病家庭治疗和护理状况进行调查。结果 A型血友病患儿诊断年龄和治疗年龄晚于首次出血年龄;凝血因子用量不足;血友病性骨关节病患病率高;开展了家庭治疗的血友病患儿从55例上升到119例,血友病患儿及家庭对发病原因、遗传规律、出血严重程度的评估和正确服用止痛药物认知率分别从80.8%、78.5%、37.4%和48.4%上升到94.7%、94.1%、52.7%和85.5%;在开展家庭康复训练、保持治疗记录完整两方面没有明显改善。结论 A型血友病患儿诊断治疗延迟,凝血因子用量不足,骨关节病发病率高,家庭护理水平仍然有待于进一步提高。%Objective To investigate the current status of home care for children with hemophilia A. Methods Twice investigation was conducted with a self-designed questionnaire about the status of home care in children with hemophilia A in 2006 and 2010. Results The diagnosis confirming and initial treatment were implemented after initial hemorrhage in children with hemophilia A. Moreover, the dosage of coagulation factor was insufficient and the incidence of joint deformity was high. The number of hemophilia A children received family therapy increased from 55 in 2006 to 119 in 2010. The mastery rates of knowledge on the etiology,inheritance rule,assesment of bleeding and proper use of analgesics were improved from 80.8 percent,78.5 percent,37.4 percent,and 48.4 percent in 2006 to 94.7 percent,94.1 percent,52.7 percent,and 85.5 percent in 2010,respectively. The status of home rehabilitation training and the completeness of medical records was not unproved. Conclusion Delayed diagnosis and treatment,insufficient dosage of coagulation factor,and high incidence of joint deformity are prevalent in the children with hemophilia A. The level of family therapy and home care is still need to

  17. Pin care (United States)

    ... gov/pubmed/24302374 . Nagy K. Discharge instructions for wound cares. The American Association of the Surgery of Trauma. . Accessed May 13, 2016.

  18. Palliative Care (United States)

    ... possessions to others, write a letter or a poem or compose a song, or decide what they ... One Year Off Treatment Transitioning to Adult Care Long-Term Follow-Up Care Coping With Cancer Overview ...

  19. Transportation capabilities study of DOE-owned spent nuclear fuel

    Energy Technology Data Exchange (ETDEWEB)

    Clark, G.L.; Johnson, R.A.; Smith, R.W. [Packaging Technology, Inc., Tacoma, WA (United States); Abbott, D.G.; Tyacke, M.J. [Lockheed Idaho Technologies Co., Idaho Falls, ID (United States)


    This study evaluates current capabilities for transporting spent nuclear fuel owned by the US Department of Energy. Currently licensed irradiated fuel shipping packages that have the potential for shipping the spent nuclear fuel are identified and then matched against the various spent nuclear fuel types. Also included are the results of a limited investigation into other certified packages and new packages currently under development. This study is intended to support top-level planning for the disposition of the Department of Energy`s spent nuclear fuel inventory.

  20. Heavy Lift Launch Capability with a New Hydrocarbon Engine (United States)

    Threet, Grady E., Jr.; Holt, James B.; Philips, Alan D.; Garcia, Jessica A.


    The Advanced Concepts Office at NASA's George C. Marshall Space Flight Center was tasked to define the thrust requirement of a new liquid oxygen rich staged combustion cycle hydrocarbon engine that could be utilized in a launch vehicle to meet NASA s future heavy lift needs. Launch vehicle concepts were sized using this engine for different heavy lift payload classes. Engine out capabilities for one of the heavy lift configurations were also analyzed for increased reliability that may be desired for high value payloads or crewed missions. The applicability for this engine in vehicle concepts to meet military and commercial class payloads comparable to current ELV capability was also evaluated.

  1. Hydrogen peroxide modified sodium titanates with improved sorption capabilities (United States)

    Nyman, May D.; Hobbs, David T.


    The sorption capabilities (e.g., kinetics, selectivity, capacity) of the baseline monosodium titanate (MST) sorbent material currently being used to sequester Sr-90 and alpha-emitting radioisotopes at the Savannah River Site are significantly improved when treated with hydrogen peroxide; either during the original synthesis of MST, or, as a post-treatment step after the MST has been synthesized. It is expected that these peroxide-modified MST sorbent materials will have significantly improved sorption capabilities for non-radioactive cations found in industrial processes and waste streams.

  2. PHISICS multi-group transport neutronic capabilities for RELAP5

    Energy Technology Data Exchange (ETDEWEB)

    Epiney, A.; Rabiti, C.; Alfonsi, A.; Wang, Y.; Cogliati, J.; Strydom, G. [Idaho National Laboratory (INL), 2525 N. Fremont Ave., Idaho Falls, ID 83402 (United States)


    PHISICS is a neutronic code system currently under development at INL. Its goal is to provide state of the art simulation capability to reactor designers. This paper reports on the effort of coupling this package to the thermal hydraulic system code RELAP5. This will enable full prismatic core and system modeling and the possibility to model coupled (thermal-hydraulics and neutronics) problems with more options for 3D neutron kinetics, compared to the existing diffusion theory neutron kinetics module in RELAP5 (NESTLE). The paper describes the capabilities of the coupling and illustrates them with a set of sample problems. (authors)

  3. Optical Design Capabilities at Lawrence Livermore National Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Lawson, J K


    Optical design capabilities continue to play the same strong role at Lawrence Livermore National Laboratory (LLNL) that they have played in the past. From defense applications to the solid-state laser programs to the Atomic Vapor Laser Isotope Separation (AVLIS), members of the optical design group played critical roles in producing effective system designs and are actively continuing this tradition. This talk will explain the role optical design plays at LLNL, outline current capabilities and summarize a few activities in which the optical design team has been recently participating.

  4. Comparing Care

    NARCIS (Netherlands)

    Evert Pommer; Isolde Woittiez; John Stevens


    Home care is one of the most important means of compensating for disabilities and ensuring continuity in people's daily functioning. Home care services in the Netherlands have recently been transferred from a national social security provision for long-term care to a local social service. In most ot

  5. Employer-Supported Child Care in Ontario. (United States)

    Ontario Ministry of Community and Social Services, Toronto.

    Six case studies describing current employer-supported child care services in Ontario are presented. The studies describe the PLADEC Day Care Center of the Kingston Psychiatric Hospital, the day care center at the Chedoke-McMaster Hospitals in Hamilton, the Early Learning Centre at Durham College in Oshawa, the Hydrokids day care center at the…

  6. Meso-scale machining capabilities and issues

    Energy Technology Data Exchange (ETDEWEB)



    Meso-scale manufacturing processes are bridging the gap between silicon-based MEMS processes and conventional miniature machining. These processes can fabricate two and three-dimensional parts having micron size features in traditional materials such as stainless steels, rare earth magnets, ceramics, and glass. Meso-scale processes that are currently available include, focused ion beam sputtering, micro-milling, micro-turning, excimer laser ablation, femto-second laser ablation, and micro electro discharge machining. These meso-scale processes employ subtractive machining technologies (i.e., material removal), unlike LIGA, which is an additive meso-scale process. Meso-scale processes have different material capabilities and machining performance specifications. Machining performance specifications of interest include minimum feature size, feature tolerance, feature location accuracy, surface finish, and material removal rate. Sandia National Laboratories is developing meso-scale electro-mechanical components, which require meso-scale parts that move relative to one another. The meso-scale parts fabricated by subtractive meso-scale manufacturing processes have unique tribology issues because of the variety of materials and the surface conditions produced by the different meso-scale manufacturing processes.

  7. Delirium assessment in Intensive Care Unit in one hospital:current practice and perceived barriers%某医院ICU护士谵妄评估现状及障碍因素调查

    Institute of Scientific and Technical Information of China (English)

    李智; 田永明; 李霞; 唐志红; 胡秀英


    Objective: To investigate the current practices of delirium assessment and analyze the perceived barriers among ICU nurses, and to provide reference to improve delirium assessment in ICU. Methods: A questionnaire survey was implemented among 256 ICU nurses in one hospital in Sichuan province. Results: 94.9% nurses had the experiences of caring delirium patients in ICU. Preferred methods for assessing delirium included clinical experience (80.5%), delirium assessment tools (14.5%), and psychiatric consultation (5.0%). The top three perceived barriers were dififculties in assessing intubated patients, assessing sedative patients and lack of delirium assessment knowledge. Nurses who assessed by clinical experience, who had never received related educations and who thought they had insufifcient knowledge, had higher scores of barriers. Conclusion: The current practices of ICU delirium assessment were unsatisfying, and the main barriers were lack of skills and knowledge.%目的:调查ICU护士谵妄评估实施现状,分析影响其评估的障碍因素,为促进ICU谵妄评估实践提供参考依据。方法:采用自行设计的问卷对四川省某医院256位ICU护士进行调查。结果:94.9%的护士护理过谵妄患者,80.5%的护士通过临床经验识别谵妄,14.5%通过评估工具,5.0%则是通过精神科医生会诊意见。插管患者评估困难、镇静患者评估困难及认为自己缺乏ICU谵妄评估相关知识是ICU谵妄评估的三大障碍因素。通过临床经验评估谵妄者、未接受过谵妄评估培训者、自评相关知识不能满足临床工作者的障碍因素得分更高,差异有统计学意义。结论:ICU谵妄评估现状尚须改善,护士缺乏谵妄评估相关技能和知识是主要障碍因素。

  8. Preconception Care and Prenatal Care (United States)

    ... at risk for complications? How does stress affect pregnancy? NICHD Research Information Clinical Trials Resources and Publications Preconception Care and Prenatal Care: Condition Information Skip sharing on social media links Share this: Page Content What is preconception ...

  9. Spin current

    CERN Document Server

    Valenzuela, Sergio O; Saitoh, Eiji; Kimura, Takashi


    In a new branch of physics and technology called spin-electronics or spintronics, the flow of electrical charge (usual current) as well as the flow of electron spin, the so-called 'spin current', are manipulated and controlled together. This book provides an introduction and guide to the new physics and application of spin current.

  10. Virtual care

    DEFF Research Database (Denmark)

    Kamp, Annette; Aaløkke Ballegaard, Stinne

    of retrenchment, promising better quality, empowerment of citizens and work that is smarter and more qualified. Through ethnographic field studies we study the introduction of virtual home care in Danish elderly care, focusing on the implications for relational work and care relations. Virtual home care entails...... and professionals, and they instigate change in organization and professional identities. Studies, which more specifically deal with telecare, stress how virtualization alters the character of the observations care workers are able to make, and how the validity of the patients’ own measurements and observations...... point out how issues of trust and surveillance, which are always negotiated in care relations, are in fact accentuated in this kind of virtual care work. Moreover, we stress that the contemporary institutional context, organization and time schedules have a vast impact on the practices developed....

  11. Who Cares for Care Leavers? (United States)

    Askew, Julie; Rodgers, Paul; West, Andrew


    This chapter describes a programme of learning and development at the University of Sheffield, United Kingdom, to support looked-after children and care leavers (youth previously provided care outside or beyond family) throughout the student lifecycle. In this context, looked-after children are those cared for by a town/city authority where…

  12. Evaluating Internal Technological Capabilities in Energy Companies


    Mingook Lee; Sungjoo Lee


    As global competition increases, technological capability must be evaluated objectively as one of the most important factors for predominance in technological competition and to ensure sustainable business excellence. Most existing capability evaluation models utilize either quantitative methods, such as patent analysis, or qualitative methods, such as expert panels. Accordingly, they may be in danger of reflecting only fragmentary aspects of technological capabilities, and produce inconsiste...

  13. Compilation of Sandia Laboratories technical capabilities

    Energy Technology Data Exchange (ETDEWEB)

    Lundergan, C. D.; Mead, P. L. [eds.


    This report is a compilation of 17 individual documents that together summarize the technical capabilities of Sandia Laboratories. Each document in this compilation contains details about a specific area of capability. Examples of application of the capability to research and development problems are provided. An eighteenth document summarizes the content of the other seventeen. Each of these documents was issued with a separate report number (SAND 74-0073A through SAND 74-0091, except -0078). (RWR)

  14. Dynamic Capabilities within the Project Management Environment



    Dynamic Capabilities is a contemporary popular notion, incorporating the ability to adjust a company’s resources adequately to exploit opportunities, prevent threats and consequently retain competitive advantage. Teece et al. (1997) coined Dynamic Capabilities and triggered a wave of research on the topic. However the notion is still in its infancy through academic disputes, different viewpoints and multiple definitions. Consequently tool, measure and procedures of Dynamic Capabilities are ab...

  15. Understanding dynamic capabilities through knowledge management

    DEFF Research Database (Denmark)

    Nielsen, Anders Paarup


    In the paper eight knowledge management activities are identified; knowledge creation, acquisition, capture, assembly, sharing, integration, leverage and exploitation. These activities are assembled into the three dynamic capabilities of knowledge development, knowledge (re)combination and knowle......In the paper eight knowledge management activities are identified; knowledge creation, acquisition, capture, assembly, sharing, integration, leverage and exploitation. These activities are assembled into the three dynamic capabilities of knowledge development, knowledge (re......)combination and knowledge use. The dynamic capabilities and the associated knowledge management activities create flows to and from the firm’s stock of knowledge and they support the creation and use of organizational capabilities....

  16. Aerodynamics Laboratory Facilities, Equipment, and Capabilities (United States)

    Federal Laboratory Consortium — The following facilities, equipment, and capabilities are available in the Aerodynamics Laboratory Facilities and Equipment (1) Subsonic, open-jet wind tunnel with...

  17. Developing Technological Capabilities in Agro-Industry

    DEFF Research Database (Denmark)

    Whitfield, Lindsay


    This article examines the emergence and trajectory of a new agro-industry in Ghana, the pineapple export industry, using the technological capabilities approach. It explains the limited expansion of the industry and its declining competitiveness in the face of new competition by looking at how...... Ghanaian exporters developed technological capabilities initially and the incentives and disincentives to building on those capabilities. The article argues that at the heart of the industry's crisis was an inability to further develop technological capabilities. The crisis had systemic features that have...

  18. Advance care directives (United States)

    ... advance directive; Do-not-resuscitate - advance directive; Durable power of attorney - advance care directive; POA - advance care directive; Health care agent - advance care directive; Health care proxy - ...

  19. Strengthening care of injured children globally. (United States)

    Mock, Charles; Abantanga, Francis; Goosen, Jacques; Joshipura, Manjul; Juillard, Catherine


    Part of the solution to the growing problem of child injury is to strengthen the care that injured children receive. This paper will point out the potential health gains to be made by doing this and will then review recent advances in the care of injured children in individual institutions and countries. It will discuss how these individual efforts have been aided by increased international attention to trauma care. Although there are no major, well-funded global programmes to improve trauma care, recent guidance documents developed by WHO and a broad network of collaborators have stimulated increased global attention to improving planning and resources for trauma care. This has in turn led to increased attention to strengthening trauma care capabilities in countries, including needs assessments and implementation of WHO recommendations in national policy. Most of these global efforts, however, have not yet specifically addressed children. Given the special needs of the injured child and the high burden of injury-related death and disability among children, clearly greater emphasis on childhood trauma care is needed. Trauma care needs assessments being conducted in a growing number of countries need to focus more on capabilities for care of injured children. Trauma care policy development needs to better encompass childhood trauma care. More broadly, the growing network of individuals and groups collaborating to strengthen trauma care globally needs to engage a broader range of stakeholders who will focus on and champion the improvement of care for injured children.

  20. The development of capability measures in health economics: opportunities, challenges and progress. (United States)

    Coast, Joanna; Kinghorn, Philip; Mitchell, Paul


    Recent years have seen increased engagement amongst health economists with the capability approach developed by Amartya Sen and others. This paper focuses on the capability approach in relation to the evaluative space used for analysis within health economics. It considers the opportunities that the capability approach offers in extending this space, but also the methodological challenges associated with moving from the theoretical concepts to practical empirical applications. The paper then examines three 'families' of measures, Oxford Capability instruments (OxCap), Adult Social Care Outcome Toolkit (ASCOT) and ICEpop CAPability (ICECAP), in terms of the methodological choices made in each case. The paper concludes by discussing some of the broader issues involved in making use of the capability approach in health economics. It also suggests that continued exploration of the impact of different methodological choices will be important in moving forward.

  1. [Current management of epilepsy]. (United States)

    Mizobuchi, Masahiro


    Epilepsy is one of the most common neurological disorders. Global neurological knowledge is essential for differential diagnosis of epileptic syndromes due to the diversity of ictal semiology, causes and syndromes. Neurologists play an important role in planning the medical care for patients with epilepsy, as medication is the most fundamental therapeutic strategy. Some patients with early-onset epilepsy require joint care by pediatric neurologists, those with intractable epilepsy by neurosurgeons, and those with psychological comorbidity by psychiatrists, and neurologists should play a coordinating role. While there is a great need for neurologists to participate in epilepsy care, neurologists in Japan currently do not participate substantially in the epilepsy management system. It is necessary to train more neurologists who can provide epilepsy care and conduct basic and clinical research on epilepsy by providing continuous education on epilepsy for general neurologists as well as pre- and post-graduate medical students. Most of the patients who require long-term treatment experience many medical problems and social handicaps, such as adverse effects of medication, social stigma, educational disadvantages and difficulties in obtaining driver's license. To improve the quality of life of patients with epilepsy, it is desirable to build broad medical-social networks participated by patients, doctors, neurological nurses, psychologists, social workers, school teachers, managers of employment support facilities and care givers.

  2. The current status of the patient safety culture in intensive care unit nurses and influencing factors%ICU护士患者安全文化认知水平现状及其影响因素研究

    Institute of Scientific and Technical Information of China (English)

    刘文婷; 尹安春


    目的 了解ICU护士对患者安全文化的认知现状,并分析其影响因素.方法 采用一般资料调查表、患者安全文化调查问卷、护理不良事件报告障碍问卷、工作授能条件量表,对大连市6家综合性医院373名ICU护士进行调查.结果 ICU护士患者安全文化各维度积极反应率均值为68.08%,其中科室内团队合作的积极反应率最高(89.95%),人员配置的积极反应率最低(35.53%).多元回归分析显示,报告意义、惩罚性文化、正式授权、机会授权、资源授权、急诊ICU科室对ICU护士患者安全文化有显著影响(P<0.05).结论 ICU护士患者安全文化平均积极反应率总体呈中等水平,仍有待进一步提升;护理管理者应结合影响因素,合理制订干预措施,提高ICU护士患者安全文化水平,增强安全文化意识,进而提升危重症护理服务质量.%Objective To investigate the current status of cognitive level of patient safety culture in intensive care unit (ICU) nurses and analyze the influencing factors.Methods Totally 373 ICU nurses were investigated with the general information questionnaire,the Hospital Survey on Patient Safety Culture instrument (HSOPSC),the Report Barriers Questionnaire and the Condition of Work Effectiveness Questionnaire (CWEQ-Ⅱ).Results The mean rate of positive response on safety culture dimensions was 68.08% in ICU nurses,Organizational learning-continuous improvement was the safety culture dimension with the highest positive response(89.95%),the lowest positive response was staffing(35.53%).Multiple regression analysis showed that the meaning of report,punitive culture,resources,opportunity,formal empowerment and ICU department were influencing factors of patient safety culture (P < 0.05).Conclusions The level of patient safety culture in ICU nurses was medium,it remains a further improvement.Nursing managers should take targeted measures according to the influencing factors to

  3. FTO5/470: Critical Incident Monitoring in Emergency Medicine Web-based System (CRIME-base): Current evidence on incident reporting and its impact to quality of care


    Arvanitis, TN; Ryan, J.


    Introduction A critical incident is "any event which is inconsistent with routine hospital practice or with the quality of patient care and which has or could have had a demonstrably adverse outcome for a particular patient" (J.A. Williamson, Critical Incident Reporting in Anaesthesia. Anaesthetic Intensive Care, 1988: 16: 101-103). Such "negative incidents" may arise as a result of a variety of reasons during routine hospital practice. Incident monitoring and reporting has been identified as...

  4. Cultivating Human Capabilities in Venturesome Learning Environments (United States)

    Hogan, Padraig


    The notion of competencies has been a familiar feature of educational reform policies for decades. In this essay, Padraig Hogan begins by highlighting the contrasting notion of capabilities, pioneered by the research of Amartya Sen and Martha Nussbaum. An educational variant of the notion of capabilities then becomes the basis for exploring…

  5. Distinctive Dynamic Capabilities for New Business Creation

    DEFF Research Database (Denmark)

    Rosenø, Axel; Enkel, Ellen; Mezger, Florian


    This study examines the distinctive dynamic capabilities for new business creation in established companies. We argue that these are very different from those for managing incremental innovation within a company's core business. We also propose that such capabilities are needed in both slow...

  6. Knowledge Perspectives on Advancing Dynamic Capability

    NARCIS (Netherlands)

    van Reijsen, J.


    Dynamic Capability is the organizational capacity to timely adapt to a changing market environment by reconfiguring resources and routines in order to stay competitive. Although dynamic capability is considered the Holy Grail of strategic management, a connection to the knowledge management domain i

  7. Methodological Individualism and the Organizational Capabilities Approach

    DEFF Research Database (Denmark)

    Felin, Teppo; Foss, Nicolai Juul


    critical individual-levelconsiderations, including individual action and heterogeneity. In this note we do not denyor reject the notion of routines or capabilities per se, but rather call for an increasedemphasis on how these collective structures originate and change as a result of individualactions.......Key words: Organizational capabilities, methodological individualism, philosophy ofsocial science...

  8. A framework for offshore vendor capability development (United States)

    Yusuf Wibisono, Yogi; Govindaraju, Rajesri; Irianto, Dradjad; Sudirman, Iman


    Offshore outsourcing is a common practice conducted by companies, especially in developed countries, by relocating one or more their business processes to other companies abroad, especially in developing countries. This practice grows rapidly owing to the ease of accessing qualified vendors with a lower cost. Vendors in developing countries compete more intensely to acquire offshore projects. Indonesia is still below India, China, Malaysia as main global offshore destinations. Vendor capability is among other factors that contribute to the inability of Indonesian vendor in competing with other companies in the global market. Therefore, it is essential to study how to increase the vendor's capability in Indonesia, in the context of global offshore outsourcing. Previous studies on the vendor's capability mainly focus on capabilities without considering the dynamic of capabilities due to the environmental changes. In order to be able to compete with competitors and maintain the competitive advantage, it is necessary for vendors to develop their capabilities continuously. The purpose of this study is to develop a framework that describes offshore vendor capability development along the client-vendor relationship stages. The framework consists of three main components, i.e. the stages of client-vendor relationship, the success of each stage, and the capabilities of vendor at each stage.

  9. Design for Development: A Capability Approach

    NARCIS (Netherlands)

    Oosterlaken, I.


    In this article I suggest a ‘capability approach’ towards designing for society, and particularly, the world’s poor. I will explain that this approach assigns a central place to human capabilities in our discussions of justice and development and criticizes a focus on utility or preference satisfact

  10. A comparison of two commercial volumetry software programs in the analysis of pulmonary ground-glass nodules: Segmentation capability and measurement accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyung Jin; Park, Chang Min; Lee, Sang Min; Lee, Hyun Joo; Goo, Jin Mo [Dept. of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul (Korea, Republic of)


    To compare the segmentation capability of the 2 currently available commercial volumetry software programs with specific segmentation algorithms for pulmonary ground-glass nodules (GGNs) and to assess their measurement accuracy. In this study, 55 patients with 66 GGNs underwent unenhanced low-dose CT. GGN segmentation was performed by using 2 volumetry software programs (LungCARE, Siemens Healthcare; LungVCAR, GE Healthcare). Successful nodule segmentation was assessed visually and morphologic features of GGNs were evaluated to determine factors affecting segmentation by both types of software. In addition, the measurement accuracy of the software programs was investigated by using an anthropomorphic chest phantom containing simulated GGNs. The successful nodule segmentation rate was significantly higher in LungCARE (90.9%) than in LungVCAR (72.7%) (p = 0.012). Vascular attachment was a negatively influencing morphologic feature of nodule segmentation for both software programs. As for measurement accuracy, mean relative volume measurement errors in nodules ≥ 10 mm were 14.89% with LungCARE and 19.96% with LungVCAR. The mean relative attenuation measurement errors in nodules ≥ 10 mm were 3.03% with LungCARE and 5.12% with LungVCAR. LungCARE shows significantly higher segmentation success rates than LungVCAR. Measurement accuracy of volume and attenuation of GGNs is acceptable in GGNs ≥ 10 mm by both software programs.

  11. Capabilities of the Large-Scale Sediment Transport Facility (United States)


    experiments in wave/current environments. INTRODUCTION : The LSTF (Figure 1) is a large-scale laboratory facility capable of simulating conditions...into a cDAQ-9184 CompactDAQ Chassis via a 16- channel NI 9220. The four offshore wave gauge signals are broadcasted wirelessly via a National...Instrument 9201 paired with a cDAQ-9191. A wireless router then moves this data onto the local area network. A Cisco SG 200 switch is used to manage the

  12. Care Ethics in Education. (United States)

    Shelby, Candice L.


    Difficulties with current models of ethics education (correct reasoning, virtue theory, directive moral education) include emphasis on reward/punishment and a presumptive bias toward abstract reasoning. Teaching a care-based ethics would promote a fuller notion of mature moral agents and broaden the school climate beyond compliance. (Contains 19…

  13. [A theory on care]. (United States)

    Svandra, Philippe


    Trying to define the nature of care when you are a health care professional, means, inevitably, going back to the very source of your professional commitment. Caring, an essential form of responsibility for the other, is thus revealed as a way of behaving towards other people, as an active and concrete commitment testifying as much to the humanity of the one who gives it as to that of the one who receives it. Starting with the notion of the phenomenology of human capacity, Paul Ricoeur thinks of independence in terms of capacity. He calls upon work of the Indian economist Amartya Sen published in the 1980s on the notion of capabilities. This leads to conceiving disease or disability as a lack of elementary or basic capacity. According to Ricoeur, this notion of capacity can only be understood by looking at its contrary: vulnerability. In this way, only a weakened frail person can be called upon to become independent. Thus the human being, and particularly the ill human being, must be looked upon as both vulnerable, and thus suffering, and capable, and thus active.

  14. Evaluating Internal Technological Capabilities in Energy Companies

    Directory of Open Access Journals (Sweden)

    Mingook Lee


    Full Text Available As global competition increases, technological capability must be evaluated objectively as one of the most important factors for predominance in technological competition and to ensure sustainable business excellence. Most existing capability evaluation models utilize either quantitative methods, such as patent analysis, or qualitative methods, such as expert panels. Accordingly, they may be in danger of reflecting only fragmentary aspects of technological capabilities, and produce inconsistent results when different models are used. To solve these problems, this paper proposes a comprehensive framework for evaluating technological capabilities in energy companies by considering the complex properties of technological knowledge. For this purpose, we first explored various factors affecting technological capabilities and divided the factors into three categories: individual, organizational, and technology competitiveness. Second, we identified appropriate evaluation items for each category to measure the technological capability. Finally, by using a hybrid approach of qualitative and quantitative methods, we developed an evaluation method for each item and suggested a method to combine the results. The proposed framework was then verified with an energy generation and supply company to investigate its practicality. As one of the earliest attempts to evaluate multi-faceted technological capabilities, the suggested model can support technology and strategic planning.

  15. Community Psychology and the Capabilities Approach (United States)


    What makes for a good life? The capabilities approach to this question has much to offer community psychology, particularly with respect to marginalized groups. Capabilities are freedoms to engage in valued social activities and roles—what people can do and be given both their capacities, and environmental opportunities and constraints. Economist Amartya Sen’s focus on freedoms and agency resonates with psychological calls for empowerment, and philosopher Martha Nussbaum’s specification of requirements for a life that is fully human provides an important guide for social programs. Community psychology’s focus on mediating structures has much to offer the capabilities approach. Parallels between capabilities, as enumerated by Nussbaum, and settings that foster positive youth development, as described in a National Research Council Report (Eccles and Gootman (Eds) in Community programs to promote youth development. National Academy Press, Washington, 2002) suggest extensions of the approach to children. Community psychologists can contribute to theory about ways to create and modify settings to enhance capabilities as well as empowerment and positive youth development. Finally, capabilities are difficult to measure, because they involve freedoms to choose but only choices actually made or enacted can be observed. The variation in activities or goals across members of a setting provides a measure of the capabilities that the setting fosters. PMID:25822113

  16. CTH reference manual : composite capability and technologies.

    Energy Technology Data Exchange (ETDEWEB)

    Key, Christopher T.; Schumacher, Shane C.


    The composite material research and development performed over the last year has greatly enhanced the capabilities of CTH for non-isotropic materials. The enhancements provide the users and developers with greatly enhanced capabilities to address non-isotropic materials and their constitutive model development. The enhancements to CTH are intended to address various composite material applications such as armor systems, rocket motor cases, etc. A new method for inserting non-isotropic materials was developed using Diatom capabilities. This new insertion method makes it possible to add a layering capability to a shock physics hydrocode. This allows users to explicitly model each lamina of a composite without the overhead of modeling each lamina as a separate material to represent a laminate composite. This capability is designed for computational speed and modeling efficiency when studying composite material applications. In addition, the layering capability also allows a user to model interlaminar mechanisms. Finally, non-isotropic coupling methods have been investigated. The coupling methods are specific to shock physics where the Equation of State (EOS) is used with a nonisotropic constitutive model. This capability elastically corrects the EOS pressure (typically isotropic) for deviatoric pressure coupling for non-isotropic materials.

  17. Community psychology and the capabilities approach. (United States)

    Shinn, Marybeth


    What makes for a good life? The capabilities approach to this question has much to offer community psychology, particularly with respect to marginalized groups. Capabilities are freedoms to engage in valued social activities and roles-what people can do and be given both their capacities, and environmental opportunities and constraints. Economist Amartya Sen's focus on freedoms and agency resonates with psychological calls for empowerment, and philosopher Martha Nussbaum's specification of requirements for a life that is fully human provides an important guide for social programs. Community psychology's focus on mediating structures has much to offer the capabilities approach. Parallels between capabilities, as enumerated by Nussbaum, and settings that foster positive youth development, as described in a National Research Council Report (Eccles and Gootman (Eds) in Community programs to promote youth development. National Academy Press, Washington, 2002) suggest extensions of the approach to children. Community psychologists can contribute to theory about ways to create and modify settings to enhance capabilities as well as empowerment and positive youth development. Finally, capabilities are difficult to measure, because they involve freedoms to choose but only choices actually made or enacted can be observed. The variation in activities or goals across members of a setting provides a measure of the capabilities that the setting fosters.

  18. Barriers to Care for Depressed Older People: Perceptions of Aged Care among Medical Professionals (United States)

    McCabe, Marita P.; Davison, Tanya; Mellor, David; George, Kuruvilla


    The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care,…

  19. A Capability Approach for the European Union


    Eiffe, Franz F.


    The aim of this paper is to develop a new concept for the EU in order to define and measure poverty no longer on the basis of income1, but on so called capabilities to argue for a capability oriented social policy. The capability approach (CA) was originally developed by Nobel laureate Amartya Sen2 and can be interpreted as critique of the utilitarian tradition of standard economics. In Sen's view, mainstream economic analysis operates on a very narrow base and does not include central inform...

  20. Photovoltaic Systems Test Facilities: Existing capabilities compilation (United States)

    Volkmer, K.


    A general description of photovoltaic systems test facilities (PV-STFs) operated under the U.S. Department of Energy's photovoltaics program is given. Descriptions of a number of privately operated facilities having test capabilities appropriate to photovoltaic hardware development are given. A summary of specific, representative test capabilities at the system and subsystem level is presented for each listed facility. The range of system and subsystem test capabilities available to serve the needs of both the photovoltaics program and the private sector photovoltaics industry is given.

  1. Maximizing Health or Sufficient Capability in Economic Evaluation? A Methodological Experiment of Treatment for Drug Addiction. (United States)

    Goranitis, Ilias; Coast, Joanna; Day, Ed; Copello, Alex; Freemantle, Nick; Frew, Emma


    Conventional practice within the United Kingdom and beyond is to conduct economic evaluations with "health" as evaluative space and "health maximization" as the decision-making rule. However, there is increasing recognition that this evaluative framework may not always be appropriate, and this is particularly the case within public health and social care contexts. This article presents a methodological case study designed to explore the impact of changing the evaluative space within an economic evaluation from health to capability well-being and the decision-making rule from health maximization to the maximization of sufficient capability. Capability well-being is an evaluative space grounded on Amartya Sen's capability approach and assesses well-being based on individuals' ability to do and be the things they value in life. Sufficient capability is an egalitarian approach to decision making that aims to ensure everyone in society achieves a normatively sufficient level of capability well-being. The case study is treatment for drug addiction, and the cost-effectiveness of 2 psychological interventions relative to usual care is assessed using data from a pilot trial. Analyses are undertaken from a health care and a government perspective. For the purpose of the study, quality-adjusted life years (measured using the EQ-5D-5L) and years of full capability equivalent and years of sufficient capability equivalent (both measured using the ICECAP-A [ICEpop CAPability measure for Adults]) are estimated. The study concludes that different evaluative spaces and decision-making rules have the potential to offer opposing treatment recommendations. The implications for policy makers are discussed.

  2. Childhood socioeconomic position and objectively measured physical capability levels in adulthood

    DEFF Research Database (Denmark)

    Birnie, Kate; Cooper, Rachel; Martin, Richard M;


    Grip strength, walking speed, chair rising and standing balance time are objective measures of physical capability that characterise current health and predict survival in older populations. Socioeconomic position (SEP) in childhood may influence the peak level of physical capability achieved...... in early adulthood, thereby affecting levels in later adulthood. We have undertaken a systematic review with meta-analyses to test the hypothesis that adverse childhood SEP is associated with lower levels of objectively measured physical capability in adulthood....

  3. Materials Capability Review Los Alamos National Laboratory April 29-May 2, 2012

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, Antoinette J [Los Alamos National Laboratory


    Los Alamos National Laboratory (LANL) uses Capability Reviews to assess the quality and institutional integration of science, technology and engineering (STE) and to advise Laboratory Management on the current and future health of LANL STE. The capabilities are deliberately chosen to be crosscutting over the Laboratory and therefore will include experimental, theoretical and simulation disciplines from multiple line organizations. Capability Reviews are designed to provide a more holistic view of the STE quality, integration to achieve mission requirements, and mission relevance. The scope of these capabilities necessitate that there will be significant overlap in technical areas covered by capability reviews (e.g., materials research and weapons science and engineering). In addition, LANL staff may be reviewed in different capability reviews because of their varied assignments and expertise. The principal product of the Capability Review is the report that includes the review committee's assessments, recommendations, and recommendations for STE.

  4. Analysis on current situation of doing their duty among maternal & child health care centers in 2008%2008年全国妇幼保健机构职能履行现状分析

    Institute of Scientific and Technical Information of China (English)

    聂妍; 王存库; 罗荣; 黄爱群; 张彤


    Objective: To find out perform of function among nationwide maternal & child health care centers by investigation of population health care services and healthcare technology services in 2767 maternal & child health care centers in 2008.Methods: Based on modern network transmission system- National Maternal & Child Health Care Center Management Information System, which is a lively reporting system.Results: Most of the MCHs have carry out multinomial population health care services and the healthcare technology services have developed smoothly, while population health care services has yet to be improved.Conclusion: Government should increase the investment in manpower, material resources and financial resources.Simultaneously pay more attention to MCHs'personnel training, improve maternal and child health management system, so that promote MCHs'standardization development.%目的:通过对2008年全国2 767所妇幼保健机构的群体保健工作以及医疗保健技术服务的调查,掌握全国妇幼保健机构职能履行情况.方法:基于现代化的网络传输系统开发,实现信息网络实时直报.结果:大部分妇幼保健机构开展了多项群体保健服务管理工作,医疗保健技术服务工作开展较顺利;辖区群体保健服务有待提高.结论:政府应加大对妇幼保健机构人力、物力、财力的投入,重视妇幼保健人才队伍的培养,完善妇幼卫生管理机制,促进妇幼保健机构规范化建设.

  5. The Impact of IT Capability on Employee Capability, Customer Value, Customer Satisfaction, and Business Performance (United States)

    Chae, Ho-Chang


    This study empirically examines the impact of IT capability on firms' performance and evaluates whether firms' IT capabilities play a role in improving employee capability, customer value, customer satisfaction, and ultimately business performance. The results were based on comparing the business performance of the IT leader companies with that of…

  6. Classifying organisational capabilities by their nature and role for technological capability

    NARCIS (Netherlands)

    Rousseva, R.


    Based on critical literature review this research highlights a number of gaps in the existing treatment of technological and organisational capabilities. It has been recognised that organisational capabilities have an important role to play in development of technological capabilities both in lateco

  7. Palliative care in home care: perceptions of occupational therapists

    Directory of Open Access Journals (Sweden)

    Séfora Gomez Portela


    Full Text Available This research aimed at understanding and reflecting on the perceptions of occupational therapists regarding the implementation of palliative care in home care. This is an exploratory, qualitative study, through semi-structured interviews, conducted in the second semester of 2012 with eight occupational therapists with experience in palliative care in the city of São Paulo. Content analysis identified four themes: characterization and professional trajectory in the field, understanding the concepts of palliative care, home care and palliative care, and occupational therapy and palliative care in home care. The results suggest that the role of the occupational therapist in this field has taken place at different levels of health care, being addressed to people with varying needs. The use of the concept of palliative care by the interviewees exceeds the notion of end of life, following the changes in the epidemiological transition. They understand that professional services follow the trend of national palliative care services with focus on specialized levels, but manifest the importance of its implementation in primary and home care. Among the barriers to practice, they identified the complexity of “being at home “, peculiarities of palliative care with high cost demands, lack of infrastructure and implementation of the current policy. Professional training and scientific roduction in the area were viewed as inadequate, although they identified a call for change. The interviewees recognized palliative care in home care as a strong professional field, but one still requiring study and discussions regarding its limits and conditions of implementation, especially in the Unified Health System.

  8. 235例患者临终关怀现状调查及其影响因素分析%The Current Situation of Hospice Care and Influencing Factors in 235 Cases

    Institute of Scientific and Technical Information of China (English)

    辛爱利; 阎向东; 王彩燕


    Objective:To survey the level of hospice care and the influencing factors in Shaanxi province. Methods:Interview and return visit method was used to investigate. Results:In total 235 patients, 37. 02% patients received hos-pice care. There is not significant difference between hospice users and no hospice users in sex and geographic differ-ences. There was significant difference between hospice users and no hospice users in personal ages, and in gap between urban and rural areas. and in medical payment, and in basic lesions. Malignant tumor patients receive hospice care most-ly. No patient received hospice care patients with acute trauma. The effect of ages on hospice is maximum ( OR =2. 877). Basic lesions is an important cause of influence whether patients receiving hospice care services(OR=1. 569). Conclusion:The level of hospice care is low in Shaanxi. The age and basic lesions is influencing factors of hospice care. The geographic differences has no effect on hospice care.%目的:了解陕西地区临终关怀现状,分析其影响因素。方法采用门诊访谈和回访两种调查方法。结果在235例被调查患者中,37.02%的患者接受了临终关怀服务;患者在性别、所在地区两方面无显著性差异,在年龄、城乡差别、医疗付费方式方面存在显著性差异;基础病变明显影响临终关怀,恶性肿瘤患者接受临终关怀最多,急性外伤患者无1例接受临终关怀服务;年龄对临终关怀影响最大( OR=2.877);基础疾病则是影响患者是否接受临终关怀服务的重要原因( OR=1.569)。结论陕西地区临终关怀处于较低水平;年龄、基础疾病是影响临终关怀的因素;地域差别对临终关怀无影响。

  9. Canadian national nuclear forensics capability project

    Energy Technology Data Exchange (ETDEWEB)

    Ball, J.; Dimayuga, I., E-mail: [Canadian Nuclear Laboratories, Chalk River, Ontario (Canada); Summerell, I. [Royal Canadian Mounted Police, Ottawa, Ontario (Canada); Totland, M. [Canadian Nuclear Laboratories, Chalk River, Ontario (Canada); Jonkmans, G. [Defence Research and Development Canada, Ottawa, Ontario (Canada); Whitlock, J. [Canadian Nuclear Laboratories, Chalk River, Ontario (Canada); El-jaby, A. [Canadian Nuclear Safety Commission, Ottawa, Ontario (Canada); Inrig, E. [Defence Research and Development Canada, Ottawa, Ontario (Canada)


    Following the 2010 Nuclear Security Summit, Canada expanded its existing capability for nuclear forensics by establishing a national nuclear forensics laboratory network, which would include a capability to perform forensic analysis on nuclear and other radioactive material, as well as on traditional evidence contaminated with radioactive material. At the same time, the need for a national nuclear forensics library of signatures of nuclear and radioactive materials under Canadian regulatory control was recognized. The Canadian Safety and Security Program, administered by Defence Research and Development Canada's Centre for Security Science (DRDC CSS), funds science and technology initiatives to enhance Canada's preparedness for prevention of and response to potential threats. DRDC CSS, with assistance from Canadian Nuclear Laboratories, formerly Atomic Energy of Canada Limited, is leading the Canadian National Nuclear Forensics Capability Project to develop a coordinated, comprehensive, and timely national nuclear forensics capability. (author)

  10. The Capabilities of the Offshore Middlemen

    DEFF Research Database (Denmark)

    Mahnke, Volker; Wareham, Jonathan

    preliminary theoretical justification for the emergence of offshore intermediaries; describe how and why they develop intermediation capabilities; and offer initial evidence substantiating their function and processes in intermediating transnational offshoring relationships in software development...

  11. Physical examinations and laboratory tests in antenatal care visits in Denmark. Do reported practice and current official guidelines concord with results of literature reviews? A nationwide study of the public scheme of shared antenatal care in general practice, centres of midwifery and hospital

    DEFF Research Database (Denmark)

    Kristensen, F B; Andersen, K V; Andersen, A M


    To analyse physical examinations and laboratory tests reported in antenatal care visits in relation to official guidelines and reviews of appropriateness.......To analyse physical examinations and laboratory tests reported in antenatal care visits in relation to official guidelines and reviews of appropriateness....

  12. Aging and DNA repair capability. [Review

    Energy Technology Data Exchange (ETDEWEB)

    Tice, R R


    A review of the literature on DNA repair processes in relation to aging is presented under the following headings: DNA repair processes; age-related occurrence of unrepaired DNA lesions; DNA repair capability as a function of age; tissue-specific DNA repair capability; acceleration of the aging process by exposure to DNA damaging agents; human genetic syndromes; and longevity and DNA repair processes. (HLW)

  13. Descriptors of server capabilities in China

    DEFF Research Database (Denmark)

    Adeyemi, Oluseyi; Slepniov, Dmitrij; Wæhrens, Brian Vejrum;


    China with the huge market potential it possesses is an important issue for subsidiaries of western multinational companies. The objective of this paper is therefore to strengthen researchers’ and practitioners’ perspectives on what are the descriptors of server capabilities. The descriptors...... are relevant to determine subsidiary roles and as an indication of the capabilities required. These descriptors are identified through extensive literature review and validated by case studies of two Danish multinational companies subsidiaries operating in China. They provided the empirical basis...

  14. Analysis of the Capability Portfolio Review (CPR) (United States)


    with affordability. The CPR process is a critical element in restoring the balance to the Army and the equipping/fielding strategies (AUSA, 2010).The...potential opportunities to allocate resources in order to optimize the balance between operational capability and financial efficiency. There are 3 types...simple color- scorecard summaries of how options rate on a number of juxtaposed criteria, such as measures of capabilities, risks, upside potential, and

  15. Creativity takes courage (and digital capabilities)


    Pinny, Kerry; Elliott, Marcus


    Our session will detail the work undertaken at the University of Lincoln (Educational Development and Enhancement Unit, 2016; Pinny, 2015; Elliott, 2016) to support staff to develop their digital capabilities. We will detail our journey from the adoption of the Jisc framework and development of an institutional digital capabilities strategy, to gaining senior management buy in, piloting of the Jisc Discovery Tool (2016) and support resources, including a pilot. This session will ...

  16. Identity Building in Organisations: Proactive Capability Development

    DEFF Research Database (Denmark)

    Rasmussen, Lauge Baungaard


    Identity building in organisations is often viewed as legitimacy of value systems of the organisation. Based on empirical studies the task of this article is to argue that such a legitimacy approach risks failing in the longer perspective, if the proactive capability development is neglected....... The participatory scenario method presented in this article is one of the possible methods to enhance identity building based on proactive capability development....

  17. Nuclear Data Needs and Capabilities for Applications

    CERN Document Server

    Bernstein, Lee; Hurst, Aaron; Kelly, John; Kondev, Filip; McCutchan, Elizabeth; Nesaraja, Caroline; Slaybaugh, Rachel; Sonzogni, Alejandro


    The Workshop on Nuclear Data Needs and Capabilities for Applications (NDNCA) was held at Lawrence Berkeley National Laboratory (LBNL) on 27-29 May 2015. The goals of NDNCA were compile nuclear data needs across a wide spectrum of applied nuclear science, and to provide a summary of associated capabilities (accelerators, reactors, spectrometers, etc.) available for required measurements. This document represents the results of the workshop and a compilation of other recent documents assessing nuclear data needs for the above-mentioned applications.

  18. Essential Medical Capabilities and Medical Readiness (United States)


    15-001098 Copy Essential Medical Capabilities and Medical Readiness John E. Whitley Joseph F. Adams Joseph J. Angello Jennifer T. Brooks Sarah K...other national challenges. Essential Medical Capabilities and Medical Readiness John E. Whitley Joseph F. Adams Joseph J. Angello Jennifer T. Brooks...noted that the ability of the Military Health System to provide operational healthcare is measured by the readiness of its medical personnel and


    Venkatapuram, Sridhar


    I argue for a conception of health as a person's ability to achieve or exercise a cluster of basic human activities. These basic activities are in turn specified through free-standing ethical reasoning about what constitutes a minimal conception of a human life with equal human dignity in the modern world. I arrive at this conception of health by closely following and modifying Lennart Nordenfelt's theory of health which presents health as the ability to achieve vital goals. Despite its strengths I transform Nordenfelt's argument in order to overcome three significant drawbacks. Nordenfelt makes vital goals relative to each community or context and significantly reflective of personal preferences. By doing so, Nordenfelt's conception of health faces problems with both socially relative concepts of health and subjectively defined wellbeing. Moreover, Nordenfelt does not ever explicitly specify a set of vital goals. The theory of health advanced here replaces Nordenfelt's (seemingly) empty set of preferences and society-relative vital goals with a human species-wide conception of basic vital goals, or ‘central human capabilities and functionings’. These central human capabilities come out of the capabilities approach (CA) now familiar in political philosophy and economics, and particularly reflect the work of Martha Nussbaum. As a result, the health of an individual should be understood as the ability to achieve a basic cluster of beings and doings—or having the overarching capability, a meta-capability, to achieve a set of central or vital inter-related capabilities and functionings. PMID:22420910


    Directory of Open Access Journals (Sweden)



    Full Text Available This paper aims to disseminate the results of a study focused on young leaders, designed to fill the gap in the specialty literature about the capabilities of young leaders in Romania. Capabilities - in our opinion, represents the leader's potentialities, the engine of transformation. They exist in a latent state and by activation they generate economic effects. Through this study we want to identify young Romanian people's attitudes towards capabilities; when we say capabilities, we understand potential. In this article we will present the capabilities from the perspective of potential. Sure, there are also other classifications, but from an economical perspective we consider that the potential of a leader is relevant through the following components: emotional potential, social potential, cognitive potential, managerial potential and behavioral potential. The overall conclusion is that in the realized study we have identified the following key capabilities of young Romanian leaders: character, confidence, empathy, credibility, leadership style, vision, memory, ability to be proactive, optimism, ability to generate respect.

  1. Health, vital goals, and central human capabilities. (United States)

    Venkatapuram, Sridhar


    I argue for a conception of health as a person's ability to achieve or exercise a cluster of basic human activities. These basic activities are in turn specified through free-standing ethical reasoning about what constitutes a minimal conception of a human life with equal human dignity in the modern world. I arrive at this conception of health by closely following and modifying Lennart Nordenfelt's theory of health which presents health as the ability to achieve vital goals. Despite its strengths I transform Nordenfelt's argument in order to overcome three significant drawbacks. Nordenfelt makes vital goals relative to each community or context and significantly reflective of personal preferences. By doing so, Nordenfelt's conception of health faces problems with both socially relative concepts of health and subjectively defined wellbeing. Moreover, Nordenfelt does not ever explicitly specify a set of vital goals. The theory of health advanced here replaces Nordenfelt's (seemingly) empty set of preferences and society-relative vital goals with a human species-wide conception of basic vital goals, or 'central human capabilities and functionings'. These central human capabilities come out of the capabilities approach (CA) now familiar in political philosophy and economics, and particularly reflect the work of Martha Nussbaum. As a result, the health of an individual should be understood as the ability to achieve a basic cluster of beings and doings-or having the overarching capability, a meta-capability, to achieve a set of central or vital inter-related capabilities and functionings.

  2. Parent Experiences with State Child Care Subsidy Systems and Their Perceptions of Choice and Quality in Care Selected (United States)

    Raikes, Helen; Torquati, Julia; Wang, Cixin; Shjegstad, Brinn


    Research Findings: This study investigated parents' experiences using Child Care and Development Fund and other state-dispersed child care subsidies, reasons for choosing their current child care program, and perceptions of the quality of child care received from their current program. A telephone survey of 659 parents receiving child care…

  3. Exploration Medical Capability System Engineering Introduction and Vision (United States)

    Mindock, J.; Reilly, J.


    Human exploration missions to beyond low Earth orbit destinations such as Mars will require more autonomous capability compared to current low Earth orbit operations. For the medical system, lack of consumable resupply, evacuation opportunities, and real-time ground support are key drivers toward greater autonomy. Recognition of the limited mission and vehicle resources available to carry out exploration missions motivates the Exploration Medical Capability (ExMC) Element's approach to enabling the necessary autonomy. The Element's work must integrate with the overall exploration mission and vehicle design efforts to successfully provide exploration medical capabilities. ExMC is applying systems engineering principles and practices to accomplish its integrative goals. This talk will briefly introduce the discipline of systems engineering and key points in its application to exploration medical capability development. It will elucidate technical medical system needs to be met by the systems engineering work, and the structured and integrative science and engineering approach to satisfying those needs, including the development of shared mental and qualitative models within and external to the human health and performance community. These efforts are underway to ensure relevancy to exploration system maturation and to establish medical system development that is collaborative with vehicle and mission design and engineering efforts.

  4. Core capabilities and technical enhancement, FY-98 annual report

    Energy Technology Data Exchange (ETDEWEB)

    Miller, D.L.


    The Core Capability and Technical Enhancement (CCTE) Program, a part of the Verification, Validation, and Engineering Assessment Program, was implemented to enhance and augment the technical capabilities of the Idaho National Engineering and Environmental Laboratory (INEEL). The purpose for strengthening the technical capabilities of the INEEL is to provide the technical base to serve effectively as the Environmental Management Laboratory for the Department of Energy's Office of Environmental Management (EM). An analysis of EM's science and technology needs as well as the technology investments currently being made by EM across the complex was used to formulate a portfolio of research activities designed to address EM's needs without overlapping work being done elsewhere. An additional purpose is to enhance and maintain the technical capabilities and research infrastructure at the INEEL. This is a progress report for fiscal year 1998 for the five CCTE research investment areas: (a) transport aspects of selective mass transport agents, (b) chemistry of environmental surfaces, (c) materials dynamics, (d) characterization science, and (e) computational simulation of mechanical and chemical systems. In addition to the five purely technical research areas, this report deals with the science and technology foundations element of the CCTE from the standpoint of program management and complex-wide issues. This report also provides details of ongoing and future work in all six areas.

  5. Core Capabilities and Technical Enhancement -- FY-98 Annual Report

    Energy Technology Data Exchange (ETDEWEB)

    Miller, David Lynn


    The Core Capability and Technical Enhancement (CC&TE) Program, a part of the Verification, Validation, and Engineering Assessment Program, was implemented to enhance and augment the technical capabilities of the Idaho National Engineering and Environmental Laboratory (INEEL). The purpose for strengthening the technical capabilities of the INEEL is to provide the technical base to serve effectively as the Environmental Management Laboratory for the Office of Environmental Management (EM). An analysis of EM's science and technology needs as well as the technology investments currently being made by EM across the complex was used to formulate a portfolio of research activities designed to address EM's needs without overlapping work being done elsewhere. An additional purpose is to enhance and maintain the technical capabilities and research infrastructure at the INEEL. This is a progress report for fiscal year 1998 for the five CC&TE research investment areas: (a) transport aspects of selective mass transport agents, (b) chemistry of environmental surfaces, (c) materials dynamics, (d) characterization science, and (e) computational simulation of mechanical and chemical systems. In addition to the five purely technical research areas, this report deals with the science and technology foundations element of the CC&TE from the standpoint of program management and complex-wide issues. This report also provides details of ongoing and future work in all six areas.

  6. 美国卒中医疗质量及其历史、现状和挑战%Quality Stroke Care, Its History, Current Status and Challenges in the USA

    Institute of Scientific and Technical Information of China (English)

    David Wang; 王拥军


    Stroke affects the whole world. To access to quality stroke care is challenging in every country. According to the situation, this review introduces history of healthcare quality improvement and stroke care quality improvement initiative in the US, then challenges the US faces in quality stroke care are described. Finally, the review makes some thoughts about the challenges of providing quality stroke care in China.%卒中影响着全世界各个国家,每6个人就有一个人罹患卒中.每个国家都面临着建立优质卒中医疗的挑战.针对这种情况,本文介绍了美国卒中质量改进的历史、美国卒中医疗质量的改进措施,就美国优质卒中医疗面临的挑战进行了描述.最后,对我国提供优质卒中医疗面临的挑战进行了思考.

  7. How Stakeholder Sensing and Anticipations Shape the Firm’s Strategic Response Capability

    DEFF Research Database (Denmark)

    Hallin, Carina Antonia; Andersen, Torben Juul; Ooi, Can-Seng

    We outline a strategic response capability framework drawing on cognitive neuroscience to explain stakeholder sensing and anticipations as essential input to environmental analysis. Stakeholders receive stimuli from ongoing interactions with the firm and thereby sense current environmental changes...

  8. Identifying management competencies for health care executives: review of a series of Delphi studies. (United States)

    Hudak, R P; Brooke, P P; Finstuen, K


    This analysis reviews a selected body of research that identifies the essential areas of management expertise required of future health care executives. To ensure consistency, six studies are analyzed, utilizing the Delphi technique, to query a broad spectrum of experts in different fields and sites of health care management. The analysis identifies a number of management competencies, i.e., managerial capabilities, which current and aspiring health care executives, in various settings and with differing educational backgrounds, should possess to enhance the probability of their success in current and future positions of responsibility. In addition, this review identifies the skills (technical expertise), knowledge (facts and principles) and abilities (physical, mental or legal power) required to support achievement of these competencies. Leadership and resource management, including cost and finance dimensions, are the highest-rated requisite management competencies. The dominant skills, knowledge and abilities (SKAs) are related to interpersonal skills. The lowest-rated SKAs are related to job-specific, technical skills. Recommendations include the review of this research by formal and continuing education programs to determine the content of their courses and areas for future research. Similarly, current health care executives should assess this research to assist in identifying competency gaps. Lastly, this analysis recommends that the Delphi technique, as a valid and replicable methodology, be applied toward the study of non-executive health care managers, e.g., students, clinicians, mid-level managers and integrated systems administrators, to determine their requisite management competencies and SKAs.

  9. 日本老年医疗护理产业的现状及发展趋势%Current Situation and Development Trend of Japan’s Elderly Health Care Industry

    Institute of Scientific and Technical Information of China (English)



    Japan’s aging population trend is very serious. Japan has formed a relatively complete industry in the ifelds of medical care, old-age pension living, elderly goods and services, etc. The Japanese government is enhancing the study on policies of the elderly medical care industries to push construction of this service system by evaluating and superintending the quality of the elderly industry service. In the meantime, Japan has regarded the“medical and health care industries”as the future growth factor of its economy development, and plans to make construction of medical and health care industries become its advantageous project and strive to participate in international competition. This article describes the practices development direction of Japan’s elderly health care industry, which is worthwhile to be shared by Chinese domestic counterparts.%日本是人口老龄化比较严重的国家,已经形成比较完善的医疗护理、养老居住、老年商品及服务等老年产业。日本政府加强老年医疗护理产业发展政策的研究,完善对该产业服务质量的评价与监督,推进该产业服务体系建设;已将“医疗和护理产业”定为日本经济未来的增长点,计划将医疗护理产业建设成为日本的优势项目,参与国际竞争。日本老年医疗护理产业的做法及发展方向,值得我国借鉴和参考。

  10. Maximizing MST's inductive capability with a Bp programmable power supply (United States)

    Chapman, B. E.; Holly, D. J.; Jacobson, C. M.; McCollam, K. J.; Morin, J. C.; Sarff, J. S.; Squitieri, A.


    A major goal of the MST program is the advancement of inductive control for the development of both the RFP's fusion potential and, synergistically, the predictive capability of fusion science. This entails programmable power supplies (PPS's) for the Bt and Bp circuits. A Bt PPS is already in place, allowing advanced RFP operation and the production of tokamak plasmas, and a Bp PPS prototype is under construction. To explore some of the new capabilities to be provided by the Bp PPS, the existing Bt PPS has been temporarily connected to the Bp circuit. One key result is new-found access to very low Ip (20 kA) and very low Lundquist number, S (104). At this low S, simulation of RFP plasmas with the MHD code NIMROD is readily achievable, and work toward validation of extended MHD models using NIMROD is underway with direct comparisons to these MST plasmas. The full Bp PPS will also provide higher Ip and S than presently possible, allowing MST to produce plasmas with S spanning as much as five orders of magnitude, a dramatic extension of MST's capability. In these initial tests, the PPS has also increased five-fold MST's Ip flattop duration, to about 100 ms. This, coupled with the recently demonstrated PPS ability to drive large-amplitude sinusoidal oscillations in Ip, will allow tests of extended-duration oscillating field current drive, the goal of which is ac sustainment of a quasi-dc plasma current. Work supported by US DOE.

  11. Symptom management in palliative care and end of life care. (United States)

    Bookbinder, Marilyn; McHugh, Marlene E


    There is a need for generalist- and specialist-level palliative care clinicians proficient in symptom management and care coordination. Major factors contributing to this need include changed disease processes and trajectories, improved medical techniques and diagnostic testing, successful screening for chronic conditions, and drugs that often prolong life. The rapid progressive illnesses and deaths that plagued the first half of the twentieth century have been replaced in the twenty-first century by increased survival rates. Conditions that require ongoing medical care beyond a year define the current chronic illness population. Long years of survival are often accompanied by a reduced quality of life that requires more medical and nursing care and longer home care. This article reviews the management of selected symptoms in palliative and end of life care.

  12. Developing Navy Capability to Recover Forces in Chemical, Biological, and Radiological Hazard Environments (United States)


    damage control; LHD flight deck and well deck operations; fleet surgical team; Afloat Training Group; Assault Craft Unit; Naval Surface Warfare Center...contaminants. Hot spots are manually scrubbed . 18 3. Current Navy Capability The assessment of current Navy capability is structured around the...supplemented beyond their organic staffing, to include a fleet surgical team, of which there may be only one deployed with an amphibious assault

  13. CARES Foundation (United States)

    ... today and CARES will receive 5% of your purchase! THEIR HISTORY: In 2001, Lauren’s Hope introduced the ... Go to the staff directory Find Us on Facebook Recent Tweets In case you missed it! http:// ...

  14. Dysarthria - care (United States)

    Speech and language disorder - dysarthria care; Slurred speech - dysarthria; Articulation disorder - dysarthria ... Dysarthria is a condition that occurs when there are problems with the muscles that help you talk. ...

  15. Residential Care (United States)

    ... Last name: Email: * Zip: * *required We will not sell or share your name. Residential Care Tweet Bookmark ... for the future. Use Alzheimer's Navigator ™ - our free online tool - to guide you as you map out ...

  16. Caring Encounters (United States)

    Gunn, Alyson


    Children with autism may seem to not care about things or have the same range of emotions as those of us who see them and care for them. But they do have empathy and they can be taught how to communicate it, says the author, a teacher of children with autism. We simply need to listen to them, watch them, and be with them in their moment.

  17. Fuel Fabrication Capability Research and Development Plan

    Energy Technology Data Exchange (ETDEWEB)

    Senor, David J.; Burkes, Douglas


    The purpose of this document is to provide a comprehensive review of the mission of the Fuel Fabrication Capability (FFC) within the Global Threat Reduction Initiative Convert Program, along with research and development (R&D) needs that have been identified as necessary to ensuring mission success. The design and fabrication of successful nuclear fuels must be closely linked endeavors. Therefore, the overriding motivation behind the FFC R&D program described in this plan is to foster closer integration between fuel design and fabrication to reduce programmatic risk. These motivating factors are all interrelated, and progress addressing one will aid understanding of the others. The FFC R&D needs fall into two principal categories, 1) baseline process optimization, to refine the existing fabrication technologies, and 2) manufacturing process alternatives, to evaluate new fabrication technologies that could provide improvements in quality, repeatability, material utilization, or cost. The FFC R&D Plan examines efforts currently under way in regard to coupon, foil, plate, and fuel element manufacturing, and provides recommendations for a number of R&D topics that are of high priority but not currently funded (i.e., knowledge gaps). The plan ties all FFC R&D efforts into a unified vision that supports the overall Convert Program schedule in general, and the fabrication schedule leading up to the MP-1 and FSP-1 irradiation experiments specifically. The fabrication technology decision gates and down-selection logic and schedules are tied to the schedule for fabricating the MP-1 fuel plates, which will provide the necessary data to make a final fuel fabrication process down-selection. Because of the short turnaround between MP-1 and the follow-on FSP-1 and MP-2 experiments, the suite of specimen types that will be available for MP-1 will be the same as those available for FSP-1 and MP-2. Therefore, the only opportunity to explore parameter space and alternative processing

  18. Current Titles

    Energy Technology Data Exchange (ETDEWEB)



    This booklet is published for those interested in current research being conducted at the National Center for Electron Microscopy. The NCEM is a DOE-designated national user facility and is available at no charge to qualified researchers. Access is controlled by an external steering committee. Interested researchers may contact Jane Cavlina, Administrator, at 510/486-6036.

  19. Machine Process Capability Information Through Six Sigma

    Energy Technology Data Exchange (ETDEWEB)

    Lackner, M.F.


    A project investigating details concerning machine process capability information and its accessibility has been conducted. The thesis of the project proposed designing a part (denoted as a machine capability workpiece) based on the major machining features of a given machine. Parts are machined and measured to gather representative production, short-term variation. The information is utilized to predict the expected defect rate, expressed in terms of a composite sigma level process capability index, for a production part. Presently, decisions concerning process planning, particularly what machine will statistically produce the minimum amount of defects based on machined features and associated tolerances, are rarely made. Six sigma tools and methodology were employed to conduct this investigation at AlliedSignal FM and T. Tools such as the thought process map, factor relationship diagrams, and components of variance were used. This study is progressing toward completion. This research study was an example of how machine process capability information may be gathered for milling planar faces (horizontal) and slot features. The planning method used to determine where and how to gather variation for the part to be designed is known as factor relationship diagramming. Components-of-variation is then applied to the gathered data to arrive at the contributing level of variation illustrated within the factor relationship diagram. The idea of using this capability information beyond process planning to the other business enterprise operations is proposed.

  20. On Capability Approach, Poverty and Corruption

    Directory of Open Access Journals (Sweden)

    Daojiu Hu


    Full Text Available The core of development is to face up with the challenge of the issue of poverty, which directly is associated with the ultimate goal of social, political and economic development. If the poverty has not been properly handled, development will be inefficient and unsustainable. This paper briefly indicates the main idea of Amartya Sen’s capability approach, then utilizing the approach to analyze poverty and the bottleneck in dealing such issues. It illustrates the inter-relationship of capability, poverty and corruption, and demonstrates that corruption is both the cause and the consequence of poverty and the failure of capability. When there corruption comes, the essential power to alleviate and eliminate poverty such as political accountability, transparency, engagement and openness are all spoiled and even wiped off. Political accountability, transparence, engagement are of great importance to both anti-corruption and poverty and promotion of capability. Economic aid for the poor and needy should be reinforced by fostering and promoting the capability of the poor and needy, so that the purpose of eliminating poverty and corruption could be achieved.

  1. NASA ATP Force Measurement Technology Capability Strategic Plan (United States)

    Rhew, Ray D.


    The Aeronautics Test Program (ATP) within the National Aeronautics and Space Administration (NASA) Aeronautics Research Mission Directorate (ARMD) initiated a strategic planning effort to re-vitalize the force measurement capability within NASA. The team responsible for developing the plan included members from three NASA Centers (Langley, Ames and Glenn) as well as members from the Air Force s Arnold Engineering and Development Center (AEDC). After visiting and discussing force measurement needs and current capabilities at each participating facility as well as selected force measurement companies, a strategic plan was developed to guide future NASA investments. This paper will provide the details of the strategic plan and include asset management, organization and technology research and development investment priorities as well as efforts to date.

  2. First Materials Science Research Rack Capabilities and Design Features (United States)

    Schaefer, D.; King, R.; Cobb, S.; Whitaker, Ann F. (Technical Monitor)


    The first Materials Science Research Rack (MSRR-1) will accommodate dual Experiment Modules (EM's) and provide simultaneous on-orbit processing operations capability. The first international Materials Science Experiment Module for the MSRR-1 is an international cooperative research activity between NASA's Marshall Space Flight Center (MSFC) and the European Space Agency's (ESA) European Space Research and Technology Center. (ESTEC). This International Standard Payload Rack (ISPR) will contain the Materials Science Laboratory (MSL) developed by ESA as an Experiment Module. The MSL Experiment Module will accommodate several on-orbit exchangeable experiment-specific Module Inserts. Module Inserts currently planned are a Quench Module Insert, Low Gradient Furnace, Solidification with Quench Furnace, and Diffusion Module Insert. The second Experiment Module for the MSRR-1 configuration is a commercial device supplied by MSFC's Space Products Department (SPD). It includes capabilities for vapor transport processes and liquid metal sintering. This Experiment Module will be replaced on-orbit with other NASA Materials Science EMs.

  3. Clopidogrel Resistance: Current Issues

    Directory of Open Access Journals (Sweden)

    NS Neki


    Full Text Available Antiplatelet agents are mainly used in the prevention and management of atherothrombotic complications. Dual antiplatelet therapy, combining aspirin and clopidogrel, is the standard care for patients having acute coronary syndromes or undergoing percutaneous coronary intervention according to the current ACC/AHA and ESC guidelines. But in spite of administration of dual antiplatelet therapy, some patients develop recurrent cardiovascular ischemic events especially stent thrombosis which is a serious clinical problem. Antiplatelet response to clopidogrel varies widely among patients based on ex vivo platelet function measurements. Clopidogrel is an effective inhibitor of platelet activation and aggregation due to its selective and irreversible blockade of the P2Y12 receptor. Patients who display little attenuation of platelet reactivity with clopidogrel therapy are labeled as low or nonresponders or clopidogrel resistant. The mechanism of clopidogrel resistance remains incompletely defined but there are certain clinical, cellular and genetic factors including polymorphisms responsible for therapeutic failure. Currently there is no standardized or widely accepted definition of clopidogrel resistance. The future may soon be realised in the routine measurement of platelet activity in the same way that blood pressure, cholesterol and blood sugar are followed to help guide the therapy, thus improving the care for millions of people. This review focuses on the methods used to identify patients with clopidogrel resistance, the underlying mechanisms, metabolism, clinical significance and current therapeutic strategies to overcome clopidogrel resistance. J Enam Med Col 2016; 6(1: 38-46

  4. 'Nothing works' in secure residential youth care?

    NARCIS (Netherlands)

    Souverein, F.A.; van der Helm, G.H.P.; Stams, G.J.J.M.


    A debate about the effectiveness of secure residential youth care is currently going on. While some continue to support secure residential youth care, others conclude that ‘nothing works’ in secure residential youth care, and argue that non-residential treatment is superior to secure residential tre

  5. Analysis and evaluation of enterprise risk management capability elements

    Institute of Scientific and Technical Information of China (English)


    Research on enterprise risk management capability is conducted with a view of discerning and processing risks, in which an evaluation index system and an evaluation model of enterprise risk management capabilities are constructed. The risk management capability consists of four aspects, i.e. risk identification capability, risk assessment capability, risk planning capability and risk control capability. Risk identification and assessment capabilities reflect the level of enterprises on finding and analyzing...

  6. Ethics, Politics, and Religion in Public Health Care: A Manifesto for Health Care Chaplains in Canada. (United States)

    Lasair, Simon


    Health care chaplaincy positions in Canada are significantly threatened due to widespread health care cutbacks. Yet the current time also presents a significant opportunity for spiritual care providers. This article argues that religion and spirituality in Canada are undergoing significant changes. The question for Canadian health care chaplains is, then: how well equipped are they to understand these changes in health care settings and to engage them? This article attempts to go part way toward an answer.

  7. Comprehensive care of travelers. (United States)

    Pust, R E; Peate, W F; Cordes, D H


    Travel, especially if it is international, often means major changes for the family. Family physicians should assess the epidemiologic risk and psychosocial significance of travel or relocation in light of the family's life-cycle stage and antecedent health. Using core references, which are kept current in partnership with public health agencies, family physicians are able to provide comprehensive immunization, medications, and patient education for all travel risks. Families are given medical record summaries and recommended sources of care at their destination. Eight weeks after their return patients are reassessed for newly acquired illness and helped to integrate the perspectives gained during the travel into the family's future dynamics. Taking advantage of growing travel medicine opportunities, family medicine educators should base the care of travelers and teaching of residents on defined competence priorities. Travelers' health provides a mutually rewarding model of shared care with public health consultants in the community medicine curriculum.

  8. Capabilitarian Sufficiency: Capabilities and Social Justice

    DEFF Research Database (Denmark)

    Nielsen, Lasse; Axelsen, David Vestergaard


    This paper suggests an account of sufficientarianism—i.e. that justice is fulfilled when everyone has enough—laid out within a general framework of the capability approach. In doing so, it seeks to show that sufficiency is especially plausible as an ideal of social justice when constructed around...... key capabilitarian insights such as freedom, pluralism, and attention to empirical interconnections between central capabilities. Correspondingly, we elaborate on how a framework for evaluating social justice would look when constructed in this way and give reasons for why capabilitarians should...... of a social being. In each category, we argue, achieving sufficiency requires different distributional patterns depending on how the capabilities themselves work and interrelate. This argument adds a new dimension to the way capabilitarians think about social justice and changes how we should target instances...

  9. Grid sensitivity capability for large scale structures (United States)

    Nagendra, Gopal K.; Wallerstein, David V.


    The considerations and the resultant approach used to implement design sensitivity capability for grids into a large scale, general purpose finite element system (MSC/NASTRAN) are presented. The design variables are grid perturbations with a rather general linking capability. Moreover, shape and sizing variables may be linked together. The design is general enough to facilitate geometric modeling techniques for generating design variable linking schemes in an easy and straightforward manner. Test cases have been run and validated by comparison with the overall finite difference method. The linking of a design sensitivity capability for shape variables in MSC/NASTRAN with an optimizer would give designers a powerful, automated tool to carry out practical optimization design of real life, complicated structures.

  10. Cosmopolitan capabilities in the HE classroom

    Directory of Open Access Journals (Sweden)

    Veronica Crosbie


    Full Text Available This study, concerning the development of cosmopolitan citizenship, draws on theories of human development and capabilities (Sen 1999; Nussbaum 2000 from a social justice perspective, where individual wellbeing is articulated as having the freedom to live a life of one’s choosing. In the context of an English to Speakers of Other Languages (ESOL classroom this involves paying attention to pedagogical strategies, power dynamics and curriculum content as a means of developing valued beings and doings (or capabilities and functionings as they are described in the literature. Sample activities are presented and evaluated to see to what extent they achieve the desired end. These include critical pedagogical interventions, students’ artefacts and extracts from focus group interviews, class reports and reflective journals.  Results from the textual data offer research evidence of successful curriculum change, demonstrating that the learning that takes place there can make a difference: in terms of the learners’ identity development, capability enhancement and cosmopolitan citizenship.

  11. Integrating Palliative Care into Primary Care. (United States)

    Gorman, Rosemary D


    Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers.

  12. Improved DFIG Capability during Asymmetrical Grid Faults

    DEFF Research Database (Denmark)

    Zhou, Dao; Blaabjerg, Frede


    the natural component of the Doubly-Fed Induction Generator (DFIG) stator flux during the fault period, their effects on the rotor voltage can be investigated. It is concluded that the phase-to-phase fault has the worst scenario due to its highest introduction of the negative stator flux. Afterwards......, the capability of a 2 MW DFIG to ride through asymmetrical grid faults can be estimated at the existing design of the power electronics converter. Finally, a control scheme aimed to improve the DFIG capability is proposed and the simulation results validate its feasibility....

  13. Trends in Microfabrication Capabilities & Device Architectures.

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, Todd [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jones, Adam [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Lentine, Anthony L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Mudrick, John [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Okandan, Murat [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Rodrigues, Arun F. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)


    The last two decades have seen an explosion in worldwide R&D, enabling fundamentally new capabilities while at the same time changing the international technology landscape. The advent of technologies for continued miniaturization and electronics feature size reduction, and for architectural innovations, will have many technical, economic, and national security implications. It is important to anticipate possible microelectronics development directions and their implications on US national interests. This report forecasts and assesses trends and directions for several potentially disruptive microfabrication capabilities and device architectures that may emerge in the next 5-10 years.

  14. Cloud-based Architecture Capabilities Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    Vang, Leng [Idaho National Lab. (INL), Idaho Falls, ID (United States); Prescott, Steven R [Idaho National Lab. (INL), Idaho Falls, ID (United States); Smith, Curtis [Idaho National Lab. (INL), Idaho Falls, ID (United States)


    In collaborating scientific research arena it is important to have an environment where analysts have access to a shared of information documents, software tools and be able to accurately maintain and track historical changes in models. A new cloud-based environment would be accessible remotely from anywhere regardless of computing platforms given that the platform has available of Internet access and proper browser capabilities. Information stored at this environment would be restricted based on user assigned credentials. This report reviews development of a Cloud-based Architecture Capabilities (CAC) as a web portal for PRA tools.

  15. Pretreatment Capabilities and Benefits of Electrocoagulation (United States)


    PRETREATMENT CAPABILITIES AND BENEFITS OF ELECTROCOAGULATION Michael Mickley Mickley & Associates Boulder, Colorado...DATES COVERED - 4. TITLE AND SUBTITLE Pretreatment Capabilities and Benefits of Electrocoagulation 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...4 2.1 Background for Electrocoagulation Technology ………………………. 4 2.1.1 Applications ……………………………………………………. 4 2.1.2

  16. Improving Social Security's Financial Capability Assessments. (United States)

    Appelbaum, Paul S; Birkenmaier, Julie; Norman, Marc


    When Social Security beneficiaries are incapable of managing their benefits, the agency can appoint a representative payee to administer benefits on their behalf. A committee of the Institute of Medicine was asked by the Social Security Administration to review the process by which financial capability determinations are made and to recommend improvements. The committee's conclusions and recommendations include the following: giving priority to real-world financial performance in assessing capability, providing clearer instructions to informants, developing systematic approaches to identifying beneficiaries at risk of incapability, exploring the use of a supervised direct payment option, and instituting regular data collection to assist in improving operations.

  17. Critical issues in burn care. (United States)

    Holmes, James H


    Burn care, especially for serious burn injuries, represents a considerable challenge for the healthcare system. The American Burn Association has established a number of strategies for the management of burn patients and dedicates its efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention, often in collaboration with other organizations. The American Burn Association has recommended that patients with serious burns be referred to a designated burn center, ie, a hospital outfitted with specialized personnel and equipment dedicated to burn care. Burn centers have been operational for over 50 years, but the complexity and costs of providing specialized burn care have given rise to a number of critical administrative and political issues. These include logistical limitations imposed by the uneven national distribution of burn centers and a potential shortage of burn beds, both during everyday conditions and in the event of a mass disaster. Burn surgeon shortages have also been identified, stemming, in part, from a lack of specialized burn care training opportunities. There is currently a lack of quality outcome data to support evidence-based recommendations for burn care, and burn care centers are compromised by problems obtaining reimbursement for the care of uninsured and publicly insured out-of-state burn patients. Initiatives are underway to maintain efficient burn care facilities that are fully funded, easily accessible, and most importantly, provide optimal, evidence-based care on a daily basis, and are well-equipped to handle a surge of patients during a disaster situation.

  18. Considerations in Launch Vehicle Abort Capability and Failure Tolerance (United States)

    Hale, N. W., Jr.; Conte, B. A.


    operations, the Space Shuttle was designed to incur loss of thrust from one engine at liftoff and return safely to a runway. This is a very unusual capability in space launch vehicles and, if desired, must be designed into the system initially. For some extremely high value payloads on future expendable launch vehicles, this capability may be cost effective as well as for human space flights. Current designers may be inclined to design a "simple" emergency escape pod to resolve this issue. That may neither be the most effective nor the safest way to provide ascent failure tolerance. This paper discusses some real-world issues associated with this capability that the designers of the Space Shuttle did take into account that have become serious issues in real operations. paper discusses the affect of payload mass on abort capability. Issues related to abort modes can also be influence by other aspects of payload mass including center of gravity concerns. In a similar mode, consumables such as on-orbit attitude control propellant is a major factor in abort mode design. multiple engine failures during the powered ascent trajectory and have a happy outcome: landing on a runway. This paper discusses options and post-design fixes to the Space Shuttle to enhance multiple engine out capability. scenarios. include propellant underload on STS-61C, off nominal performance of engine clusters on STS-78 and STS-93, and other flights. Designers of these future human rated vehicles should consider the Space Shuttle experience in designing their systems. About the Authors: N. Wayne Hale, Jr. is currently the Deputy Chief for Shuttle of the NASA/JSC Flight Director Office. In 23 years with NASA at Houston's Johnson Space Center, he has served in the Mission Control Center for 41 Space Shuttle flights including 25 as Entry Flight Director. Mr. Hale received his Bachelor of Science Degree in Mechanical Engineering from Rice University in 1976 and his Master of Science Degree in

  19. A Secured Health Care Application Architecture for Cyber-Physical Systems

    CERN Document Server

    Wang, Jin; Lee, Sungyoung; Shu, Lei; Xia, Feng


    Cyber-physical systems (CPS) can be viewed as a new generation of systems with integrated control, communication and computational capabilities. Like the internet transformed how humans interact with one another, cyber-physical systems will transform how people interact with the physical world. Currently, the study of CPS is still in its infancy and there exist many research issues and challenges ranging from electricity power, health care, transportation and smart building etc. In this paper, an introduction of CPeSC3 (cyber physical enhanced secured wireless sensor networks (WSNs) integrated cloud computing for u-life care) architecture and its application to the health care monitoring and decision support systems is given. The proposed CPeSC3 architecture is composed of three main components, namely 1) communication core, 2) computation core, and 3) resource scheduling and management core. Detailed analysis and explanation are given for relevant models such as cloud computing, real time scheduling and secu...

  20. Development of an analysis capability for the National Transportation System

    Energy Technology Data Exchange (ETDEWEB)

    Anson, D.; Nelson, R.


    The purpose of this report is to examine the Department of Transportation`s (DOT) National Transportation System (NTS) initiative, to document what has been learned, and to outline a National Transportation Network Analysis Capability (NTNAC) based on a ``TRANSIMS-like`` approach. This study was conducted over a two month period at the end of FY1997. The scope of the effort was carefully defined to accommodate the short time horizon and to provide focus to a very large analytical problem. The objectives were to: (1) define the NTS and the NTS problem; (2) identify problem characteristics; (3) describe an analytical solution based on the TRANSIMS approach; (4) identify data requirements and availability; (5) develop criteria for a scenario to be used in a prototype demonstration; and (6) select a scenario for the prototype demonstration.